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3. Cat & Dog > ECC VPOCUS > Flashcards

ECC VPOCUS Flashcards

1
Q

Veterinary Point-of-Care Ultrasound (VPOCUS)
- what is it? what do we use it for?

A

Extension of physical examination, modern visual stethoscope

  • Initial screening test: answer specific (Y/N) clinical questions
    > direct stabilization & resuscitation efforts
    > guide diagnostic plans & clinical course
    > monitor progression or resolution
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2
Q

Veterinary Point-of-Care Ultrasound (VPOCUS) does not replace what?

A

DO NOT replace clinical assessment, thoracic auscultation, formal diagnostic imaging (x-rays, ultrasound, CT, echocardiography)

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3
Q

Advantages of VPOCUS

A
  • Non-invasive, safe
  • Bedside, portable, widely available
  • Minimal restraint (unstable patients)
  • Rapid, early detection
  • expedites timely diagnosis of many conditions
  • Inexpensive, serial examinations
  • Radiation sparing
  • Achievable proficiency, easily-mastered skills
  • No clipping, alcohol sufficient
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4
Q

avoid what position for VPOCUS

A

dorsal recumbency

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5
Q

what dictates stabilization & order of POCUS

A

Triage Exam

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6
Q

what colour are fluids, soft tissue, air, bone, stones, on US?

A

anechoic / black = some fluid

hypoechoic / isoechoic / shades of grey
= soft tissue, some fluid

hyperechoic / whites = air, bone, stones, fibrous tissue
()
Air looks like striped lines
fluid looks black
soft tissue is grey
fibrous tissue is white
stones/bones are white with defined border

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7
Q

properties of linear array probe
- frequency, depth, resolution

A
  • higher frequency
  • less penetration (↓ depth)
  • better resolution (details)
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8
Q

properties of curvilinear array probe
- frequency, depth, resolution

A

Curvilinear (microconvex) array
- lower frequency
- greater penetration (↑ depth)
- poorer resolution (details)

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9
Q

how do we keep out bearings with US?

A

reference mark on probe,
- should point to head if longitudinal
- points to patient’s right if transverse

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10
Q

what is FAST and what is it used for?

A
  • Focused Assessment with Sonography for Trauma, Triage, Tracking
  • 2004 veterinary: free fluid (trauma) > intraabdominal, intrathoracic lesions (beyond trauma) > trending (monitoring)
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11
Q

what is included in global FAST

A
  • Abdominal FAST® +/- specific target organs
  • Thoracic FAST®
  • Vet BLUE®
  • Focused ECHO
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12
Q

Abdominal FAST® or POCUS - what is included?

A
  • Original AFAST: 4 sites
    > Diaphragmaticohepatic (DH) - Subxiphoid
    > Splenorenal (SR)
    > Cystocolic (CC)
    > Hepatorenal (HR)
  • 5-point standardized AFAST: 5 sites
    > NEW: 5th umbilical view
  • Free fluid: Y/N
  • Specific target organs of interest
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13
Q

Abdominal fluid scores (AFS)
- what do they mean?

A
  • # of FAST positive sites: 0-4> if ≤ 5mm (cat) or ≤ 1cm (dog): give score of 0.5
    positive sites: origin of injury?
  • Degree of hemorrhage, need for blood transfusions
    > AFS 3-4: big bleeder
    > AFS 1-2: small bleeder
  • Serial exams q 4-6 hours: monitor ongoing/resolution
    > n=27, 17% became positive on serial AFAST®
    > time, fluid resuscitation
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14
Q

Thoracic FAST® & Evolution of TFAST®
- what is our scanning positions? what views do we take? what are we assessing?

A
  • Scanning position: standing or sternal*
  • Original TFAST: 4 views
    > Chest tube sites (CTS) 7th to 9th ICS
    > Pericardial sites (PCS)
  • 5-point standardized TFAST: 5 views
    > DH site: window into pleural & pericardial spaces
    > Dogs: heart rests on diaphragm
  • Free fluid: Y/N
  • Pneumothorax: Y/N
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15
Q

Vet BLUE® or PLUS - what are they? what are they for?

A
  • Veterinary Bedside Lung Ultrasound Examination
    > more extensive regionally-based lung scan
    > wet lung (B-lines) vs. dry lung (glide sign and A-lines)
  • Pleural space & Lung UltraSound
  • Screening evaluation: respiratory distressed / respiratory-compromised
  • Pattern-based approach, categorize into probable causes:
    > upper airway vs. lower airway
    > heart failure vs. lung disease vs. respiratory look-a-likes
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16
Q

Vet BLUE® Protocol

A
  • 8 sites:
  • Caudodorsal lung lobe region (CdLL)
  • Perihilar lung lobe region (PhLL)
  • Middle lung lobe region (MdLL)
  • Cranial lung lobe region (CrLL)
17
Q

Lung Surface Artifacts
- normal? abnormal?

A

Normal:
Gator/bat sign
P-P line
A-lines
Z-lines
Glide sign
Seashore sign
Curtain sign
()
Abnormal:
Barcode sign
Lung point
B-lines
Shred sign
Tissue sign
Nodule sign
Free fluid (quad sign)

18
Q

Gator/Bat Sign
- what is it?

A
  • Normal: intercostal orientation
19
Q

P-P (Pulmonary-Pleural) Line
- what is it?

A
  • Hyperechoic linear continuity between ribs
  • Normal: parietal & visceral pleura
20
Q

A-Lines
- what are they?

A
  • Equidistant hyperechoic parallel lines distal to P-P line
  • Normal: air reverberation artifacts
21
Q

Glide Sign
- what is it? good or bad? how to enhance?

A
  • Normal: Glide is Good
  • Real-time shimmering appearance at P-P line
  • Parietal (thoracic wall) & visceral (lung) pleura apposition
  • To-and-fro sliding motion at different speed & direction
  • Absent = pneumothorax
    ()
    3 tricks to enhance:
    1. reduce gain (brightness)
    2. tilt probe to scan at an angle
    3. slide probe over a rib
22
Q

Seashore vs. Barcode Sign
- what does it mean?

A

pneumothorax

23
Q

B-Lines (a.k.a. Lung Rockets, Comet Tails)
- what are they? what do they mean?

A
  • Laser-like hyperechoic lines extending from P-P line to the far field
  • Obliterates A-lines, oscillate (bold arrows) with respiration
    ()
  • Wet lung, alveolar-interstitial syndrome = non-specific, ↓ aeration in lungs
  • Patient signalment, history, PE findings, regional lesion distribution pattern:
  • Cardiogenic pulmonary edema
  • Non-cardiogenic pulmonary edema
  • Pulmonary contusions / hemorrhage
  • Pneumonia - Atelectasis
  • Fibrosis, etc.
    ()
  • Rule out pneumothorax
24
Q

The Vet BLUE® B-Line Scoring System

A
  • Normal = infrequent 1-3 B-lines at single site
  • ↑↑B-lines∝↑↑severity
    ()
  • Sentinels:
  • wet lung (interstitial syndrome)
  • alveolar flooding (alveolar syndrome) - lung consolidation (shred, tissue signs)
25
Q

Shred Sign
- what does this mean?

A
  • Lung consolidation with aeration
  • Sig. deviation from normal linear continuity of hyperechoic P-P line
  • Hypoechoic, echo-poor tissue with rough-jagged margins (shredded)
26
Q

Tissue Sign
- what does this mean?

A
  • Lung consolidation with no aeration
  • Ultrasonographic appearance of lung similar to tissue
  • Tissue (lung) hepatization = looks like liver
27
Q

Nodule Sign
- what does this look like?

A
  • Focal, well-marginated, circumscribe hypoechoic structure(s)
  • Surrounded distally by air-filled lung
28
Q

Free Fluid (Quad Sign)
- what does it look like?

A

Ranges in echogenicity
- anechoic (black) > moderate echogenicity (shades of grey)
- degree of viscosity & cellularity

29
Q

Limitations of Vet BLUE® or PLUS

A
  • US cannot adequately image through aerated lung (air)
  • Lung surface pathologies: 3 mm
    > detect lesions extended to lung periphery
    > unable to detect centrally (deeper) located pulmonary lesions
  • DO NOT replace formal diagnostic imaging (x-rays, CT scan)
    ()
  • Non-specific, pattern-based approach
    > cannot definitively diagnose lung conditions
    > similar to interpretation of thoracic x-rays findings
30
Q

Focused ECHO
- what is the purpose? not a replacement for what?

A
  • Investigate causes of clinical signs > immediate treatment decisions
    > pericardial effusion
    > volume status (hypovolemia), cardiac contractility (systolic dysfunction, DCM)
    > LA enlargement (L-CHF, volume overload), R-sided enlargement (PH)
    > cardiac mass(es), thrombus, thickened valves (endocarditis)
    ()
  • Particularly useful in cats: respiratory distress
    > +/- murmur, gallop, non-specific radiographic findings
    > differentiate heart failure from other causes
    ()
  • DO NOT replace formal echocardiography
31
Q

Focused ECHO scanning position? views?

A
  • Scanning position: standing or sternal*
    ()
  • R parasternal long-axis view:
    > Four-chamber view
    ()
  • R parasternal short-axis view:
    > LV papillary muscle (mushroom) view
    > Mitral valve (fish-mouth) view
    > LA:Ao (Mercedes-Benz) view
32
Q

Focused ECHO
- Tips & tricks:

A
  1. rolled towel under cranial thorax
    - optimize probe maneuverability, better heart base visualization
  2. point of maximal intensity (PMI)
  3. reference mark towards shoulder/elbow
  4. find short-axis (mushroom) view 1st

3. Cat & Dog (33 decks)

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