POCUS Learn (Sick Kids Online Modules) Flashcards
When doing a soft tissue scan for possible cellulitis/abscess/etc. what are the two types of scans you must do?
Both done with high frequency linear probe:
- Scan two planes at the area of interest
- Use color doppler to make sure what you are seeing is not a blood vessel (if there is a fluid collection)
What are 3 possible findings on POCUS for patient with possible cellulitis vs abscess?
- Thickened subcutaneous tissue
- Cobblestoning - fatty tissue surrounded by hypoechoic fluid representing edema
- Hypoechoic collection - coalescing fluid pockets forming an abscess, may contain debris, walls are not always well defined
How does a foreign body appear on POCUS?
Hyperechoic object with posterior acoustic shadowing/posterior reverberation artifact
- metal: hyperechoic with reverberation artifact
- wood: loses echogenicity over time
- glass: exception = may NOT be hyperechoic
If you find a hypoechoic collection on POCUS of soft tissue, what should you do next before incision and drainage?
- Use color flow doppler to make sure it is not a blood vessel before cutting it
- Make sure you see well-defined borders to rule out fistula
What are findings of nec fasc on ultrasound?
Pockets of air (hyperechoic) and/or fluid (hypoechoic) along the fascial planes
What does air look like on soft tissue POCUS?
Hyperechoic (very very white) with posterior shadowing near the fascial plane
-if you see this, be concerned for nec fasc!
What are the purposes of the following cardiac views:
- parasternal long axis
- parasternal short axis
- subxiphoid
- apical 4 chamber view
- Parasternal long: excellent view of LV, LA and aortic outflow tract. IDEAL view for global ventricular functioning and pericardial fluid
- Parasternal short axis: excellent view of left ventricle, can also see right ventricle. IDEAL view for assessing global left ventricular function
- Subxiphoid: IDEAL for assessing pericardial fluid
- Apical four chamber: excellent view of all four chambers of the heart and can assess overall ventricular sizes qualitatively
What are the 3 abnormal findings you may see on a POCUS cardiac scan?
- Global left ventricular dysfunction
- Pericardial effusion
- Right ventricular dilatation
Thats it! Can’t do more than that
What are signs of global left ventricular dysfunction on cardiac POCUS? (3)
- Endocardial border excursion (you should see the ventricle squeeze well enough for the walls to almost touch)
- Myocardial thickening of the LV
- Anterior mitral valve fails to touch the interventricular septum (no mitral valve slapping against the septum)
What are findings of cardiac standstill?
- No movement of the heart
2. Might see clot in the left ventricle
You perform a cardiac POCUS and see an anechoic space between the epicardium and the pericardium only around the right ventricle. What is the significance of this?
This is most likely physiological - effusions appearing only around the right ventricle are often physiological
What is the POCUS Triad for Cardiac Tamponade?
- Pericardial effusion
- RA diastolic collapse –> RV diastolic collapse
- Dilated IVC
What size should the RV be compared to the LV in children?
-what about in infants?
RV is smaller than the LV and should be a ratio of 0.66:1
-infants: because of increased pulmonary pressures, will still have RV:LV ratio closer to 1:1
What is the best view to look at ventricle size?
Apical 4 chamber view
What are the 6 possible interpretations you can make on a cardiac POCUS?
- Normal
- Cardiac standstill
- Impaired global left ventricular function
- Physiological pericardial effusion
- Pathologic pericardial effusion without evidence of tamponade
- Pericardial effusion with evidence of tamponade
