- AAA youtube
- FAST youtube
- Thoracic US (Hemothorax, Pneumothorax, Rib Fracture)
Pneumothorax- Thoracic US should be included in FAST exam
- decrease depth to 5 cm (we're not looking on deeper structures)
- 3rd, 4th ICS, MCL
- lack of sliding sign youtube
- move the probe:
1) estimate the size
2) look for the LUNG POINT sign: where the lung is intimately attached to chest wall
- very specific for pneumothorax, whereas lack of sliding is non specific, also in:
1) Pleural adhesion
2) pulmonary infiltrate/contusion
3) ARDS
4) Atelectasis
5) mainstem intubation
1) Lack of Pleural Sliding (Sliding sign): Parietal pleura slides vs visceral pleura
2) Lack Comet Tail or B lines: echogenic reverberation artifacts tapering from pleura down to far field
3) No evidence of motion in M mode or Color doppler
SEASHORE SIGN: granular apperance from distinct linear appearance of chest wall
- no pneumothorax
STRATOSPHERE SIGN: same laminar linear appearance
- pneumothorax
- Echocardiography youtube
-use convex or phased array probe
-limited ED Echo: pericardial effusion, EF, cardiac standstill
-also: Ascending aortic dissection- Subxiphoid/Subcostal: indicator to the Right
- aimed at the center of chest, pressure, almost coronal plane
- may need to increase depth - Parasternal Long: indicator to the Right shoulder
- Left sternal border, 3rdd-5th ICS, parallel to the heart axis (R shoulder to L hip)
- the marker is always opposite of the LV (radiologist marker is on the right, therefore LV is on the left; this is opposite of the cardiologists)
- Parasternal Short: turn the probe counterclockwise about 90 degrees, indicator to R hip
- cross sectional of the cardiac chambers
- Apical 4-chamber: indicator to inferior tip of R scapula
- at the PMI; small probe movement and adjustment
- best in L lateral decubitus
- Proximal IVC
- sagittal plane, probe at subcostal plane, marker towards feet
- 2-3cm distal to RA
- AP diameter should collapse more than 50% during sniffing or forceful inspiration
- if less than 50%: Right sided filling pressure and CVP are elevated (eg tamponade)
- Pericardial effusion
- hypoechoic signals (DDx: pericardial fat anteriorly and pleural effusion posteriorly)
- pericardial fat: not too anechoic, only hypoechoid; has shadowing; does not show on entire cardiac cycle/show, hides
- pericardial effusion should be between descending aorta and heart - low EF: hypokinetic heart
- Cardiac standstill
- no cardiac activity after 20 minutes of ACLS: mortality is 100% - ascending aorta dissection
- IVC collapse: Hypovolemia
- IVC less than 50% collapse: high CVP, fluid overload, cardiac tamponade
- Subxiphoid/Subcostal: indicator to the Right
- DVT youtube
- Gallbladder youtube |
- make sure gallbladder is visualised and not bowel or cyst, by following connection to bile duct
- either supine or left lateral decubitus
- at Morrison's pouch or 7th/8th intercostals (cannot elicit murphy's, ribs might obscure)- Stone
- hyperechoic structure with significant shadowing
- if not impacted at the neck, having patient move will also move the stone
- polyps or valves of Heister might misidentify as stone
- stones impacted in the neck may be missed
- Cholecystitis
- thickened anterior wall >4mm
- pericholecystic fluid
- transverse diameter >5 cm
- Sonographic murphy's sign: pushing the probe while gallbladder is center in view elicits more pain
- Bile sludge: common but not specific
- Obstruction
- Duct >0.6cm if patient is 60 yo; (if post ERCP; duct size is not indicative of pathology)
- Stone
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