Cardiac UltrasoundDr Cliff Reid Greater Sydney Area HEMSAmbulance Service New South Wales
HYPOXAEMIAHYPOVOLAEMIAHYPER/HYPOKALAEMIAHYPOTHERMIATENSION PNEUMOTHORAXTAMPONADETOXIC / METABOLIC /THROMBOSIS - PULMONARY ...
PEA / HypotensionVolume Obstruction PumpTensionpneumothoraxTamponadePulmonaryembolism
Probe typeProbe orientationECGPatient positionModesJust FAST in the CHEST?
Echo%Modes2D ‘B’ modeM modeDoppler
Echo%Modes2D ‘B’ modeM modeDoppler
Echo%Modes2D ‘B’ modeM modeDoppler
PLAX PSAXA4CSC4C✓
Parasternal%Long%Axis
Parasternal%Long%AxisAnima6on%from%Yale%University%Atlas%of%Echocardiography
Parasternal%Long%AxisImage credit: CC Patrick J. Lynch and C. Carl Jaffe, Yale University, 2006.
Parasternal%Short%AxisAnima6on%from%Yale%University%Atlas%of%Echocardiography
Parasternal%short%axisImage credit: CC Patrick J. Lynch and C. Carl Jaffe, Yale University, 2006.
Parasternal%short%axisAISL
27
28
29
Anima6on%from%Yale%University%Atlas%of%EchocardiographyApical%4%chamber
Apical%4%chamberImage credit: CC Patrick J. Lynch and C. Carl Jaffe, Yale University, 2006.
Image courtesy of MikeMallinsNightsOut.com
Apical%4%chamber
post ovarian cystectomy 24 hrs +FAST with clots in pelvispost ovarian cystectomy 24 hrs +FAST with clots in pelvispost ova...
post ovarian cystectomy 24 hrs +FAST with clots in pelvispost ovarian cystectomy 24 hrs +FAST with clots in pelvispost ova...
Cri6cal%Care%UltrasoundEmergency%Medicine%Spring%Conference%2007Normal Patient
Normal Patient
Parasternal short axis
Anima6on%from%Yale%University%Atlas%of%EchocardiographySubcostal
SubcostalImage credit: CC Patrick J. Lynch and C. Carl Jaffe, Yale University, 2006.
post ovarian cystectomy 24 hrs +FAST with clots in pelvispost ovarian cystectomy 24 hrs +FAST with clots in pelvispost ova...
Hypothermia, hypotension
Scanning the IVC‘Volume Assessment’
You will see charts like this*IVC$Size$(cm)Changes$with$respira6on$or$“sniff”Es6mated$mean$CVP$(mmHg)Small%<%1.5 Collapse 0...
No-one cares what the CVP isCVP vs Blood volume in 1500 measurements in 188 ICU patientsChest. 2008 Jul;134(1):172-8.Does ...
“Only aWindow Lickeruses CVP to makeclinical decisionsregarding fluidmanagement.”- Someone in Australia
TheVolume QuestionDoes this patient havea fluid responsivecardiac output?
So what does the IVC tell us?How much a change in pressure changesthe volume (=compliance)How stretched the vessel is(volu...
PressureVolumeIVC compliance
PressureVolumeIVC complianceSmall%IVC%collapse%when%volume%highrespiratory%change%in%pleural%pressure%transmiVed%to%IVC
IVC complianceVolumeLarge%IVC%collapse%when%volume%lowPressurerespiratory%change%in%pleural%pressure%transmiVed%to%IVC
CLINICAL assessmentHEARTDo NOT interpret in isolationLUNGS
Affected by Sampling LocationAcad Emerg Med. 2010 Jan;17(1):96-9Inferior vena cava percentage collapse during respiration ...
BIGGER SMALLERCirculatory obstruction with high RAPHigh intraabdominal pressureRight lateral positionAthletesSupine positi...
66
67
68
71
post ovarian cystectomy 24 hrs +FAST with clots in pelvispost ovarian cystectomy 24 hrs +FAST with clots in pelvispost ova...
post ovarian cystectomy 24 hrs +FAST with clots in pelvispost ovarian cystectomy 24 hrs +FAST with clots in pelvispost ova...
Image Courtesy of Dr Tim Rogerson FCEM
Image Courtesy of Dr Tim Rogerson FCEM
post ovarian cystectomy 24 hrs +FAST with clots in pelvispost ovarian cystectomy 24 hrs +FAST with clots in pelvispost ova...
post ovarian cystectomy 24 hrs +FAST with clots in pelvispost ovarian cystectomy 24 hrs +FAST with clots in pelvispost ova...
post ovarian cystectomy 24 hrs +FAST with clots in pelvispost ovarian cystectomy 24 hrs +FAST with clots in pelvispost ova...
post ovarian cystectomy 24 hrs +FAST with clots in pelvispost ovarian cystectomy 24 hrs +FAST with clots in pelvispost ova...
post ovarian cystectomy 24 hrs +FAST with clots in pelvispost ovarian cystectomy 24 hrs +FAST with clots in pelvispost ova...
post ovarian cystectomy 24 hrs +FAST with clots in pelvispost ovarian cystectomy 24 hrs +FAST with clots in pelvispost ova...
post ovarian cystectomy 24 hrs +FAST with clots in pelvispost ovarian cystectomy 24 hrs +FAST with clots in pelvispost ova...
post ovarian cystectomy 24 hrs +FAST with clots in pelvispost ovarian cystectomy 24 hrs +FAST with clots in pelvispost ova...
post ovarian cystectomy 24 hrs +FAST with clots in pelvispost ovarian cystectomy 24 hrs +FAST with clots in pelvispost ova...
post ovarian cystectomy 24 hrs +FAST with clots in pelvispost ovarian cystectomy 24 hrs +FAST with clots in pelvispost ova...
post ovarian cystectomy 24 hrs +FAST with clots in pelvispost ovarian cystectomy 24 hrs +FAST with clots in pelvispost ova...
PNEUMOTHORAXPUMP FAILUREPLEURAL FLUIDPERITONEAL FLUIDPERICARDIAL FLUIDMASSIVE PEOBSTRUCTIONPUMPVOLUME
mail@cliffreid.comhttp://resus.me/castlefest
Cardiac ultrasound
Cardiac ultrasound
Cardiac ultrasound
Cardiac ultrasound
Cardiac ultrasound
Cardiac ultrasound
Cardiac ultrasound
Cardiac ultrasound
Cardiac ultrasound
Cardiac ultrasound
Cardiac ultrasound
Cardiac ultrasound
Cardiac ultrasound
Cardiac ultrasound
Cardiac ultrasound
Cardiac ultrasound
Cardiac ultrasound
Cardiac ultrasound
Cardiac ultrasound
Cardiac ultrasound
Cardiac ultrasound
Cardiac ultrasound
Cardiac ultrasound
Cardiac ultrasound
Cardiac ultrasound
Cardiac ultrasound
Cardiac ultrasound
Cardiac ultrasound
Cardiac ultrasound
Cardiac ultrasound
Cardiac ultrasound
Cardiac ultrasound
Cardiac ultrasound
Upcoming SlideShare
Loading in...5
×

Cardiac ultrasound

760

Published on

Slides from Castlefest 2013

Published in: Health & Medicine, Education
0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
760
On Slideshare
0
From Embeds
0
Number of Embeds
3
Actions
Shares
0
Downloads
0
Comments
0
Likes
1
Embeds 0
No embeds

No notes for slide

Transcript of "Cardiac ultrasound"

  1. 1. Cardiac UltrasoundDr Cliff Reid Greater Sydney Area HEMSAmbulance Service New South Wales
  2. 2. HYPOXAEMIAHYPOVOLAEMIAHYPER/HYPOKALAEMIAHYPOTHERMIATENSION PNEUMOTHORAXTAMPONADETOXIC / METABOLIC /THROMBOSIS - PULMONARY /CORONARY
  3. 3. PEA / HypotensionVolume Obstruction PumpTensionpneumothoraxTamponadePulmonaryembolism
  4. 4. Probe typeProbe orientationECGPatient positionModesJust FAST in the CHEST?
  5. 5. Echo%Modes2D ‘B’ modeM modeDoppler
  6. 6. Echo%Modes2D ‘B’ modeM modeDoppler
  7. 7. Echo%Modes2D ‘B’ modeM modeDoppler
  8. 8. PLAX PSAXA4CSC4C✓
  9. 9. Parasternal%Long%Axis
  10. 10. Parasternal%Long%AxisAnima6on%from%Yale%University%Atlas%of%Echocardiography
  11. 11. Parasternal%Long%AxisImage credit: CC Patrick J. Lynch and C. Carl Jaffe, Yale University, 2006.
  12. 12. Parasternal%Short%AxisAnima6on%from%Yale%University%Atlas%of%Echocardiography
  13. 13. Parasternal%short%axisImage credit: CC Patrick J. Lynch and C. Carl Jaffe, Yale University, 2006.
  14. 14. Parasternal%short%axisAISL
  15. 15. 27
  16. 16. 28
  17. 17. 29
  18. 18. Anima6on%from%Yale%University%Atlas%of%EchocardiographyApical%4%chamber
  19. 19. Apical%4%chamberImage credit: CC Patrick J. Lynch and C. Carl Jaffe, Yale University, 2006.
  20. 20. Image courtesy of MikeMallinsNightsOut.com
  21. 21. Apical%4%chamber
  22. 22. post ovarian cystectomy 24 hrs +FAST with clots in pelvispost ovarian cystectomy 24 hrs +FAST with clots in pelvispost ovarian cystectomy 24 hrs +FAST with clots in pelvisMale age 40DyspneaHypotension
  23. 23. post ovarian cystectomy 24 hrs +FAST with clots in pelvispost ovarian cystectomy 24 hrs +FAST with clots in pelvispost ovarian cystectomy 24 hrs +FAST with clots in pelvisMale age 40 SOB HypotensionIncreasingbreathlessness overtwo weeksPreviously wellQuiet heart sounds,BP 85/62, JVP 6cm
  24. 24. Cri6cal%Care%UltrasoundEmergency%Medicine%Spring%Conference%2007Normal Patient
  25. 25. Normal Patient
  26. 26. Parasternal short axis
  27. 27. Anima6on%from%Yale%University%Atlas%of%EchocardiographySubcostal
  28. 28. SubcostalImage credit: CC Patrick J. Lynch and C. Carl Jaffe, Yale University, 2006.
  29. 29. post ovarian cystectomy 24 hrs +FAST with clots in pelvispost ovarian cystectomy 24 hrs +FAST with clots in pelvispost ovarian cystectomy 24 hrs +FAST with clots in pelvisMale 70sFound on floorHypotensionHypothermia
  30. 30. Hypothermia, hypotension
  31. 31. Scanning the IVC‘Volume Assessment’
  32. 32. You will see charts like this*IVC$Size$(cm)Changes$with$respira6on$or$“sniff”Es6mated$mean$CVP$(mmHg)Small%<%1.5 Collapse 0L5Normal%1.5%–%2.5 by%≥%50% 5%–%10Normal%1.5%–%2.5 by%≤%50% 10%–%15Dilated%>%2.5 by%<%50% >%15*usually unreferencedBOLLOCKS
  33. 33. No-one cares what the CVP isCVP vs Blood volume in 1500 measurements in 188 ICU patientsChest. 2008 Jul;134(1):172-8.Does central venous pressure predict fluid responsiveness? A systematic review of the literature and the tale of seven mares.
  34. 34. “Only aWindow Lickeruses CVP to makeclinical decisionsregarding fluidmanagement.”- Someone in Australia
  35. 35. TheVolume QuestionDoes this patient havea fluid responsivecardiac output?
  36. 36. So what does the IVC tell us?How much a change in pressure changesthe volume (=compliance)How stretched the vessel is(volume in the IVC, not the body)AND
  37. 37. PressureVolumeIVC compliance
  38. 38. PressureVolumeIVC complianceSmall%IVC%collapse%when%volume%highrespiratory%change%in%pleural%pressure%transmiVed%to%IVC
  39. 39. IVC complianceVolumeLarge%IVC%collapse%when%volume%lowPressurerespiratory%change%in%pleural%pressure%transmiVed%to%IVC
  40. 40. CLINICAL assessmentHEARTDo NOT interpret in isolationLUNGS
  41. 41. Affected by Sampling LocationAcad Emerg Med. 2010 Jan;17(1):96-9Inferior vena cava percentage collapse during respiration is affected by the sampling location: an ultrasound study in healthy volunteers.HepaticVein2 cm caudalto hepaticvein inlet
  42. 42. BIGGER SMALLERCirculatory obstruction with high RAPHigh intraabdominal pressureRight lateral positionAthletesSupine position Left lateral positionTamponadePulmonary embolismTension pneumothoraxHypovolaemiaHeart failureVolume overloadPositive pressure ventilation
  43. 43. 66
  44. 44. 67
  45. 45. 68
  46. 46. 71
  47. 47. post ovarian cystectomy 24 hrs +FAST with clots in pelvispost ovarian cystectomy 24 hrs +FAST with clots in pelvispost ovarian cystectomy 24 hrs +FAST with clots in pelvisFemale 30sHypotensionDyspnea
  48. 48. post ovarian cystectomy 24 hrs +FAST with clots in pelvispost ovarian cystectomy 24 hrs +FAST with clots in pelvispost ovarian cystectomy 24 hrs +FAST with clots in pelvisMale 49Hypoxia++Normotensive
  49. 49. Image Courtesy of Dr Tim Rogerson FCEM
  50. 50. Image Courtesy of Dr Tim Rogerson FCEM
  51. 51. post ovarian cystectomy 24 hrs +FAST with clots in pelvispost ovarian cystectomy 24 hrs +FAST with clots in pelvispost ovarian cystectomy 24 hrs +FAST with clots in pelvisElderly MDyspneaHypotension
  52. 52. post ovarian cystectomy 24 hrs +FAST with clots in pelvispost ovarian cystectomy 24 hrs +FAST with clots in pelvispost ovarian cystectomy 24 hrs +FAST with clots in pelvis
  53. 53. post ovarian cystectomy 24 hrs +FAST with clots in pelvispost ovarian cystectomy 24 hrs +FAST with clots in pelvispost ovarian cystectomy 24 hrs +FAST with clots in pelvis
  54. 54. post ovarian cystectomy 24 hrs +FAST with clots in pelvispost ovarian cystectomy 24 hrs +FAST with clots in pelvispost ovarian cystectomy 24 hrs +FAST with clots in pelvis
  55. 55. post ovarian cystectomy 24 hrs +FAST with clots in pelvispost ovarian cystectomy 24 hrs +FAST with clots in pelvispost ovarian cystectomy 24 hrs +FAST with clots in pelvis
  56. 56. post ovarian cystectomy 24 hrs +FAST with clots in pelvispost ovarian cystectomy 24 hrs +FAST with clots in pelvispost ovarian cystectomy 24 hrs +FAST with clots in pelvis
  57. 57. post ovarian cystectomy 24 hrs +FAST with clots in pelvispost ovarian cystectomy 24 hrs +FAST with clots in pelvispost ovarian cystectomy 24 hrs +FAST with clots in pelvisMale 50sDyspneaHypoxic
  58. 58. post ovarian cystectomy 24 hrs +FAST with clots in pelvispost ovarian cystectomy 24 hrs +FAST with clots in pelvispost ovarian cystectomy 24 hrs +FAST with clots in pelvis
  59. 59. post ovarian cystectomy 24 hrs +FAST with clots in pelvispost ovarian cystectomy 24 hrs +FAST with clots in pelvispost ovarian cystectomy 24 hrs +FAST with clots in pelvis
  60. 60. post ovarian cystectomy 24 hrs +FAST with clots in pelvispost ovarian cystectomy 24 hrs +FAST with clots in pelvispost ovarian cystectomy 24 hrs +FAST with clots in pelvis
  61. 61. post ovarian cystectomy 24 hrs +FAST with clots in pelvispost ovarian cystectomy 24 hrs +FAST with clots in pelvispost ovarian cystectomy 24 hrs +FAST with clots in pelvis
  62. 62. PNEUMOTHORAXPUMP FAILUREPLEURAL FLUIDPERITONEAL FLUIDPERICARDIAL FLUIDMASSIVE PEOBSTRUCTIONPUMPVOLUME
  63. 63. mail@cliffreid.comhttp://resus.me/castlefest

×