POCUS

Question 1

What hidden conditions can increase the risk of pulmonary aspiration?

Answer 1

• Secondary gastroparesis
• Pain/trauma
• Opioid consumption
• Bowel obstruction
• Patient non-compliance w/ NPO guidelines

Question 2

Out of the 8 benefits of gastric POCUS name 3:

Answer 2

• Objective evaluation of gastric contents
• Independent of patient & provider bias
• Usable by all levels of providers
• Rapid
• Non-invasive
• Reliable & valid
• Easily accessed
• Cost-effective

Question 3

Where do you want the liver positioned on the US screen? What about the antrum?

Answer 3

Liver at 9 o’clock

Antrum at 11 or 1 o’clock

Question 4

Your POCUS presents with frosted glass what do you suspect?

Answer 4

A recent meal

- cannot see organ structures below

Question 5

What does a black antrum represent?

Answer 5

Recent liquid intake

Question 6

Your POCUS presents with a “starry night” appearance what does this suggest?

Answer 6

Curdling, congealing, turbulence from just swallowing, or carbonation

• Milk curdles & can have a typical biphasic (hyperechoic/hypoechoic) appearance

Question 7

You are performing your first POCUS as a nurse anesthesia resident on a pre-operative patient, what is the ideal sign they have been NPO?

Answer 7

A Bullseye sign

- this means the stomach is empty and you can see rugae and a thick muscle wall.

Question 8

You understand that fluid in the antrum can either be high or low risk for aspiration what measurements and assessments do you perform to fully evaluate the mL?

Answer 8

• Fluid present in right lateral decubitus only = 75% likely < 100 mL GV (Grade 1)
• Fluid present in both RLD & supine = 75% likely > 100 mL GV

< 1.5 mL/kg = LOW risk
> 1.5 mL/kg = High risk

Question 9

What is a normal amount of gastric volume (GV) in a fasted patient?

Answer 9

100 mL

Question 10

What conditions limit the POCUS creating an inaccurate reading?

Answer 10

• Large hiatal hernia
• Gastric fundoplication
• Gastric bypass/resection

Question 11

What probe and frequency do you use for an abdominal POCUS in large pediatrics or adults?

Answer 11

Curved array probe with a low-frequency (2-5 mHz)

Question 12

What probe and frequency do you use for an abdominal POCUS in small children?

Answer 12

Linear probe with high-frequency (5-12 mHz)

Question 13

What is the technique for performing a POCUS

Answer 13

• Abdominal setting on the US
• Curved array transducer for adults (linear for peds)
• Scan epigastric in sagittal plane
• Sweep from L to R along the subcostal margin
• Identify the gastric antrum
• Start in the supine position
• Follow w/ the right lateral decubitus (RLD)

Question 14

You are only able to scan the patient in supine position for a POCUS is this sufficient?

Answer 14

You can never call an empty stomach based on the supine position