ultrasound Flashcards
shock/unexplained hypotension
collapsed IVC (+ SVC but that’s hard to see), IJ usually not useful b/c pts can’t sit up. heart = small, hyperdynamic, LVEF > 75%
cardiogenic shock
LVEF < 30%, plethoric IVC, +/- lung rockets
massive PE
R:L ventricle ratio reversal, paradoxical septal motion, plethoric IVC
tension ptx
clinical Dx. absence of lung sliding
pericardial tamponade
2D:
presence of pericardial effusion
diastolic collapse of right ventricle
IVC dilatation and loss of respiratory variations
respiratory increase of inter-ventricular dependence
Doppler:
respiratory variations > 25% in mitral, aortic and/or tricuspid flow
distributive shock
heart: hyperdynamic, well-filled w/normal/high LVEF. warm, well-perfused extremities, high CVO2 sat
septic/neurogenic shock
use EMBU to target Tx, addressing intravascular volume 1st
AAA
large aortic diameter: EMBU b/c high urgency, simple to perform. bowel gas can be limiting
aortic dissection
intimal flap: EMBU b/c urgent, but hard to do. TTE up to 90% accurate for experts, otherwise lower. high specificity
gallstones/related dz
stones +/- shadowing, wall thickening/edema for cholecystitis, can see CBD obstruction, intrahepatic cholestasis. EMBU b/c it’s convenient
kidney stones
hydronephrosis, EMBU not great, but good w/chronic stones b/c you can r/u obstruction and decrease need for radiation studies
pyelonephritis, ARF
no EMBU: not reliable
trauma
duh. but usually can’t identify injured organ. 500-650cc fluid threshold. there might be a grainy picture of morrison’s pouch on the exam
bowel problems
EMBU is bad b/c we can’t really see air-filled bowel, and non-specialists aren’t good at this. possible exceptions: intussusception, appendicitis have high specificity when they are visualized.
