critical care ultrasound
DESCRIPTION
TRANSCRIPT
Critical Care UltrasoundEdward M. Omron MD, MPH, FCCP
Critical Care ServiceAlta Bates Summit
Nomenclature for Transducer Locations
Normal four chamber subxiphoid view
Parasternal Short Axis and Subcostal View in Severe Right Ventricular Failure
Subxiphoid View:
Pulmonary Embolism with dilatedRight ventricle
After TPA administraton
Subcostal View: Massive Pulmonary Embolism
Pericardial Tamponade with Right Atrial Collapse
Subcostal View of Large Ventriculoseptal Defect and Left to Right Shunt
IVC Caliper Measurement as an Index of preload responsiveness
Only valid in sedated, mechanically ventilated patients
Mechanical ventilation: Inspiratory caliper increases secondary to positive thoracic pressure Expiratory caliper is constant
IVC caliper increases in right heart failure, hypervolemia, or could be normal
IVC caliper decreases in hypovolemia
Preload responsiveness:IVC Caliber change with respiration
IVC Collapse in HypovolemiaNotice Left Renal VeinEnd Expiratory Collapse
Measurement Technique• Valid only in mechanically ventilated Patients• The patient remains supine• IVC is sought in the longitudinal axis• Look for the left renal vein and measure distal to it• End expiratory measurement is needed• A caliper less than 10 mm was correlated with a
central venous pressure of less than 7 mm Hg– Sensitivity 84%, Specificity 95%, PPV 89%, NPV 92%
Caliper of IVC when Central Venous Pressure is altered