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Echo In the ED

An overview of the basics of Point of care cardiac US for the beginning emergency sonographer
by

Bob Stuntz

on 23 June 2016

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Transcript of Echo In the ED

Goals
No disclosures to make
Disclosures
Indications
Views
Normal
Abnormal
Dyspnea
Hemodynamic compromise
Presumed effusion/tamponade
Ejection fraction
CHF
Shock
Pulmonary embolus
Cardiac arrest
Parasternal Long Axis (PSLA)
Parasternal Short Axis (PSSA)
Apical 4 or 5 chamber (A4C)
Subxyphoid (SX)
IVC
Standard Views
PSLA
LV function
MV
AV
Where's the fluid?
AV
MV
Wall motion
PSSA
LLD/PMI
LV : RV
Color?
Best, hardest
Apical 4 Chamber
(A4C)
Use the liver
Get flat
Effusion
FAST
Subxyphoid
PSLA
PSSA
A4C
SX
< 50 CC
Rate of accumulation?
Where's the fluid?
Fat pad
Causes
Idiopathic
Viral
Neoplasm
Post OHS
Hemorrhage
Traumatic
Non traumatic
Pericardial Effusion
Physiology
Rate of accumulation
Pulsus paradoxis?
Sonographic findings
RV diastolic collapse
RA systolic collapse
MiV Variation
M mode
Clinical setting
Tamponade
Measuring: When?
Small: < 1 cm (<100 cc)
Medium: 1-2 cm (100-500 cc)
Large: > 2 cm (> 500 cc)
Pericardial Effusion
Shock
Fluid resuscitation
Keep it simple
Hyperdynamic
Normal/mildly diminished
Moderately/Severely diminished
Ejection Fraction
Evaluation of function with ROSC
Search for causes
Assessing the dying heart
Valvular activity
Non perfusing squeeze
Confirmation of death
When do you do it?
Cardiac Arrest
Dead
McConnell's sign
Helpful if known acute
77% sensitive
94% specific
PPV: 84%
Can be secondary to chronic conditions
D sign
RV:LV ED ratio> 0.7
Sensitivty 66%
Specificity 77%
Right Sided Strain
McConnell MV, Solomon SD, Rayan ME, Come PC, Goldhaber SZ, Lee RT (1996). "Regional right ventricular dysfunction detected by echocardiography in acute pulmonary embolism". Am. J. Cardiol. 78 (4): 469–73
Lodato JA, Ward RP, Lang RM. Echocardiographic predictors of pulmonary embolism in patients referred for helical CT. Echocardiography. 2008 Jul;25(6):584-90.
Where's the fluid?
Anterior
Echos
Moves with the heart
Fat Pad
7 July 2014
Bob Stuntz, MD, RDMS
Echo Fundamentals:
Wellspan York Hospital Department of Emergency Medicine
Pericardial effusion and tamponade
Ejection fraction
Right heart strain
Cardiac arrest
We can do this!

Take Home
Questions?
Email: rstuntz@wellspan.org
bobstuntzmd@gmail.com
This presentation: http://prezi.com/utslp54fyt1_/cardiac-echo/

Blog: www.emrespodcast.org
Twitter: @BobStuntz
Facebook: EM Res

Thank You!
Best view
LV function
Valves
Difficult
LLD
Inspire
Probe
Sometimes the Basics Are All You Need
Full transcript