EDE US course

Question 1

Cardiac EDE - external landmark for cardiac US?

Answer 1

subxyphoid

Question 2

Cardiac EDE - internal landmark for cardiac US?

Answer 2

liver

Question 3

Cardiac EDE - Which ventricle (R or L) is immediately next to the liver on cardiac US?

Answer 3

right ventricle
remember that the probe is coming into contact with inferior aspect of the heart
inferior heart in near field, septum pointing up to upper right

Question 4

Cardiac EDE - Area of interest in cardiac US?

Answer 4

pericardium (not the chambers)

Question 5

Cardiac EDE - Aside from pericardial effusion, what other thing can we assess with cardiac US?

Answer 5

Contractility - ie present, absent.. cardiac standstill to help you call a code

Question 6

Cardiac EDE - What should you do in a code situation where you check cardiac contractility and you see that it is vigorous but still pulseless?

Answer 6

aggressive fluid rescus

Question 7

Cardiac EDE - What specific point within the heart do you need to see to definitely say that there is no pericardial effusion?

Answer 7

must always be able to see the pericardium all the way to the septum

Question 8

Cardiac EDE - What colour is the pericardium? What colour is the pericardial fluid?

Answer 8

pericardium is white, fluid between beating heart and pericardium is black

Question 9

Cardiac EDE - Can you tell from the US if the patient is in tamponade when you see a pericardial effusion?

Answer 9

No, tamponade is a clinical diagnosis
- hypotension.. tachycardic

Question 10

Cardiac EDE - Fat pad vs anterior fat pad? How to know?

Answer 10

Fat is anterior - “fat is flat”, ie probe is flat. If you sweep posteriorly and there is no effusion, you only see the black with your probe is flat (ie anterior) then probably just a fat pad

Question 11

Abdominal EDE - quadrant sweep happens with movement of the probe in what way?

Answer 11

probe interface stationary, rotate anterior and posterior

Question 12

Abdominal EDE - what quadrant is most important?

Answer 12

RUQ, 80% of the time free fluid will be here if present

Question 13

Abdominal EDE - Morrisons pouch is what quadrant? is this the same as hepatorenal?

Answer 13

RUQ, yes

Question 14

Abdominal EDE - first movement to find the interface of interest in the RUQ?

Answer 14

PALMS - PA.. anterior posterior plane parallel to the stretcher, want to be in the posterior axillary line (tendency to be mid-axillary)

Question 15

Abdominal EDE - what consitutes hemodynamic instability with free fluid seen on EDE?

Answer 15

tachycardia refractory to fluid bolus.. dont wait for frank hypotension, call gen surg immediately

Question 16

Abdominal EDE - fluid in the LUQ collects where?

Answer 16

subdiaphragmatic! Not splenorenal actually.
Find this on screen-left!

Question 17

Abdominal EDE - what part of the liver or spleen must you find EVERY TIME?

Answer 17

The caudal tip

Question 18

Thoracic EDE - pleural effusion external landmark?

Answer 18

Same as abdo EDE! posterior axillary line and xyphoid

Question 19

Thoracic EDE - pleural effusion internal landmark?

Answer 19

diaphragm, if you dont see it right away then slide towards head (cephalad)

Question 20

Thoracic EDE - pleural effusion area of interest?

Answer 20

medial diaphragmatic angle (ie next to the heart!) NOT the costophrenic angle
“A wedge-shaped area cephalad to the medial half of the hemidiaphragm”

Question 21

Thoracic EDE - waht sign CONFIRMS the presence of a pneumothorax?

Answer 21

lung point

Question 22

Thoracic EDE - intubated patient, no lung slide on the left… what might be going on?

Answer 22

intubation into right mainstem, pull back tube a few cms and check again

Question 23

Thoracic EDE - what s the button to press to see ?seashore sign

Answer 23

M-mode

Question 24

Thoracic EDE - for pneumothorax, what is the rule of threes?

Answer 24

check each spot for three full respirations, three different spots, and always try to confirm a ptx with lung point

Question 25

Obstetric EDE - external and internal landmarks?

Answer 25

pubic symphysis
bladder

Question 26

Obstetric EDE - transvaginal probe, what is the hand model?

Answer 26

helps you know how to sweep, thumb up, fingers extended is the plane of the us probe

Question 27

Obstetric EDE - when you see a line inside an oval… what should you think?

Answer 27

this is probably the vagina.. uterus is more circular

Question 28

Obstetric EDE - what are you looking for in this US?

Answer 28

intrauterine pregnancy, if not, and a positive bHCG then its ectopic. Look for signs of instability ie tachycardia (not hypotension because these healthy ladies compesate well then crash)