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

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

Author: Core IM Team November 19, 2025 Duration: 34:44

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?


🔹 Sponsor: Oakstone CME

Use the code "CORE30" for 30% off: https://www.coreimpodcast.com/MKSAP 


🔹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



Find the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840

Our Sponsors:
* Check out Quince: https://quince.com/coreim
* Use code FIGSRX for a great deal: https://wearfigs.com


Advertising Inquiries: https://redcircle.com/brands

Privacy & Opt-Out: https://redcircle.com/privacy

Ever find yourself in the middle of a busy day, wondering about the 'why' behind a common treatment or needing a clear way to think through a complex diagnosis? That's the space where Core IM | Internal Medicine Podcast lives. Created by the Core IM Team, this isn't just a lecture series; it's a practical companion for clinicians, students, and anyone curious about the inner workings of medical practice. Each episode is structured into distinct segments that tackle different facets of the clinical world. You'll hear "5 Pearls" for concise, immediately useful takeaways, and "Mind the Gap" explores the evidence and reasoning behind our everyday decisions. When management gets tricky, "Gray Matters" steps in to untangle the thought process, while "Hoofbeats" focuses on sharpening diagnostic acumen. Finally, "At the Bedside" brings it all together, addressing the real and often nuanced challenges faced in patient care. The conversation throughout this podcast is grounded, thoughtful, and driven by a genuine desire to deepen understanding beyond the textbook. It’s about connecting the dots between knowledge and application, making the intricate landscape of internal medicine a bit more navigable, one discussion at a time.
Author: Language: English Episodes: 100

Core IM | Internal Medicine Podcast
Podcast Episodes
#124 A1c & Glucose Measurements: Mind the Gap Segment [not-audio_url] [/not-audio_url]

Duration: 21:21
What does the HbA1c really measure? What are its limitations? How does fructosamine and glycated albumin work? What will falsely elevate or decrease it? What are the benefits of continuous glucose monitoring? What are th…
#123 Pacemakers & ICDs: 5 Pearls Segment [not-audio_url] [/not-audio_url]

Duration: 47:31
When do you have a device interrogated? Do you know what kind of device your patient has? Do you know how to manage patients with a device who develop bacteremia? How do you discuss end of life care in patients with devi…
#122 Kidney Transplant Preparation: 5 Pearls Segment [not-audio_url] [/not-audio_url]

Duration: 46:03
How does transplant compare to dialysis? Who is a good candidate for a kidney transplant? How long do patients have to wait for a deceased donor kidney transplant? What can increase or decrease the waiting time for your…
#121 Trach Care: 5 Pearls Segment [not-audio_url] [/not-audio_url]

Duration: 42:58
What is your approach to trach complications? What do all the words in the one liner of a trach patient mean? What are best practices for airway clearance? When is a patient ready for a speaking valve? What is the proces…
#118 "Futility": At the Bedside Segment [not-audio_url] [/not-audio_url]

Duration: 41:56
How do you approach requests for 'futile' care? What do we mean by futility? What kind of recovery do we think is meaningful? How do we evaluate potentially inappropriate care? Where can we go for guidance on this?Show n…
#117 Atrial Fibrillation: Gray Matters Segment [not-audio_url] [/not-audio_url]

Duration: 37:30
What does the duration of afib tell you about the thromboembolic risk? When do you start anticoagulation for post-op afib? What do the most recent guidelines recommend for perioperative anticoagulation management? How ma…
#116 The Lipid Panel Reimagined: Mind the Gap Segment [not-audio_url] [/not-audio_url]

Duration: 19:52
Is it enough to look at LDL-C? What is Apo-B? How do you use TG/HDL ratio to understand your patients cardiovascular risk? Do you need to get a fasting lipid panel? How does it affect the triglycerides and LDL?Show notes…
#115 Hope: At the Bedside Segment [not-audio_url] [/not-audio_url]

Duration: 35:04
What are some ways you address unrealistic hopes with your patients? How can you build a portfolio of hope with your patients? Can you learn to guide your patients hope?Show notes, Transcript and References: https://www.…