POCUS Flashcards
what immediate information can you get from U/S? (LA clinical utilities)
-volume, type of free fluid
-gastric dilatation, contents
-small intestinal contents, motility, wall thickness, diameter
-large intestinal contents, wall thickness
what immediate information can you get from U/S? (SA clinical utilities)
-free fluid (peritoneal, pleural, pericardial)
-pneumothorax
-specific target organs of interest
advantages of POCUS (8)
-non-invasive, safe
-bedside, portable, widely available
-minimal restraint
-rapid, early detection
-inexpensive, serial examinations
-radiation sparing
-achievable proficiency, easily mastered skills
-no clipping, alcohol sufficient
what can the equine limited exam tell us/what can we assess? where should we scan?
scan on caudoventral abdomen or left caudal intercostal space (splenorenal)
assess: intestinal position, contents, wall thickness, distension, motility, presence of free fluid, y/n strangulating obstruction, y/n nephrosplenic entrapment
for the equine FLASH exam, what points to be u/s on the left vs the right side
left
- ventral abdomen, gastric, splenorenal, left middle 3rd abdomen
right
-duodenal, right middle 3rd abdomen, cranial ventral thorax
what are the 5 Ts of POCUS?
Triage/Trauma = dictables stabilization and order of POCUS
~history, triage exam, triage POCUS
Treat
Track (monitor) -> serial POCUS, is there improvement?
Total screen -> systemic POCUS
what position should we avoid putting animals in for POCUS?
avoid dorsal if neeeded… can cause animal to decompensate
what is the best positive to scan patients in?
right lateral….. but not always possible so depending on the case, just go for whatever the patient prefers
what are the 4 sites for the abdominal POCUS in dogs? what is the 5th site added?
-diaphragmaticohepatic (DH) ; subxiphoid
-splenorenal (SR)
-cystocolic (CC)
-hepatorenal (HR)
-New = umbilical view
what does the DH view show us?
diaphgram and liver interface + gallbladder + stomach + heart
what issues can we dx at the DH site?
-peritoneal/pleural/pericardial effusion
-gallbladder wall edema
-gallbladder mucocele
-liver mass(es), splenic mass(es)
-fluid filled distended stomach, ileus
-caudal vena cava
wht does the HR/right paralumbar fossa view let us evaulate?
liver and right kidney interface
what issues can we identify in the HR position
-(retro)peritoneal effision
-kidney: hydronephrosis, renal pelvis +/_ ureteral dilation, cysts, size, contour, echogenicity
what does the cystocolic (CC)/ midline bladder view let us see
bladder apex
what issues can we determine when looking at the CC/midline view
-peritoneal effusion
-bladder: size, shape, wall thickness, intraluminal structures
-urine production
what does the SR/ left paralumbar view let us see
spleen and left kidney interface
what issues can we see in the SR view
-(retro)peritoneal effusion
-kidney: hydronephrosis, renal pelvis +/_ ureteral dilation, cysts, size, contour, echogenicity
abdominal fluid score scale
of quadrants with free fluid so 0-4
if <5mm in a cat or <1cm in a dog, give a 1.2 score
what does the umbilical view let us see
gravitationally dependent structures and free fluid
what issues can we determine with the umbilical view
-peritoneal effusion; best abdominocentesis site
-intestines; ileus, intussesception
what is the range in echogenicity and degree?
anechoic (black) -> moderate echogenicity (shades of gray)
degree of viscosity and cellularity
when looking at the abdomen, what issue is represented by a bullseye appearance
intussusception
what is the scanning position for a thoracic TFAST
standing or sternal
what issues can we see at the CTS in thoracic FASTs?
-pleural effusion
-pneumothorax
what issues can we see at the pericardial site for thoracic FASTs?
-pericardial effusion
-cardiac tamponade (cardiac mass, thrombus)
-pleural effusion
what will you not see if there is a pneumothorax?
wont se the horizontal shimmer! negative pulmonary pleural glide sign
limitations of POCUS
-large depth/size and the probe cant show deep enough
-low quality image in portable machines
-highly operator dependent (artifacts, failure to tract, misinterpretation, confusion with fluid filled structures)
-false negatives
what happens if you put excessive pressure on the transducer
will appear as a 0 AFS…. will push the free fluid away so you will think its not present/will miss it
