Anaesthesiology - Critical Care Medicine - POCUS Flashcards

1
Q

Define different echogenicities produced by US probe

A
  • Isoechoic
  • Hyperechoic – e.g. stones
  • Hypoechoic – e.g. lymph node
  • Anechoic – e.g. fluid
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2
Q

Define colours on colour flow doppler

A

Blue away, Red towards (BART)

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3
Q

4 positions of cardiac imaging by POCUS

A
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4
Q

Define the structures seen on PLA on cardiac POCUS

S

A
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5
Q

Define the structures seen on PSA on cardiac POCUS

A
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6
Q

Define the structures seen on apical 4 chambers view on cardiac POCUSS

A
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7
Q

Define the structures seen on subxiphoid view on cardiac POCUS

A
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8
Q

Define Cavel Index and clinical use

A

Cavel index measures respiratory variation in diameter of the inferior vena cava to predict fluid responsiveness in spontaneous breathing emergency department patients with signs of shock.

Index correlates IVC size on POCUS with CVP

Assesses volume status and guides fluid management: low caval index in a patient with signs of shock is associated with fluid unresponsiveness; high caval index is inconclusive

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9
Q

What is the normal size of the right ventricle at the apical 4 chamber view?

A

right ventricle is less than 2/3 of the size of the left ventricle

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10
Q

Where is pericardial effusion in relation to the descending aorta in the parasternal long axis?

A

Anterior to the descending aorta

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11
Q

List applications of cardiac POCUS

A

Assess cardiac function

Valvular assessment: Valve morphology (number of leaflets, movement, rheumatic heart valves, calcifications, vegetation)

Fluid status

Pericardial effusion +/- tamponade

Acute right heart strain (e.g. acute pulmonary embolism)

Aortic dissection

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12
Q

Methods to assess left heart function on POCUS

A

LeLt ventricular ejection fraction
- Assess in Parasternal long axis view
- estimate bu “eyeballing LV movement” or degree of “LV squeeze”
- Measure distance of anterior mitral valve leaflet to septum (MV slapping septum = >50% LVEF; MV not touching septum = 30-50%; MV not moving = <30% LVEF)

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13
Q

Assess severity of mitral regurgitation on POCUS

A

Observe doppler colour and size of mitral regurgitation jet:

Jet <20% of LA area = mild MR
Jet 20-40% of LA area = moderate MR
Jet >40% = severe MR

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14
Q

Identify pathology

A

Calcified aortic valve (bright area), with severely impaired valve opening

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15
Q

Identify pathology

A

Aortic regurgitation

Jet return to LA during systole

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16
Q

Identify pathology

A

Tricuspid regurgitation

17
Q

Features of Rheumatic heart disease on cardiac POCUS

A
  • Mixture of valvular dysfunction
  • Atrial fibrillation
  • Systolic doming on anterior mitral valve leaflet with “Hockey stick” appearance
  • LA dilation
18
Q

Identify pathology

A

Mitral valve calcification

19
Q

Identify pathology

A

Endocarditis with vegetation on MV

20
Q

Define position of pericardial effusion and pleural effusion to the descending aorta

A

Pericardial effusion: Anterior to descending aorta

Pleural effusion:
Posterior to descending aorta

21
Q

Cardiac tamponade
Features on cardiac POCUS

A

Early: Systolic collapse of RA

Late: Diastolic collapse of RV

22
Q

Identify pathology

A

Massive pericardial effusion

23
Q

Features of pulmomary embolism on cardiac POCUS

A

Acute right heart strain:
RV dilatation
Interventricular septum bowing during systole into LV - D-shape LV

24
Q

Aortic dissection

Features on cardiac POCUS

A

Dilated aortic root
Dissection flap visible
Aortic regurgitation

25
Q
A
26
Q

Lung POCUS
- Standard views
- Positions

A

R1/L1: Anterior Superior lung field for pneumothroax and/or interstitial edema
- Straight linear probe
- At 2nd and 3rd ICS at MCL at left and right side
- Find Batwing Sign (confirm between two ribs) and Lung Sliding (visceral and parietal pleura sliding over) and A-lines (equdistant artifacts under pleural line)

R2/L2: Lateral lung view
- Midaxillary line at 6th-7th ICS, lateral to nipple

R3/L3: Posterolateral/ Posterior- Inferior lung view
- Posterior axillary line, 10th-12th ICS
- Indicator towards patient’s head
- Find Liver (R) or spleen (L), kidney, diaphragm, spine
- FInd curtain sign (aerated lung slide over organs during inspiration)

27
Q

Absent lung sliding on lung POCUS

Specific signs
Ddx

A

There is no lung sliding present when the parietal and visceral pleura become separated by air (pneumothorax) or fluid (pleural effusion).

Furthermore, severe COPD or anything that hyperinflates the lungs can markedly reduce pleural sliding.

Ddx:
- Pneumothroax
- Pleural effusion
- Pleurodesis
- Acute infectious/ inflammatory consolidation
- Fibrotic lung diseases
- ARDS
- Mainstem intubation

Absence of lung sliding can be seen using B-mode or using M-mode (stratosphere sign and barcode sign).

28
Q

Interstital edema

Features on Lung POCUS

A

B-lines form when interlobular septa and lung tissue thicken or fill with fluid.

  • Appear ray-like, hyperechoic, and vertical (c.f. A lines that are horizontal)
  • Emanate from the pleural line.
  • Move with lung sliding.
  • Extend to the periphery of the far-field.
  • Can be associated with a thickened pleural membrane.

Fluid build-up causes convergence of B-lines into “Confluent B-lines.”

29
Q

Lung consolidation

Features on POCUS

A

Consolidation is fluid build-up in lungs

ultrasound findings will progress from multiple B-lines, confluent B-lines, subpleural consolidation, the shred sign, to a dense consolidation, and then “hepatization of the lung”

Air-trapped inside consolidations cause:
- Dynamic Air Bronchograms tend to occur in pneumonia and move as the patient inhales and exhales.
- Static Air Bronchograms tend to occur when air bubbles are trapped behind an obstruction, as occurs in atelectasis, and don’t move with respiration.

30
Q

Pleural effusion

Features on POCUS

A

Signs: The PLAPS point is the most specific and sensitive view used to diagnose pleural effusion.

  • Spine Sign: sound waves can pass through the pleural fluid allowing the spine to be seen above the diaphragm.
  • Jellyfish sign: consolidated lung is seen floating in the pleural effusion
  • Sinusoid Sign: parietal and visceral pleura moving closer and further apart while the patient breathes
  • Quad Sign: anechoic appearance often delineated by the pleural line, the rib shadows, and the lung line
  • Plankton Sign: shows an exudative effusion with swirling, hyperechoic debris.
  • Hematocrit Sign: echogenic layering of material in a pleural effusion
  • Loculated Pleural Effusions
31
Q
A
32
Q

COPD or Asthma

Features on POCUS

A

normal findings such as lung sliding and A-lines but the patient still has symptoms and difficulty breathing, you should consider COPD, asthma, pulmonary embolism, or nonpulmonary conditions causing the patient’s dyspnea.

– Bilateral A-lines
– Reduced lung sliding

33
Q

Pulmonary embolism

Features on POCUS

A

– Bilateral A-Lines
– Deep Vein Thrombosis in Upper or Lower Extremities
– Right Ventricular Enlargement (massive/submassive PE)

34
Q

Outline diagnosis of pneumothroax by POCUS

A

First, if lung sliding is present, you can rule out pneumothorax with 100% accuracy at that ultrasound point

Second, if lung sliding is ABSENT, you should not automatically assume pneumothorax. Think ddx: severe consolidation, chemical pleurodesis, acute infectious or inflammatory states, fibrotic lung diseases, acute respiratory distress syndrome, or mainstem intubation.

Third, if a lung point is present, you can rule in pneumothorax with 100% accuracy. Lung point is when you can see the transition between normal lung sliding and the absence of lung sliding. This is the transition point between the collapsed lung and normal lung.