@ThinkingCC Great case. Take it opening pressures were quite high.
2 questions - 1. Any concerns re LP with ICP high? 2. ONSD wide but no Optic disc elevation?
@RJonesSonoEM@USIGcleveland@NephroP Great clip. Any chance we can use this clip and twinkling image in educational videos we're producing for CPoCUS. I can email you more details re request. My email is [email protected]. Thx!
@POCUS_Doug@ThinkingCC With the growing use of TEE, we can look for saddle emboli/Prox R PA quite easily, and forego looking for the the secondary RV strain with its inherent false positives peri arrest.
@AndrewMFried@cnwilsono@PeterEamonn@mackendc @rehberg_joshua Great clip. Thx for sharing. Beyond the clot in R PA, the L PA is well seen, somewhat of a rarity. Was there significant clot burden on the L side?
@gidsgvilla_r@kyliebaker888 Great vids. Challenging to parse out the acute RV strain from the Chronic as clear RVH in the A4C. In favour of acute is the under filled hyper dynamic LV, paradoxical septal bowing s’en better in the PSS, and what appears to be so called clot in transit in the RV.
@kyliebaker888 The experience of many is that B’fly TTE views are poor. A big drawback in this study, is that for the cart based machines, the curvilinear probe was used for the TTE views.
@kyliebaker888 3.
This gives you a short axis view of the IVC from a lateral perspective. Screen left is anterior, screen right posterior so you can actually see the AP dimension change. You were probably aware of this already, but just in case...
@kyliebaker888 2.
In the long axis view, locate the appropriate segment of the IVC in the superior-inferior dimension, centre it on the screen and rotate the probe 90°, so the indicator is anterior.
3.
@kyliebaker888 Interesting question.
1.
In the case that the original tweet describes, one can actually get an AP diameter using the lateral approach.
2.
@PulmCrit@iBookCC What is your approach to the patient with submassive (bordering on massive) PE with large clot burden visible in RA and/or RV? Put another way, is there risk of knocking off RA/RV clot and making them worse with rapid infusion/bolus dose of tPA?
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@edwardbrowden @CarolBlymire Funny, I was thinking it’s very much like talking to the leftward leaning politically correct
Why don’t we just agree that just like this young ladies rigidity left her coworkers in dismay, rigidity on either side of the political spectrum it’s something to be admonished.
@Al_Errazuriz@ultrasoundpod 58 yo last nite with very similar RA appearance, clearly going thru TV on occasion. Hemodynamically little unstable. CTPA bilateral Saddle emboli. Echogenic structure - presumed clot - in RA not migrating over 1.5 hrs while in ER. In your case do you think it was all clot?
Great protocol. Even though it would be unlikely to change management - all pts get at least a D dimer - the heart rate score in the rGeneva score should be modified for pregnant patients. A heart rate of 95, which would accord them 5 points, is commonplace in later pregnacy
A rational approach to PE workup in pregnancy https://t.co/bG8MIUVHZ1 based on recent AnnIM article (Medscape registration free) #FOAMed@UMEmergencyMed