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Us lecture

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Us lecture

  1. 1. Physics, the Abdomen and Spaghetti
  2. 2. Knobology y ilit dibcre
  3. 3. Knobology Power y ilit dibcre
  4. 4. The Probes
  5. 5. Physics part one
  6. 6. Physics part two
  7. 7. Physics Attenuation-Artifactsdimunition of theamplitude/dampening of thewave=ATTENUATION - it is a loss ofsound strength =ENEMY or HERO.
  8. 8. Physics Attenuation-Artifactsdimunition of theamplitude/dampening of thewave=ATTENUATION - it is a loss ofsound strength =ENEMY or HERO.
  9. 9. Acoustic Shadowing Physics Attenuation-Artifacts
  10. 10. Acoustic Shadowing Physics Attenuation-Artifacts
  11. 11. Depth• Increasing the Depth• Decreasing the Depth• Depth Marker
  12. 12. Gain
  13. 13. Gain
  14. 14. Abdomen Probe position
  15. 15. Abdomen Probe position LIVER KIDNEY
  16. 16. RUQ
  17. 17. RUQ
  18. 18. RUQ Exam- Morison’s pouch
  19. 19. RUQ(Impedance/mirror image/refraction)
  20. 20. Gallbladder (Evaluation)CURVILINEAR
  21. 21. Gallbladder(normal longitudinal and transverse) Text TextAcoustic enhancement
  22. 22. Gallbladder(sludge vs hemobilia)
  23. 23. Gallstones
  24. 24. Gallbladder(acute cholecystitis) >4mm >5cm
  25. 25. Sonographic Murphy Sign 86%
  26. 26. Sonographic Murphy Sign
  27. 27. Gallbladder(Gangrenous/Perforated)
  28. 28. Gallbladder(acalculous cholecystitis)
  29. 29. Gallbladder (portal triad)
  30. 30. Gallbladder(Common Bile Duct)
  31. 31. Gallbladder(Common Bile Duct) >6mm
  32. 32. Gallbladder(Common Bile Duct - Pathology)
  33. 33. Spleen
  34. 34. Spleen
  35. 35. Renal US (Goal)
  36. 36. Right Kidney (Normal - Longitudinal)9-124-5
  37. 37. Right Kidney (Normal - Transverse)transverse
  38. 38. Right Kidney(Normal - Transverse Blood Supply)
  39. 39. Normal Variations
  40. 40. Acute Renal Colic
  41. 41. Dilated Ureter (Transverse view)
  42. 42. Hydronephrosis (Longitudinal - Mild)
  43. 43. Hydronephrosis(Longitudinal / Transverse - Moderate)
  44. 44. Hydronephrosis (Severe)
  45. 45. Renal Cysts
  46. 46. Multiple Renal Cysts
  47. 47. Kidney Stone
  48. 48. Dilated Ureter with Stent
  49. 49. Foley Catheter
  50. 50. PelvisLongitudinal View
  51. 51. PelvisLongitudinal - Male
  52. 52. Pelvis - Female Longitudinal - Normal
  53. 53. PelvisTransverse View
  54. 54. PelvisTransverse
  55. 55. the END...
  56. 56. EXTRA SLIDES
  57. 57. Right Middle Left
  58. 58. Shock• Cardiogenic• Hypovolemic• Obstructive• Distributive
  59. 59. Course AgendaIntroduction Abdominal ExamDr. Nitin Puri Orlando Debesa5 min 20 minPre-testDr. Nitin Puri Practice on Models10 min 30 minCardiology Exam Vascular ExamOrlando Debesa Nitin Puri20 min 10 minPractice on Models Post-test30 min 10 minPulmonary ExamNitin Puri Extra Practice ??20 min 60 minPractice on Models30 min
  60. 60. INTRODUCTION (Nitin Puri)
  61. 61. Pre-test
  62. 62. MODE KEYS(example Exam pictures)
  63. 63. CARDIOLOGY (Shock Categories)Diagnosis + Initial Care Optimize Text Jones, Critical Care 2004
  64. 64. CARDIOLOGY (Shock Categories)New Guidelines
  65. 65. CARDIOLOGY (Shock Categories) 4 C.T. S. Shah, JAMA 2005
  66. 66. CARDIOLOGY (Nomenclature and Views)60%
  67. 67. CARDIOLOGY (Nomenclature and Views)60%
  68. 68. CARDIOLOGY (View Identification)
  69. 69. CARDIOLOGY (View Identification)Parasternal Long Axis
  70. 70. CARDIOLOGY (View Identification) RVParasternal Long Axis
  71. 71. CARDIOLOGY (View Identification) RV LVParasternal Long Axis
  72. 72. CARDIOLOGY (View Identification) RV LV LAParasternal Long Axis
  73. 73. CARDIOLOGY (View Identification) RV LV Ao LAParasternal Long Axis
  74. 74. CARDIOLOGY (View Identification)
  75. 75. CARDIOLOGY (View Identification)
  76. 76. CARDIOLOGY (View Identification)
  77. 77. CARDIOLOGY (View Identification)
  78. 78. CARDIOLOGY (View Identification)
  79. 79. CARDIOLOGY (View Identification)
  80. 80. CARDIOLOGY (View Identification)
  81. 81. CARDIOLOGY (View Identification)
  82. 82. CARDIOLOGY (View Identification)
  83. 83. CARDIOLOGY (View Identification)
  84. 84. CARDIOLOGY (View Identification)
  85. 85. CARDIOLOGY (View Identification)
  86. 86. CARDIOLOGY (View Identification)
  87. 87. CARDIOLOGY (View Identification)
  88. 88. CARDIOLOGY (View Identification)
  89. 89. CARDIOLOGY (View Identification)
  90. 90. CARDIOLOGY (View Identification)
  91. 91. CARDIOLOGY (View Identification)
  92. 92. CARDIOLOGY (View Identification)
  93. 93. CARDIOLOGY (View Identification)
  94. 94. CARDIOLOGY (View Identification)
  95. 95. CARDIOLOGY (View Identification)
  96. 96. CARDIOLOGY (View Identification)
  97. 97. CARDIOLOGY (View Identification)
  98. 98. CARDIOLOGY (View Identification)
  99. 99. CARDIOLOGY (View Identification)
  100. 100. CARDIOLOGY (View Identification)
  101. 101. CARDIOLOGY (View Identification)
  102. 102. CARDIOLOGY (View Identification)
  103. 103. CARDIOLOGY (View Identification)
  104. 104. CARDIOLOGY (View Identification)
  105. 105. CARDIOLOGY (View Identification)
  106. 106. CARDIOLOGY (View Identification)
  107. 107. CARDIOLOGY(Pathology Identification)
  108. 108. RV
  109. 109. RVLV
  110. 110. RVLV LA
  111. 111. RVLV Ao LA
  112. 112. RV LV Ao LAPericardial Effusion
  113. 113. RV RV LV Ao LAPericardial Effusion
  114. 114. RV RV LV Ao LAPericardial Effusion
  115. 115. CARDIOLOGY(Pathology Identification)
  116. 116. CARDIOLOGY(Pathology Identification)
  117. 117. CARDIOLOGY(Pathology Identification)
  118. 118. CARDIOLOGY(Pathology Identification)
  119. 119. CARDIOLOGY (Pathology Identification)<2cm diameter with < 50% collapse = CVP < 10cm H2O IVC Variability IVC NO Variability
  120. 120. CARDIOLOGY(Contractility Function)
  121. 121. Cardiac(Subxiphoid view)
  122. 122. FAST Exam(Cardiac - Normal Subxiphoid view)
  123. 123. FAST Exam(Cardiac - Normal Subxiphoid view)
  124. 124. FAST Exam(Cardiac - Subxiphoid view) Large Pericardial effusion
  125. 125. FAST Exam(Cardiac - Subxiphoid view) Large Pericardial effusion
  126. 126. FAST Exam(Cardiac - Subxiphoid view) Pitfalls - Pericardial fat
  127. 127. Cardiac(Parasternal Long Axis view)
  128. 128. FAST Exam(Cardiac - Parasternal Long Axis view)
  129. 129. FAST Exam(Cardiac - Parasternal Short Axis view)
  130. 130. ContractilityParasternal long axis
  131. 131. ContractilityParasternal Short Axis
  132. 132. Right Ventricle
  133. 133. IVC
  134. 134. PULMONARY The RUSH Exam 45 (Pathology Identification)Fig. 14. M-mode: normal lung versus pneumothorax.
  135. 135. PULMONARY(Pathology Identification)
  136. 136. PULMONARY(Pathology Identification)
  137. 137. LungPleural Fluid
  138. 138. FAST Exam (Pneumothorax)• granular M-mode
  139. 139. FAST Exam(Pneumothorax)
  140. 140. FAST Exam(Pneumothorax)
  141. 141. Right 100cc Left Middle
  142. 142. Appendicitis
  143. 143. Abdomen Probe position
  144. 144. FAST Exam- Morison’s pouch
  145. 145. Morison’s pouch
  146. 146. Morison’s pouch
  147. 147. Morison’s pouch
  148. 148. Spleen
  149. 149. Pancreas
  150. 150. Pancreas(Transverse Plane)
  151. 151. Pancreas(Transverse Plane)
  152. 152. Pancreas(Transverse Plane)
  153. 153. Pancreas(Transverse Plane)
  154. 154. Pancreas(Transverse Plane)
  155. 155. Pancreas(Transverse Plane)
  156. 156. Pancreas(Longitudinal Plane)
  157. 157. Pancreas(Longitudinal Plane)
  158. 158. Pancreas(Longitudinal Plane)
  159. 159. Pancreas(Longitudinal Plane)
  160. 160. Pancreas
  161. 161. Pancreas Pathology
  162. 162. Pancreas Pathology
  163. 163. PancreasPathology???
  164. 164. Pancreas Pathology
  165. 165. PelvisLongitudinal View
  166. 166. PelvisLongitudinal - Male
  167. 167. Pelvis - Female Longitudinal - Normal
  168. 168. PelvisTransverse View
  169. 169. PelvisTransverse
  170. 170. Aorta(Transverse)
  171. 171. Proximal Aorta (Transverse)
  172. 172. Proximal Aorta (Longitudinal)
  173. 173. Mid to Distal Aorta (Transverse)
  174. 174. Lower Aorta and Bifurcation
  175. 175. AAA(Transverse)
  176. 176. AAA(Transverse)
  177. 177. Differential Diagnosis• Ruptured ectopic • Abdominal Aortic pregnancy Aneurysm• hemorrhagic corpus luteum cyst
  178. 178. Reference• http://www.criticalecho.com/content/tutorial-4-volume-status-and-preload- responsiveness-assessment• http://imaging.consult.com/imageSearch? query=pelvis&qyType=AND&global_search=Search&modality=&thes=true&no rmalVariantImage=false&groupByNode=anatomicRegion&anatomicRegion=&m odalityFilter=Ultrasound• http://www.erpocketbooks.com/er-ultrasounds/renal-bladder-ultrasounds/
  179. 179. INTRODUCTION (Knobology) MODE KEYS - 2D - M-mode - Color - Doppler
  180. 180. compressedrarified t i m e
  181. 181. cyst
  182. 182. Gallbladder(WES Sign vs Porcelain GB)
  183. 183. Reverbation
  184. 184. B mode
  185. 185. M mode
  186. 186. Doppler
  187. 187. FAST Exam(Pelvis - Long Axis view)
  188. 188. FAST Exam(Pelvis - Long Axis view)
  189. 189. FAST Exam(Pelvis - Long Axis view)
  190. 190. FAST Exam(Pelvis - Transverse Axis view)
  191. 191. References• http://www.sonoguide.com/FAST.html• http://www.sonoguide.com/renal.html• ATLS Book• GALLBLADDER: http://www.youtube.com/watch?v=nD8DrZCPFBI&NR=1• PANCREAS: http://www.auntminnie.com/index.asp? sec=ser&sub=def&pag=dis&ItemID=56966• http://taqidoc.com/blog/2010/01/04/normal-measurement-in-ultrasound/• http://www.criticalecho.com/• RUSH Exam
  192. 192. EXTRA SLIDES

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