PoCUS – Measurements and Quick...
3
PoCUS – Measurements and Quick Reference 2.0 – Dr Heather Flemming – DEM Dalhousie 2017 Edited by Dr Heather Flemming, Dr David Lewis and Dr Ryan Henneberry Area of interest PoCUS – Measurements and Quick Reference Abdominal Aorta Normal = <3cm diameter Renal Degrees of hydronephrosis Mild - Minimal separation of calyces Moderate - Dilation of major and minor calyceal system Severe - Marked dilation of the renal pelvis, thinning of parenchyma Gallbladder Width: 40-50mm Wall thickness: Average 2-3mm Pathologic >3.5 mm CBD: Normal 4mm (<6mm) • Age dependent CBD diameter change (Normal size in mm roughly equals age in decades) • 8-10mm after cholecystectomy may be normal Bladder Width: Normal empty bladder <5mm • Distended bladder <3mm Post void residual <100-150ml Optic nerve Diameter: Normal < 5mm (measured 3mm posterior to globe) Appendix Features of a normal appendix: • Compressible, blind-ended tubular structure • Surrounded by normal appearing fat • Wall thickness <3mm (serosa to lumen) • Diameter<6mm (serosa to serosa) Features of appendicitis: • Characterized by wall thickness >3mm, diameter>6mm. • Hypervascular wall with color Doppler, • Free fluid and presence of appendicolith are secondary signs. Small Bowel SBO: ≥3 loops dilated (>25 mm), non-compressible small bowel proximal to collapsed, compressible bowel Secondary signs: localized bowel wall edema (>3 mm thick), free fluid between bowel loops (Tanga sign), abnormal peristalsis (to and fro peristalsis)
Transcript of PoCUS – Measurements and Quick...
PoCUS–MeasurementsandQuickReference2.0–DrHeatherFlemming–DEMDalhousie2017
EditedbyDrHeatherFlemming,DrDavidLewisandDrRyanHenneberry
Areaofinterest
PoCUS–MeasurementsandQuickReferenceAbdominalAorta
Normal=<3cmdiameter
Renal
DegreesofhydronephrosisMild-MinimalseparationofcalycesModerate-DilationofmajorandminorcalycealsystemSevere-Markeddilationoftherenalpelvis,thinningofparenchyma
Gallbladder
Width:40-50mmWallthickness:Average2-3mmPathologic>3.5mmCBD:Normal4mm(<6mm)
• AgedependentCBDdiameterchange(Normalsizeinmmroughlyequalsageindecades)
• 8-10mmaftercholecystectomymaybenormalBladder
Width:Normalemptybladder<5mm
• Distendedbladder<3mmPostvoidresidual<100-150ml
Opticnerve
Diameter:Normal<5mm(measured3mmposteriortoglobe)
Appendix
Featuresofanormalappendix:
• Compressible,blind-endedtubularstructure• Surroundedbynormalappearingfat• Wallthickness<3mm(serosatolumen)• Diameter<6mm(serosatoserosa)
Featuresofappendicitis:• Characterizedbywallthickness>3mm,diameter>6mm.• HypervascularwallwithcolorDoppler,• Freefluidandpresenceofappendicolitharesecondarysigns.
SmallBowel
SBO:≥3loopsdilated(>25mm),non-compressiblesmallbowelproximaltocollapsed,compressiblebowelSecondarysigns:localizedbowelwalledema(>3mmthick),freefluidbetweenbowelloops(Tangasign),abnormalperistalsis(toandfroperistalsis)
PoCUS–MeasurementsandQuickReference2.0–DrHeatherFlemming–DEMDalhousie2017
EditedbyDrHeatherFlemming,DrDavidLewisandDrRyanHenneberry
Areaofinterest
PoCUS–MeasurementsandQuickReferenceMSK:
Tendinopathy:NormalAchilles:<6mmmeasuredatlevelofmedialmalleolusPatellarTendon:Normal=3-4mmPlantarfascia:Plantarfascitiis>4mm
Obstetric
Embryonicstructure
TransVagU/S TransAbdoU/S
GestationalSac 4.5-5wks 5.5-6wksYolkSac 5-5.5wks 6-6.5wksFetalPole 5.5-6wks 6.5-7weeksFetalHeartBeat 6wks 7wksDefinitiveIUP=YolkSacandorFetalPoleinsideGestationalSacLevelofbeta-HCGabovewhichIUPtypicallyseen:Transvaginal-1,500-2,000Transabdominal-6,500
IVC
IVCcollapsesslightlyoninspirationinspontaneouslybreathingpatient,butcollapsesonexpirationinmechanicallyventilatedpatient
PoCUS–MeasurementsandQuickReference2.0–DrHeatherFlemming–DEMDalhousie2017
EditedbyDrHeatherFlemming,DrDavidLewisandDrRyanHenneberry
CardiacPoCUS–MeasurementsandQuickReferenceAssessment
Parameters
Values
RVthickness
Measuredonsubcostalviewatleveloftricuspidvalvecordae.
Lessthan0.5cmisnormal
Mitralannularplanesystolicexcursion(MAPSE)
Surrogateoftheleftventricularlongitudinalfunction.SystolicexcursionofthelateralmitralannulusMeasuredinM-mode
Normalrange12+/-2mm
E-pointseptalseparation(EPSS)
Measuredfromtheanteriormitralvalveleaflettotheventricularseptuminearlydiastole.
≥7mmindicatesEF<30%.
TricuspidAnnularPlaceSystolicExcursion(TAPSE)
Lineisplacedfromtheapextothelateraltricuspidvalveandthemotionmeasured.A4Cview/M-mode
Normal>2cm
Valves:Aorticvalvediameter
MeasurementsinPSLAX
Leafletsnomorethan2mmMinimumtipseparation2cminmidsystole
Interventricularseptalthickness
DiastolicM-moderecordingsPSLAX
Normal:<1cmMen<0.9cmwomen
