#193 Venous Congestion & VEXUS Interview with Dr. Ross Prager

Core IM | Internal Medicine Podcast

Core IM Team

Mental Health, Education, Health & Fitness, Medicine

4.8 • 1K Ratings

🗓️ 19 November 2025

⏱️ 38 minutes

🔗️ Recording | iTunes | RSS

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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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🔹Transcript and Shownotes

(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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