Katie Wiskar
@katiewiskar.bsky.social
Academic General Internist 👩🏼⚕️ | GIM #POCUS fellowship lead www.ubcimpocus.com 🩺| SonoNerd 🤓| Obsessed with volume status 💦| #MedSky #POCUSky 🦋| Boy mom ❤️
Fair, but we’re looking at patterns of pulsatility, not measured amplitude; I think the former would be preserved
February 26, 2025 at 8:53 PM
Fair, but we’re looking at patterns of pulsatility, not measured amplitude; I think the former would be preserved
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)
February 25, 2025 at 8:42 PM
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)
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/...
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
February 25, 2025 at 6:30 PM
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/...
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/...
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/
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
February 25, 2025 at 6:30 PM
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/
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/
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.
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.
February 25, 2025 at 6:30 PM
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.
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.
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.
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.
February 25, 2025 at 6:30 PM
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.
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.
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).
February 25, 2025 at 6:30 PM
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).
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.
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.
February 25, 2025 at 6:30 PM
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.
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.
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/...
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
February 19, 2025 at 7:53 PM
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/...
Come join us at #HR25! May 22-23, 2025 🇨🇦
ccusinstitute.wixsite.com/ccus/events/...
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 ✨
An intensivist, physiology enthusiast, and all-star medical educator, he'll be speaking at #HR25 all about next-level Non-Invasive Ventilation ✨
February 19, 2025 at 7:53 PM
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 ✨
An intensivist, physiology enthusiast, and all-star medical educator, he'll be speaking at #HR25 all about next-level Non-Invasive Ventilation ✨
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!
February 16, 2025 at 4:27 PM
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!
I love that question - “can anyone think of anything we’re missing?” Medicine is a team sport and I value feedback from everyone!
February 14, 2025 at 5:03 PM
I love that question - “can anyone think of anything we’re missing?” Medicine is a team sport and I value feedback from everyone!
There is lots more to be said here, so I'm curious to hear from others: what are your top tips for efficient rounding? 👩⚕️📋⏰💉🤓
#MedSky #skeetorial #emimcc #InternalMedicine
#MedSky #skeetorial #emimcc #InternalMedicine
February 14, 2025 at 4:32 PM
There is lots more to be said here, so I'm curious to hear from others: what are your top tips for efficient rounding? 👩⚕️📋⏰💉🤓
#MedSky #skeetorial #emimcc #InternalMedicine
#MedSky #skeetorial #emimcc #InternalMedicine
Especially early on in training, I would MUCH rather see trainees who are very thorough in their rounding, even if they take slightly longer; than those who race to finish and miss important details.
February 14, 2025 at 4:32 PM
Especially early on in training, I would MUCH rather see trainees who are very thorough in their rounding, even if they take slightly longer; than those who race to finish and miss important details.
10. For early trainees: don't sacrifice thoroughness for efficiency
All this being said: a huge part of rounding efficiency comes from experience. As you become more comfortable managing common problems and your knowledge base expands, so too will your rounding efficiency 🧠
All this being said: a huge part of rounding efficiency comes from experience. As you become more comfortable managing common problems and your knowledge base expands, so too will your rounding efficiency 🧠
February 14, 2025 at 4:32 PM
10. For early trainees: don't sacrifice thoroughness for efficiency
All this being said: a huge part of rounding efficiency comes from experience. As you become more comfortable managing common problems and your knowledge base expands, so too will your rounding efficiency 🧠
All this being said: a huge part of rounding efficiency comes from experience. As you become more comfortable managing common problems and your knowledge base expands, so too will your rounding efficiency 🧠
The patient admitted with pneumonia who had half a second of brief tingling pain in their big toe, now resolved - probably doesn't need an urgent CT scan.
The vasculopath admitted for heart failure who has new colour change and pulselessness in their foot, in contrast, certainly does!
The vasculopath admitted for heart failure who has new colour change and pulselessness in their foot, in contrast, certainly does!
February 14, 2025 at 4:32 PM
The patient admitted with pneumonia who had half a second of brief tingling pain in their big toe, now resolved - probably doesn't need an urgent CT scan.
The vasculopath admitted for heart failure who has new colour change and pulselessness in their foot, in contrast, certainly does!
The vasculopath admitted for heart failure who has new colour change and pulselessness in their foot, in contrast, certainly does!
9. Not everything has to be an issue
This comes largely with experience and a growing knowledge base, but knowing when something is an issue that requires further (possibly urgent) investigation, and when something can be safely deferred or observed, is a key skill 🗝️
This comes largely with experience and a growing knowledge base, but knowing when something is an issue that requires further (possibly urgent) investigation, and when something can be safely deferred or observed, is a key skill 🗝️
February 14, 2025 at 4:32 PM
9. Not everything has to be an issue
This comes largely with experience and a growing knowledge base, but knowing when something is an issue that requires further (possibly urgent) investigation, and when something can be safely deferred or observed, is a key skill 🗝️
This comes largely with experience and a growing knowledge base, but knowing when something is an issue that requires further (possibly urgent) investigation, and when something can be safely deferred or observed, is a key skill 🗝️
8. Batch work
This is not always possible for patient care and flow reasons, but I do find it helpful ✅
For example: I will often save my discharge summaries and do these after completing my rounding on all my patients.
This is not always possible for patient care and flow reasons, but I do find it helpful ✅
For example: I will often save my discharge summaries and do these after completing my rounding on all my patients.
February 14, 2025 at 4:32 PM
8. Batch work
This is not always possible for patient care and flow reasons, but I do find it helpful ✅
For example: I will often save my discharge summaries and do these after completing my rounding on all my patients.
This is not always possible for patient care and flow reasons, but I do find it helpful ✅
For example: I will often save my discharge summaries and do these after completing my rounding on all my patients.
But if you can, try to set aside focused work periods and minimize interruptions that are not time-sensitive ⏰
Having a dedicated time to discuss with Allied Health, for example; or a system whereby nurses can leave non-urgent messages for the care team (without a phone call/page), can be helpful
Having a dedicated time to discuss with Allied Health, for example; or a system whereby nurses can leave non-urgent messages for the care team (without a phone call/page), can be helpful
February 14, 2025 at 4:32 PM
But if you can, try to set aside focused work periods and minimize interruptions that are not time-sensitive ⏰
Having a dedicated time to discuss with Allied Health, for example; or a system whereby nurses can leave non-urgent messages for the care team (without a phone call/page), can be helpful
Having a dedicated time to discuss with Allied Health, for example; or a system whereby nurses can leave non-urgent messages for the care team (without a phone call/page), can be helpful
7. Avoid interruptions*
I know, I know - this can be next to impossible in a hospital setting, especially in certain environments. (Hats off to all my EM friends who manage near constant interruptions!)
I know, I know - this can be next to impossible in a hospital setting, especially in certain environments. (Hats off to all my EM friends who manage near constant interruptions!)
February 14, 2025 at 4:32 PM
7. Avoid interruptions*
I know, I know - this can be next to impossible in a hospital setting, especially in certain environments. (Hats off to all my EM friends who manage near constant interruptions!)
I know, I know - this can be next to impossible in a hospital setting, especially in certain environments. (Hats off to all my EM friends who manage near constant interruptions!)
When I round the next day, I can quickly and easily see my proposed plan.
That's not to say that your plan can't change from day to day, but it makes it much easier if you've already done the initial cognitive legwork.
That's not to say that your plan can't change from day to day, but it makes it much easier if you've already done the initial cognitive legwork.
February 14, 2025 at 4:32 PM
When I round the next day, I can quickly and easily see my proposed plan.
That's not to say that your plan can't change from day to day, but it makes it much easier if you've already done the initial cognitive legwork.
That's not to say that your plan can't change from day to day, but it makes it much easier if you've already done the initial cognitive legwork.