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Emergency Medicine Clerkship > Ultrasound > Flashcards

Ultrasound Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

What can eFAST be used to diagnose?

A

Pneumothorax
Pericardial effusion
Abdominal free fluid

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2
Q

Sensitivity and specificity of abdominal free fluid on eFAST?

A

Sensitivity ~85% (need 200 cc of free fluid)

Specificity 99% (false positives 2/2 ascites, urine, diasylate)

Somewhat dependent on operator and body habitus
Cannot see retroperitoneal space

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3
Q

Sensitivity and specificity of pneumothorax on eFAST?

A

98%; 99%

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4
Q

eFAST algorithm?

A

If stable:
+eFAST - CT
-eFAST - CT or Obs

If unstable:
+eFAST - OR
-eFAST - ?? (think of other causes)

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5
Q

Which probe is low frequency? Which probe is high frequency?

A

Low: curvilinear

High: linear

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6
Q

Which probe is used in the abdominal vs. cardiac vs. thoracic cavity windows?

A

Curvilinear: abdominal and cardiac

Linear: thoracic cavity

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7
Q

Compare the resolution and penetration of the curvilinear vs. linear probes.

A

Curvilinear has improved penetration (30 cm), but less resolution

Linear has less penetration (6 cm) but higher resolution

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8
Q

How should a trauma patient be positioned?

A

Backboard/supine, with C-spine immobilization

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9
Q

Why is supine position helpful for eFAST? Why is Trendelenberg helpful?

A

Supine: creates dependent areas, detect pooled blood

Trendelenberg: improves sensitivity of exam

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10
Q

Describe probe positioning for thoracic windows.

A

2nd ICS at MCL, march probe down
~5 respiratory cycles
Indicator up, sagittal view
M-mode (motion mode)

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11
Q

Normal thoracic view in M-mode?

A

Seashore sign (like waves on a normal beach) = normal movement of the chest wall

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12
Q

Pneumothorax in M-mode?

A

Bar code sign (not wavy at all)

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13
Q

Describe probe positioning for the RUQ window.

A

Hepatorenal space/Morison pouch
Midaxillary line of R flank
Indicator up, oblique and coronal views
Diaphragm to lower pole kidney

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14
Q

Describe probe positioning for the cardiac windows.

A

Sub-xiphoid AND parasternal long axis (back-up, best done with a different probe)

Indicator to patient’s right
Point probe to patient’s left shoulder
Just to the right of midline

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15
Q

Describe probe positioning for the LUQ window.

A

Splenorenal space
Indicator up
Coronal view
More posterior than you think

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16
Q

Why is it important to be appropriately posterior in the LUQ window?

A

Liquid in the stomach can be mistaken for free fluid

17
Q

Describe probe positioning for the suprapubic window.

A

Rectovesicular space
Rectouterine space (Pouch of Douglas)
Sagittal and transverse views

18
Q

Define velocity.

A

Speed of US wave, assumed to be constant (translates to depth -> the faster the waves return, the closer the tissue is located)

19
Q

Define frequency.

A

Lower frequency -> achieve better images of deeper structures

Higher frequency -> achieve better images over shorter images

20
Q

Define amplitude.

A

Intensity of US wave; constant, independent of frequency.

21
Q

Hyperechoic = ___ amplitude

A

High

22
Q

Hypoechoic = ___ amplitude

A

Low

23
Q

2 primary factors contributing to attenuation in US?

A

Absorption (soft tissue, variable depending on tissue)

Reflection (bone and air -> acoustic shadowing)

24
Q

Tissues with high attenuation coefficient

A

Gas
Bone

Decrease amplitude

25
Q

Tissues with low attenuation coefficient

A

Fluid

Minimal effect on amplitude

26
Q

What are lateral and axial resolution?

A

Lateral - ability to distinguish objects side by side

Axial - ability to distinguish objects above and below each other

27
Q

3 types of probes with most machines?

A
  1. High frequency linear (aka vascular probe)
  2. Phased array
  3. Low frequency curvilinear (aka abdominal probe)
28
Q

3 planes of US scans?

A
  1. Transverse (axial) - horizontal, L to R scans, indicator to R side
  2. Longitudinal (sagittal) - vertical, top to bottom scans, indicator to head
  3. Coronal - probe on patient’s side, vertical cuts, indicator to head

Emergency Medicine Clerkship (18 decks)

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