So we had a blast with the VExUS Course a few weeks ago, it was really great to see how much enthusiasm and actual clinical use it is getting all over the world. Humbled, grateful and certainly feeling like the hard work was worth it to have this impact. So even after the workshop, there was a lot of questions, and some take more than a few lines to dig into, and since one participant, Dr. Rajiv Sinanan, a nephrologist, was so organized in his case questions, including a powerpoint with cases, I thought it was worth sharing. My life being busy and chaotic, I unfortunately had to do this on the way to work, so apologies for the audio and video quality! But I think there are some good pearls in there for those starting to use VExUS out there!
For those of you interested in learning more, we are hoping to soon have the ability to hold an in-person workshop, so we do not yet know when the next VExUS Course will be offered, but the online material is available here, and the cost of the online material + later workshop is the same as the full course. Going thru the material and getting some practice in may also help you by providing you with cases to discuss during the workshop.
So I was really honoured to have been invited to talk about VExUS for the Mayo Clinic’s CC department. In the last year watching the spread of VExUS has been really rewarding because so far, everyone who has incorporated it into their clinical practice has seen the substantial impact it can have. And it is just the beginning, with exciting new studies in the pipeline and papers about to be published.
Anyhow, the invitation to speak “at” (Zoom of course given that this is COVID times) Mayo represents another step in the spread of precision medicine as applied to venous congestion.
So a lot of people have been asking for a VExUS tutorial, and since our paper was just accepted, I figured it’s a pretty good time to do it! Thanks to Dr. Ian Ajmo of FrancoFoam fame who put on his Hollywood director’s hat and filmed it!
Here is the classification that has been validated:
I’m attaching our chapter on venous congestion below as well.
Of course, Andre Denault, William Beaubien Souligny, Rory Spiegel, Korbin Haycock and myself will be running VExUS workshops at H&R2020. There aren’t many spots left!
So I love the UVM EM Update at Stowe. It’s a great little conference, run by my good friend and all around awesome guy Peter Weimersheimer (VTEMsono) ED Pocusologist, and his super team including Kyle DeWitt (@emergpharm), Meghan Groth (ENpharmgirl) and Mark Bisanzo (@mbisanzo). It’s a smooth running show with some really amazing speakers where I always learn a bunch. Had the chance to finally meet Sergey Motov (@painfreeED) and learn from an awesome opioid lecture. And it’s always great to hang with Josh (@PulmCrit) and listen to the pearls!
So here is my fluid talk. The Keynote pdf is just below. Hope there’s a useful tidbit or two in there!
So recently a colleague asked me about one of my twitter posts where I had put a clip of doing venous congestion assessment using a handheld – which is without pulsed Doppler (PW). Since VEXUS is predominantly based on Doppler findings, seems like 2D and colour might not cut it, but can it be done in a screening or “lite” fashion?
Definitely. Here is a mini-discussion about it, and some clips below to illustrate.
Clearly Pulsatile PV likely near 100%
Ascites, plethoric IVC, pulsatile PV, markedly abnormal HV with “police siren” appearance due to substantial retrograde flow – likely VExUS 3 or C.
Normal looking HV
Markedly abnormal HV
Love to hear some questions or comments!
of course, lots of VExUS discussions with William Beaubien Souligny, Andre Denault, Rory Spiegel, Korbin Haycock and myself at H&R2020!
So I’m really glad to see that recently, a lot of discussion has been taken place on the topic of right sided failure and venous congestion, which has huge clinical applications. Even more so, the fact that a lot of individual practitioners have taken this on and have been applying it clinically with physiological results is really amazing.￼
So a common question that has been popping up revolves around clinical thresholds of significance, and I thought it was worth clarifying that we need to stay away from a pure threshold approach, but rather try to embrace a holistic cardio pulmonary and whole body assessment.￼
So here’s my two cents:
Thank you, love to hear any comments!￼￼
ps obviously, this type of discussion will be what H&R2020 will be chock full of!
So here was a late-breaker talk at H&R2019. Portal vein pulsatility and hyponatremia by a nephrologist – intensivist. Love it. Sharad, a really great guy, also recently published a case report on this topic.
There is a lot of stuff on venous congestion in the woodwork, some of which we are involved in, but also some springing up from different places, and this is really exciting, because POCUS gives you a non-invasive tool to assess and differentiate pathological degrees of congestion that really nothing else can with as much breadth, and as part of a comprehensive exam.
Venous POCUS is worth learning, and keep your eye on this space for how it evolves as a clinical tool. Our VEXUS classification will soon have some real substance behind it.