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Simple-appearing #IMPOCUS scenario but important!
Thread:
1/ Consulted for AKI. Patient: Middle-aged gentleman with significant peripheral edema.
Plan: Let& #39;s try diuretic
Oh, may be perform #POCUS
-> IVC looks plump, doesn& #39;t appear to collapse
https://abs.twimg.com/emoji/v2/... draggable="false" alt="👇" title="Down pointing backhand index" aria-label="Emoji: Down pointing backhand index"> = needs diuretic. #MedEd
Thread:
1/ Consulted for AKI. Patient: Middle-aged gentleman with significant peripheral edema.
Plan: Let& #39;s try diuretic
Oh, may be perform #POCUS
-> IVC looks plump, doesn& #39;t appear to collapse
= needs diuretic. #MedEd" title="Simple-appearing #IMPOCUS scenario but important!Thread:1/ Consulted for AKI. Patient: Middle-aged gentleman with significant peripheral edema. Plan: Let& #39;s try diureticOh, may be perform #POCUS -> IVC looks plump, doesn& #39;t appear to collapse https://abs.twimg.com/emoji/v2/... draggable="false" alt="👇" title="Down pointing backhand index" aria-label="Emoji: Down pointing backhand index"> = needs diuretic. #MedEd" class="img-responsive" style="max-width:100%;"/>
2/ but the renal attending likes to do #VExUS
Let& #39;s look at portal vein #POCUS
-> Looks great, doesn& #39;t seem to indicate congestion
Let& #39;s look at portal vein #POCUS
-> Looks great, doesn& #39;t seem to indicate congestion
3/ What about the renal vein #POCUS?
Not a great picture due to breathing but seems the waveform is continuous (appears noisy because the gain was increased intentionally) [don& #39;t pay attention to RI - its inaccurate]
![3/ What about the renal vein #POCUS?Not a great picture due to breathing but seems the waveform is continuous (appears noisy because the gain was increased intentionally) [don& #39;t pay attention to RI - its inaccurate]](https://pbs.twimg.com/media/EWEtSrvWkAMbBAU.png "3/ What about the renal vein #POCUS?Not a great picture due to breathing but seems the waveform is continuous (appears noisy because the gain was increased intentionally) [don& #39;t pay attention to RI - its inaccurate]")
Not a great picture due to breathing but seems the waveform is continuous (appears noisy because the gain was increased intentionally) [don& #39;t pay attention to RI - its inaccurate]
Lungs?
Overall A-line pattern. Left sided image shownhttps://abs.twimg.com/emoji/v2/... draggable="false" alt="👇" title="Down pointing backhand index" aria-label="Emoji: Down pointing backhand index">
Overall A-line pattern. Left sided image shown
Something doesn& #39;t sound right...why was IVC plump? No h/o pulm HTN or severe TR based on recent Echo.
Let& #39;s repeat IVC #POCUShttps://abs.twimg.com/emoji/v2/... draggable="false" alt="👇" title="Down pointing backhand index" aria-label="Emoji: Down pointing backhand index">
Let& #39;s repeat IVC #POCUS
oh no...it& #39;s barely 1cm in max diameter and collapsing with normal inspiration.
What& #39;s wrong with the initial IVC (done few minutes before, same machine)?
Caudate lobe of the liver was mistaken for IVC!
IV diuretic would have worsened AKIhttps://abs.twimg.com/emoji/v2/... draggable="false" alt="🤔" title="Thinking face" aria-label="Emoji: Thinking face">
Trust me, this is not an uncommon scenario. #VExUS is a great addition to day-to-day #POCUS Thanks to @ThinkingCC & co
Caudate lobe of the liver was mistaken for IVC!
IV diuretic would have worsened AKI
Trust me, this is not an uncommon scenario. #VExUS is a great addition to day-to-day #POCUS Thanks to @ThinkingCC & co
