#POCUS #MedEd education 📖 | by Abhilash Koratala MD @KoraAbhi, “Echo-friendly” Nephrologist and Intensivist I Founding Member @POCUSIAPN | X≠ medical advice
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Time to update the #VExUS resources pinned thread 🧵📌
1/ Tweetorial on image acquisition.
#POCUS #MedEd
#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])
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Great clip! Shared this before, but definitely worth resharing.
#POCUS #echofirst #FOAMed
Courtesy: Rahim, et al. CASE (Phila). 2022 PMID: 36451870
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NephroPOCUS retweeted
Fluid responsiveness: 10–15% increase in stroke volume following the administration of fluids, often achieved through a 400–500 mL isotonic fluid challenge
#Nephpearls #AKIinICU
Fluid tolerance: Involves evaluating a patient’s ability to withstand IV fluids
The passive leg raising (PLR) test is among the most promising of these techniques for assessing fluid responsiveness
🫁 The presence of a plethoric IVC, B-lines on lung US, and/ or the absence of fluid responsiveness during PLR generally suggest that the patient may not benefit from fluid administration and could potentially be harmed by it
📌 It is advisable to assess fluid tolerance in any patient being contemplated for fluid administration.
👉 shop.lww.com/Handbook-of-Cri…
👉 us.elsevierhealth.com/nephro…
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1⃣ What wave is this?
2⃣ Pathologic or not? - pertinent measurements provided.
#echofirst #POCUS #Nephpearls
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NephroPOCUS retweeted
If you think that tricuspid regurgitation limits vexus interpretation, think again! Great post @NephroP
New post on NephroPOCUS.com
"#VExUS Beyond Volume: What Tricuspid Regurgitation Teaches Us"
#POCUS #Nephpearls #FOAMed 🔗nephropocus.com/2026/09/23/v…
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NephroPOCUS retweeted
New post on NephroPOCUS.com
"#VExUS Beyond Volume: What Tricuspid Regurgitation Teaches Us"
#POCUS #Nephpearls #FOAMed 🔗nephropocus.com/2026/09/23/v…
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NephroPOCUS retweeted
Here @Turningthe_Tide, we discuss Bozeat et al's paper on whether crystalloid still belongs in the first hours of trauma haemorrhage
- When fluid has a job
- When it does not
- How permissive hypotension and vasopressors fit
- Why “the bag is already up” is not an indication. #FOAMed #FOAMcc
fluids.info/members/articles…
Made with AI
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Can a nephrologist pass the cardiology #echoboards? Apparently, yes!!
Happy to share that I passed the #NBE Examination of Special Competence in Adult Echocardiography.
With Critical Care echo certification and previously passing the advanced Peri-op TEE exam, I’m now a "Triple Testamur" of the NBE, spanning #cardiology, #criticalcare, and #anesthesia echo.
Passion for #POCUS can take a nephrologist to some interesting places! 😄
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NephroPOCUS retweeted
Ya esta abierto... últimos evento del año. Profesores de 5 hospitales con Nefrointervencion.. @SLANH_ @DeNefrologos @ArgaizR @MarkOO7S @SENefrologia @NephroP. Nueva tecnologia de ultrasonidos mayores aplicaciones. INSCRIPCIONES: brenda.calixto@mozarcmedical.com
En búsqueda de la excelencia académica, El talón de Aquiles de la Nefrología, acceso de la terapia de reemplazo renal. Te invitamos a nuestro próximo evento Masterclass !! Cupo limitado !!
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Poll for #VExUS learners:
Is the hepatic vein Doppler here S > D or S < D? And why?
#POCUS #Nephpearls
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38%
Likely S > D
34%
Likely S < D
11%
S-reversal with bifid D
17%
I have no idea
64 votes • Final results
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The answer is S < D.
As nicely illustrated by @MynephCC in the replies, the point of this exercise is to use the intrarenal trace, where you have simultaneous arterial and venous waveforms to help interpret the hepatic vein Doppler.
Think of the intrarenal arterial tracing as a built-in EKG. It makes it clear that, in the kidney, S < D. So the best guess is that the hepatic vein is also S < D. I’ve included the image with an actual EKG below, which confirms it.
Of course, this isn’t universal. You could have improving congestion where the hepatic and portal vein waveforms have already normalized, while the renal venous waveform is lagging behind because of persistent interstitial edema or another local factor. In this particular patient, though, the portal vein was also abnormal.
So if you don’t have an EKG, it can be helpful to look at the portal and femoral veins as additional clues. Still, NOTHING is completely foolproof.
If you haven’t seen it already, I’ve previously discussed a few ways to interpret hepatic vein waveforms without an EKG on NephroPOCUS.com. Check it out! 🔗nephropocus.com/2025/03/27/h…
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The answer is S < D.
As nicely illustrated by @MynephCC in the replies, the point of this exercise is to use the intrarenal trace, where you have simultaneous arterial and venous waveforms to help interpret the hepatic vein Doppler.
Think of the intrarenal arterial tracing as a built-in EKG. It makes it clear that, in the kidney, S < D. So the best guess is that the hepatic vein is also S < D. I’ve included the image with an actual EKG below, which confirms it.
Of course, this isn’t universal. You could have improving congestion where the hepatic and portal vein waveforms have already normalized, while the renal venous waveform is lagging behind because of persistent interstitial edema or another local factor. In this particular patient, though, the portal vein was also abnormal.
So if you don’t have an EKG, it can be helpful to look at the portal and femoral veins as additional clues. Still, NOTHING is completely foolproof.
If you haven’t seen it already, I’ve previously discussed a few ways to interpret hepatic vein waveforms without an EKG on NephroPOCUS.com. Check it out! 🔗nephropocus.com/2025/03/27/h…
Poll for #VExUS learners:
Is the hepatic vein Doppler here S > D or S < D? And why?
#POCUS #Nephpearls
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