Hiten Patel

2021 was quite a year. Lots of studies. Lots of new evidence. Today I had the opportunity to share some practice changing articles with our residents - here is a quick summary. @OhioAFP @aafp @OhioStateFamMed @EEvidencePlus

My wife’s a boss. Making cookies for her co-residents before her night shift in the MICU at @IMRiversideOH. Lucky for me there was some left over!

5/ And if lucky, as shown here, the pulmonary artery and its branching can be seen. Theoretically a saddle pulmonary embolus would be visualized in this view. Anyone have a clip of this?

4/ The view can be useful to see all the leaflets of the AV. All three leaflets are seen in this clip, the “Mercedes Benz” view. Poor leaflet movement or calcification can be suggestive of Aortic stenosis.

3/ To get the AV level of the PSAX, the probe should be fanned toward the right shoulder. This level demonstrates the aortic valve (AV), pulmonic valve (PV), pulmonary outflow tract (POT), RV, RA, and LA. This clip is of a patient with RV failure and chronic RV dilation.

2/ The classic PSAX view. LV in the far field and RV in the near field. Sweeping towards the nipple, shows progression from the MV level to the papillary level of the LV. View is good for: -Wall motion abnormalities -Detecting effusions -RV dilation Clip credit @thepocusatlas

1/ One of my new favorite #POCUS views is the Parasternal short axis (PSAX) view at the AV level. So much can be seen in this view. - AV valve - PV and pulmonary artery - TV @Scottiedoc1 @PratsEM @NephroP @OSUultrasound @POCUS_Society @CreaghB

Ideally would be the combination of the above, but often time precludes this. – at Columbus, OH

7/ In summary: - Indirect sign of tamponade on POCUS are RV collapse, RA collapse, and plethoric IVC - Calculate the MVI in the A4c view to assess for tamponade physiology. MVI > 25% is concerning for tamponade physiology Summerized well here by @UltrasoundJelly

6/ Back to our patient, here is his MVI variation. MVI was 18%. MVI Variation > 25% is concerning for tamponade physiology. Of note, the patient also has impaired diastolic filling pattern with e<a wave.

5) Not so fast. Lets check the MVI variation(Mitral Valve Inflow Variation). What MVI variation? It assesses the variation of mitral inflow with respiration, and conceptually a way to check for pulsus paradoxus on echo. This slide summarizes how to get an MVI Variation

3/ And the A4c (actually an A5c)

2/ This was a new finding, so we proceeded to look at the rest of the cardiac views. Here is the PLAX

1/ You never know what you'll find with #POCUS. Middle-aged man presenting with flank pain, with no hydro on RUS. An education aorta and IVC view was obtained, which ultimately led to this. @Scottiedoc1 @PratsEM @CreaghB @POCUS_Society

The more I learn, the more I realize I still have oh so much to learn. Climbing back up the #DunningKrugerCurve – at Columbus, OH

5. Hydronephrosis grading can be challenging, this graphic from @NephroP is very useful. Focus on differentiating between mild vs moderate/severe hydronephrosis.