Clinical Questions

Question 1

ECHO

Answer 1

1 - What is the LV function?

-Severely depressed (< 30%), mild-moderate depressed(30-55%), normal (>55%), hyperdynamic (> 70%)

2 - Is there evidence of RV strain?

• Normal RV:LV is .6:1
• Best spot to compare is at the tips of the atrio-ventricular valves in diastole
• Make sure apex is at top center of screen in apical 4 chamber view when comparing RV and LV size

3 - Is there a pericardial effusion?

• Small (< .5 cm), moderate (.5-2 cm), large (> 2 cm)
• Tamponade? RV free wall inversion during ventricular diastole, RA inversion during ventricular systole AKA during atrial diastole, dilated IVC with less respiratory variation

Question 2

E-Fast

Answer 2

1 - Is there intra-abdominal fluid?

• RUQ: between the kidney and liver
• LUQ: between spleen and diaphragm NOT between spleen and kidney (spleno-renal ligament)
• Pelvis: retrovesicular in males, anterior and posterior to uterus in females

2 - Is there pericardial effusion?

• Sub-xiphoid

3 - Is there hemothorax?

• Similar to RUQ/LUQ but up a few rib spaces with probe to head to look for fluid ABOVE diaphragm

4- Is there PTX?

• Lung sliding in fields 1 & 5

Question 3

Thoracic

Answer 3

1 - Is there PTX?
- Zones 1 & 5 looking for lung sliding

2- Is there pleural effusion?
- Zones 4 & 8 looking for spine sign, B lines, fluid above diaphragm

3- Is there consolidation?
- Hepatization of lung, subpleural consolidations, dynamic air bronchograms, fluid bronchograms, effusion or B lines

4- Is there evidence of PE?
- subpleural consolidations (circular, triangular or polygonal hypoechoic lesions that break the pleural line between .5-3cm in size)

Question 4

RUSH

Answer 4

1 - Is there pericardial effusion? tamponade? Poor LV function? RV strain?

2- Is there PTX?

3- Is there intra-abdominal fluid? RUQ/LUQ/bladder

4- Is there ruptured aorta? Measure below heart, supra-renal, infrarenal, iliac bifurcation

5 - IVC size? < 1 .5 cm with collapse (dec volume), > 2.5 cm without collapse (inc volume)

Question 5

RUQ

Answer 5

1 - Are there GB stones? (white with shadow and DEPENDENT)

2 - Is there peri-cholic fluid?

3 - Is the anterior GB wall > 3 mm? (wall closest to the probe in transverse view)

4 - Is the CBD diameter > 6 mm (from inner wall to inner wall - just the lumen)

5 - Is there a sonographic Murphy’s sign?

Question 6

Appendix

Answer 6

1- Is it a blind-ended pouch?

2 - Is the appendix dilated to > 6 mm (outer wall to outer wall)

3 - Is it non-compressible? (stays open with graded compression as psoas muscle moves to surface)

4 - Hyperemia? (inc doppler flow - RING OF FIRE is flow around periphery of the appendix in transverse view)

5 - Peri-appendiceal fluid?

Question 7

Pelvic

Answer 7

1 - Is there an IUP? Yolk sac (cheerio) + gestational sac (black)

2- Is there fetal heart activity? M mode

3 - Is there free pelvic fluid?

Question 8

Renal

Answer 8

1 - Is there hydronephrosis?

Mild- enlargement of calyces, papillae normal

Moderate - calyces become blunted or rounded, obliteration of papillae

Severe - calyces balloon and cortex thickens

2- Can you visualize stones in kidneys or bladder?