Gustavo Cunha

MD | former hematologist | intensive care resident

[IMCrit @IM_Crit_]

Nice review article by @Aboumarie (kudos!) examining the evolution, physiological principles, and clinical applications of point-of-care ultrasound (POCUS) and Critical Care Echocardiography (CCE)

Some take-home points:
* POCUS has expanded from simple bedside "rule-in/rule-out" exam into a comprehensive diagnostic approach
** The "POCUS Pyramid": Effective hemodynamic evaluation relies on integrating three key pillars rather than evaluating an organ in isolation:
echocardiogram + lung ultrasound + systemic venous assessment (VEXUS)

Key applications in Critical Care:
1. Differentiating shock phenotypes
2. Assessing hemodynamics & preload responsiveness
3. Evaluating hypoxemia

You may find useful the proposed algorithms for the evaluation of patients with hypotension and/or hypoxemia:

[Papa Heme @Papa_Heme]

Hematologic chest pain
Good luck cardiologists

55 yo male presents to ER with progressive SOB over the last few weeks and now acute chest pain.

Troponin and BNP markedly elevated.

WBC 39,000, Eos 37,000, Hgb 11, Plt 160

Karyotype below.

Diagnosis?

Fusion gene?

Treatment?

[Nico Gagelmann @NicoGagelmann]

Here is a blood smear of an immunocompromised patient with fever, hemolytic anemia and multi-organ failure. Diagnosis?

[Nicolas Duployez @NicolasDuployez]

Read the cell, guess the genetics.
#HemePath #Genetics #leusm #AMLsm 🔬🧬🩸

[Ross Prager @ross_prager]

Sepsis is a cause NOT phenotype of shock.

[𝗙𝗜𝗔𝗚𝗢 🇩🇪 @fiago7]

We must apologize to South America.

[Cliff Reid @cliffreid]

Ever heard someone say ‘too sick to be intubated’

No one is

Here’s a ‘physiologically challenging airway’

Intubation for hypoxaemia & septic shock

2 emergency medicine specialists -1 on hemodynamics & oversight, 1 on oxygenation & supervising registrar intubation

Art line in, Peripheral norepi, epi 1:100000 ready to push

POCUS excluded RV failure

Ramped, preox via NIV-ST mode, allowing supported ventilation during induction

Intubated 1st pass over bougie using VL

No desat, no hypotension

Resus nurses all over it

Calm, smooth, safe. Just like we train

A shared mental model in a cohesive trained team leads to effective resuscitation

Resuscitate Before You Intubate!

[Mohammed Megri. MD @MegriMohammed]

🤯 What comes to mind when you gaze at these waves on the monitor? Believe it or not, this is all very real! Allow me to take you on a journey through this fascinating story!

[Katie Wiskar @katiewiskar]

1/
I love love LOVE scanning the heart 😍, but when it comes to bang for your buck for ultrasound novices, lung ultrasound is such a winner 🏆

It's time for another #POCUS basics #tweetorial 🧵

Let's talk about common pitfalls in #LungUltrasound and how to correct these ✔️

[Katie Wiskar @katiewiskar]

1/
We talked about #POCUS for paracentesis last week; so it seems appropriate today to talk about POCUS tips for #thoracentesis 🧵

This is another procedure that I can't believe used to be done blind! 🙈

#emimcc

[Bread & Butter Haematology @MorphologyAmigo]

A bit of High Grade Lymphoma Genomics to start your Monday Morning👇👇

The More you dig deeper - The More Interesting the Landscape Gets 😜

How deep does the rabbit hole go to Wonderland 🤔🤔
https://t.co/EFzMAKj6ab
#hematology #lymsm #hemepath #medtwitter

[IMCrit @IM_Crit_]

Awake intubation is an important airway management skill, especially when you work in the trenches and have no Anesthesia friends in the neighborhood 24/7. You will not need it often but when you need it, you need it...

Nice - open access - article:

https://t.co/BJ4YOhX7vj

[Dr. Javier Flores @farmacotips]

APPs médicas que todos deberían tener.

¿Cuál otra añadirías?

[Intensive Care Medicine @yourICM]

Invasive fungal infections in non‑neutropenic patients? IFI pose significant diagnostic & therapeutic challenges in #ICU. Here short review focused on the two most prominent fungal pathogens in this population:
🍄 candidiasis
🍄 aspergillosis
#FOAMcc
🔓 https://t.co/YLquQbBEcz

[NephroPOCUS @NephroP]

Organ perfusion assessment in the shocked patient.
#POCUS #MedEd #Nephpearls #FOAMcc
🔗 https://t.co/2YAG7ISUsK

[marina @mrscIaflin]

charlotte de witte tocando the age of love no main stage do tomorrowland brasil esse é o tweet

[Ross Prager @ross_prager]

(1/x) Shock is the next door neighbor to death.

Here are 10 tips for managing your patient with shock.

A 🧵

#medtwitter #foamed

[Eddy J. Gutierrez, MD @eddyjoemd]

With every decision we make while caring for ICU patients, we weight the risks and benefits. Providing platelets to patients is no exception. This paper breaks down what we need to know about this process in 10 elegant points. 🎩 tip to the authors.

https://t.co/4Ise540F2X

[Intensive Care Medicine @yourICM]

Intubation in critical adults with physiologically difficult airway, consensus & expert statements @SOCCA_CritCare
➡️location + factors ⬆️complications
➡️team preparation + human factors
➡️pt preparation & optimization
➡️procedure
➡️post‑intubation care
🖇️ https://t.co/n1YZVhx2aH

[Eddy J. Gutierrez, MD @eddyjoemd]

Anyone who cares for critically ill patients should intimately understand the heart-lung interaction. I will admit that it’s not easy, as there is nuance and numerous variables to take into account. It’s worth the effort, though. 🎩 tip to the authors.

https://t.co/wtiQFg1wGN