role of ultrasound in icu

2. Morbidity & Mortality
• This patient 43 Y old
• morbid obese
• no comorbidities
• with Covid pneumonia tested positive
on 5th August.
• was admitted in Field Hospital for
management and treatment and stay with
them for 18 days
• receive medication AS PROTOCOL
 MTP
CEFTRAXONE
TOCILIZUMAB
LMWH

3. Morbidity & Mortality
Evaluation in Field Hospital
o CNS: conscious but tired
o Chest :Kept on NIV BiPAP 90% 16/10
SPO2 91% RR 46/M
o CVS : BP 132/73 mmhg HR 117/M
o Temp AFEBRILE
o LABS : Hb 14 PLT 238
WBCs 31 CRP 23
LDH 6458 ferritin 1587
He was deteriorating as tachypnea
and desaturation so the plan to shift him
after acceptance from our Consultants

4. Morbidity & mortality
Pupils reactive 3 mm
Soft N/G IN SITU
P SIMV ,FIO2 100% PEEP 8 RR 25/M
SPO2 86%
Fentanyl 200 + midazolam 10
+ nimbex 10
Bp 133/75
HR 118/M
CVP RT FEMORAL
AFEBRILE , DEHYDARTED
2nd degree bed sores in sacral
region haematoma both hands
PH 7.2 PCO2 74 PO2 49
FOLYS CATH , DARK URINE
On arrival ON 22th AUG @ 14:45

5. Morbidity & Mortality
oMedication : tazocin , cleaxne ,
oPLAN WAS
STABLIZE
To insert ARTEREIAL ,
do chest X-ray ,
send labs + LMW assay
UPDATE FAMILY
NB : No proning as
unstable hemodynamically requiring
increasing doses of vasopressors

6. Morbidity & Mortality
Echo: normal Rt side size and contractility, normal LV systolic function but colapsed IVC
pulsed with steroids and more fluids No proning AS Still critical
Defer proning
ECHO to role out PE start Heparin infusion
hypotensive requiring NA infusion 0.8
Acidotic PH 6.9 PCO2 130 LACT 5.4
WBCS 37
OLIGURIC ,GFR now is 65 ,
fluid given and kept on Lasix infusion
Next day 23th patient REMAIN unstable

7. Morbidity & Mortality
• NEXT DAY 24th
SVT , HR >
180/m
• Mg So4
• 2nd ECHO--> same finding
Hypotension
BP 88/49
• NA 1 MG
• Start VASOPRESS
Hb 7.1 in
ABG
• 1st u/S abdomen
• Blood requested , hold heparin
NB:
• Abdomen was distended with
no bowel opening since admission
, no sign of bleeding or melena
• Lab
: PH 7.3 PCO2 54 PO2 52 LACT 1.9
Hb 7.1 GFR 49
• cannot start CVVHD as unstable
• U/S abdomen no abnormality
• Blood transfusion started

8. Morbidity & Mortality
• NEXT DAY 25Th
UNSTABLE
• Hb <5.5 (after 3 units) PLT 84 GFR 23 NO UOP
• MAX INOTROPES FIO2 100% THERE IS OZZING FROM CVP LINE WITH SWELLING
IN RT THIGH
U/S
• 2ND U/S :hematoma in Lt hypogastrium (mostly RETROPERITONEAL)collection
around spleen, large cystic collection Lt hypochondrium, rim fluid in hepatorenal
• All this collection was not their yesterday scan
EHCO
• 3RD ECHO : Rt ventricle dilated but preserved contractility

9. Morbidity & Mortality
• Continue DAY 25Th
SURGERY
REFERAL
CT ANGIO
UNSTABLITY
• ACTIVAVATE MASSIVE BLOOD
TRANSFUION
11 PRBCS , 6 FFP,1PLT
• UPDATE FAMILY
• INSERT NEW FVC IN LT FEMORAL AND
CVP RT IJV , STOP USING OLD CENTRAL
LINE
• Suddenly patient spo2 dropped to 55%
then reach to 17% still on fio2 100%
• At End of day bradycardia and arrest

12. •Causes blunt trauma
, farctures , stab , gun
shots …
•Mortality is high up
to 18%

13. Non traumatic
• Causes :
• complications of percutaneous
procedures like PCI , appear to
be arterial puncture above the
level of the inguinal ligament,
warfarin (Rt Femoral CVP )
• spontaneous in nature. more
common in the elderly, patients
receiving anticoagulation
therapy, and those with
underlying coagulopathy.
• Mortality is high

14. ULTRASOUND
Extended Focused Assessment with Sonography in Trauma
•It is even extended to bedside in MICU/SICU
•Perform the complete eFAST Ultrasound Exam 5 simple Steps
•Evaluate a patient with suspected intra-abdominal or intrathoracic
free fluid collection
•Evaluate a patient for suspected cardiac tamponade
•Evaluate a patient for a suspected pneumothorax
Limitations
•Does not localize the injured abdominal organ
•Views may be limited in patients with subcutaneous emphysema
•Views may be limited in patients who have a hollow-viscus injury

15. Why
ultrasound
PORTABLE EASY TO USE QUICK
ASSESSMENT
CT ROOM
BUSY
CAN USED
FOR MANY
PROCEDURE
EASY TO
CLEAN
NO SPECIAL
PREPARATION
(IV LINE ,
VENTILATION ,
INFUSION, …)

16. Patient lying supine
Ultrasound Machine
on the patient’s right side
PROBE :
cardiac probe
curvilinear probe
Remember : fluid is black

17. eFAST

20. • LONGITUDINAL • TRANSVERSE

21. PELVIS --- LONGITUDINAL
• FEMALE
• MALE

22. PELVIS ---- TRANSVERSE
• MALE • FEMLAE

23. CARDIAC VEIW
• SUBXIPHOID • PARASTERNAL LONG AXIS

24. CARDIAC VIEW----SUBXIPHOID

25. CARDIAC ---PARASTERNAL LONG AXIS

26. LUNG VIEW
• RT • LT

27. LUNG VIEW

28. Reference :

29. Reference :

30. Recommendation
Evaluation of any
patient is very
important . Also
reevaluation after
arrival to ICU .
documentation by
doctors , nurses .
Recently there is an
admission form can be
filled by Doctors.
Communication with
family and explain to
them about current
condition and
treatment plan
Work as a team doctors
and nurses will
minimize time required
for Evaluation and
registration.
Ultrasound is
recommended to
evaluate patients as a
part of invetsigtion .
Encourage doctors to
attend lectures and use
ultrasound as basic skills