Read on Twitter
#echofirst #pocus. 2am case from last night. c/o increasing dyspnea, leg swelling, fatigue, weight gain ~15 lb. EKG: isolated flipped twave in I and AVL. trop~ 0.8. renal fxn nml. IVC 2.5cm, lungs with bilat B-lines, trace eff. First echo:
2/x. For non-cardiologists and fledgling sonographers (which I am), this one view is abnormal but not insanely terrible. However, look closer and the walls are not doing what they should. you can see hinge points at the basal lateral wall and basal septum. Time to dig
3/x. apical three chamber from subxiphoid: again, basal inf/lat wall and basal septum moving but the rest not so much. Function here looks much worse than prior view
4/x. ap4. perhaps there is a little suspicious thing in the apex. much of myocardium not moving. apex has a little wink with a hyperdensity along endocardial border
5/x. apical 2chamber. another look at apex. echogenic thrombus perhaps?
6/x. My thoughts:
A)echo is really hard and takes a tremendous amount of practice to be functional, let alone good. Every echo performed is a learning experience.
B)WMA require imaging of whole of myocardium and take patience/practice/good windows.
C) one view is insufficient
A)echo is really hard and takes a tremendous amount of practice to be functional, let alone good. Every echo performed is a learning experience.
B)WMA require imaging of whole of myocardium and take patience/practice/good windows.
C) one view is insufficient
7/.
D) Know your limitations
E). Lastly, POCUS is is facilitated by asking directed questions -- lest we risk being flooded with data, thereby making us ineffectual at the bedside. The KISS principle: keep it simple stupid.
D) Know your limitations
E). Lastly, POCUS is is facilitated by asking directed questions -- lest we risk being flooded with data, thereby making us ineffectual at the bedside. The KISS principle: keep it simple stupid.
tagging some smart peeps: @IMPOCUSFocus @khaycock2 @Thind888 @ThinkingCC @NephroP @cianmcdermott @load_dependent @pdsalinas @POCUS_Society @ArgaizR @coreultrasound
