Cyril Emad

[Cyril Emad @CyrilEmad]

"Pray as though everything depended on God. Work as though everything depended on you." ~ St. Augustine

[RutgersNJMS_POCUS @RutgersPOCUS]

Free link expiring soon:
#Echo for Acute Pulmonary Embolism vs Chronic Pulmonary Hypertension
https://t.co/W2pPg3tbkq
@SAlerhand @RobertAdrianMD @1indaqiu

[RutgersNJMS_POCUS @RutgersPOCUS]

Dynamic air bronchograms (hyperechoic lines, moving within consolidated lung throughout resp cycle) are an ultrasonographic sign of pneumonia
• Artifact due to air in bronchioles surrounded by consolidated lung
• Up to 94% specificity in differentiating pneumonia vs atelectasis

[RutgersNJMS_POCUS @RutgersPOCUS]

A right heart thrombus is thin, mobile, and worm-like. It floats to-and-fro within the right-sided chambers.

A vegetation attaches to the valve, usually the proximal side. Its movement is usually chaotic and independent from that of the valve (though not in this case).

[RutgersNJMS_POCUS @RutgersPOCUS]

Replacing a G-tube is quick if not out too long and no trauma.

Yet, confirmation by gastrograffin x-ray takes forever.

Consider POCUS to confirm placement:
- Place probe adjacent to tube, see catheter and balloon
- Instill 50+ cc of saline, watch stomach expand with bubbles

[RutgersNJMS_POCUS @RutgersPOCUS]

Evidence suggests that POCUS is superior to the landmark technique for accurately identifying the Cricothyroid Membrane. This may be useful for marking the CTM prior to a difficult anticipated airway (i.e. an obese hypercarbic COPD or opioid intox patient).

[RutgersNJMS_POCUS @RutgersPOCUS]

How to measure AAA diameter correctly?
- measure outer wall to outer wall, at the widest diameter
- avoid underestimation by only measuring the lumen, always include thrombus / plaque

[Rutgers New Jersey Medical School @Rutgers_NJMS]

Dr. Lewis Nelson, NJMS chair of the Department of Emergency Medicine, discusses the dangers of the Gen Z social media trend, BORG, (Blackout Rage Gallon). #RutgersNJMS
https://t.co/90S2ROr9c0

[RutgersNJMS_POCUS @RutgersPOCUS]

Signs of pleural effusion:
- Jellyfish sign
- Spine sign

[RutgersNJMS_POCUS @RutgersPOCUS]

Scrotal sono to r/o torsion:
- linear high-frequency probe
- both testes side-by-side ('buddy shot')
- power doppler to assesses low-flow vessel flow, turn up gain until you see artifact
- edema and change in echogenicity (vs normal homogenous pattern) can take 6+ hrs to develop

[RutgersNJMS_POCUS @RutgersPOCUS]

US findings in acute appendicitis:
a) Dilated (>6 mm OD), non-compressible, aperistaltic blind ending structure ​
b) Appendicolith with shadowing ​
c) Wall Thickening (>2 mm) ​
Peri-appendiceal findings: ​
d) Hypoecholic fluid OR ​
e) Hyperechoic fat with ↑flow

[RutgersNJMS_POCUS @RutgersPOCUS]

The confirmation of an intra-uterine pregnancy (IUP) in a patient with a positive pregnancy test requires at minimum the visualization of gestational sac AND yolk sac (hyperechoic ring within the gestational sac) on POCUS. Even better to visualize fetal pole +/- fetal heartbeat.

[RutgersNJMS_POCUS @RutgersPOCUS]

Curtain sign: sonographic lung tissue (i.e. A-, B-lines) moving inferiorly over the diaphragm w/ inspiration, and superiorly just above the diaphragm w/ expiration. Like a "curtain" opening and closing. When present at the lung base, there is no (significant) pleural effusion.

[RutgersNJMS_POCUS @RutgersPOCUS]

A hip effusion is diagnosed by a fluid stripe greater than 5 mm along the femoral neck or a greater than 2 mm fluid stripe asymmetry when compared to the contralateral hip.
@SAlerhand @IOstrovsky99 @annettemdinnyc @drmuellerreport

[RutgersNJMS_POCUS @RutgersPOCUS]

When there’s NO lower extremity DVT at a given location, vein will fully compress with pressure.
When there IS a DVT, vein will NOT fully compress (attached).
Doppler is not necessary.
An acute clot (attached) usually appears anechoic.
An older clot usually appears echogenic.

[RutgersNJMS_POCUS @RutgersPOCUS]

RV hypertrophy suggests chronic RV dysfunction - best assessed from zoom-in SX view.
Chronic dysfunction:
1Qual: RV free wall appears as thick as LV posterior wall (assuming not thinned out by prior MI), and has muscular trabeculations.
2Quant: RV free wall thickness > 5 mm

[RutgersNJMS_POCUS @RutgersPOCUS]

Pseudoaneurysm (PA): artery leaks pulsatile blood into surrounding tissue, eg 2/2 catheterization or penetrating trauma.
POCUS ying-yang sign: one color is blood flow from artery into PA, other color is blood within the PA that circles back around. Clots in tissue are echogenic.

[Houssein Safa, MD @hsafaMD]

Unpopular opinion but if a trainee asks you a simple medical question that you can answer in 2 min during rounds plz don’t ask them to look it up themselves when you have the needed information at your immediate disposal. It’s both discouraging and inefficient. Agree? Disagree?

[Cyril Emad @CyrilEmad]

@BishoiAziz You can take a round trip back to staten for all i care

[Cyril Emad @CyrilEmad]

@MaggHann Some are actually the worst 🙃