Point of Care Ultrasound UCSF Continuing Medical Education Cardiac - - PowerPoint PPT Presentation

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Point of Care Ultrasound UCSF Continuing Medical Education Cardiac - - PowerPoint PPT Presentation

Dec 16, 2022 125 likes •561 views

Point of Care Ultrasound UCSF Continuing Medical Education Cardiac Trevor Jensen, MD, MPH October 21-22, 2018 Disclosure I have no relevant financial relationships with any companies related to the content of this course. POCUS Cardiac and

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October 21-22, 2018

Point of Care Ultrasound UCSF Continuing Medical Education Cardiac Trevor Jensen, MD, MPH

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Disclosure

I have no relevant financial relationships with any companies related to the content of this course.

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POCUS Cardiac and IVC


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Cardiac US

  • Keep it basic
  • Echocardiography is very complex
  • We will focus on the fundamentals that

will help you care for your patients at the beside

  • These images will be used with the

clinical history to make decisions on your patient

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Utility & Protocols

  • RUSH

– Rapid Ultrasound in Shock – Patient is hypotensive or unresponsive

  • CLUE Protocol

– Cardiopulmonary Limited Ultrasound Exam – Patient needs rapid assessment for heart failure

  • BLUE Protocol

– Bedside Lung Ultrasound in Emergency – Patient is in respiratory failure

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Probe Selection

Phased Array Low Frequency Small footprint to image between ribs

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How to Hold the Probe

  • Hold probe like a pencil
  • Brace hand on the patient
  • Larger motions that gradually become finer

movements to improve image

  • Sufficient use of ultrasound gel
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Position of the Patient

  • Most likely will be supine in the ED/

Hospital/ICU

  • Left Lateral Decubitus will usually result

in improved images

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  • 3 Windows
  • Parasternal
  • Apical
  • Subcostal

Sonographic Windows

Slide adapted with permission from Arun Nagdev

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Parasternal Long

Parasternal Short Apical 4-Chamber Subcostal

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Parasternal Long: Probe + Position

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Parasternal Long Anatomy

Images obtained from echocardiographer.org

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LV

RV

Parasternal Long Axis View

LV

RV Ao

DTA

Mitral Valve Leaflets

Slide adapted with permission from Arun Nagdev

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Parasternal Long: Interpretation

  • Utility

– Effusion – LV Function

  • Indices

– Movement of mitral valve leaflet tips (EPSS) – Movement of lateral mitral valve annulus – LV Wall Thickening – Change in chamber size

  • Functional Categories (all views)

– Hyperdynamic – Normal – Mildly decreased – Severely decreased

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Parasternal Long: Normal

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Parasternal Long: Abnormal

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Parasternal Long Tips

  • Stay close to sternum
  • Sonographic windows and axes vary
  • Difficult in COPD
  • Look for the Mitral Valve
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Parasternal Short: Position

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Parasternal Short: Orientation

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Parasternal Short: Orientation

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Parasternal Short: Interpretation

  • Utility

– Gross LV systolic function – Assessed at level of papillary muscles – Regional wall motion abnormalities – RV size

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Parasternal Short: Normal

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Parasternal Short: Abnormal

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Parasternal Short Tips

  • Stay close to sternum
  • Sonographic windows and axes vary
  • Difficult in COPD
  • Look for the Mitral Valve
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Subcostal View: Position

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Subcostal View: Orientation

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Subcostal View: Interpretation

  • Utility

– LV Systolic Function – Pericardial Effusion – Right atrium and ventricle size

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Subcostal View: Normal

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Subcostal View: Abnormal

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Subcostal 4 Chamber View

  • Tips:
  • Firm pressure
  • Inspiratory hold
  • Bend the knees
  • Bowel Gas? Try right of midline
  • Great for COPD patients
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Apical 4 Chamber

  • Utility

– Systolic function – Chamber size – Valvular abnormalities – Doppler measurements

  • Challenges

– most difficult view to obtain – prone to errors in interpretation

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Apical 4 Chamber: Orientation

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Apical 4 Chamber: Normal

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Apical 4 Chamber: Abnormal

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Apical 4 Chamber

  • Tips:
  • Under the breast fold
  • Left lateral decubitus
  • End-expiratory hold
  • Aim sound waves


toward right scapula

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IVC: Position

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IVC: Orientation

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IVC: Measurement

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IVC: Interpretation

  • Location:
  • 2-3 cm caudal to RA or 0-1 cm caudal to hepatic vein
  • Metrics
  • Max diameter: 2.1 cm
  • Collapsibility: 50%
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Don’t fall for Aorta!

IVC Aorta

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Fan IVC/Aorta/IVC

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IVC: Abnormal

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Summary

  • Focus on the basic exams + basic interpretations

first

– Most evidenced based for non-cardiologists

  • Even basic exams have broad list of applications

– Hypotension – Dyspnea – Volume overload – Unresponsiveness

  • Build towards more complex exams and protocols