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