Ultrasound by ICU Nurse
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The document discusses using ultrasound in the ICU to assess a 44-year-old patient who presented with a motor vehicle crash. It recommends performing a focused assessment with sonography in trauma (FAST) exam to check for internal bleeding and describes how ultrasound can detect as little as 250cc of total fluid or 100cc in a specific area of the abdomen. The document also discusses using ultrasound to check for signs of increased intracranial pressure like enlarged optic nerve sheath diameter and abnormal pupillary size and reactivity. Overall it promotes ultrasound as a valuable tool in the ICU for rapidly evaluating trauma patients.
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Ultrasound by ICU Nurse
- 1. Ultrasound by ICU Nurse Sanjeev Bhoi MD FACEE Additional Professor Department of Emergency Medicine AIIMS Trauma Centre
- 2. 0730hrs ICU 44 yrs old presents to the ICU with Motor Vehicle crash . Arrival Vital Signs BP: 80/64mmHg, HR- 130, RR-24, Confused, cold and clammy How will you manage the patient??
- 3. Initial Assessment and Management • Triage-Red • Primary Survey • FAST • Secondary Survey Treat first that kills first
- 4. Why US in EMED? TIME CRITICAL In a disease in which there is a golden hour, every minute counts! AUTLS
- 5. Point of Care Ultrasound • Goal Directed • Highly focused • Limited Examination • Binary questions • Binary answers
- 6. Who should be doing in acute care? Journal of Emergencies trauma and Shock ,January 2013
- 7. who should be doing in ED? Non-radiologist vs Radiologist
- 14. THE RUSH EXAM Leaking tank Internal blood loss – Haemothorax / Hemo-peritoneum (Hypo-volumic shock) in trauma by FAST exam (Focused Assessment with Sonography in Trauma) (ED sensitivity - 92% & specificity - 100% for hemothorax) How much fluid can FAST detect? • 250 cc total • 100 cc in Morison’s pouch
- 16. DISABILITY AUTLS
- 17. • ASSESS PUPIL AND PUPILLARY REFLEX
- 18. Seeing through Closed Eye
- 19. Pupillary size
- 20. ICP RAISED ?
- 23. Optic Nerve Sheath Diameter AUTLS
- 24. OUT OF PLANE
- 26. IN PLANE
- 28. ACUTE CARE SONOGRAPHY FOR NURSES Brachial pl. Block in ED Sea-Shore sign
- 29. “Unlearn and keep Learning”
Editor's Notes
- Continue this clinical scenario when you are describing the ABCDE by usg .give this clinical scenario in each block and use the word Visual stethoscope
- The probe is oriented transversely to the vessel, and the vessel appears as a circular anechoic structure. n Needle appears as a hyper echoic “dot” on the ultrasound screen.• Tip of the needle is harder to localize
- In plane A vein appears as a tubular anechoic structure. The needle is inserted parallel to the probe directly under the center and therefore lies completely within the plane of imaging Provides a better needle slope positioning and can monitor the needle throughout the procedure• Tip of the needle is easier to localize