Korbin Haycock, ER doc extraordinaire.
So a few months ago I got to talking with Korbin about POCUS, fluids and resuscitation, only to find out this guy is doing all sorts of awesome stuff in his ED in sunny California. Got to meet him at H&R2018 and he had even more tricks up his sleeve he was telling me about. He will definitely be back for H&R2019 on the faculty side of things.
In the meantime, let’s review renovascular ultrasound with him:
And here is our discussion that took place at TheRounds Backstage during #HR2018.
Interesting stuff. It isn’t always so easy to get a nice renal view in ICU patients, but with some perseverance you often can. I’ve been toying with it and tying it in with the hepatic and portal flow patterns, but I have to admit I had sort of dismissed renal resistive index based on what I could find in the literature, that is until I got to chat with Korbin, who made me see there are some interesting avenues, especially the example he states on seeing it improve with vasopressin use in shock patients, which correlates with some of the data out there suggesting decreased need for RRT and better outputs with vasopressin on board.
I have a feeling there is relevance to this in acute care, and that the next couple of years will reveal some usefulness. The glitch had always been in not knowing what the baseline RRI is, and that it can be abnormal in chronic RF. There are, however, many patients who were perfectly well previously and where the assumption that their baseline is normal is probably safe.
Love to hear comments from anyone using this!
cheers
Philippe
thinking critical care 
Superb to have this reminder on how-to and who. Great to meet Korbin and hear of his experience.
Korbin- do we have to get the patient to breath hold for the best reading, or is it relatively robust ? (I notice you managed without much breath hold there)
Usually you can get a reading without a breath hold. If the patient is taking very deep breaths, however, it can be little challenging as the PW Doppler is sampling over a moving target. The primary barrier to interrogating the internal vessels is usually body habitus (as in patients with a lot of habitus). If you find this to be the case in your large patients, the curvilinear probe will work a little better than the phased array. Also, push the probe a little deeper into the patient, or try a slightly different angle to align the doppler beam in line with the direction of blood flow.
[…] a lovely little primer on renovascular POCUS from our own Phil Rola and Korbin Haycock, looking at the renal resistive index and venous flow. […]
Love when there’s some live video instruction to supplement our discussion. Much needed, because I’ve been having a tough time getting my RRIs & renal vein waveforms. Helpful! Gracias a los dos!
[…] kort film om hur man mäter RRI dvs förhållandet mellan max och sluthastighet i blodflödet i mindre […]