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Focused bedside Echocardiography
- 1. How to perform a focused bedside Echocardiography ? Ahmed Elborae How to ? series
- 3. Every ER shift scenarios • 40 years old gentleman, smoker , presenting to ER with 3 hours history of severe chest pain, 1st set Troponin-I is negative • Cardiac Ischemic ? (CAD) • Cardiac Non-Ischemic (Dissection, embolism, pericarditis, etc.…..) • Non cardiac
- 4. Every ER shift scenarios • 60 year old lady, vague history of ischemic heart disease, diabetic foot, presenting to ER with shock Septic shock ! Definitely cardiogenic shock ! Cardiologist Internal medicine
- 5. Every ER shift scenarios • 35 years old lady, presenting with shortness of breath and chest pain , examination is free Pscychic?
- 6. • Patient returned to ER 2 hours later shocked !!!!
- 8. Fortunately, you don’t need this !
- 10. CW: Continuous wave Doppler= Gradient M-mode= Cut section Color Doppler= Flow Gain= contrast Acquire= save Measure=General measures Calc.=Specific measures Enter= Ok Depth= Depth : ) Be familiar with the machine ! PW: Pulsed wave Doppler= Pressure at point
- 11. Clinical implications 1-Chest pain +/- SOB D.D
- 12. Chest pain +/- SOB MI PE Dissection Pericarditis Clinical ECG,ABG,CXR Well’s criteria > CTPA/D-dimer Clinical ECG Troponin Clinical CXR CT aortography Clinical ECG Troponin Echocardiography RWMA RV&PASP Flap-AR Effusion
- 15. Chest pain +/- SOB 2-Pulmonary embolism McConnell's sign 60/60 sign RV dilatation
- 17. Chest pain +/- SOB 3-Aortic dissection Just space above, Color for AR
- 20. Chest pain +/- SOB MI PE Dissection Pericarditis Clinical ECG,ABG,CXR Well’s criteria > CTPA/D-dimer Clinical ECG Troponin Clinical CXR CT aortography Clinical ECG Troponin Echocardiography RWMA RV&PASP Flap-AR Effusion
- 22. Shock Cardiogenic Septic/Hypovolemic Obstructive Pulmonary embolism Obstructive Tamponade Clinical Sepsis markers SOFA score Clinical ECG Clinical CXR CTPA Clinical ECG Echocardiography EF%,IVC, Valves EF%,IVC RV-ePASP-PA Effusion
- 23. Cardiogenic shock 1-Assessment of LV function PLAX view Probe position Knob towards Right shoulder PLAX view M-mode EF%
- 24. Or just eye balling
- 25. Or just eye balling
- 26. Cardiogenic shock 2-Assessment of Volume status Probe position Knob points 12 O clock Subcostal view Dilated IVC, collapse < 50%
- 27. Cardiogenic shock 3-Assessment of lung congestion Congested lung Vertical (B-lines) Normal lung “Horizontal A lines” Probe position Knob points upward ( 12 O clock) ≥ 3 B-lines in + ≥ 2 sites Lung comets
- 29. Stroke volume and cardiac output calculation PLAX view A5 view
- 30. Obstructive shock Pulmonary embolism McConnell's sign 60/60 sign RV dilatation
- 32. Rate dependent not volume dependent Obstructive Shock Cardiac tamponade
- 33. Obstructive Shock Cardiac tamponade Measure at end diastole not systole
- 34. Late diastole Inspiration Early diastole Inspiration A4 view A4 view
- 35. RV diastolic collapse by m-mode PLAX
- 36. Respiratory variation > 25% PWD mitral or > 40% PWD tricuspid
- 37. Shock Cardiogenic Septic/Hypovolemic Obstructive Pulmonary embolism Obstructive Tamponade Clinical Sepsis markers SOFA score Clinical ECG Clinical CXR CTPA Clinical ECG Echocardiography EF%,IVC, Valves EF%,IVC RV-ePASP-PA Effusion
- 38. 1 1&2 2 3 4 4 3 1-LV function (Global- RWMA) 2-RV (Dilatation-PASP) 3-Pericardium 4-Aorta 5-IVC
- 39. Further reading
- 40. Further practice
- 41. Thank You