Adriano

Anaesthesia/ICU EDAIC. Interested in Cardiothoracic anaesthesia and critical care medicine. ECMO and TOE fan.

[POCUSmedicine @POCUSpeek]

🔍 Ultrasound-Guided Lumbar Puncture – an essential POCUS technique for improving procedural success in CSF sampling, especially in ↑BMI or anatomically challenging patients with spinal deformities or prior surgeries, minimizing traumatic taps, needle redirects, and complications to enhance diagnostic accuracy and patient safety in emergency, neurology, and critical care environments.

Best annotated and explained video I’ve seen 🤩

⚡ Employ pre-procedural static marking to locate optimal L3-L4/L4-L5 interspace, boosting first-pass success rates to over 90% in difficult cases and reducing overall attempts. 🩺

📏 paramedian sagittal views for hyperechoic spinous processes (crescent-shaped with shadowing) and transverse views for midline identification, ensuring precise needle trajectory and depth estimation. 📐

🚨 Switch to curvilinear probes in obese patients for better penetration; this halves failure rates compared to landmark-based methods, particularly when BMI exceeds 30. 📈

🔍 Incorporate real-time guidance to avoid bone contacts and minimize traumatic LPs (e.g., RBC counts <400/mm³), with meta-analyses showing fewer complications like post-dural puncture headaches. ⚠️

🤝 Integrate ultrasound with clinical assessment (e.g., palpation, patient positioning in sitting/lateral recumbent) for holistic management, supported by randomized trials in adult and pediatric populations across ED and ICU settings. 👥

[IMCrit @IM_Crit_]

Another step-by-step approach: how to use critical care ultrasound to guide decisions on fluid administration in critically ill patients

[Gustavo Plotnikow 🇦🇷 @GAPlotnikow]

El fenómeno #Pendelluft tiene varias implicaciones en pacientes con ventilación mecánica y respiración espontánea, y (música de suspenso) en los #Cocodrilos
Aunque su naturaleza es en gran parte teórica, los avances han hecho que el pendelluft sea más tangible y medible (1/11)

[Jose Luis Merino @joselmerino]

The EHRA Antiarrhythmic Drug Compendium is now published in full
A practical, comprehensive resource for the safe and effective use of AADs in daily practice.

[Ahmed T Abdellah @MynephCC]

Nice case
" Reverse McConnell sign"

[AHA Science @AHAScience]

High blood pressure is the most prevalent and modifiable risk factor for the development of cardiovascular diseases, including coronary artery disease, heart failure, atrial fibrillation, stroke, dementia, chronic kidney disease, and all-cause mortality.

This reflects several major changes since 2017, including use of the American Heart Association’s PREVENT risk calculator to estimate cardiovascular disease risk.

@accintouch @aanp_news @AAPAorg @ABCardio1 @ACCP @ACPM_HQ @AmerGeriatrics @AmerMedicalAssn @ASPCardio @NationalMedAssn @HeartNurses @SocietyGIM

✍️ @HeartDocSadiya @DrHeatherJohn @DaichiShimbo @marwahabdalla @nataliebello9

[𝘈𝘯𝘢𝘦𝘴𝘵𝘩𝘦𝘴𝘪𝘢 @Anaes_Journal]

Delirium is the most common sign of acute brain dysfunction & is prevalent in ICUs.

What do you do to prevent and manage it?

Only half of UK ICUs use a standardised care package, with inconsistent implementation.

#anaesthesia #ICU #delirium #MedTwitter

https://t.co/Y3yxlwF6Jr

[NephroPOCUS @NephroP]

Hepatic vein Doppler
#POCUS #VExUS #Nephpearls

[IMCrit @IM_Crit_]

The American Thoracic Society (ATS) updated its recommendations on some aspects of the diagnosis and management of community-acquired pneumonia (CAP)

[Rafael Reyes-Monge @RafaelReyes_MD]

Administrar bicarbonato en pacientes críticos con acidosis metabólica redujo la mortalidad a 30 días en 1.9% (RR 0.86, 0.80–0.91). Se usaron dosis de 100–200, habitualmente al 8.4%
Mayor beneficio en casos con AKI, vasopresores o pH &lt; 7.2.

🔗 https://t.co/FDeuVfaTe7

[CardiovascularCorner @TrackYourHeart]

What is VTI (Velocity Time Integral) in echocardiography?
VTI measures the distance a column of blood travels during systole through the LVOT. It’s a vital parameter to estimate stroke volume and cardiac output noninvasively.

How is VTI measured?
1️⃣ Obtain an apical 5-chamber view (5C).
2️⃣ Place PW Doppler just below the aortic valve (at LVOT).
3️⃣ Measure the area under the velocity curve during systole➡️ that’s the VTI (in cm).
Calculation of Stroke Volume (SV):
SV = VTI × LVOT area
LVOT area = π × (LVOT diameter/2)²
Requires accurate LVOT diameter from parasternal long-axis view.
Then,
Cardiac Output (CO) = SV × HR
♦️Normal LVOT VTI: ~18–22 cm (adults)
▶️A low VTI often means reduced stroke volume, requiring further hemodynamic assessment.

#Echo #Cardiology #VTI #StrokeVolume #CardiacOutput #POCUS

[CardioNova @AppCardioNova]

🔴 Guidelines for the Echocardiographic Assessment of the Right Heart in Adults &amp; Special Considerations in Pulmonary Hypertension #ASE2025

🔗DOI 10.1016/j.echo.2025.01.006
#Meded #medx #MedTwitter #CardioEd #cardiotwitter #POCUS

[𝘈𝘯𝘢𝘦𝘴𝘵𝘩𝘦𝘴𝘪𝘢 @Anaes_Journal]

"In the face of clear evidence of benefit, clinicians appear reluctant to fully embrace ultrasound in neuraxial puncture. This [is similar] to the implementation of videolaryngoscopy into routine clinical care."

@clistenes_cc @elboghdadly

#anaesthesia #medicine #regionalanaesthesia

https://t.co/f9Du4H2qZE

[𝘈𝘯𝘢𝘦𝘴𝘵𝘩𝘦𝘴𝘪𝘢 @Anaes_Journal]

Here is a suggested algorithm for peri-operative management of directly acting anticoagulants.

You can read about the use of blood components &amp; their alternatives in these new Association of Anaesthetists guidelines!

#anaesthesia #haematology #medicine

https://t.co/FUNKh4KD6I

[𝘈𝘯𝘢𝘦𝘴𝘵𝘩𝘦𝘴𝘪𝘢 @Anaes_Journal]

Do we need a new classification system for VL intubation in children?

The PeDiAC score uses the categories of visualisation, epiglottis, obstruction and intubation to create a number of 'points', resulting in documentation of a 'notable VL intubation' or a 'difficult VL intubation'.

https://t.co/99nAb1eCfE

[𝘈𝘯𝘢𝘦𝘴𝘵𝘩𝘦𝘴𝘪𝘢 @Anaes_Journal]

Want to read the most up-to-date guidance on how to manage an airway in a patient with a c-spine injury!?

Look no further!

@STHJournalClub @iliff_helen @MikeDonnellon @leechcaroline @stevemathieu75 @ukmat82 @elboghdadly

🔗https://t.co/VlCjAEWlze

[𝘈𝘯𝘢𝘦𝘴𝘵𝘩𝘦𝘴𝘪𝘢 @Anaes_Journal]

How to manage peri-operative anaphylaxis - for anaesthetists and intensivists!

Resuscitation Council UK algorithm for the treatment of peri-operative anaphylaxis

@LouiseSavic @jas_soar

🔗https://t.co/Kps7l8RqVV

[Critical Care Reviews @CritCareReviews]

Liberation from mechanical ventilation in critically ill patients: Korean Society of Critical Care Medicine Guidelines

CCR Journal Watch
https://t.co/Sp06oA6IDG

Get the latest critical care literature every weekend via the CCR Newsletter - subscribe at https://t.co/nitMzacLrj

[Cardiac Trials @CardiacTrials]

ST Segment Depression

A DDx👇

[Cardiac Trials @CardiacTrials]

Use of carbonic anhydrase inhibitors in HF? Acetazolamide blocks reabsorption of sodium bicarb in the kidney, leading to ⬆️ natriuresis. This landmark trial showed faster achievement of euvolemia with acetazolamide routinely added. ADVOR Trial, NEJM 2022 ♥️