Doug Barber

[Doug Barber @POCUS_Doug]

@NephroP @Rajiv_Sinanan Interesting point. How often are subtle b-lines at the bases a sign of fluid intolerance vs. normal physiology?

In the ED we often are looking for the cause of SOB, in which case B-lines are anterior and obvious in pulm edema. But prob need diff approach for fluid tolerance?

[Doug Barber @POCUS_Doug]

@EUSmkh Pleural effusion, moderator band, coronary sinus I believe

[Doug Barber @POCUS_Doug]

@NephroP Nice view of the right renal artery in cross section as well!

[Doug Barber @POCUS_Doug]

@EUSmkh Sagittal uterus with yolk sac and double decidual sign - IUP!

[Doug Barber @POCUS_Doug]

@NephroP Did they have JVD? In my experience, when VExUS is this bad, their ears are wiggling

[Doug Barber @POCUS_Doug]

@EUSmkh Hi! This looks like a lymph node. Can be due to lymphadenitis or malignancy or just reactive lymphadenopathy

[Doug Barber @POCUS_Doug]

@easypocus @ria_dancel @NephroP Great point! And is AC / upper arm PIVs are much more likely to fail than forearm. Safer for pressor infusions and more durable

[Doug Barber @POCUS_Doug]

@HoosierPocus For VExUS, renal vein Doppler should be done on arcuate/interlobar veins. Not pathological for greater renal veins to be pulsation

[Doug Barber @POCUS_Doug]

@dan___kim Enhanced peritoneal stripe sign consistent with pneumoperitoneum.

Keeping in mind that if the colon overlies the liver (Chilaiditis sign), you can get this appearance in RUQ. Can distinguish intra- bowel air from peritoneal air by decreasing depth or switching to linear probe

[Doug Barber @POCUS_Doug]

@critconcepts Ah that’s true, prob won’t make a difference and most phased array probes don’t have power doppler anyway

[Doug Barber @POCUS_Doug]

@nephro_superman @NephroP @khaycock2 @ThinkingCC @EchoSoliman @ArgaizR @askrenal @WBeaubien Based solely on the anecdotes of Twitter and one case series, I believe most left heart failure congestion can be safely diuresed to PV pulsatility <50%. Some with severe RH failure might not tolerate further dieresis (but they might)

[Doug Barber @POCUS_Doug]

@IM_Crit_ Great case. It is a shame when patients get diagnosed with pneumonia, get harmed with fluids, when the Dx by US was there all along

[Doug Barber @POCUS_Doug]

@pdsalinas Good point that TAPSE and S’ are just another tool in your toolbox. Visually that is a very sad RV - a finding that even beginner US users would likely pick up on

[Doug Barber @POCUS_Doug]

@NephroP @MayoClinicNeph Keep spreading POCUS! Medicine thanks you for it

[Doug Barber @POCUS_Doug]

@Rajiv_Sinanan @NephroP @khaycock2 @ThinkingCC Even in cross section, and considering the side-to-side collapse, IVC looks full to me. Suspect elevated RAP

[Doug Barber @POCUS_Doug]

@ArgaizR @ShariqShamimMD @purviparwani @iamritu @onco_cardiology @mandeep_mayo @SinghVasvi @Serginho1409 @ChamsiPash @ASE360 @KemalogluOz @tumleal Have consulted cards for new severe MR on focused US during flash pulm edema/scape. When they came to see hours later after nitro and bipap, the MR disappeared.

I swear it was there before! But then remembered that MR and even EF is load dependent

[Doug Barber @POCUS_Doug]

@nephneev @NephroP Nice work. Small point but you may want to try lowering your baseline and decreasing your scale for the PV.

[Doug Barber @POCUS_Doug]

@Asiritrauma1 Were they trying to decompress the heart

[Doug Barber @POCUS_Doug]

@NephroP Is that falciform ligament?