critical care ultrasound
DESCRIPTION
TRANSCRIPT
![Page 1: Critical Care Ultrasound](https://reader037.vdocuments.mx/reader037/viewer/2022110114/54666ad8b4af9fdf3f8b4f1e/html5/thumbnails/1.jpg)
Critical Care UltrasoundEdward M. Omron MD, MPH, FCCP
Critical Care ServiceAlta Bates Summit
![Page 2: Critical Care Ultrasound](https://reader037.vdocuments.mx/reader037/viewer/2022110114/54666ad8b4af9fdf3f8b4f1e/html5/thumbnails/2.jpg)
Nomenclature for Transducer Locations
![Page 3: Critical Care Ultrasound](https://reader037.vdocuments.mx/reader037/viewer/2022110114/54666ad8b4af9fdf3f8b4f1e/html5/thumbnails/3.jpg)
Normal four chamber subxiphoid view
![Page 4: Critical Care Ultrasound](https://reader037.vdocuments.mx/reader037/viewer/2022110114/54666ad8b4af9fdf3f8b4f1e/html5/thumbnails/4.jpg)
Parasternal Short Axis and Subcostal View in Severe Right Ventricular Failure
![Page 5: Critical Care Ultrasound](https://reader037.vdocuments.mx/reader037/viewer/2022110114/54666ad8b4af9fdf3f8b4f1e/html5/thumbnails/5.jpg)
Subxiphoid View:
Pulmonary Embolism with dilatedRight ventricle
After TPA administraton
![Page 6: Critical Care Ultrasound](https://reader037.vdocuments.mx/reader037/viewer/2022110114/54666ad8b4af9fdf3f8b4f1e/html5/thumbnails/6.jpg)
Subcostal View: Massive Pulmonary Embolism
![Page 7: Critical Care Ultrasound](https://reader037.vdocuments.mx/reader037/viewer/2022110114/54666ad8b4af9fdf3f8b4f1e/html5/thumbnails/7.jpg)
Pericardial Tamponade with Right Atrial Collapse
![Page 8: Critical Care Ultrasound](https://reader037.vdocuments.mx/reader037/viewer/2022110114/54666ad8b4af9fdf3f8b4f1e/html5/thumbnails/8.jpg)
Subcostal View of Large Ventriculoseptal Defect and Left to Right Shunt
![Page 9: Critical Care Ultrasound](https://reader037.vdocuments.mx/reader037/viewer/2022110114/54666ad8b4af9fdf3f8b4f1e/html5/thumbnails/9.jpg)
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
![Page 10: Critical Care Ultrasound](https://reader037.vdocuments.mx/reader037/viewer/2022110114/54666ad8b4af9fdf3f8b4f1e/html5/thumbnails/10.jpg)
IVC Collapse in HypovolemiaNotice Left Renal VeinEnd Expiratory Collapse
![Page 11: Critical Care Ultrasound](https://reader037.vdocuments.mx/reader037/viewer/2022110114/54666ad8b4af9fdf3f8b4f1e/html5/thumbnails/11.jpg)
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%
![Page 12: Critical Care Ultrasound](https://reader037.vdocuments.mx/reader037/viewer/2022110114/54666ad8b4af9fdf3f8b4f1e/html5/thumbnails/12.jpg)
Caliper of IVC when Central Venous Pressure is altered