Emergency Ultrasound
-
Upload
ramkumar-subburaj -
Category
Documents
-
view
223 -
download
1
description
Transcript of Emergency Ultrasound
![Page 1: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/1.jpg)
Emergency Ultrasound
Mary Ann Edens, M.D.Assistant Professor, Dept. of
EMDirector of Emergency
Ultrasound
![Page 2: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/2.jpg)
Physics Sound waves with frequencies
greater than 20 kHz are called ultrasound
Medical ultrasound waves have frequencies between 1 – 20 MHz
Sound waves are mechanical waves Created in the transducer by back
and forth displacement
![Page 3: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/3.jpg)
Physics and Knobology
![Page 4: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/4.jpg)
Physics Ultrasound transducers send out
sound waves and then “listen” for returning echoes
Most transducers at this time send out waves only approximately 1% of the time
![Page 5: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/5.jpg)
Physics Acoustic impedance determines
the amount of sound waves transmitted and reflected by tissues
Reflection occurs when the ultrasound beam hits two tissues (areas) having different acoustic impedance
Large differences in impedances inhibit useful information
![Page 6: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/6.jpg)
![Page 7: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/7.jpg)
Terms Hyperechoic
Structure reflects most sound waves
Structure appears white on screen
![Page 8: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/8.jpg)
![Page 9: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/9.jpg)
![Page 10: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/10.jpg)
Terms Anechoic
Structure allows most sound waves through
Structure appears black on screen
![Page 11: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/11.jpg)
![Page 12: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/12.jpg)
![Page 13: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/13.jpg)
![Page 14: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/14.jpg)
Terms Echogenic
Tissues in between
Allow some sound waves through and reflect others
Structures appear in various shades of gray depending on amount of reflection
![Page 15: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/15.jpg)
![Page 16: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/16.jpg)
![Page 17: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/17.jpg)
Terms Homogeneous
Tissue has uniform texture
![Page 18: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/18.jpg)
Terms Heterogeneous
Various degrees of echogenicity present
![Page 19: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/19.jpg)
Terms Isoechoic
Two tissues with same amt of echogenicity
![Page 20: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/20.jpg)
Transducers The higher the frequency, the
better the resolution The better the resolution, the
better you can distinguish objects from each other
![Page 21: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/21.jpg)
Transducers Lower frequency
![Page 22: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/22.jpg)
Transducers Higher frequency
![Page 23: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/23.jpg)
Transducers Linear
Gives rectangular image Generally has higher frequency Good for looking at a smaller area
and for gauging depth Gives more of a one dimensional view Sometimes referred to as the vascular
probe
![Page 24: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/24.jpg)
Transducers Linear
![Page 25: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/25.jpg)
From Heller & Jehle. Ultrasound in Emergency Medicine. Philadelphia:W.B. Saunders, 1995, p. 202.
![Page 26: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/26.jpg)
Transducers Curvilinear
Uses same linear orientation but arranged on a curved surface
Generally lower frequency Gives a wider angle of view
![Page 27: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/27.jpg)
Transducers Curvilinear
![Page 28: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/28.jpg)
![Page 29: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/29.jpg)
![Page 30: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/30.jpg)
Transducers The footprint refers to the portion
of the transducer that contacts the patient
Curvilinear transducers come with different footprints for different purposes
![Page 31: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/31.jpg)
Transducers Transducers have a marker that
corresponds to a mark on the screen
Helps with spatial orientation
![Page 32: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/32.jpg)
![Page 33: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/33.jpg)
Knobology Power
Controls the strength or intensity of the sound wave
Use ALARA principle As low as reasonably acheivable
![Page 34: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/34.jpg)
Knobology Gain
Degree of amplification of the returning sound
Increasing the gain, increases the strength of the returning echoes and results in a lighter image
Decreasing the gain, does the opposite
![Page 35: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/35.jpg)
Knobology Too much gain
![Page 36: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/36.jpg)
Knobology Too little gain
![Page 37: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/37.jpg)
Knobology Optimal gain
![Page 38: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/38.jpg)
Knobology Time gain compensation
Used to equalize the stronger echoes in the near field with the weaker echoes in the far field
Should be a gentle curve
![Page 39: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/39.jpg)
Knobology Focal zone
Where the narrowest portion of the beam is
Gives the optimal resolution
![Page 40: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/40.jpg)
Knobology Focal zone off Focal zone right
![Page 41: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/41.jpg)
Knobology Depth
Each frequency has a range of depth of penetration
Decrease the depth to visualize superficial structures
May need to increase the depth of penetration to visualize larger organs
![Page 42: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/42.jpg)
Knobology Zoom
Can place zoom box on a portion of a frozen image to enlarge that portion of the image
May lose some resolution because pixels are enlarged
![Page 43: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/43.jpg)
Basic OB/Gyn Ultrasound
![Page 44: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/44.jpg)
Goals To perform a focused examination
on patients with complicated first trimester pregnancies
To rule in an intrauterine pregnancy (not to rule out an ectopic)
![Page 45: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/45.jpg)
Scanning Techniques Transabdominal
Supine position A full bladder will provide sonographic
window 3.5 MHz curvilinear transducer Place transducer in the sagittal plane
just above the pubic bone
![Page 46: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/46.jpg)
![Page 47: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/47.jpg)
Scanning Techniques Transabdominal
Locate the long-axis of uterus and sweep from side to side
Turn transducer 90 degrees counter-clockwise
![Page 48: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/48.jpg)
![Page 49: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/49.jpg)
Scanning Techniques Transabdominal
Locate the short-axis of the uterus and angle cephalad and caudad
Goal is to see the entire uterus
![Page 50: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/50.jpg)
Scanning Techniques Transvaginal
Supine lithotomy position 5.0-7.5 MHz intracavitary transducer Need to apply gel to the transducer
and transducer cover Have assistant to chaperone
![Page 51: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/51.jpg)
Scanning Techniques Transvaginal
With locator anterior, scan the long-axis of the uterus
Transducer does not need to be inserted all the way to the cervix
![Page 52: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/52.jpg)
![Page 53: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/53.jpg)
Scanning Techniques Transvaginal
Turn transducer 90 degrees counter-clockwise to scan the short-axis of the uterus
Goal is to see the entire uterus
![Page 54: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/54.jpg)
![Page 55: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/55.jpg)
Sonographic FindingsNonpregnant Uterus May see endometrial stripe
![Page 56: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/56.jpg)
![Page 57: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/57.jpg)
![Page 58: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/58.jpg)
Sonographic FindingsNormal Intrauterine Pregnancy Gestational sac
First indication of pregnancy but not a reliable sign of an IUP
Transabdominal scanning 5.5 – 6 weeks gestation B-HCG of 6500
![Page 59: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/59.jpg)
Sonographic FindingsNormal Intrauterine Pregnancy Gestational sac
Transvaginal scanning 4.5 – 5 weeks gestation B-HCG of 1000-2000
![Page 60: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/60.jpg)
Sonographic FindingsNormal Intrauterine Pregnancy Gestational sac
Features of normal sac Round or oval in shape Central position in uterus Smooth contour
![Page 61: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/61.jpg)
![Page 62: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/62.jpg)
Sonographic FindingsNormal Intrauterine Pregnancy Yolk sac
First reliable sign of an intrauterine pregnancy
Should be seen by 5 – 6 weeks gestation
![Page 63: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/63.jpg)
![Page 64: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/64.jpg)
Sonographic FindingsNormal Intrauterine Pregnancy Fetal pole
Should be seen by TV when mean gestational sac diameter is > 16 mm
Cardiac activity usually detected by TV by 6 weeks gestation
Use M-mode to confirm activity
![Page 65: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/65.jpg)
![Page 66: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/66.jpg)
![Page 67: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/67.jpg)
![Page 68: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/68.jpg)
Sonographic FindingsEctopic Pregnancy Detection of ectopic pregnancy
outside uterus < 20% Suggestive findings
No IUP with high B-HCG Pseudogestational sac Complex adnexal mass Free fluid in cul-de-sac
![Page 69: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/69.jpg)
![Page 70: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/70.jpg)
![Page 71: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/71.jpg)
![Page 72: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/72.jpg)
Basic Trauma Ultrasound
The FAST Scan
![Page 73: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/73.jpg)
Goals Bedside screening test for the
detection of hemopericardium and hemoperitoneum
Not a formal study to detect pathology
![Page 74: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/74.jpg)
Scanning Techniques Four standard views
Pericardial Subxiphoid (parasternal if cannot obtain
subxiphoid view) Perihepatic Perisplenic Pelvic
3.5 MHz curvilinear transducer
![Page 75: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/75.jpg)
Scanning Techniques Pericardial views
Subxiphoid view Place transducer in midline and aim
towards the patient’s left shoulder
![Page 76: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/76.jpg)
![Page 77: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/77.jpg)
Scanning Techniques Pericardial views
Parasternal view Place transducer oriented between ribs
on the patient’s left
![Page 78: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/78.jpg)
![Page 79: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/79.jpg)
Scanning Techniques Perihepatic view
Place the transducer on the patient’s right in the midaxillary line between the 8th and 11th intercostal spaces
![Page 80: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/80.jpg)
![Page 81: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/81.jpg)
Scanning Techniques Perisplenic view
Place the transducer on the patient’s left in the midaxillary line between the 8th and 11th intercostal spaces
![Page 82: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/82.jpg)
![Page 83: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/83.jpg)
Scanning Techniques Pelvic view
Place the transducer in midline just above the pubic symphysis
![Page 84: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/84.jpg)
![Page 85: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/85.jpg)
Sonographic FindingsPericardial Views Subxiphoid view
Four chamber view The visceral and parietal pericardium
are adherent
![Page 86: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/86.jpg)
![Page 87: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/87.jpg)
![Page 88: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/88.jpg)
Sonographic FindingsPericardial Views Subxiphoid view
Pericardial fluid will show as a dark layer in between the visceral and parietal pericardial layers
Tamponade is diagnosed by circumferential fluid collection with diastolic collapse of the right atrium or ventricle
![Page 89: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/89.jpg)
![Page 90: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/90.jpg)
Sonographic FindingsPerihepatic View Normal view
The kidney and liver will be adjacent to each other
Morrison’s pouch will not be visible Morrison’s pouch is the space between
the liver and the right kidney
![Page 91: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/91.jpg)
![Page 92: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/92.jpg)
Sonographic FindingsPerihepatic View Abnormal view
Intraperitoneal fluid will appear as anechoic area in Morrison’s pouch
Be careful not to misinterpret a fluid filled structure (i.e. gallbladder, colon, duodenum) as free fluid
![Page 93: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/93.jpg)
![Page 94: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/94.jpg)
![Page 95: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/95.jpg)
![Page 96: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/96.jpg)
Sonographic FindingsPerisplenic View Normal view
The left kidney and spleen are normally adjacent to each other
![Page 97: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/97.jpg)
![Page 98: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/98.jpg)
![Page 99: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/99.jpg)
Sonographic FindingsPerisplenic View Abnormal view
Intraperitoneal fluid will appear as anechoic area in the subphrenic space or splenorenal fossa
Be careful not to misinterpret a fluid filled structure (i.e. stomach, colon) as free fluid
![Page 100: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/100.jpg)
![Page 101: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/101.jpg)
Sonographic FindingsPelvic View In female patients, intraperitoneal
fluid will appear in the pouch of Douglas just posterior to the uterus
In male patients, intraperitoneal fluid will appear in the retrovesicular pouch or cephalad to the bladder
![Page 102: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/102.jpg)
![Page 103: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/103.jpg)
Interpretation of FAST Positive pericardial view
Patient should go to the OR Positive perihepatic, perisplenic or
pelvic view The stable patient should go to CT to
further define injuries The unstable patient should go to the
OR
![Page 104: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/104.jpg)
Basic Abdominal Ultrasound
![Page 105: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/105.jpg)
GallbladderGoals Evaluation of RUQ abdominal pain
for diagnosis of Cholelithiasis Cholecystitis
![Page 106: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/106.jpg)
GallbladderScanning Technique Supine or left lateral decubitus
position Ideally patient should be NPO for
4-6 hours 3.5-5.0 MHz curvilinear transducer Start with transducer in sagittal
plane in the midclavicular line at the lower costal margin
![Page 107: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/107.jpg)
![Page 108: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/108.jpg)
GallbladderScanning Technique Slide and angle through liver to
find gallbladder Look for main lobar fissure to lead to
the gallbladder Having patient take a deep breath
may help Once gallbladder is visualized, turn
transducer slightly to find long-axis of the gallbladder
![Page 109: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/109.jpg)
GallbladderScanning Technique Sweep from side to side to
evaluate for stones Turn the transducer 90 degrees
counterclockwise to find short-axis of the gallbladder
Angle the transducer to evaluate the entire gallbladder
![Page 110: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/110.jpg)
![Page 111: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/111.jpg)
GallbladderSonographic Findings Normal gallbladder
Anechoic Wall thickness < 3 mm Transverse diameter < 4 cm May see folds or valves within the
gallbladder
![Page 112: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/112.jpg)
![Page 113: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/113.jpg)
![Page 114: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/114.jpg)
![Page 115: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/115.jpg)
GallbladderSonographic Findings Abnormal gallbladder -
cholelithiasis Stones > 3mm in size will cause
shadowing Smaller stones and “sludge” will not
May see wall-echo sign in a gallbladder full of stones
Evaluate neck of gallbladder carefully for an impacted stone
![Page 116: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/116.jpg)
![Page 117: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/117.jpg)
![Page 118: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/118.jpg)
![Page 119: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/119.jpg)
![Page 120: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/120.jpg)
GallbladderSonographic Findings Abnormal gallbladder -
cholecystitis Wall thickening > 3 mm Gallbladder enlargement Pericholecystic fluid Sonographic Murphy’s sign
Pressing with transducer directly over the gallbladder elicits pain
![Page 121: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/121.jpg)
![Page 122: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/122.jpg)
![Page 123: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/123.jpg)
RenalGoals Detection of obstructive uropathy
(i.e. hydronephrosis) in patients with Suspected renal colic Acute renal failure
![Page 124: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/124.jpg)
RenalScanning Techniques Left lateral decubitus or right
lateral decubitus for each respective kidney
3.5–5.0 MHz curvilinear transducer Use intercostal oblique technique
described for the FAST scan May also use subcostal approach in
the sagittal plane at the midclavicular line
![Page 125: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/125.jpg)
![Page 126: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/126.jpg)
![Page 127: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/127.jpg)
RenalScanning Techniques Once kidney is found turn
transducer slightly to find long-axis Scan through entire kidney Then turn transducer 90 degrees
counterclockwise to find the short-axis
Scan through entire kidney
![Page 128: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/128.jpg)
![Page 129: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/129.jpg)
![Page 130: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/130.jpg)
RenalSonographic Findings Normal kidney
The renal pelvis appears echogenic The surrounding renal cortex is
hypoechoic The size is ~ 9-13 cm in length
![Page 131: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/131.jpg)
![Page 132: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/132.jpg)
RenalSonographic Findings Abnormal kidney - hydronephrosis
Appears as anechoic dilatation of the renal pelvis
Marked thinning of the cortex implies long- standing hydronephrosis
The degree of hydronephrosis does not correspond with the degree of obstruction
May be present uni- or bilaterally
![Page 133: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/133.jpg)
![Page 134: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/134.jpg)
![Page 135: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/135.jpg)
![Page 136: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/136.jpg)
RenalSonographic Findings Abnormal kidney – renal cysts
Appears as anechoic areas within the cortex with a normal renal pelvis
![Page 137: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/137.jpg)
![Page 138: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/138.jpg)
![Page 139: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/139.jpg)
AortaGoals Evaluation of abdominal or back
pain to rule out AAA
![Page 140: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/140.jpg)
AortaScanning Technique Supine position 2.5-5.0 MHz curvilinear transducer Start with transducer in sagittal
plane in the midline just below the xiphoid process
Angle the transducer slightly to the patient’s left to locate the aorta
![Page 141: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/141.jpg)
![Page 142: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/142.jpg)
AortaScanning Technique Slide and rock the transducer
caudally down the abdomen to follow the aorta all the way to the bifurcation
Then move the transducer back to the subxiphoid space and relocate the aorta
Turn the transducer 90 degrees counterclockwise to visualize the short-axis of the aorta (transverse view)
![Page 143: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/143.jpg)
![Page 144: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/144.jpg)
AortaScanning Technique Again slide the transducer caudally
down the abdomen to follow the aorta all the way to the bifurcation
Any measurements of the aorta should be taken in this transverse view
Pressure may be placed to distinguish the aorta from the IVC The IVC will collapse, the aorta will
not
![Page 145: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/145.jpg)
AortaSonographic Findings Normal aorta
Diameter no greater than 3 cm at any point
Be careful not to measure obliquely Should taper distally Lumen should appear anechoic
![Page 146: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/146.jpg)
![Page 147: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/147.jpg)
![Page 148: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/148.jpg)
![Page 149: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/149.jpg)
AortaSonographic Findings Abnormal aorta - aneurysm
Diameter greater than 3 cm at any point
Be careful not to measure obliquely Most aneurysms are found
infrarenally Mural thrombus may be seen as areas
of low to medium echogenicity within the wall
![Page 150: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/150.jpg)
![Page 151: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/151.jpg)
AortaSonographic Findings Abnormal aorta - dissection
Aorta may be greater than 3 cm, but not always
Diagnosed when an intimal flap is visualized within the vessel lumen
![Page 152: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/152.jpg)
AscitesGoals Evaluation of the patient with liver
failure May be helpful in deciding the
most appropriate needle placement for paracentesis
![Page 153: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/153.jpg)
AscitesScanning Techniques Same general technique as
described with FAST scan
![Page 154: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/154.jpg)
AscitesSonographic Findings Same general findings as
described with FAST scan
![Page 155: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/155.jpg)
Basic Cardiac Ultrasound
![Page 156: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/156.jpg)
Goals To evaluate the patient with
cardiac failure for Pericardial fluid/tamponade Cardiac activity
![Page 157: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/157.jpg)
Scanning Technique Same general technique as
described with FAST scan Best way to document the
presence of cardiac activity is with the M-mode
![Page 158: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/158.jpg)
Sonographic Findings Pericardial fluid as described with
FAST scan M-mode shows good movement
with normal cardiac activity
![Page 159: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/159.jpg)
![Page 160: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/160.jpg)
Sonographic Findings In cardiac arrest, four-chamber
view may be difficult to see M-mode shows no movement in area
of heart
![Page 161: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/161.jpg)
![Page 162: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/162.jpg)
Central Line Placement US can be used for placement Easiest line to use for is IJ Place patient in Trendelenberg
position if able Place linear probe on neck
![Page 163: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/163.jpg)
![Page 164: Emergency Ultrasound](https://reader035.fdocuments.us/reader035/viewer/2022062422/563db7db550346aa9a8e9d13/html5/thumbnails/164.jpg)