Cardiac POCUS

Question 1

cardiac POCUS: 3 key right parasternal echo views are

Answer 1

two right parasternal short axis views: mushroom (shows RV and LV), Mercedes and whale (shows aorta, left atrium) = one right parasternal long axis view: 4 chamber view. note you also need to take a subxiphoid view

Question 2

cardiac POCUS subjective LA:AO assessment: if LA : Ao ratio is greater than 2:1, or you could fit 4 aortas into LA, you should think…

Answer 2

LA is enlarged

Question 3

cardiac POCUS: 2 causes of LA enlargement are

Answer 3

CHF or iatrogenic fluid overload

Question 4

cardiac POCUS: a cat presents in dyspnea and has a very enlarged LA:Ao ratio. the drug you would give is (the one from lecture)

Answer 4

furosemide

Question 5

cardiac POCUS: what are the two key Y/N questions to answer for CARDIAC POCUS?

Answer 5

is there pericardial effusion? is there an enlarged LA?

Question 6

what are the three key questions to answer for ABDOMINAL POCUS?

Answer 6

is there free fluid? what is bladder volume? BG halo sign?

Question 7

what are 2 key questions to answer with lung/pleural space POCUS?

Answer 7

normal or abnormal lung surface? pleural effusion y/n?

Question 8

what is FAST? what is it developed for?

Answer 8

focused assessment with sonography for trauma, developed to detect pathology in trauma patients. (abdominal: 4 spaces to evaluate for free abdominal fluid. thoracic: 2 spaces to evaluate for pleural effusion and pericardial effusion).

Question 9

when performing the abdominal FAST, what key pathology are you looking for?

Answer 9

free abdominal fluid

Question 10

when performing the THORACIC FAST, what key pathology are you looking for?

Answer 10

pleural effusion and pericardial effusion

Question 11

there is a significant difference in the prevalence of free fluid in dogs and cats, t/f?

Answer 11

false, there is no significant difference

Question 12

stable patients (based on triage) have ___% chance of free fluid (of any cavity with POCUS)

Answer 12

<10%

Question 13

UNstable patients (based on triage) have ___% chance of free fluid (of any cavity with POCUS)

Answer 13

> /= 75%

Question 14

do we still use FAST? if not, what term do we use instead?

Answer 14

no. POCUS

Question 15

tell me the definition of POCUS

Answer 15

acquisition, interpretation, and immediate clinical integration of sonographic imaging performed pt-side by clinical to answer focused questions (rather than all strx of an organ by specialist)

Question 16

give the 5 questions to answer for 5-point APOCUS (abdominal POCUS)

Answer 16

free abdominal fluid (at the 5 sites) y/n, urine production y/n, gallbladder Wall edema y/n, pericardial effusion y/n, pleural effusion y/n

Question 17

what patient position to avoid in unstable pt

Answer 17

dorsal

Question 18

5 T’s of POCUS are

Answer 18

trauma, triage, treatment, tracking, total

Question 19

abdominal POCUS: where do we look for free fluid? ie. where do we put the probe

Answer 19

subxiphoid (in the palpable V at midline, target organs are liver, gallbladder, and diaphragm),
left paralumbar (tail of spleen, left kidney, and intestines),
urinary bladder (bladder and colon),
right paralumbar (liver, right kidney, intestines),
umbilical 5th view

Question 20

give the number of sites you use the probe at for an abdominal POCUS, a cardiac POCUS, and a lung/pleural space POCUS

Answer 20

abdominal: 5
cardiac: 3 right parasternal + subxiphoid
lung/pleural:

Question 21

what are 3 things to note about free fluid

Answer 21

fluid can be anywhere, fluid moves with position of patient, fluid movement can be impeded/trapped

Question 22

what is the general shape of free fluid on an ultrasound? (hint: how does it look different from fluid in an organ or vessel?)

Answer 22

free fluid will be hypoechoic SHARP ANGLES, crescents, triangles. fluid in an organ or vessel is rounded and contained nicely

Question 23

should you be able to discern individual liver lobes from U/S?

Answer 23

no! this means there is free fluid in abdomen

Question 24

when should you perform a SERIAL abdominal POCUS? state the 3 cases you would repeat if there is free fluid

Answer 24

if unstable and cause (of free fluid) is unknown, if pt changes from stable to unstable and cause is unknown, following therapy if cause is unknown

Question 25

you do an abdominal POCUS and there is no free fluid. does a negative POCUS rule out injury?

Answer 25

no. it doesn’t assess all sites of abdomen, all organs, or all possible ddxs)

Question 26

APOCUS: tell me how to estimate bladder volume.

Answer 26

W x L x (DL+DT)/2 x 0.52

Question 27

APOCUS: give at least 3 causes of gallbladder wall thickening

Answer 27

anaphylaxis, sepsis, RSHF, pericardial effusion, hypoalbuminemia, renal insufficiency, cirrhosis, IMHA, cholecystitis, pancreatitis

Question 28

PLUS: what are A-lines? are they normal?

Answer 28

A-lines are reverberation artifacts at air and soft tissue interfaces. they are seen below the pleural line. they are normal. (think A for air)

Question 29

PLUS: how do you find the pleural line?
what should it look like normally?

Answer 29

find the bat sign, then between the top of the wings there is a (normally) horizontally shimmering line which is the pleural line. (the shimmering is the glide sign. lung sliding will only occur if the pleura are in contact and the patient is breathing)

Question 30

PLUS: what is the glide sign? what does it indicate?

Answer 30

indicates lung sliding (at the pleural line): patient is breathing and the parietal and visceral pleural are in contact. it is normal.

Question 31

PLUS: what are B lines? are they normal?

Answer 31

occur when there is less air at lung surface. appear as hyperechoic extending downwards.
0-3 is normal. more is abnormal.
if extending downward from the pleural line, indicate there is not pneumothorax at that probe location.

Question 32

PLUS: what is the curtain sign? is it normal?

Answer 32

transition between thorax and abdomen. normal.
curtain sign is seen in healthy and aerated lungs. An aerated lung is like a “curtain” because as it fills with air, it looks like a curtain sweeping down and over the other organs, momentarily obscuring them from view.

Question 33

PLUS: 4 key pathologies

Answer 33

pleural effusion or pneumothorax in the pleural space.
increased B lines or consolidations in the lung.

Question 34

PLUS: what do >3 B-lines in a single window indicate

Answer 34

abnormal finding.
decreased peripherally aerated lung; indicates alveolar interstitial syndrome
in the lung, there is either decreased air (atelectasis), increased cell numbers or tissue (eg. neoplasia), or increased extravascular lung water (e.g CHF, aspiration pneumonia)

Question 35

PLUS: what do excess