Critical Care Ultrasound

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Critical Care Ultrasound

  1. 1. Critical Care Ultrasound<br />Edward M. Omron MD, MPH, FCCP<br />Critical Care Service<br />Alta Bates Summit<br />
  2. 2. Nomenclature for Transducer Locations<br />
  3. 3. Normal four chamber subxiphoid view<br />
  4. 4. Parasternal Short Axis and Subcostal View in Severe Right Ventricular Failure<br />
  5. 5. Subxiphoid View:<br />Pulmonary Embolism with dilated<br />Right ventricle<br />After TPA administraton <br />
  6. 6. Subcostal View: Massive Pulmonary Embolism<br />
  7. 7. Pericardial Tamponade with Right Atrial Collapse<br />
  8. 8. Subcostal View of Large Ventriculoseptal Defect and Left to Right Shunt<br />
  9. 9. IVC Caliper Measurement as an <br />Index of preload responsiveness<br />Only valid in sedated, mechanically <br />ventilated patients<br />Mechanical ventilation:<br /> Inspiratory caliper increases<br /> secondary to positive thoracic <br /> pressure<br /> Expiratory caliper is constant<br />IVC caliper increases in right heart <br />failure, hypervolemia, or could be <br />normal <br />IVC caliper decreases in hypovolemia <br />Preload responsiveness:<br />IVC Caliber change with respiration<br />
  10. 10. IVC Collapse in Hypovolemia<br />End Expiratory Collapse<br />Notice Left Renal Vein<br />
  11. 11. Measurement Technique<br />Valid only in mechanically ventilated Patients<br />The patient remains supine<br />IVC is sought in the longitudinal axis<br />Look for the left renal vein and measure distal to it<br />End expiratory measurement is needed<br />A caliper less than 10 mm was correlated with a central venous pressure of less than 7 mm Hg<br />Sensitivity 84%, Specificity 95%, PPV 89%, NPV 92%<br />
  12. 12. Caliper of IVC when Central Venous Pressure is altered<br />

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