EMedical Academy

12/23/2022

10/21/2022

New partnership with POCUS Certification Academy to provide a combined prep course and POCUS Certification!

10/12/2022

Check out our lung ultrasound interpretation card!

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09/13/2022

Excited to participate in the upcoming POCUS World Conference!

02/03/2022

Take a look at our new, cost-effective, subscription-based fee structure!

01/16/2022

A 101-year-old patient suffered cardiac arrest shortly after arriving to the ICU. CPR and ACLS initiated. This clip was recorded in the first pulse check that images were recorded.

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What would you recommend to the team leader?

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The TTE clip of the SLAX view demonstrates ventricular fibrillation.

You should recommend to the team leader to shock the patient.

Point-of-care ultrasound (POCUS), is a widely used in the management of critically ill patients. In this regard, the utility of POCUS in cardiac arrest is gaining interest.

Integration of POCUS in ACLS and CPR requires training and should not interfere with the protocols. Specifically, it should not extend the maximum 10-seconds pulse check.

In the setting of cardiac arrest, POCUS can rule out some of the causes of arrest – tamponade, PE leading to arrest, severe "pump failure", severe hypovolemia and pneumothorax. In addition, ventricular fibrillation or other arrythmias can be seen with ultrasound.

While there is no scientific evidence yet, sometimes it can shorten the duration of pulse check by quickly demonstrating VF like in this example.

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12/13/2021

Happy holiday!

09/24/2021

What is the mitral valve area of this patient? Is there stenosis? If yes, how severe?

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The area of a normal mitral valve is 4-6 cm2, allowing for a large amount of blood to flow across the valve from the LA to the LV.

As the valve becomes stenotic, mean LA pressure increases and therefore, the degree of mean pressure gradient correlates with the degree of stenosis.

Mean gradient (mmHg):
< 5: Mild stenosis
5-10: Moderate stenosis
>10: Severe stenosis

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Mitral Valve Area (MVA) Calculations:

Commonly, MVA calculation of a native valve is calculated using the pressure half-time (PHT), which was originally developed and used in the cardiac catheterization lab.

PHT is defined as the time required for the peak pressure gradient between the LA and LV to be reduced by half. In contrast to the Cath Lab, with Doppler imaging the velocity, rather than pressure is measured. PHT is a useful measure of severity of disease progression. As stenosis worse, PHT increases, which leads to slower decrease in diastolic velocity.

Empirically, it was found that MVA is approximately equal 220 divided by PHT:
MVA = 220/PHT

MVA = 220/202 = 1.0 cm2

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09/20/2021

Until November 15 — 15% discount on the CCEeXAM Question Bank

3 months access

Over 350 questions & answers

04/28/2021

Goldfinger….
A patient in her early 60s was transferred to our hospital with abdominal pain, blood loss anemia, nausea and vomiting.
Shortly after arrival she suffered PEA arrest. ROSC was achieved within 10 minutes of ACSL and CPR. She was hemodynamically unstable in the MICU.
Surgery was consulted and she was rushed to the operating room for exploratory laparotomy. As part of the resuscitation efforts, we performed intraop TEE.
While the surgeon was exploring the posterior aspect of the stomach, we all of a sudden heard him say "oh, oh…. I think that my finger is in the heart…"

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Gastropericardial fistula is a life-threatening abnormal communication between the stomach and the pericardial sac. It is often deadly. They can present as a very rare cause of severe upper GI bleeding in a patient with previous gastric or esophageal surgery, ulcer perforation or gastric cancer or a combination of the above.
This patient had history of GI bleeding and open gastric bypass surgery.
Communication has been described between the stomach and the left ventricle as well as the right ventricle (rare). They are more prominent in men.
Presentations included chest or left shoulder pain (2/3 of cases), dyspnea, epigastric pain, fever and dysphagia/vomiting/hematemesis/melena.

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04/21/2021

Often, "cool images" mean bad things for our patients…

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This patient of ours, who was in his 50s, had history of metastatic melanoma and presented to the hospital with shortness of breath.

In a recent previous admission, he underwent pleurocentesis of the right lung to alleviate shortness of breath. In the more remote past, he had pericardial effusion that required pericardial window.

On this admission, the echo showed tamponade with pericardial mass invading into the RV wall as seen in this SLAX view.

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Melanomas are extremely aggressive tumors that can metastasize to a wide variety of organs, including the heart. While cardiac involvement is frequent, it is usually only diagnosed post-mortem. Initial presentation with cardiac symptoms, without further systemic disease, is uncommon.
The most common presenting symptom of cardiac metastasis is shortness of breath and the most common physical exam finding is tachycardia.
In one series, the most common site of cardiac metastasis is the left ventricle followed by the right atrium.
While cardiac metastases usually tend to remain silent, they can cause:
1. Mechanical complications caused by the limitation of blood flow through the cardiac chambers
2. Electrical complications due to the destruction of the cardiac conduction system by myocardial infiltrative masses
3. Embolization of the tumor, which can mimick TIAs or acute coronary syndrome

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