نکات

When to use POCUS for Venous Congestion Evaluation for venous congestion using Point of Care Ultrasound (VExUS POCUS) can be performed when trying to assess the fluid status of the patient. This can be especially important in our septic shock, congestive heart failure, and acute renal failure patients to help give us more data points towards starting fluids, stoping fluids, diureses, or vasopressor choice. This exam should be done in conjunction with the clinical picture, lab values, and hemodynamic status of the patient. It should also be combined and interpreted along with cardiac ultrasound findings when possible. The VExUS Score can give you evidence of venous congestion in the liver, gut, and kidneys to help predict early signs of end-organ damage and allow you to change/optimize your fluid management approach for your patient. It can also prompt you to look for the etiologies of your venous congestion such as causes of right heart failure.

Vexus: renal vein

Vexus: portal vein

Visual Disturbances: Symptoms & DDx 8⃣ Dyschromatopsia (color vision disturbance) ➕Congenital red-green color vision deficiency the most prevalent, affecting up to 8% of males and 0.5% of females of Northern European descent. It is lifelong, non-progressive, and typically isolated to color discrimination without other visual symptoms. ➕Optic neuritis presents with acquired dyschromatopsia, especially in young adults, and often associated with multiple sclerosis. Color vision loss may persist even after visual acuity recovers. ➕Toxic or drug-induced optic neuropathy Ethambutol toxicity is a leading cause; with bilateral, progressive dyschromatopsia and central visual field defects. ➕Age-related macular degeneration Can cause subtle color vision changes, especially in early or intermediate stages, but is less common. ➕Cataract Alters color perception due to lens opacification, typically causing a yellowing or dimming of colors, but less likely to cause profound dyschromatopsia. 8/8🔚

Visual Disturbances: Symptoms & DDx 7⃣ Metamorphopsia (distorted vision): ➕macular degeneration (wet or dry) ➕epiretinal membrane ➕macular edema (diabetic or vein occlusion) ➕central serous chorioretinopathy ➕macular hole 7/👇

Visual Disturbances: Symptoms & DDx 6⃣ Floaters: ➕posterior vitreous detachment most frequent. ➕vitreous hemorrhage critical to exclude. ➕retinal tear/detachment critical to exclude. ➕uveitis ➕asteroid hyalosis: a benign degenerative condition of the vitreous with accumulation of numerous small, spherical, refractile bodies composed primarily of calcium and phospholipids suspended within the vitreous gel.     6/👇

Visual Disturbances: Symptoms & DDx 5⃣ Photopsias (flashes): ➕posterior vitreous detachment leading cause, especially in older adults ➕retinal tear/detachment must be excluded. ➕migraine aura can cause positive visual phenomena. ➕optic neuritis can cause positive visual phenomena. ➕ocular trauma 5/👇

Visual Disturbances: Symptoms & DDx 4⃣ Diplopia: ➕cranial nerve palsies (III, IV, VI) most frequent, often microvascular in older adults. ➕myasthenia gravis variable diplopia. ➕thyroid eye disease variable diplopia. ➕orbital trauma ➕internuclear ophthalmoplegia 4/👇

Visual Disturbances: Symptoms & DDx 3⃣ Transient visual loss: ➕migraine aura common and reversible. ➕amaurosis fugax (transient retinal ischemia) a vascular event, often embolic. ➕papilledema may cause transient obscurations. ➕transient increased intraocular pressure (angle-closure) can cause intermittent blurring. ➕optic neuritis presents with transient loss, often with pain.  3/👇  

Visual Disturbances: Symptoms & DDx 2⃣ Visual field defects: ➕glaucoma (chronic open-angle or angle-closure) typically causes peripheral field loss. ➕retinal detachment presents with sudden onset of a curtain or shadow. ➕ischemic optic neuropathy especially arteritic, causes altitudinal or sectoral field loss. ➕stroke (retrochiasmal lesions) can cause homonymous hemianopia. ➕advanced age-related macular degeneration leads to central scotomas. 2/👇

Visual Disturbances: Symptoms & DDx 1⃣ Blurred vision: ➕uncorrected refractive error Uncorrected refractive error is the leading cause globally and is often overlooked in patients with concurrent ocular disease. ➕cataract presents with painless, progressive blurring and glare, especially in older adults. ➕age-related macular degeneration (early/dry) Early age-related macular degeneration causes difficulty with low-light tasks and slow dark adaptation. ➕posterior vitreous detachment Posterior vitreous detachment may cause mild blur with floaters. ➕migraine aura Migraine aura can cause transient blurring, often with associated neurologic symptoms. 1/👇