Bedside US

Question 1

Primary EMBU applications:

Answer 1

1. Cardiac / IVC / shock
2. FAST and pneumothorax
3. Aorta
4. Gallbladder and biliary
5. First trimester pregnancy and female pelvis
6. Evaluation for ureterolithiasis and acute renal failure
7. Procedural guidance
8. Evaluation for DVT

Question 2

EMBU is ideal for evaluating disease processes which are…

Answer 2

• Unstable – Rapidly progressive

Question 3

EMBU is ideal for guiding interventions which are…

Answer 3

Rapid Potentially dangerous

Question 4

Sensitivity and Specificity of FAST:

Answer 4

Generally relatively high: Sensitivity about 85 Specificity about 97

Question 5

FAST shortcomings compared to CT:

Answer 5

Misses retroperitoneal and pelvic injury

Question 6

FAST shortcomings compared to DPL

Answer 6

Misses hollow viscus injury

Question 7

Speed of DPL vs FAST

Answer 7

DPL is slower

Question 8

Dependent areas of abdominal cavity:

Answer 8

Perisplenic Hepatorenal Sub-diaphragmatic

Question 9

4 regions and 10 potential spaces for fluid:

Answer 9

Subxiphoid - Pericardial RUQ - Pleural, subphrenic, hepatorenal, infrarenal LUQ - Pleural, subphrenic, splenorenal, infrarenal Suprapubic - Pouch of Douglas (F) or Retrovesicular

Question 10

Other name for hepatorenal space:

Answer 10

Morison’s

Question 11

Where is this.

Label it/

Answer 11

RUQ

Question 12

Describe the mirror artifact and clinical utility

Answer 12

The presence of air in the normal lung gives the appearance of “liver above the diaphragm”

Hemothorax causes LOSS of mirror artifact

Question 13

View needed for showing all 4 chambers of heart:

Answer 13

Transverse plane shows all 4 chambers

(Pointer to “9 o’clock”)

Question 14

What happened to this driver in an MVA?

Answer 14

Pericardial effusion

Question 15

General rule regarding “pointy findings” on US:

Answer 15

Some pathological process (fluid accumulation)

Question 16

What’s happening?

Answer 16

Hemothorax

Question 17

Placement of probe for visualization of rectovesical space / Pouch of Douglas:

Answer 17

Probe immediately cephalad to pubic symphysis

Angle probe caudad

Superior to seminal vesicles (male)

Level of cervix (female)

• (inferior to peritoneal reflection)

Question 18

What’s this an image of?

Label the different structures (there are 4 of them between the 2 images)

Answer 18

This is the female pelvic region

Question 19

US vs CXR in detecting PTX:

Answer 19

US was much more sensitive and pretty much just as specific

Question 20

Signs of normal lung and pleura in US eval of PTX

Answer 20

Pleural sliding

Pleural based comet tail artifacr

Question 21

Signs of abnormal lung or pleura for US eval of PTX:

Answer 21

Absence of pleural sliding

Leading esge sign

Question 22

How much of chest to scan for PTX:

Answer 22

Mid-clavicular line each side

Clavicle to diaphragm

Examine each rib space

Question 23

Most widely used probes for FAST and why

Answer 23

Convex,microconvex, Most widely described

– Easy transition from FAST

– “Pie-slice” exaggerates pleural sliding

– Good for intercostal windows

– Ribs and shadows clear

Question 24

Problem: Handmotion appears like lung sliding

• Solution?

Answer 24

Anchor probe to the chest wall with fingertips

Question 25

Issues with heart and diaphragm with PTX assessment

Answer 25

Cardiac motion and diaphragms

– may be confused with pleural sliding (!false negative)

– may be confused with leading edge (!false positive)

Question 26

Causes of false negatives in PTX?

Solutions?

Answer 26

• Small / localized PTX
  
  • Solution: Systematic, methodical scanning on mid-clavicular line … wider area if pleural scarring suspected
• Bilateral PTX
  
  • Clinician reassured by “symmetric” absence of pleural sliding
  • In 12/13 bilat PTX’s, 1 or both sides were missed
  • Solution: Consider bilateral PTX

Question 27

Some causes of false positives in PTX-US:

Answer 27

Pleural scarring, adhesion, COPD, blebs, pulmonary contusion - consider the patient’s clinical appearance

Poor respiratory effort - urge patient to take deep breaths