POCUS Geek
POCUS Geek
  • 83
  • 2 679 023
Cardiogenic Shock Case 2: Part 2 - Explanation
POCUS can be used at the bedside to focus the diagnosis and guide interventions in the sickest patients. In this case we’ll review the findings of a patient in cariogenic shock.
If you’d first like to take a chance to interpret the findings of this exam you can access the video here and the associated worksheet:
POCUS exams are focused exams and typically have binary questions from which we can formulate medical diagnosis and plans. In cardiac ultrasound we try to answer the following questions to guide diagnosis.
-Is there organized cardiac activity?
-Is the Left Ventricle (LV) function normal?
-If the LV function is not normal - what is it?
Hyperdynamic?
Depressed?
Severely depressed?
-Is there fluid surrounding the heart (Pericardial effusion)?
-If there is a pericardial effusion; is there diastolic collapse of the RA or RV free wall?
-Are any of the chambers of the heart abnormal in size?
-Is the IVC collapsed?
-If not, is there respiratory variation with greater than 50% collapse?
-Anything else?
In this particular video we will review a case of Acute Aortic Regurgitation. This is a true emergency and early identification can be life saving. In reviewing this video will be better prepared to make this diagnosis at the bedside with POCUS.
This content is only meant for information and educational purposes only. This is NOT medical advice. The content does not substitute for professional medical advice and no doctor-patient relationship is formed through the video. The video content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health clinician with any questions you may have regarding a medical condition.
Author:
Jared T Marx MD
www.unmc.edu/emergency/faculty/Marx.html
Resources about Acute Aortic Regurgitation:
Hamirani YS, Dietl CA, Voyles W, Peralta M, Begay D, Raizada V. Acute aortic regurgitation. Circulation. 2012 Aug 28;126(9):1121-6. doi: 10.1161/CIRCULATIONAHA.112.113993. PMID: 22927474.
Dewaswala N, Chait R. Aortic Regurgitation. [Updated 2023 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: www.ncbi.nlm.nih.gov/books/NBK555944/
Переглядів: 924

Відео

Cardiogenic Shock Case 2: Part 1 - Interpretation Challenge
Переглядів 646Місяць тому
Test you interpretive skills for cardiac ultrasound by watch the video and filling out this google form: forms.gle/Cpq5wzPS9ccrcRME8 After filling out the form you will remove immediate feedback for your answers. You can watch the explanation video by clicking on the link at the end of the video. POCUS can be used at the bedside to focus the diagnosis and guide interventions in the sickest pati...
POCUS: Case of Cardiogenic Shock
Переглядів 9964 місяці тому
Point of Care Ultrasound (POCUS) is a vital tool for evaluating the critical hypotensive patient. It can help to focus the differential diagnosis and guide resuscitation. Critical care ultrasound requires ability to evaluate the Heart (pump), lungs, abdomen (tank) and vasculature (pipes). The ability to implement POCUS in critical patients is a skill that every emergency physician or critical c...
POCUS: Positive E-FAST after MVC - Can you identify all of the findings?
Переглядів 2,5 тис.8 місяців тому
In this Extended Focused Assessment with Sonography in Trauma (E-FAST) there are many positive findings. Can you identify them? Hypotension after blunt abdominal trauma should key you into the possibility of hemorrhagic shock. In this video you will get the chance to identify all of the findings. Afterwards we will review some key educational topics of E-FAST in the evaluation of the hypotensiv...
POCUS: Lung Ultrasound - Irregular pleural line
Переглядів 1,1 тис.8 місяців тому
Difficulty Level: Beginner Identification of an irregular pleural line can be helpful in making the correct diagnosis. Sub-pleural consolidations and C-Lines have clinical implications that can lead to the appropriate clinical management. In this video we will discuss the causes of an irregular pleural line, show different examples of an irregular pleural line, and review the causes of this son...
POCUS: Lung Ultrasound - Identifying B-lines
Переглядів 4,1 тис.9 місяців тому
Difficulty Level: Beginner Identifying interstitial lung (pulmonary) edema with ultrasound is a skill needed by anyone caring for a patient with shortness of breath. Lung ultrasound will identify diffuse and localized edema much sooner than chest X-ray with increased sensitivity and specificity. In this video we will review the focused goal of identifying B-Lines which can indicate the presence...
POCUS: Lung Ultrasound - Basic Anatomy and Lung sliding - Updated - 2nd Edition
Переглядів 7 тис.10 місяців тому
Difficulty Level: Beginner Lung ultrasound is an essential skill for evaluating patients with shortness of breath, difficulty of breathing and in respiratory distress. Ultrasound is better at identifying lung pathology than the more utilized chest x-ray. With an understanding of lung ultrasound, diagnosis of many lung pathologies can be made earlier and with improved sensitivity and specificity...
Ultrasound Guided Distal Radius Fracture Reduction
Переглядів 4,9 тис.Рік тому
Soft tissue/musculoskeletal point-of-care ultrasound (POCUS) has many applications including assessing for signs of cellulitis, abscess, necrotizing soft tissue infections, fractures, dislocations, procedural guidance, and more. In this video we will review and underutilized POCUS skill and review the basics of POCUS to guide bedside fracture reduction and the benefits it provides. Disclaimer: ...
Patient Draping for Lung Ultrasound
Переглядів 3 тис.Рік тому
When performing point-of-care ultrasound (POCUS) of the lungs it can be difficult to appropriately drape the patient, keeping breast tissue covered, and at the same time obtain adequate views of the lungs. In this video we will review basic draping of the chest while performing lung ultrasound. Special thanks to iEXCEL Advanced Human Simulation for their collaboration on this project. Produced ...
Patient Draping for Cardiac Ultrasound
Переглядів 11 тис.Рік тому
When performing point-of-care ultrasound (POCUS) of the heart it can be difficult to appropriately drape the patient, keeping breast tissue covered, and at the same time obtain adequate views of the heart. In this video we will review basic draping of the chest while performing cardiac ultrasound in both the supine and left lateral decubitus positions. Special thanks to iEXCEL Advanced Human Si...
POCUS in Acute Renal Failure
Переглядів 3,1 тис.Рік тому
Post renal failure (obstructive failure) can account for up to 15% of acute renal failure. POCUS can be used in the acute setting to determine if obstruction is contributing to an acute episode of renal failure. In this video the causes of unilateral and bilateral obstruction, including the degrees of hydronephrosis, will be reviewed. Implementation of POCUS can lead to early discovery of obstr...
Urinary Retention with Bilateral Severe Hydronephrosis
Переглядів 2,2 тис.Рік тому
Urinary retention is typically a very painful acute problem for a patient. It is, however, the development from a more chronic problem. This is more common in male patients and is most often due to an enlarged prostate. When urinary retention occurs it can also cause dilation of the entire urinary system which can lead to renal dysfunction. In this video we will see a case urinary retention com...
Ureterolithiasis at the Ureterovesical Junction (UVJ) with Twinkle Artifact
Переглядів 4,1 тис.Рік тому
A stone located in the ureter is not always seen on ultrasound but in the right clinical presentation and by identifying hydronephrosis with ultrasound ureterolithiasis can be our leading diagnosis and management can be implemented. In this brief video we see a patient with ureterolithiasis located at the ureterovesical junction which is a common area that passing stones becomes lodged. In addi...
POCUS: Misdiagnosis of Pneumothorax
Переглядів 3,8 тис.Рік тому
Resuscitation of trauma patients includes diagnostic and therapeutic intervention in timely manner. Recognition of emergent pathologies in trauma is essential and bedside ultrasound can be integral in making the diagnosis. In this case we will review a misdiagnosis of a pneumothorax by clinical ultrasound and will talk about the pitfalls that can lead to this misdiagnosis and how to avoid them....
POCUS: Cardiac - Misdiagnosis for Asystole
Переглядів 3,7 тис.Рік тому
Resuscitation of critical patients receiving CPR can be very difficult. Often there is very little information to guide resuscitation efforts. Ultrasound can be a useful tool in guiding resuscitation along with ACLS guidelines. In this video, though, we will review a misdiagnosed clotted hemoperricardium with tamponade. Recognition of the any tamponade is crucial to resuscitation as this guides...
POCUS: EFAST - Progression free fluid in the Right Upper Quadrant (RUQ)
Переглядів 4,2 тис.Рік тому
POCUS: EFAST - Progression free fluid in the Right Upper Quadrant (RUQ)
POCUS - Fall from ladder with lung point and pneumothorax
Переглядів 4,1 тис.2 роки тому
POCUS - Fall from ladder with lung point and pneumothorax
POCUS - Positive EFAST exam with hemopericardium
Переглядів 3,5 тис.2 роки тому
POCUS - Positive EFAST exam with hemopericardium
POCUS - Visually Estimating Cardiac Function
Переглядів 18 тис.2 роки тому
POCUS - Visually Estimating Cardiac Function
POCUS - Cardiac Arrest Case and Review
Переглядів 6 тис.2 роки тому
POCUS - Cardiac Arrest Case and Review
POCUS - Extended Focused Assessment with Sonography in Trauma (EFAST) - Revised 2021
Переглядів 44 тис.3 роки тому
POCUS - Extended Focused Assessment with Sonography in Trauma (EFAST) - Revised 2021
POCUS: 1st Trimester Pregnancy Case 6 - Pregnancy Unknown Location
Переглядів 4,1 тис.3 роки тому
POCUS: 1st Trimester Pregnancy Case 6 - Pregnancy Unknown Location
POCUS - Cardiac Ultrasound - Subxiphoid Short Axis
Переглядів 15 тис.4 роки тому
POCUS - Cardiac Ultrasound - Subxiphoid Short Axis
POCUS: 1st Trimester Pregnancy - Case 5 - Complex adnexal mass
Переглядів 5 тис.4 роки тому
POCUS: 1st Trimester Pregnancy - Case 5 - Complex adnexal mass
POCUS: 1st Trimester Pregnancy Case 4 - Ectopic Pregnancy
Переглядів 16 тис.4 роки тому
POCUS: 1st Trimester Pregnancy Case 4 - Ectopic Pregnancy
POCUS: 1st Trimester Pregnancy Case 3 - Twin Gestation 6w5d
Переглядів 46 тис.4 роки тому
POCUS: 1st Trimester Pregnancy Case 3 - Twin Gestation 6w5d
POCUS: 1st Trimester Pregnancy Case 2
Переглядів 2,8 тис.4 роки тому
POCUS: 1st Trimester Pregnancy Case 2
POCUS: 1st Trimester Pregnancy Case 1
Переглядів 11 тис.4 роки тому
POCUS: 1st Trimester Pregnancy Case 1
POCUS - COVID Lung Ultrasound
Переглядів 22 тис.4 роки тому
POCUS - COVID Lung Ultrasound
POCUS - Ejected driver from rollover at highway speeds - EFAST
Переглядів 1,5 тис.4 роки тому
POCUS - Ejected driver from rollover at highway speeds - EFAST

КОМЕНТАРІ

  • @chinecheremheskeywills
    @chinecheremheskeywills 18 годин тому

    Excellent explanation

  • @RessaMichelle
    @RessaMichelle День тому

    Needed this physics refresher to understand the difference between some of the similar artifacts!

  • @mujawayezutherese4806
    @mujawayezutherese4806 3 дні тому

    very helpful thank you!

  • @charlesagumadu3582
    @charlesagumadu3582 4 дні тому

    Excellent teaching. Thanks very much.

  • @atifbilal1345
    @atifbilal1345 14 днів тому

    Great

  • @hazimdaham975
    @hazimdaham975 16 днів тому

    Very. Very nice. Thanks

  • @Gaperina
    @Gaperina 17 днів тому

    Plus evaluate cardiac filling vs contractility. Filling hypovolemic shock. RV dilated and poor contraction-> PE, LV contraction shock with MI.

  • @abdulansari4719
    @abdulansari4719 17 днів тому

    Thank you Jared. Lucid, clear and bang on the core..!

  • @user-uc1eo3pz6i
    @user-uc1eo3pz6i 19 днів тому

    THE best video! Phenomenal , so extremely helpful for a cardiolgy resident

  • @mahaqalbani4867
    @mahaqalbani4867 23 дні тому

    you made it so much easier to understand.....thank you

  • @SimpleRaag
    @SimpleRaag 23 дні тому

    Very nice video. You cared about the modesty of the patient very well. I don't understand why maximum male technicians ask to remove complete clothes above the waist without providing any towel or gown even for ecg. It's very humiliating. I wonder if they are perverts.😢

  • @cathompson58
    @cathompson58 Місяць тому

    Good job ... but since nobody else is saying it, I will.. The images on lung ultrasound are horrible and remind me of the very early days of tomography and auscultation by stethoscope where providers were convinced they could see and hear more than they really could .. we really need computed ultrasound that can construct real images .. this revolutionized tomography.. I'm also suspicious you have blind zones behind ribs... this is also time consuming and would be difficult to do if you were handling multiple ICU patients with office patients waiting, bronchs to get done and floor consults pending.. better for training programs and critical care only providers with time to spare ... is there a way to save images for legal investigation?

  • @JimmyGray
    @JimmyGray Місяць тому

    thanks:)

  • @cathybeams9550
    @cathybeams9550 Місяць тому

    Great info thank you i have atherosclerotic calcifications in abdominal aorta so im soon to have test

  • @spillingtheteawithdr.t2283
    @spillingtheteawithdr.t2283 Місяць тому

    Excellent video!

  • @smokeydops
    @smokeydops Місяць тому

    great video

  • @rollingnay
    @rollingnay Місяць тому

    Great video.

  • @abdulansari4719
    @abdulansari4719 Місяць тому

    Feeling eFast and Curious... 🎉 Thank you.. Amazing work

  • @omar9908
    @omar9908 Місяць тому

    Simply excellent

  • @Dr.everything4307
    @Dr.everything4307 Місяць тому

    So why was the splenic injury missed at LUQ window?

    • @POCUSGeek
      @POCUSGeek Місяць тому

      Ultrasound does NOT identify organ injury well. You are looking for blood (free fluid) that indicates there has been an injury.

  • @generale1234456
    @generale1234456 Місяць тому

    This is really great! Thank you very much

  • @darthrevanakc
    @darthrevanakc Місяць тому

    I learned a lot watching this video format. I could tell it looked weird, but not why. Once you put up the normal echo for comparison it was very obvious with the aortic valves pointing the wrong way. Thanks!

  • @samirprates904
    @samirprates904 Місяць тому

    I really liked this format. Great videos!

  • @dr.deepakgore1079
    @dr.deepakgore1079 Місяць тому

    Excellent post 🎉❤

  • @mirani18
    @mirani18 Місяць тому

    Very useful explanation. Loved it

  • @POCUSGeek
    @POCUSGeek Місяць тому

    Dedicated Cardiac windows for the quiz Parasternal Long Axis (PLAX) - 4:04 Parasternal Short Axis (PSAX) - 4:22 Apical 4 Chamber (AP4) - 4:39 Subxiphoid 4 Chamber (SX4C) - 4:57 Subxiphoid Short Axis (SXSA) - 5:15 Inferior Vena Cava (IVC) - 5:33 End Screen/Explanation Video Link: 6:00

  • @FeTheStampede
    @FeTheStampede Місяць тому

    Keep it up, don't stop uploading this kind of videos, please!

  • @FeTheStampede
    @FeTheStampede Місяць тому

    Great case

  • @MuhammadAli-qm1qg
    @MuhammadAli-qm1qg Місяць тому

    This man is absolutely beast he knows how to explain

  • @darthrevanakc
    @darthrevanakc Місяць тому

    Awesome case, super useful

  • @christee3538
    @christee3538 Місяць тому

    Thank you for this 😊

  • @safihibtihal4242
    @safihibtihal4242 Місяць тому

    The best channel, i did this morning the DVT Poc US i found all the images they are all very good and so nice, was so proud of my self, thank you, tomorrow will try the gall bladder and portal triade

  • @easyeb3702
    @easyeb3702 2 місяці тому

    Perfect explanation!

  • @arunrocks02
    @arunrocks02 2 місяці тому

    Which scan is best during early pregnancy? Transvaginal sagittal or transvaginal coronal?

  • @jirgis13
    @jirgis13 2 місяці тому

    Excellent review and to the point, you are an excellent teacher, hope you are in a teaching position. Thank you

  • @fagaloa68
    @fagaloa68 2 місяці тому

    Great simple explanations

  • @fakhruddin16
    @fakhruddin16 2 місяці тому

    Excellent

  • @mohamedsidibe9023
    @mohamedsidibe9023 2 місяці тому

    thanx tou so much for this excellent tutorial

  • @ErikStPierre1
    @ErikStPierre1 2 місяці тому

    Great case, very informative. Different kind of case but similar findings on ultrasound. I had a dialysis patient who presented with 3rd degree heart block. Somewhat widened QRS on EKG. US showed a very poorly contracting heart & left ventricle. I was suspicious for hyperkalemia. Gave Calcium and you could see the improvement on ultrasound almost immediately after giving it along with a narrowing of the QRS and his heart rate went up to 60 from 20 and the block went away. It was cool to see the changes in hemodynamics, ultrasound and EKG with treatment. 40 minutes later call from the lab with critical K+ of 7.4.

  • @inderpalyadav2308
    @inderpalyadav2308 2 місяці тому

    Thanks for sharing sir

  • @user-qe5vj8bz3r
    @user-qe5vj8bz3r 3 місяці тому

    Elisete

  • @user-qe5vj8bz3r
    @user-qe5vj8bz3r 3 місяці тому

    Elisete Almeida Ribeiro Monteiro e f

  • @abbyrupert5555
    @abbyrupert5555 3 місяці тому

    Great explanations of structures and physiology. Perfectly clear.❤

  • @myfzmas8766
    @myfzmas8766 3 місяці тому

    Great job

  • @medicalstudents9076
    @medicalstudents9076 3 місяці тому

    This is awesome just a doubt simple We will put the ‘ dot marker of probe ‘to the right side of the patient is that so ???? Please anyone

  • @simmo2007oz
    @simmo2007oz 4 місяці тому

    Dismally = distally

  • @simmo2007oz
    @simmo2007oz 4 місяці тому

    I’ve just been diagnosed with “extensive venous thrombus extends from the adductor hiatus level dismally, no more proximal involvement”. My GP seemed I’ll equipped to explain. I want to know 1) where exactly does the clot begin and end; 2) what vein/artery is blocked; 3) what exactly occurs when the vein “dies”? Which is what my GP said will happen. Varicose veins? Where? What else happens down the track? Can you answer any?

  • @RomuloGaudencio-ey3lp
    @RomuloGaudencio-ey3lp 4 місяці тому

    Great vid! Greetings from Brazil!

  • @SAmini-ek7gt
    @SAmini-ek7gt 4 місяці тому

    One of the best videos I haave watched. So well explained. logical.

  • @ernestwakulwa7691
    @ernestwakulwa7691 4 місяці тому

    Correlation between DVT and lymphadenopathy