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Icu echocardiography
- 1. Dr. Santosh KumarBhaskar ICU ECHOCARDIOGRAPHY
- 3. The five mostimportant things to know 1.Know your limits 2.ECHO views 3.Eyeball assessment of LV function 4.Diagnosis of pericardial and pleural effusion 5.Assessment of volume status.
- 4. Indications for ECHOCARDIOGRAPHY incritically ill patients. ESTIMATION OF VOLUME STATUS CIRCULATORY FAILURE Etiology Tamponade Left ventricle dysfunction Severe valvulopathy Pulmonary embolism Hemodynamic assessment Monitoring RESPIRATORY DISTRESS DISTINCTION BETWEEN CARDIOGENIC AND LESIONAL PULMONARY EDEMA PROBLEMS IN WEANING PATIENTS FROM THE VENTILATOR THORACIC TRAUMA CHEST PAIN CARDIAC ARREST
- 5. Preparation of thepatient Patient position Lying on the left side with the arm widely abducted. Room Quiet and dark for better visualization. Echographer Scanning hand -Use your dominant hand and always scan in the same position Holding the probe-hold the probe between your thumb and your 2nd and 3rd fingers. Rest your wrist on the patients chest to steady your position without sliding. Echocardiographic device Ideally the machine should be infront of you. Gel – to improve the contact.
- 6. The probe Echoprobe frequency range -3.5 -5 MHz. There is a notch or a dot on one side of the probe. Direction of ultrasound beam. Corresponds to the dot on screen. Movement of the probe Translation-right to left Angulation- up to down Rotation-clockwise- anticlockwise.
- 7. TTE CHAMBERS EVALUATION VALVES EVALUATION PERICARDIUM
- 8. How to getthe plax view The plax window is located next to sternum between 3rd and 5th intercostal spaces. The notch on the probe must be directed toward the sternum at 9-10 oclock .
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- 10. Criteria of qualityfor good plax view The septum must be as horizontal as possible. You should not visualize the apex of the left ventricle You should see the aortic and mitral valves but the tricuspid valve
- 11. How to improveyour image ? If you see the tricuspid valve --------- angle your probe upwards. If you see the apex of the left ventricle ---- rotate your probe a few degrees clockwise. If you lose the image -----come back closer to the sternum ,you may be sliding on the chest.
- 12. Apical 4 chamberview Probe at the apex of lt ventricle. Probe oriented towards the rt shoulder, the notch at 2-3 oclock .
- 13. Apical 4 chamberview
- 14. Criteria of qualityof the image Apex of the left ventricle should be close to the probe and the lines of crux should be vertical and horizontal,the intersection point at the middle of the image. Be careful not to shorten the apex which would appear round shaped and hyperkinetic.
- 15. Trouble shooting Cruxof the heart is tilted towards right— tranlate your probe laterally. Crux of the heart is tilted towards left --- translate your probe medially. Don’t see the mitral and tricuspid valve----- angle the probe up. Don’t see the lv apex – try to scan one or two intercostal space lower. If you see big and round shaped rt ventricle –you are too medial and too high.
- 16. Subcostal view Patientlying flat with knees bend to relax the abdominal muscles. Probe is oriented toward the patients sternum with the notch at 3 o clock .
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- 18. How to getthe subcostal 4 chamber view? Begin 3-4 cm below the xiphoid,then angle upwards till you see the 4 chambers. If not getting image because of any reason try to move your probe toward the rt flank under the liver keeping the direction of probe toward the lt. shoulder of the patient.
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- 20. Troubleshooting Important tovisulize the merging of the IVC with RA. Measurement of IVC diameter and its respiratory variation is the corner stone for the evaluation of patients volume status. Measure IVC 2-3 cm before its merging in the RA. Use M-Mode to determine the
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- 22. HEMODYNAMICS VOLUME STATUS TAMPONADE RIGHT VENTRICULAR SYSTOLIC PRESSURE CARDIAC OUTPUT
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- 24. How toassess hemodynamic response to fluid challenge? Clinical parameters like heart rate ,blood pressure and urine output are neither specific nor sensitive. More than 15% change is CARDIAC OUTPUT is considered positive fluid response. How to predict hemodynamic response to fluid challenge? Passive leg raising test. Patient on mechanical ventilation with no spontaneous breathing activity.
- 25. How to predicthemodynamic response to fluid challenge?
- 26. Severe hypovolumia Collapsed chambers CollapsedIVC LVOT obstruction
- 27. Tamponade Presence of pericardialeffussion Collapse of RV free wall Loss of IVC respiratory variation Increeased interventricular dependance
- 29. RA and RVcollapse
- 30. Loss of IVCrespiratory variation
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- 32. Respiratory change inchamber size
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