NephroPOCUS

#POCUS #MedEd education 📖 | by Abhilash Koratala MD @KoraAbhi, “Echo-friendly” Nephrologist and Intensivist I Founding Member @POCUSIAPN | X≠ medical advice

[NephroPOCUS @NephroP]

Time to update the #VExUS resources pinned thread 🧵📌
1/ Tweetorial on image acquisition.
#POCUS #MedEd
https://t.co/IqNJIPM7Vf

[NephroPOCUS @NephroP]

#POCUS #MedTwitter #Nephpearls
Many #VExUS enthusiasts asked for a #tweetorial on image acquisition pearls. Did one b4 but time for an updated one 🧵

#1 Let's start with basics
Color Doppler identifies the flow + tells the direction (blue is away & red towards the probe [BART])

[NephroPOCUS @NephroP]

Classic images!
Likely diagnosis?
Context: renal allograft, h/o recent biopsy (few days ago), stable hemoglobin
#Nephpearls #POCUS #FOAMed

[NephroPOCUS @NephroP]

Thank you for all your efforts in advancing this field and educating others Professor.
Delighted to collaborate on this important article.
#POCUS #hepatorenal #Nephpearls
🔗 https://t.co/EqQPji9Gts

[Amir Kazory, MD @AmirKazory]

@NephroP and I recently proposed hemodynamic profiling, rather than conventional “volume assessment”, to guide management in patients with HepatoCardioRenal syndrome, a more targeted approach to understanding their physiology and tailoring treatment. #POCUS

[Amir Kazory, MD @AmirKazory]

An honor to speak on HepatoCardioRenal Syndrome at the Wadi N. Suki Symposium at @MethodistHosp today. Grateful for the invitation and the opportunity to discuss the complex interplay among the liver, heart, and kidneys with wonderful colleagues. @UFNephrology

[Vaishnavi Venkatasubramanian @dr_vaish26]

@isn_india How to asses at bedside? Multiorgan POCUS

CARDIAC
•CVP
• LV /RV systolic/diastolic function
• Septal position
LUNG
• B-lines
• Pleural effusion
VENOUS DOPPLER – VExUS
• IVC
• HV
• PV
• Intrarenal venous flow

No single parameter sufficient. Interpret clinically

[NephroPOCUS @NephroP]

@dr_vaish26 @isn_india Good points. Also, just because a patient is fluid tolerant doesn’t mean they need fluids. This is especially relevant in cirrhosis-AKI, where cardiac output is often already high, and giving more fluids is unlikely to provide much benefit.
https://t.co/sYkCeZBbCt

[NephroPOCUS @NephroP]

#POCUS in #Nephrology and #criticalcare

Volume status assessment or, more accurately, “hemodynamic assessment” is not about scanning a single organ. It requires a solid understanding of the entire hemodynamic circuit, knowing when a particular parameter is useful or misleading, and recognizing whether the image quality and acquisition technique are adequate for reliable interpretation.

[NephroPOCUS @NephroP]

@alex1708ander @ABCDEcografia Interesting, ☝️looks more like a tiger 🐯 stripes artifact (due to oscillating structure - the device itself) rather than electromechanical interference, isn’t it?

[NephroPOCUS @NephroP]

Here’s a continuous-wave Doppler tracing across the tricuspid valve from the right ventricular inflow view.
What’s causing all those horizontal lines?
(The clue is in the inset)
#POCUS #echofirst #Nephpearls

[Alexander Mladenow MD @alex1708ander]

@NephroP @ABCDEcografia Same phenomenon here - CWD tracing across the aortic valve …

[NephroPOCUS @NephroP]

@ThinkingCC You're impelled in the right direction!😃

[NephroPOCUS @NephroP]

My physics is limited but the Impella uses a miniature electromagnetic motor with a permanent-magnet rotor. Current flowing through the motor windings generates a rotating magnetic field that drives the impeller at extremely high speeds, up to approximately 50,000 revolutions per minute in some models! So, despite its small size, the motor and its electrical components can generate electromagnetic interference that appears as repetitive artifacts on spectral Doppler. It's not necessarily due to physical vibration of the device.

[NephroPOCUS @NephroP]

Clue

[NephroPOCUS @NephroP]

This is an interesting contrast #echofirst image. What does it demonstrate?
#POCUS

[NephroPOCUS @NephroP]

@Kevin34050619

[NephroPOCUS @NephroP]

@jh1bbs Not RP. There is a pacemaker lead if you are referring to the RV inflow image.

[Philippe Rola @ThinkingCC]

The Praxis Founding Member window is closing soon.

We’re building something different.

Not just lectures and courses, but an international community where clinicians exchange ideas, challenge dogma, discuss cases, and collaborate to advance bedside medicine.

Founders get our highest level of access, including the full VExUS course, AI coaches, conference archives, live discussions, and direct faculty interaction.

🔒 Your Founding Member rate stays locked in as long as you remain a member.

We’re keeping this group small because meaningful interaction matters. Less than a handful of spots left.

**Last chance to be part of the founding chapter. But no worries the Collaborative level is awesome too. **

https://t.co/pfKv0o1jlH

[NephroPOCUS @NephroP]

@Bappieidk Likely both. They coexist most of the time.

[NephroPOCUS @NephroP]

@SoulSoul2710 https://t.co/JSN1vNBRzQ

[NephroPOCUS @NephroP]

Periodic reminder.
#POCUS #echofirst #Nephpearls

[NephroPOCUS @NephroP]

@OSHeartDoc

[NephroPOCUS @NephroP]

#POCUS answer: Jugular vein
The point of this quiz is to highlight that not everything that looks pulsatile is an artery! Color Doppler flow can be red in a vein, and spectral Doppler flow can appear above the baseline. It all depends on the direction of blood flow relative to the transducer, not whether the vessel is an artery or a vein.
It's also about learning to distinguish venous from arterial flow - when a simultaneous ECG is available, it is a great clue. Here, you can see fusion of the systolic and diastolic flow components rather than a distinct high-velocity systolic peak followed by lower-velocity diastolic flow, as typically seen in carotid artery.
I'm also attaching an arterial Doppler tracing from the same patient for comparison. Again, pay attention to the timing in relation to the ECG. Fusion of systolic and diastolic components (S and D-waves) is not uncommon, especially in hyperdynamic states, and is not necessarily abnormal by itself.
Another point: Here, the artery doesn't appear simply red or blue on color Doppler. Instead, you see a mixture of colors due to aliasing because the color Doppler velocity scale is set much lower than the actual blood flow velocity in the artery.

[NephroPOCUS @NephroP]

For #eVExUS enthusiasts
Artery or vein?
Scan location: right neck
POLL in thread below
#POCUS #Nephpearls #FOAMed