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Katie Wiskar

@katiewiskar.bsky.social

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Katie Wiskar @katiewiskar.bsky.social · Nov 10

Migrated over from the other place 🐣 to check out these blue skies 🦋

In the meantime - registration for the Hospitalist and the Resuscitationist #HR25 is open!! May 22-23 in Montreal 🇨🇦

There’s no better gathering of hemodynamic and physiology enthusiasts 🩺

thinkingcriticalcare.com/2024/06/05/h...

H&R2025 – The Hospitalist & The Resuscitationist, Montreal, May 21-24, 2025. #HR25 – REGISTRATION is OPEN !!!

A few words about it… HR2025 is about putting it all together. We’ve been talking about the venous side for a long time and it has been fantastic seeing how much it has taken off – at l…

thinkingcriticalcare.com

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Katie Wiskar @katiewiskar.bsky.social · Mar 27

It’s been a while, #MedSky

Been busy with a top-priority project 🥰

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Katie Wiskar @katiewiskar.bsky.social · Feb 27

Fabulous little thread on #LungUltrasoung

Agree with all of these! 🙌

#emimcc

Segun Olusanya @drfreeze.bsky.social · Feb 27

I had the pleasure of teaching lung #pocus at a “train the trainers” course, with the ever excellent @avkwong.bsky.social and Cian McDermott as faculty

Some reflections from the day:

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Katie Wiskar @katiewiskar.bsky.social · Feb 26

Fair, but we’re looking at patterns of pulsatility, not measured amplitude; I think the former would be preserved

Katie Wiskar @katiewiskar.bsky.social · Feb 25

Not really, as long as you’ve got a segment aligned vertically on your screen (ie you don’t want to be seeing a short-axis cut of it)

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Katie Wiskar @katiewiskar.bsky.social · Feb 25

So: want to learn more about portal venous doppler and #VEXUS?

Dr Curro Mirrales is speaking all about Portal Venous waveforms at #HR25 - come learn from the best!! May 22-23 in Montreal 🇨🇦. Grab your spot today!!!

ccusinstitute.wixsite.com/ccus/events/...

HR2025 - Fluid Tolerance, all Things VExUS & Shock Hemodynamics | CCUS.meducate

For more info and for the preliminary schedule, please click here or copy/paste: https://thinkingcriticalcare.com/2024/06/05/hr2025-the-hospitalist-the-resuscitationist-montreal-may-21-24-2025-hr25/

ccusinstitute.wixsite.com

Katie Wiskar @katiewiskar.bsky.social · Feb 25

Likewise, their IVCs and hepatic veins (because of the proximity to the IVC) will always be abnormal.

By moving farther away to the portal vein, we can get a better reflection of organ congestion with diuresis, as was elegantly demonstrated in this recent paper

pubmed.ncbi.nlm.nih.gov/38734970/

Portal vein Doppler tracks volume status in patients with severe tricuspid regurgitation: a proof-of-concept study - PubMed

This proof-of-concept study suggests that PVD is the only sonographic marker that can track volume removal in severe TR, offering a potential indicator for decongestion in this population. Further int...

pubmed.ncbi.nlm.nih.gov

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Katie Wiskar @katiewiskar.bsky.social · Feb 25

3. It's the most useful in those challenging patients with severe TR

The R-heart failure/severe TR patients are often the most challenging to assess in terms of congestion.

Many of them will ALWAYS live at a high CVP.

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Katie Wiskar @katiewiskar.bsky.social · Feb 25

2. It's the easiest to interpret

Unlike the hepatic vein, which can be misleading in the absence of EKG gating, the portal vein is easily interpreted

You can use calipers to measure pulsatility fraction; but you can also use the eyeball method to assess mild vs moderate vs severe pulsatility.

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Katie Wiskar @katiewiskar.bsky.social · Feb 25

You should see a nice vertically-aligned segment of the portal vein pop into view; easily recognized by its bright hyperechoic borders and hepatopetal blood flow (which will look RED on colour doppler).

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Katie Wiskar @katiewiskar.bsky.social · Feb 25

1. It's easy to obtain

Unlike the intra-renal veins, which can be elusive even to the most experienced scanners, the portal vein is usually easily identifiable.

From R coronal plane in the mid-axillary line, with your liver/kidney in view, fan or slide your probe in the anterior-posterior plane.

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Katie Wiskar @katiewiskar.bsky.social · Feb 25

A quick #VEXUS thread 🧵-

3 reasons why the portal vein is the most useful single venous doppler waveform 🥇

(if you're only going to do ONE site to look for venous congestion, this is probably the most useful one!)

#emimcc

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Katie Wiskar @katiewiskar.bsky.social · Feb 19

Whether you work in a ward setting, critical care unit, or emergency department - I guarantee you will learn something from him!

Come join us at #HR25! May 22-23, 2025 🇨🇦
ccusinstitute.wixsite.com/ccus/events/...

HR2025 - Fluid Tolerance, all Things VExUS & Shock Hemodynamics | CCUS.meducate

For more info and for the preliminary schedule, please click here or copy/paste: https://thinkingcriticalcare.com/2024/06/05/hr2025-the-hospitalist-the-resuscitationist-montreal-may-21-24-2025-hr25/

ccusinstitute.wixsite.com

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Katie Wiskar @katiewiskar.bsky.social · Feb 19

In the wise words of @drfreeze.bsky.social - "The goal is to titrate PEEP to the triad of best compliance, best oxygenation, and best RV function" 🫁🫀👍

An intensivist, physiology enthusiast, and all-star medical educator, he'll be speaking at #HR25 all about next-level Non-Invasive Ventilation ✨

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Katie Wiskar @katiewiskar.bsky.social · Feb 19

Non-invasive positive pressure ventilation - BiPAP and CPAP, for example - can be a bit of a black box to most of us ⬛️

Once it's started, the nuances of how to adjust it to optimize each patient's physiology takes skill, experience, and often, a bit of trial and error 🔎

#emimcc

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Katie Wiskar @katiewiskar.bsky.social · Feb 16

Yeah definitely lots of local variation; and ICU carries its own set of needs due to the extremely high acuity. I think many of these are fairly universal though!

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