Ultrasound Flashcards
Indications for fascia iliac block
Femoral shaft#
Thigh anterior wound/procedure
Hip dislocation
Fracture neck of femur
3 different approach to needle visualisation/ guidance using USS
In plane
Out of plane
Oblique
Ultrasound assisted (site marked prior inserting needle blind)
Absolute contraindications to perform regional anaesthesia
Allergy to local anaesthetic
Infection at site
Agitated/ Confused
Acute or pre-existing Neuro deficit to that region
Recent local anaesthetic - above safe dosage
Relative contraindication to perform regional anaesthesia
Risk of compartment syndrome
Multi trauma
Coagulopathy
What drug and maximum dose use for femoral block?
Ropivacaine Max 3mg/kg less cardiac toxic than bupivocaine
Benefits of performing an ultrasound guided femoral nerve block
- Improved safety: direct visualisation, decreased risk of arterial puncture, decrease risk of nerve damage
- More successful
- Decreased opioid requirements, including less side effects/ adverse events
4 early clinical features of local anaesthetic toxicity
Tinnitus Visual changes- loss of focus Dizziness/ light headlines Anxiety, agitation, confusion, disorientation, drowsiness Perioral/ tongue numbness Metallic taste
Risk factors developing DVT
- Recent travel
- Acute medical illness with immobilisation for at least 3 days
- Oestrogen therapy
- Pregnancy/ post partum
- Active cancer
- Antiphospholipid syndrome
- Long haul travel
- Leg injury associated with reduced mobility for at least 3 days
- ongoing non malignant condition associated with 2x fold or higher increased recurrent VTE after stopping anticoagulant therapy( IBD/ chronic inflammatory states)
Acute complications of DVT
Phlegmasia cerulea dolens
Phlegmasia Alba dolens
Pulmonary embolus
Advantages abdominal FAST scan in HAEMODYNAMICALLY stable blunt trauma patient
- Identification of free fluid ( inc mortality/ morbidity)
- Repeatable
- No radiation
Disadvantage abdo FAST in HAEMO Stable blunt trauma patient
- Cannot exclude solid organ injury( low send in stable pt)
- Cannot exclude retroperitoneal bleed / pelvic bleed/ bowel injury
- Skill operator required : potential for misinterpretation if not aware of artefacts
List 3 causes that an lead to absence of lung sliding
Adhesions
Pleurodesis
Pain/ splinting
Contusions
US findings help diagnose pneumothorax
- Lung point
- Absence of lung sliding
- Lung pulse
- Absent power slide
- Absent b-lines
US findings diagnose haemothorax
- Location: Dependent/ lower
- Description: Anechoic/ hypoechoic/+/- echogenic debris
- Other: spine sign/ absent lung slide/ collapsed lung- whale tail
US findings pericardial tamponade
- Location: pericardial space/ global around heart
- Description: effusion/ anechoic/hypoechoic:+/- echogenic debris
- Other: fixed dilated IVC, chamber wall effects - RV diastolic collapse/ RA systolic collapse, swinging heart
Features of intrauterine gestational sac
- Smooth, ovoid appearance
- Eccentric location
- Presence of a yolk sac/ foetal pole/ foetal HR
- Double deciding layer
Features of pseudogestational sac
- Irregular shape
- Pointed edges
- Central location
- Absent yolk sac
- Thick surrounding deco dual layer
- Contain debris
