0:00

This is gonna be like a, a case-based, uh, talk.

0:04

So just look at the cases and challenge yourself.

0:07

So, let's get started. Okay, so this is my disclosure.

0:13

And so what we, uh, what I just want to review, uh,

0:18

initially, 'cause I'm gonna show some Venus cases

0:21

at least to begin with.

0:22

So how do we do venous ultrasound if it's very basic

0:25

and I apologize, but I just think it's important to,

0:29

um, to review this.

0:30

So when we look at a venous ultrasound,

0:34

I think the most important uh, feature is actually a

0:37

transfer gray scale image.

0:40

Where here we have the common femoral vein.

0:42

You have the artery and the vein,

0:44

and we want to show that with

0:47

compression from the transducer.

0:48

You can nicely see on the clip.

0:50

And we ask our, uh, technologist to,

0:52

or sonographers to do clips like that.

0:54

The vein should be dark, so no internal echoes

0:59

and should be very easily collapsible for from, uh,

1:03

you know, just a little bit of pressure from the transducer.

1:06

It's much easier to do it transverse

1:07

because that you see the whole vein.

1:09

You make sure you're not rolling off the vein, uh,

1:12

as if you were doing it sag.

1:14

So that's the most important, uh,

1:19

question in my opinion of the case

1:21

to exclude a deep vein thrombosis.

1:24

And then of course, what we also look at, we put color just

1:27

to make sure the vein is filling.

1:29

The wall is thin, and then we get a doppler spectrum.

1:33

'cause we want to make sure that there is venous type flow,

1:36

which is relatively monophasic,

1:38

but it, there should be some physicality from transmitted

1:43

respiratory and cardiac, um,

1:46

physic to the vein.

1:48

And that is a very important concept

1:50

because that means that there is no blockage in between, uh,

1:54

more central vein and what you're examining.

1:58

And so this is what we do.

2:00

Now, we do not do augmentation in the oldest.

2:03

We used to augment in the cap. We don't do that.

2:05

First of all, it's,

2:06

it's increase the length of the examination.

2:09

Uh, it's not really necessary.

2:12

And, uh, you know, if the patient does have a clot,

2:15

there's always a small risk that by,

2:16

by doing calf compression you can throw in

2:19

a pulmonary embolus.

2:20

So we don't do that anymore.