Ultrasound imaging is a routine imaging modality that is quick, cheap compared to other options, and does not require strict patient preparation or positioning. It can be used at the bedside. Some key uses of ultrasound in emergencies include detecting free fluid in blunt abdominal trauma (FAST exam), assessing cardiac activity and pericardial effusions, evaluating causes of bleeding in pregnancy, and detecting issues like acute cholecystitis. Ultrasound is also used for trauma, cardiac issues, acute abdominal pain, testicular torsion, and more.

1. Ultra sound imaging A routine imaging modality

2. Why U/S is day to day imaging modality? Quick Cheap compare to other imaging Strict patient prep. not required Patient position is flexible Bedside imaging possible Repeat/ review possible No radiation hazard

3. Ultrasound in emergency It is focused in YES or NO question eg. Is there ruptured entopic? Is there cardiac tamponade? Is there abdominal aortic aneurysm? etc. etc.

4. Indication in emergency Trauma Cardiac Bleeding in pregnancy Acute abdominal pain Torsion of testis

5. Trauma Focussed abdominal sonography for trauma……….FAST

6. What is FAST? Detection of free intra abdominal fluid in blunt abdominal trauma Quite reliable and sensitive

7. FAST IN 4 views Check fluid in_ 1. Morrison’s pouch 2.Perisplenic view 3.Pelvic view (rectovesical/ cul de sac__ less than 250ml. fluid is detectable) 4.Pericardium

8. Cardiac To detect cardiac activity if pulse less electrical activity To detect pericardial effusion if yes, Is patient in cardiac tamponade? ( thumping on right cardiac chamber)

9. Bleeding in pregnancy Whatever is the gestational period It could be_ ectopic pregnancy threatened abortion placenta praevia any other

10. Acute abdominal colic/pain Few eg._ acute cholelithiasis acute choledocholithiasis acute pancreatitis acute nephrolithiasis acute torsion of ovary ruptured aortic aneurysm

11. Torsion of testes Use of Doppler to assess vascular supply

12. U/S is not diagnostic for Intestinal obstruction Perforation Plain X-ray supine/ erect or lateral decubitus is the first line of imaging modality

13. Indications other than emergency Abdominal Cardiac Vascular Pelvic

14. Contd. Eye Neck Breast Neonatal head/ brain Any other in consultation with clinician

15. Abdominal problems Ascitis_ to know the underlying cause hepatic - chr. liver disease renal - renal failure cardiac - cardiac failure extra pulmonary tubercular malignancy

16. Contd. Jaundice_ Is it? extrahepatic or intrahepatic and then to see the cause for it

17. Mass in abdomen To assess the size, shape and texture Origin of mass Extent of mass Adjoining vessels/ viscera Associated lesion( ascitis/ pl.effusion/ PE)

18. Fever of unknown origion Sub clinical/ occult malignancy Abdominal tuberculosis HIV ( immunosuppression) related complication eg. abscess

19. Cardiac problem All cardiac lesion (except conduction defect or arrhythmia) like_ cardio-megaly on X-ray chest valvular lesion congenital defects

20. Vascular problem Any pulsatile swelling- aneurysm Arterial thrombus Deep vein thrombosis Varicosity Peripheral vessel disease( limited help)

21. Pelvic problems Gynaecological_ infertility bleeding disorder mass in pelvic cavity pelvic pain lost IUCD

22. Trans/endo vaginal scanning Pregnancy less than 6 wks. Ectopic pregnancy Post menopausal bleeding Follicular study

23. Obstetric ultrasound To ascertain pregnancy_ size/ gestational age site( IU/ ectopic) viability( cardiac activity ) number position/ lie

24. Contd. Placental localization Amniotic fluid ( normal AFI- 10) Umbilical cord Any congenital anomaly

25. Doppler U/S in Obs. To assess IUGR ( though the specificity is low ) Fetal distress Commonly umbilical, middle cerebral, uterine artery are examined for systolic/ diastolic peak to assess RI/ PI

26. Eye problem Proptosis Trauma/ foreign body Retinal detachment/ tear/ haemorrhage Vitrous haemorrhage/ collapse

27. Contd. Ocular mass Cataract Retrobulbar mass Optic nerve( gross lesion ) Whenever funduscopy is inconclusive

28. Neck problem Enlarged thyroid Submandibular swelling Cervical lymphadenopathy Carotid artery plaque/ thrombosis(doppler)

29. Breast problem Enlarged breast eg. Fibrocystic disease Mass in breast Bleeding from nipple U/S guided FNAC or cyst aspiration

30. Neonatal head/ brain Enlarged head- ? hydrocephalus Neonatal fits- hypoxia haemorrhage Congenital anomaly Birth trauma- ? subdural hematoma

31. Last but not least Any problem in consultation with clinician where ultrasound can help directly or by way of exclusion.

32. Eur.J.emergency.Med 2009 Jul4 Epub Imaging studies performed by technologist and then reviewed by radiologist with no patient contact are better quality studies. This para digm of imaging misses the point of clinicians performed U/S Clinician performed sonography in emergency has better accuracy

33. Request from clinicians Accurate clinical picture is really helpful for correct interpretation of U/S image

34. Recent advances in U/S imaging Despite developments other imaging techniques, the role of U/S continues to expand. Its unrivalled ability to show events in the body in real time with continuing technological advances will