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DMS 241: Advanced Abdominal Sonography > Emergent Ultrasound Procedures > Flashcards

Emergent Ultrasound Procedures Flashcards

1
Q

What problems are the reasons people frequently visit the ER?

A
  • gastrointestinal
  • genitourinary
  • respiratory
  • nervous
  • cardiac systems
  • ortho conditions
  • lacerations
  • fractures
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2
Q

What is a “FAST” scan?

A
  • focused assessment with sonography for trauma
  • has become an extension of the physical examination of the trauma patient
  • limited exam of abdomen or pelvis to evaluate free fluid or pericardial fluid
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3
Q

What does a FAST scan evaluate for?

A

-the abdomen or pelvis for free fluid or pericardial fluid

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4
Q

How is the FAST exam a decision-making tool?

A

-in the context of traumatic injury, the timely diagnosis of life-threatening hemorrhage found during this exam helps determine the transfer to the operating room, CT scanner, or angiography

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5
Q

What spaces are assessed in a FAST exam?

A
  • perihepatic/hepatorenal space
  • perisplenic
  • pelvis–cul-de-sac
  • pericardium
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6
Q

Where does fluid collect?

A

in the most dependable areas of the abdomen and pelvis

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7
Q

How long does the FAST exam usually take?

A

-about 5 min

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8
Q

What is performed simultaneously with the FAST exam?

A

-physical assessment, resuscitation, and stabilization of trauma patient

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9
Q

What is the goal of the FAST exam?

A

-scan four quadrants, pericardial sac, and cul-de-sac for presence of free fluid or hemoperitoneum

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10
Q

What does free fluid usually represent in the trauma setting? What else could it be?

A
  • usually represents hemoperitoneum

- may also represent bowel, urine, bile, or ascitic fluid

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11
Q

How does the fluid look sonographically?

A

-hypoechoic or hyperechoic, with scattered internal echoes representing the blood, and conforms to the anatomic site it occupies

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12
Q

What is the most common site of fluid accumulation regardless of the site of the injury?

A

-subhepatic space (*Morison’s pouch)

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13
Q

What is the next most common space for fluid accumulation?

A

pelvis-pouch of Douglas

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14
Q

*What is one of the most common reasons for emergent surgery?

A

-*acute appendicitis

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15
Q

What is the best way to scan the appendix?

A
  • linear sequential array (unless pt is obese than convex) due to superficiality
  • over right iliac/inguinal region
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16
Q

What is the FAST scan protocol?

A
  • fill urinary bladder
  • scan subxiphoid to look for pericardial effusion
  • evaluate the RUQ, liver texture for abnormalities, epigastrium, LUQ, RLQ, LLQ
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17
Q

How is the pericardium surveyed in a FAST scan?

A

-a subcostal approach with the transducer angled in a cephalic direction toward the 4-chamber view of the heart to image the pericardial sac for pericardial effusion

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18
Q

What can extreme shortness of breath be a sign of?

A

pericardial effusion

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19
Q

What is evaluated in the RUQ during a FAST scan?

A

-diaphragm, dome of live, subhepatic space (Morison’s pouch), right kidney, and right flank

20
Q

What is evaluated in the epigastric area during a FAST scan?

A

pancreas, vessels

21
Q

What is evaluated in the LUQ of FAST scan?

A

spleen and left kidney

22
Q

What is evaluated in the lower quadrants of a FAST scan?

A

-urinary bladder and uterus

23
Q

What transducer is best for evaluating for pericardial effusion?

A

sector array

24
Q

What is the difference between pleural effusion and ascites?

A
  • pleural effusion is above the diaphragm

- ascites is fluid in the peritoneal cavity

25
Q

What are normal reasons to see a small amount of fluid in a woman of menstrual age?

A

-ovulation and menstruation

26
Q

What causes variances in the sonographic appearance of hepatic and splenic injuries?

A

-vary according to type and time of injury

27
Q

What are more easily detected with ultrasound than any other visceral abdominal injury?

A

liver lacerations or contusions

28
Q

How do parenchymal injuries appear?

A

*heterogeneous or hyperechoic

29
Q

How will hematomas and localized lacerations appear initially?

A

-hypoechoic with low-level echoes generated from RBCs

30
Q

How will hematomas and localized lacerations appear as the blood begins to coagulate and after?

A

-echogenic, which over time will become more anechoic with the on set of hemolysis

31
Q

What are the pitfalls of abdominal ultrasound?

A

-failure to show contained solid-organ injuries; injuries to the diaphragm, pancreas, and adrenal gland, and some bowel injuries.

32
Q

*Why is close clinical observation or CT warranted after a negative ultrasound?

A

-*because it does not exclude an intraperitoneal injury

33
Q

What are common emergency conditions?

A

Cholecystitis and pancreatitis, urolithiasis, and aortic dissection, appendicitis, and paraumbilical hernia

34
Q

What are the clinical and sonographic findings of cholecystitis?

A
  • Clinical: RUQ pain, fever, nausea, vomiting, leukocytosis

- Sonographic: thickened GB wall, + Murphy’s sign, pericholecystic fluid, dilated GB, an immobile gallstone, sludge

35
Q

What are the clinical and sonographic findings of pancreatitis?

A
  • Clinical: mid-epigastic pain, radiating to back, fever, leukocytosis (amylase, lipase)
  • Sonographic: normal to edematous gland, enlarged and hypoechoic texture, irregular borders, increased vascular flow
36
Q

*What is the most common cause of acute cholecystitis?

A

-*a cystic duct obstruction, generally by a gallstone. Stones as small as 0.5mm may be visualized with ultrasound

37
Q

What are clinical and sonographic findings to urolithiasis?

A
  • Clinical: spasmodic flank pain, pain may radiate into pelvis, leukocytosis, hematuria, and fever
  • Sonographic: echogenic foci w/ shadowing, hydronephrosis may be present, and look for ureteral jets in bladder
38
Q

What are the clinical and sonographic findings of aortic dissection?

A
  • Clinical: sudden onset of severe chest pain with radiation to arms, neck or back; syncope may be present
  • Sonographic: aneurysm, look for flap at site of dissection, look for false lumen
39
Q

What are the sonographic findings in aortic dissection?

A
  • presence of an echogenic membrane (false lumen)
  • visualization of the flap at the site of dissection
  • decreased or reversed blood flow in the false lumen
40
Q

What are the causes of aortic dissection?

A
  • hypertension (70-90%)
  • Marfan syndrome (16%)
  • pregnancy
  • acquired or congenital aortic stenosis
  • acquired or congenital aortic stenosis
  • coarctation of aorta
  • trauma
  • iatrogenic (cardiac catherization, aortic valve replacement)
41
Q

Where do the majority of aortic dissections occur? And where do the others occur?

A
  • *approx. 70% of aortic dissections occur in the ascending aorta
  • 20% in the abdominal aorta
  • 10-20% in the aortic arch
42
Q

What are the clinical and sonographic findings of appendicitis?

A

-Clinical: intense RLQ, nausea and vomiting, fever, leukocytosis
Sonographic: distended non-compressible appendix, color flow, McBurney’s sign

43
Q

What are the clinical and sonographic findings of paraumbilical hernia?

A
  • Clinical: asymptomatic to mild discomfort, palpable mass, Valsalva shows exaggeration of mass, reduce sac with gentle pressure, occurs more often in female adults
  • sonographic: lower/mid abdominal mass; look for real time peristalsis of bowel hernia
44
Q

What must be ruled out for patients presenting with acute pelvic pain?

A
  • tubo-ovarian abscess, ruptured ovarian cyst, or ectopic pregnancy
  • ovarian torsion is likewise an emergent situation for severe pelvic pain
45
Q

What is the ring sign?

A

gestational sac lying outside the uterine cavity in the fallopian tube (ectopic)

DMS 241: Advanced Abdominal Sonography (3 decks)

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