#193 Venous Congestion & VEXUS Interview with Dr. Ross Prager
Core IM | Internal Medicine Podcast
Core IM Team
4.8 • 1.2K Ratings
🗓️ 19 November 2025
⏱️ 38 minutes
🧾️ Download transcript
Summary
Why is venous congestion not the same as volume overload? How can looking at IVC as well as doppler on the hepatic vein, portal vein, and/or intrarenal vein help? Can venous congestion explain someone's delirium? Or be at play in septic shock? What are the limitations of the VEXUS score?
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(00:00) | Volume overload vs. Venous Congestion
(05:49) | Venous Congestion and AKI, mortality, possible delirium
(10:10) | Measuring Venous Congestion and the Role of VEXUS
(15:05) | Common Mistakes and Best Practices of VEXUS score
(23:13) | Assessing Fluid Tolerance and Risks with Venous Doppler in Acute Care
(25:29) | Fluid vs. Vasopressor Strategy Guided by Venous Assessment
Tags: CoreIM, Internal Medicine, Critical Care, Nephrology, Cardiology, Fluid Management, POCUS, Ultrasound, Doppler, Hospital Medicine, Clinical Reasoning, Medical Education
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Transcript
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| 1:00.8 | let's get back into the episode. We spend a disproportionate amount of time in medicine, |
| 1:05.4 | agonizing over decisions to give or remove fluids with either fluids or diuretics. |
| 1:12.5 | Every low urine output prompts kind of this discussion about should we be giving this patient fluids. And if we |
| 1:17.1 | actually think about it at kind of the most simple level, IV fluids are just salt and water. |
| 1:22.3 | Salt water hasn't and never will be the treatment or so many diseases. So I guess I just hope that |
| 1:27.2 | in 2025 and beyond, |
| 1:28.7 | we can stop kind of overestimating the perceived benefit of fluid |
| 1:32.3 | and maybe just kind of focus more on the core things. |
| 1:35.0 | Like, have we addressed the underlying contraceptis? |
| 1:37.8 | That's Dr. Ross-Pachor, an intensivist and scientists |
| 1:40.5 | who taught me a ton in this interview |
... |
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