pocus Flashcards
what is the FATE exam
Focused assess transthoracic echocardiogram
IVC assessment
what can be assessed in a pulm echo
normal lung
pnuemothorax
pulm edema
pleural effusion
diaphragm assessment
what can be assessed in abdomen US
gastric
FAST
Bladder
what are the three types of POCUS probes
linear
curvilinear
phased
what is linear probe used for
central lines,
PIC,
lung ultrasound,
superficial structures,
crisp images,
high frequency
nerve blocks
what is curvilinear probe used for
FAST exam,
gastric ultrasound,
deep 4-8 cm,
low frequency,
images not crisp but better depth
what do we use phased array probes for
cardiac, pulmonary, gastric
smaller footprint
fewer PZE crystals activated in different phases to allow steering of the beam and a small footprint (in between ribs)
transthoracic
how does a low gain present
darker
how does a high gain present
white out
what is TGC
Time gain compensation
helps keep the brightness of same tissues the same
what are hyperechoic structures
dense structures are white:
bone, needle, nerve bundles
what are hypoechoic structures?
grey, less dense structures:
lymph nodes, nerves
what are anechoic structures
black: air and fluid
what pattern do nerves appear as
hypoechoic areas separated by hyperechoic
honeycomb
What is the seashore sign? in lungs
on M-mode structures above pleural line dont move (lines)
pleura below moves (sand)
normal finding
what is stratosphere sign or barcode sign in lungs
straight lines all the way through, air in between parietal and visceral pleura
abnormal- pnueomothorax
what is a lung pulse
small lung movements with cardiac pulsations
when do you usually see lung pulse
apneic patients
what does a lung pulse mean
lung that is aerated but not ventilated
also means there is no air between the pleura
what are B-lines in lungs
hyperechoic beams emanating from the pleural line and extending through the field
moves with lung sliding
what does 1-2 B lines and lower lobes tell you
normal in dependent areas
what do many B lines suggest
pulm edema
what are A-lines in lungs
normal horizontal artifact at regular intervals
what are normal lung signs on US
lung sliding
A-lines
1-2 B lines
seashore sign
what are pneumothorax lung signs
no lung sliding
no B lines
no lung pulse
stratosphere sign
LUNG POINT
how accurate is lung point sign for pneumo
95-100%
what is a lung point
interface between aerated and non-aerated lung
seashore and barcode sign intermittent in M mode
what are the steps to determining pneumo on ultrasound
lung sliding (no=pneumo)
B-lines (no=pneumo)
Lung pulse (no=pneumo)
Seashore (no=pneumo)
stratosphere with Lung Point= pnemo
what probe do you use for a pleural assessment
linear at the axillary line
what is spine sign indicative of
pleural effusion
where do you find spine sign
axillary line, base of lung
how does spine sign present
dark anachoic triangle with spine visible is abnormal and indicative of pleural effusion
why is spine not usually visible through lung
ultrasound cant move through air
where do you perform diaphragm assessment
zone of apposition
how do you position the probe for diaphragm assessment
point it cephalad
what is a normal diphragm sign
30% thickening at end inspiration
what is occurring if the diaphragm does not thicken by 30%
diaphragmatic peresis
what would you do FATE exam for pre op
screen high risk
volume assess
what would you use FATE exam for post-op
MI
pulm embolism
hypovolemia
what complication can FATE exam differentiate
MI, PE, Tamponade, LV failure
what is goal of FATE exam
abnormal vs normal
exclude obvious pathology
assess wall thickness
assess contractility
evaluate volume status
what probe is preferred for FATE exam
phased array
what are the four parts of FATE exam
- subcostal
- apical 4-chamber
- PLAX (long Axis)
- PSAX (LV short axis)
where do you place probe for subcostal 4-chamber view of FATE exam
below xiphoid pointed toward shoulder
how does pericaridal effusion appear
anachoic line around heart
how should legs be placed in abdomen
down so abd doesnt push on chest
what are you looking for in subcostal 4-chamber view of FATE
MV/TV disease
pericardial effusion
massive PE
hypovolemia
what is viewable in the subcostal IVC view
IVC, RA, Liver
what are indications for subcostal IVC view
fluid status
how can you get CVP from FATE
max IVC- min IVC/maxIVC (after sniff) x100
a 50% change in IVC diameter with respiration indicated
hypovolemia
where do you put probe for apical 4C view
PMI then into axillary line, patient must be as much on left side as possible
what is the first strucutre you hit in apical 4C view
LV
which direction does the IVS move in contraction
towards LV
what are indications for apical 4C view
cardiac function
MV/TV
pericardial defects
septal wall defects
massive PE
hypovolemia
where do you place probe for PLAX (parasternal long axis) of FATE exam
2-3 ICS LSB orientation towards R shoulder
what is indication for PLAX
cardiac function
AV/MV
pericardial infusion
aortic stenosis
hypovolemia
how should RV diameter appear
<3.3 CM or it is dialated
internal no more than 2/3 of LV
apex no more than 2/3 of LV
where do you position probe for PSAX (parsternal short axis) view
2-3 ICS towards L shoulder
what are indications for PSAX view
cardiac function
pericardial effusion
massive PE
hypovolemia
what are findings of a massive PE
enlarged RV
flattened LV IVC (D sign)
McConnel sign in apical 4c view
what is the goal of gastric ultrasound
decrease incidence of aspiration
when do you do gastric ultrasound
patient is not NPO
delayed gastric emptying
inability to communicate
dishonest patient
what can you tell from gastric ultrasound
gastric volume
participate load
gastric function
what probe do you use for gastric ultrasound
curvilinear on abd setting, indicator toward head
how do you position patient for abd exam
start in supine position
follow with the right lateral decubitus position
do you say a stomach is empty based on supine alone
no
what strucutres border the gastic antrum
L border of liver
pancrease
what indicates an empty gastric antrum
donut look/bulleseye
how does clear liquid appear on US
anachoic
what does stary night appearance of antrum tell us
just drank
carbonated liquid
how do you assess liquid volume from stomach
r lateral decubitus
what is a grade of 0 of antral grading
empty in both supine and TLD
minimal volume
low aspiration risk
what is a grade 1 of antral grading
empy in supine, clear fluid in RLD
<1.5 ml/kg compatable with baseline gastric secretions
low risk of aspiration
what is a grade 2 of antral grading
clear fluid visible in both positions
>1.5 ml/kg in excess of baseline gastric secretions
high risk of aspiration
how does recently ingested food appear on gastric US
frosted glass appearance due to ingested air with food
how does digested food appear on US
hypoachoic (grey)
what does a FAST exam identify
focused assess sonogram for trauma patients
looking for blood
where does FAST exam look for fluid
peritoneal
retroperitoneal
pericardial
what is in the retroperitoneal space
kidney
IVC
aorta
colon
What is in the infraperitoneal area?
bladder
distal rectum
how much blood does FAST exam detect
> 200ml
how much fluid is in 1 cm of hypoechoic space
150 ml
where does blood in upper abd collect
morisons pouch RUQ (from RUQ and LUQ down phrenicolic ligament)
what if you see blood in LUQ
then morisons pouch is full, lots of blood
where does blood from lower abd collect
bladder wall
where is morisons pouch
RUQ between liver and kidney
what structures do you look for in morrisons pouch
pleural space
infradiphragmatic space
caudal liver tip
hepatorenal space (actual pouch)
what position is patient in for FAST
supine
where is probe for FAST EXAM
start MCL, slide to MAL 10th rib
what is the LUQ fast exam view
parasplenic view
what is the area of fluid accumulation around bladder
pouch of douglas or pelvic couldesac
where should orientation of probe be for pelvic FAST
right
where does fluid appear in pelvic FAST
around bladder
what is the sign of the ETT in tracheal lumen
double tract or double lumen sign
what is soft tissue value for US speed
1540
what is lung value for US speed
500
