Maria Serna ECOCRITIC

Ecografista • Facultativa en el Hospital de Denia • Alicante • España • Fundadora de la Sociedad Española de Ecografía en Críticos

[Sudarshan Balla @sudarshanballa]

97 yo female with stroke - one view- diagnosis? #echofirst @WvuCvFellows @BritoCardio @CASivaram1 @a_l_bailey @alex1708ander @iamritu

[Maria Serna ECOCRITIC @DraMariaSerna]

@ecommartinez @David_eficaz OPUS

[NephroPOCUS @NephroP]

#POCUS image of the day:
Not every pulsatile structure is an artery. 👇
Pulsatile internal jugular vein in severe tricuspid regurgitation.
Courtesy 🔗 doi: 10.1007/s00134-019-05542-z.

[Maria Serna ECOCRITIC @DraMariaSerna]

@ToruGotoMD Si. De hecho los dibujos sencillos generan una menor carga cognitiva que esquemas y dibujos complejos. Compartirlo con todo el equipo quirúrgico!!! Incluyendo al anestesiólogo. Richard E. Mayer. https://t.co/cAKENvKj3M https://t.co/sR0ZG5Fmhx

[NephroPOCUS @NephroP]

Clot-in-transit ⚠️🚨
#POCUS #FOAMed #CriticalCare
Courtesy 🔗 Loebig, et al. European Heart Journal - Case Reports, Volume 9, Issue 2, 2025.

[Alexander Mladenow MD @alex1708ander]

Right-heart clot-in-transit & left-heart clot-in-transit. In both cases reported mortality is very high without treatment and remains substantial even with therapy #echofirst

[CardiovascularCorner @TrackYourHeart]

Striking case of ventricular fibrillation during CPR, followed by successful return of spontaneous circulation

[Jamal Ali @The_sonoguy]

It’s live 🎉
I built a bowel ultrasound masterclass. Here’s why: 🧵
1/ I’m a gastroenterologist. I scan every day IBD patients, acute abdomens, ward emergencies.
2/ Bowel ultrasound saved my patients from unnecessary CTs more times than I can count.
https://t.co/coT0IRKPPB
⬇️

[Maria Serna ECOCRITIC @DraMariaSerna]

@ABCDEcografia Estómago de retenci��n. Recolocar la sonda… ☺️

[NephroPOCUS @NephroP]

Love this quote 😄
But “precision guesswork”….now upgraded with #POCUS, because seeing beats blind guessing (or even semi-blind with labs alone) 👀
#Nephrology #Medicine

[NephroPOCUS @NephroP]

#POCUS image of the day: Continuous sweeping transversal scan performed along the right mid-clavicular line. What do we see here?
#FOAMed #Nephpearls #CriticalCare
Image courtesy: J Clin Monit Comput. 2024, PMID: 38460104.

[Dr Ihab Suliman @IhabFathiSulima]

What is happening?

[Nacho Redondo @nachorredondo]

Usar gorros quirúrgicos de tela reutilizables es seguro: este metaanálisis con 45.708 procedimientos no encontró más infecciones quirúrgicas frente a los desechables. Además, reduce impacto ambiental 🌍🏥

DOI: https://t.co/jRPnSyWQsq

#Sostenibilidad #Cirugía #Anestesia

[Maria Serna ECOCRITIC @DraMariaSerna]

@NephroP @nickmmark In 22% of septic patients, a dynamic left ventricular outflow tract obstruction can occur, increasing mortality in these patients. So remember that sepsis is not just vasoplegia and norepinephrine… doi: 10.1186/s13054-015-0980-z. PMID: 26082197; PMCID: PMC4522114.

[Dr. Chacón-Lozsán F .'. @franciscojlk]

🩺 Arterial line ≠ just a number on the monitor

If you’re only looking at MAP…
you’re missing most of the physiology.

🧠 Invasive BP is a real-time hemodynamic language

Every component tells a different story:

▪️ MAP → organ perfusion
▪️ DAP → vascular tone
▪️ SAP → LV afterload
▪️ Pulse Pressure (PP) → stroke volume surrogate

➡️ It’s not one number.
It’s a dynamic physiological system

⚠️ First rule, often ignored:

👉 If the waveform is wrong → everything is wrong

Before interpreting:

✔️ Check damping
✔️ Perform fast flush test
✔️ Look for:

Rapid upstroke

Dicrotic notch

Smooth diastolic decay

➡️ Bad waveform = bad decisions

📉 MAP alone is NOT enough

We target MAP ≥65 mmHg…
but:

▪️ Duration of hypotension matters
▪️ Individual physiology matters
▪️ CVP matters

👉 Think instead:

🎯 Perfusion pressure = MAP − CVP (MPP)

➡️ A “normal MAP” can still mean hypoperfusion

🔥 DAP = your vasopressor trigger

Low DAP = low vascular tone

▪️ Septic shock → ↓ DAP
▪️ Early signal before MAP collapses

👉 Use it to:

✔️ Start norepinephrine earlier
✔️ Avoid delayed vasopressor therapy

➡️ It’s one of the most underused variables in ICU

⚡ Pulse Pressure = hidden CO monitor

PP reflects:

▪️ Stroke volume
▪️ Arterial stiffness

👉 Dynamic changes = key:

✔️ PLR
✔️ Fluid challenge
✔️ Ventilator cycles (PPV)

➡️ You can track CO trends without a CO monitor

🧬 Next-level physiology (very underrated):

New indices:

▪️ DSI = HR / DAP
→ identifies vasoplegia early

▪️ VNERi = DAP / (HR × NE dose)
→ detects norepinephrine resistance

👉 These may define who needs vasopressin early

💡 Mindset shift

Don’t ask:

❌ “What’s the MAP?”

Ask:

✔️ “What is the physiology behind this waveform?”

🧠 Take-home

Arterial line monitoring is not passive.

It’s:

▪️ Diagnostic
▪️ Therapeutic
▪️ Predictive

➡️ If you read it correctly…
it becomes a precision resuscitation tool

📚 Bertrand M et al. (2025)Annals of Intensive Care
DOI: 10.1186/s13613-025-01608-y

[Maria Serna ECOCRITIC @DraMariaSerna]

@PierpaDiNick @JMMR83 @AskMedSphere @jpalacinp @Nehal_Nagy95 @ABCDEcografia @nkouenkeu_happi @thoracicrad @marioalrb84_a Wooowww!!! Not easy!!! The solution for me would’ve been a scanner 😂 My takeaway from this case: the importance of detecting abnormalities with ultrasound and ordering a CT scan to reach the diagnosis ☺️

[Maria Serna ECOCRITIC @DraMariaSerna]

@alex1708ander I wouldn’t say it’s hyperdynamic, usually it is more, to compensate cardiac output. But it’s not still… ☺️

[NephroPOCUS @NephroP]

#POCUS #anatomy quiz:
Identify 1️⃣2️⃣3️⃣4️⃣ on this upper abdomen scan.
#FOAMed #Nephpearls

[José S. Vaque Ramírez, MD @drvaque_eco]

https://t.co/wIA2qy4dbl