Thread by @cianmcdermott, Session IV ft @ThinkingCC @aron_jonny @drhazemlashin Hemodynamics, RV and #VEXUS #covid19pocus [...]

Session IV ft @ThinkingCC @aron_jonny @drhazemlashin

Hemodynamics, RV and #VEXUS #covid19pocus

Early phase = predicted fluid responsive state

RV struggles at an early stage as result of hyperinflammatory lung condition - moderate dilation, increase in TRVmax, worsening RV strain pattern

RV thrombus in COVID19 - consider early TPA

But the LV is also susceptible to stress cardiomyopathy (adrenergic, metabolic, sepsis, high dose sedation). Look for RWMA

Don't forget the lungs as cause of obstructive shock

Bottom line - Echo is vital for diagnosis, treatment initiation and monitoring

Next up - RV failure in COVID19 @drhazemlashin
*hypoxia *pulmonary vasoconstriction *high PEEP *excess fluids or diuresis are the culprits

Look for acute cor pulmonale using FUSIC techniques http://bit.ly/3eQihuI

Here's how....

Who is assessing RV systolic function? https://annalsofintensivecare.springeropen.com/articles/10.1186/s13613-020-0636-2

Feasibility, reproducibility and diagnostic usefulness of right ventricular strain by 2-dimensional...

Right ventricular (RV) function evaluation by echocardiography is key in the management of ICU patients with acute respiratory distress syndrome (ARDS), however, it remains challenging. Quantificat...

https://annalsofintensivecare.springeropen.com/articles/10.1186/s13613-020-0636-2

OK - last leg is @ThinkingCC with #VExUS - quick review

https://theultrasoundjournal.springeropen.com/articles/10.1186/s13089-020-00163-w

Quantifying systemic congestion with Point-Of-Care ultrasound: development of the venous excess...

Organ congestion is a mediator of adverse outcomes in critically ill patients. Point-Of-Care ultrasound (POCUS) is widely available and could enable clinicians to detect signs of venous congestion at...

https://theultrasoundjournal.springeropen.com/articles/10.1186/s13089-020-00163-w

My #VEXUS resources

https://www.acep.org/how-we-serve/sections/emergency-ultrasound/news/june-2020/venous-doppler-and-iv-fluid-administration/

These guys also

@iceman_ex @Wilkinsonjonny https://criticalcarenorthampton.com/vexus-score/#more-23104

VExUS Score

VExUS scoring can aid your decision to offload patients with venous excess. See how here!

https://criticalcarenorthampton.com/vexus-score/#more-23104

Could delirium result from venous congestion? https://pubmed.ncbi.nlm.nih.gov/31395469/

Portal Hypertension Is Associated With Congestive Encephalopathy and Delirium After Cardiac Surgery...

These data present an association among hepatic congestion, delirium, and encephalopathy in patients undergoing cardiac surgery. Further studies should explore whether those neurological complicati...

https://pubmed.ncbi.nlm.nih.gov/31395469/

This is how @ThinkingCC does it https://thinkingcriticalcare.com/2020/02/28/a-vexus-mini-tutorial-foamed-pocus/ #covid19pocus

A VExUS Mini-Tutorial. #FOAMed, #POCUS

So a lot of people have been asking for a VExUS tutorial, and since our paper was just accepted, I figured it’s a pretty good time to do it! Thanks to Dr. Ian Ajmo of FrancoFoam fame who put …

https://thinkingcriticalcare.com/2020/02/28/a-vexus-mini-tutorial-foamed-pocus/

#VExUS and AKI in COVID19 @khaycock2 #covid19pocus https://thinkingcriticalcare.com/2020/06/25/bedside-physiology-in-septic-aki-with-korbin-haycock-foamed-foamcc/amp/?__twitter_impression=true

Bedside Physiology in Septic AKI with Korbin Haycock. #FOAMed, #FOAMcc

So I’ve been meaning to fine tune this concept and really start applying and following more rigorously, so I wanted to see what the only clinician I know of doing it at the bedside was doing …

https://thinkingcriticalcare.com/2020/06/25/bedside-physiology-in-septic-aki-with-korbin-haycock-foamed-foamcc/amp/?__twitter_impression=true

@threadreaderapp unroll #covid19pocus

https://threadreaderapp.com/thread/1276898413045526530.html #covid19pocus

Thread by @cianmcdermott: Session IV ft @ThinkingCC @aron_jonny @drhazemlashin Hemodynamics, RV and...

Thread by @cianmcdermott: Session IV ft @ThinkingCC @aron_jonny @drhazemlashin Hemodynamics, RV and #VEXUS #covid19pocus Early phase = predicesponsive state RV struggles at an early stage as result...

https://threadreaderapp.com/thread/1276898413045526530.html

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