Link To The Twitter Thread On POCUS For Pulmonary Embolus And Subpleural Pulmonary Embolus

In this post I link to and excerpt from a Twitter Thread from @IMPOCUSFOCUS, POCUS For PE and Subpleural PE.

Note to myself and my readers: To review this great thread, go to the link, POCUS For PE and Subpleural PE

I post excerpts in my blog for two reasons:

  1. Posting excerpts helps me to remember the material.
  2. The resource is easier for me to find once posted because I can use my blog’s search function.

Here are excerpts from the thread.

@IMPOCUSFocus

1/ Good morning! If you’re failing to thrive this Monday, join us for our next #POCUS #TwitterReport case. Credit to Dr. Raghu Purushothaman for the case + images 73 yo M w hx of COPD presents with generalized weakness, failure to thrive, SOB, weight loss, and cough.
2/ Recent fall, spending more time in bed. Sig smoking hx. Breast + lung cancer in family. Physical exam: Afebrile, BP 135/90, HR 115, RR 16, O2 sat 92% on RA. Chronically ill appearing tachycardic and regular, cannot appreciate JVP b/l wheezing 1+ pitting edema b/l
IM POCUS Focus
@IMPOCUSFocus

Replying to

3/ CT lumbar spine in ED with concern for metastatic disease WBC 10, Cr 1.7 (BL 0.9), otherwise labs unremarkable. Representative CXR attached here.

IM POCUS Focus
@IMPOCUSFocus

4/ Poll: Pre-POCUS, what do you think is the most likely etiology of her SOB?
  • Pulmonary edema
    14.5%
  • COPD exacerbation
    33.9%
  • PE
    14.5%
  • Malignancy
    37.1%
62 votesFinal results
IM POCUS Focus
@IMPOCUSFocus

5/ Poll: Pre-POCUS, how do you want to manage this patients SOB?
  • Diuresis
    8.5%
  • Steroids + duonebs
    40.7%
  • Empiric AC
    1.7%
  • Await chest CT results
    49.2%
59 votesFinal results
IM POCUS Focus
@IMPOCUSFocus

7/ On further questioning, pt notes SOB has been slowly progressive over the past couple weeks when he fell, but doesn’t provide much other info. Pre-POCUS ddx: COPD exacerbation, CHF, manifestation of malignancy, PNA or PE.
IM POCUS Focus
@IMPOCUSFocus

8/ This table outlines the pre-POCUS thought process. Always important to identify your POCUS questions and how your findings may or may not change your management.
[Review the pictures of the POCUS findings of 9 through 21. These tweets show the results of the POCUS of the heart, lungs and leg veins inthis case. A complete POCUS for PE requires completing all three exams.]
IM POCUS Focus
@IMPOCUSFocus

21/ (Poll) Post-POCUS, what do you think is the primary cause of her SOB?
  • Pulmonary edema
    5.3%
  • COPD exacerbation
    8.8%
  • PE
    78.9%
  • Malignancy
    7%
57 votesFinal results
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