Point of Care Cardiac U/S


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Powerpoint Presentation - exported from Keynote Mac presentation. Introduction to Cardiac Point of Care U/S. Talk was meant for Emergency Medicine Residents PG1-3 level. Modest tweaks of font and spacing required prior to your own use. Associated PDF file in original Keynote format.

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Point of Care Cardiac U/S

  1. 1. Fundamentals of Point of Care Cardiac Ultrasound For Emergency Medicine Residents Frank W Meissner, MD, RDMS, RDCS FACP, FACC, FCCP, FASNC, CPHIMS, CCDS
  2. 2. POC U/S Hand Held Devices Excellent 2D imaging OK quality Color Flow Doppler U/S Newest System incorporates PW Doppler - but rare to have this capability- won’t discuss PW Doppler today
  3. 3. No REVIEW of U/S Physics Although important to understanding of U/S image production Not possible given short time given to discussion Additionally, simplified knob-ology of POC U/S results in lack of user control of imaging parameters, thus not vital to understand U/S physics in order to obtain dx images
  4. 4. When & Why Chest Pain Evaluation Dyspnea Evaluation Known LV Dysfunction Possible SBE or Cardiac Embolization
  5. 5. Potential Chest Pain Dx Chest Pain Ischemic Dz Rgnal Wall Motion prior to EKG changes or clinical symptoms Unlike current enzyme protocols can detect ischemia rather than infarct >80% lesion will result in resting regional wall motion abnmlty
  6. 6. Potential Dx Critical Aortic Valve Stenosis Aortic Dissection of Root or Arch Pulmonary Embolism CFD > mod-large TR Jet with nml sized RA McConnell Sign (hyperdynamic apex + hypokinetic/Akinetic RV Free Wall) Pericarditis (small Pericardial Effusion) R/O Pericardial Tamponade Mitral Valve Prolapse - Barlow’s Syndrome Acute cholecystitis vs GB colic Pleurisy with effusion Atrial Myxoma
  7. 7. Dyspnea Evidence of Valvular Dysfunction (AoV/MV Stenosis vs Severe AI/MR ) Evidence of Pulmonary Embolism Evidence of Systolic vs Diastolic HF Pleural Effusion, Atelectasis, Pneumonia
  8. 8. Cardiac Cycle
  9. 9. Systole AV Valves Closed
  10. 10. Diastole AV Valves Open
  11. 11. Transducer Positions & Cardiac Views Parasternal Position Long Axis Short Axis Apical Position 4-, 5-, 2-, 3- chamber Views Subcostal Position IVC & hepatic veins, RV/LV inflow view, LV-aorta, RV outflow Suprasternal Notch (not covered)
  12. 12. Transducer Positions
  13. 13. Imaging Planes
  14. 14. Imaging Windows
  15. 15. Parasternal LA View What is seen? Mid portion & base of the LV, MV leaflets, non- coronary & RV leaflets of AoV, Aortic Root, RA, RV Imaging plane aligned parallel to the Long Axis of LV With medial angulation/rotation of transducer RV/TV/RA brought into view
  16. 16. Parasternal LA View
  17. 17. Parasternal LAX View
  18. 18. Detailed Anatomy - Parasternal LAX View
  19. 19. Detailed Anatomy - PLAX RV Wall RV Interventricular Septum LV Posterior Wall MV Papillary Muscles Chordae Tendinae LA AoV Ascending Aorta
  20. 20. RV Inflow Tract View
  21. 21. Parasternal SAX (AoV Level) RVOT TV PV PA AoV RA LA Intra-atrial Septum
  22. 22. Parasternal SAX (AoV Level)
  23. 23. Parasternal SAX (MV Level) RV Free Wall IVS LV MV orifice LVPW Pericardium
  24. 24. RV Free Wall RV Cavity IVS LV Cavity Papillary Muscles Posterior LV Wall Pericardium Parasternal SAX (Papillary Level)
  25. 25. Apical 4-Chamber LV Apex RV Cavity IVS Intra-atrial Septum LV Cavity LV Lateral Wall MV TV Papillary muscles Chordae Tendinae Pulmonary Veins LA RA Pu
  26. 26. Apical 5-chamber LV Apex RV Cavity IVS Intra-atrial Septum LV Cavity LV Lateral Wall MV TV AoV LV Outflow Tract Pulmonary Veins LA RA Pu
  27. 27. Apical 2 Chamber LV Apex Anterior Wall LV Inferior Wall LV LV Cavity MV LA Pulmonary Veins
  28. 28. LV Apex AntSeptal LV InferiorLat LV LV Cavity MV LA AoV LV outflow tract RV Infundibulum Apical Long Axis or 3-Chamber View
  29. 29. Cardiac Valves
  30. 30. Septal Walls - Apical 4Chamber
  31. 31. Wall Seg - Coronary Artery Relationships
  32. 32. RUSH Protocol Probe Positions
  33. 33. Rush Protocol Probe Positions Evaluate ‘The Pump’
  34. 34. Rush’ed Exam
  35. 35. “The Pump” Severe LV Systolic Dysfunction
  36. 36. “The Pump” Large Pericardial Effusion
  37. 37. “The Pump” Hemorrhagic Tamponade
  38. 38. “The Pump” Acute RV Strain => Pulmonary Embolism
  39. 39. “The Pump” RA Thrombus => Pulmonary Embolism
  40. 40. Rush Probe Positions Evaluate ‘The Tank’
  41. 41. ‘The Tank’ Evaluate IVC with Sniff Test
  42. 42. ‘The Tank’ Eval IVC with ‘Sniff test’ m-mode
  43. 43. ‘The Tank’ Eval IVC with ‘Sniff Test’ in case of High Filling Pressures
  44. 44. ‘The Tank’‘The Tank’ Fast Exam - Fluid in Morrison’s Pouch
  45. 45. ‘The Tank’ e-FAST Eval - Pleural Effusion
  46. 46. ‘The Tank’ e-FAST eval R/O PTX
  47. 47. ‘The Tank’ e-FAST Eval Pulm Edema
  48. 48. RUSH Exam - Probe Sites ‘The Pipes’
  49. 49. ‘The Pipes’ Large Abdominal Aortic Aneurysm
  50. 50. “The Pipes’ Acute Abdominal Aortic Dissection
  51. 51. ‘The Pipes’ Acute Thoracic Arch Dissection
  52. 52. ‘The Pipes’ Acute DVT of Femoral Vein
  53. 53. Levels of Echo Competence
  54. 54. Conclusions POC U/S is a Wholistic Tool We have Discussed the Available Cardiac U/S Views We have Discussed in Detail the Rush Protocol for Shock The Key to Mastery Is To ‘Probe’ Every Patient - This Requires Discipline in a Busy ED