Cardiac EDE

Question 1

What is the external landmark for the sub xiphoid cardiac US?

Answer 1

Midline just cephalad to umbilicus

Question 2

What is the internal landmark for sub xiphoid cardiac US?

Answer 2

Liver

Question 3

What are the two areas of interest for the sub xiphoid cardiac US?

Answer 3

1) Inner walls of L ventricle at the mid-ventricular level (just beyond mitral valve leaflets) to grossly assess cardiac activity
2) Entire inferior epicardium to intersection with inter ventricular septum to assess for PCE

Question 4

What is the technique used to assess for a pericardial effusion (PCE)?

Answer 4

Sweep first anteriorly then posteriorly, maintaining continuous contact with the liver, using the disappearance of the heart in both directions as an endpoint

Question 5

What are 4 troubleshooting tips for sub xiphoid cardiac US?

Answer 5

1) Ensure constant, first contact between probe and liver
2) Bent patient’s knees/flex hips
3) Slide probe to pt’s right and heel medially
4) Ask patient to take a deep breath and hold it (then push probe back to ensure good liver contact, sweep posteriorly)

Question 6

How do you differentiate an epicardial fat pad from a PCE?

Answer 6

Fat pads move with the beating of the heart, they are more stippled and echogenic

Question 7

What size of pericardial effusion is clinically insignificant?

Answer 7

Trick question- there is no size threshold.
Small PCEs can be clinically significant if they accumulate rapidly. Conversely, large PCEs that accumulate slowly may not be as clinically significant.

Question 8

When using cardiac US in cardiac arrest, you must pause for no longer than ______.

Answer 8

5 seconds

Question 9

What is required for a negative scan for PCE?

Answer 9

No PCE seen while the entire inferior pericardium, to where it intersects the inter ventricular septum, is swept ant/post until the heart disappears.
Liver must be on screen to declare a negative scan

Question 10

What is fractional shortening?

Answer 10

Decrease in distance between the LV inner walls during systole (when the MV is closed)

Question 11

How do you characterize/”eyeball” cardiac activity on sub xiphoid cardiac US?

Answer 11

Good- 30% or greater fractional shortening

Poor- Much less than 30% fractional shortening (eyeball that the LV is not squeezing well)

Absent- no movement of LV walls

Indeterminate- unable to visualize the LV inner walls at LV level