point of care cardiac u/s
DESCRIPTION
Powerpoint Presentation - exported from Keynote Mac presentation. Introduction to Cardiac Point of Care U/S. Talk was meant for Emergency Medicine Residents PG1-3 level. Modest tweaks of font and spacing required prior to your own use. Associated PDF file in original Keynote format.TRANSCRIPT
![Page 1: Point of Care Cardiac U/S](https://reader038.vdocuments.net/reader038/viewer/2022110308/556e3f81d8b42a16278b4ccc/html5/thumbnails/1.jpg)
Fundamentals of Point of Care Cardiac Ultrasound For
Emergency Medicine Residents
Frank W Meissner, MD, RDMS, RDCSFACP, FACC, FCCP, FASNC, CPHIMS, CCDS
![Page 2: Point of Care Cardiac U/S](https://reader038.vdocuments.net/reader038/viewer/2022110308/556e3f81d8b42a16278b4ccc/html5/thumbnails/2.jpg)
POC U/S
Hand Held Devices
Excellent 2D imaging
OK quality Color Flow Doppler U/S
Newest System incorporates PW Doppler - but rare to have this capability- won’t discuss PW Doppler today
![Page 3: Point of Care Cardiac U/S](https://reader038.vdocuments.net/reader038/viewer/2022110308/556e3f81d8b42a16278b4ccc/html5/thumbnails/3.jpg)
No REVIEW of U/S Physics
Although important to understanding of U/S image production
Not possible given short time given to discussion
Additionally, simplified knob-ology of POC U/S results in lack of user control of imaging parameters, thus not vital to understand U/S physics in order to obtain dx images
![Page 4: Point of Care Cardiac U/S](https://reader038.vdocuments.net/reader038/viewer/2022110308/556e3f81d8b42a16278b4ccc/html5/thumbnails/4.jpg)
When & Why
Chest Pain Evaluation
Dyspnea Evaluation
Known LV Dysfunction
Possible SBE or Cardiac Embolization
![Page 5: Point of Care Cardiac U/S](https://reader038.vdocuments.net/reader038/viewer/2022110308/556e3f81d8b42a16278b4ccc/html5/thumbnails/5.jpg)
Potential Chest Pain Dx
Chest Pain
Ischemic Dz
Rgnal Wall Motion prior to EKG changes or clinical symptoms
Unlike current enzyme protocols can detect ischemia rather than infarct
>80% lesion will result in resting regional wall motion abnmlty
![Page 6: Point of Care Cardiac U/S](https://reader038.vdocuments.net/reader038/viewer/2022110308/556e3f81d8b42a16278b4ccc/html5/thumbnails/6.jpg)
Potential Dx
Critical Aortic Valve Stenosis
Aortic Dissection of Root or Arch
Pulmonary Embolism
CFD > mod-large TR Jet with nml sized RA
McConnell Sign (hyperdynamic apex + hypokinetic/Akinetic RV Free Wall)
Pericarditis (small Pericardial Effusion)
R/O Pericardial Tamponade
Mitral Valve Prolapse - Barlow’s Syndrome
Acute cholecystitis vs GB colic
Pleurisy with effusion
Atrial Myxoma
![Page 7: Point of Care Cardiac U/S](https://reader038.vdocuments.net/reader038/viewer/2022110308/556e3f81d8b42a16278b4ccc/html5/thumbnails/7.jpg)
Dyspnea
Evidence of Valvular Dysfunction (AoV/MV Stenosis vs Severe AI/MR )
Evidence of Pulmonary Embolism
Evidence of Systolic vs Diastolic HF
Pleural Effusion, Atelectasis, Pneumonia
![Page 8: Point of Care Cardiac U/S](https://reader038.vdocuments.net/reader038/viewer/2022110308/556e3f81d8b42a16278b4ccc/html5/thumbnails/8.jpg)
Cardiac Cycle
![Page 9: Point of Care Cardiac U/S](https://reader038.vdocuments.net/reader038/viewer/2022110308/556e3f81d8b42a16278b4ccc/html5/thumbnails/9.jpg)
Systole AV Valves Closed
![Page 10: Point of Care Cardiac U/S](https://reader038.vdocuments.net/reader038/viewer/2022110308/556e3f81d8b42a16278b4ccc/html5/thumbnails/10.jpg)
Diastole AV Valves Open
![Page 11: Point of Care Cardiac U/S](https://reader038.vdocuments.net/reader038/viewer/2022110308/556e3f81d8b42a16278b4ccc/html5/thumbnails/11.jpg)
Transducer Positions & Cardiac Views
Parasternal Position
Long Axis
Short Axis
Apical Position
4-, 5-, 2-, 3- chamber Views
Subcostal Position
IVC & hepatic veins, RV/LV inflow view, LV-aorta, RV outflow
Suprasternal Notch (not covered)
![Page 12: Point of Care Cardiac U/S](https://reader038.vdocuments.net/reader038/viewer/2022110308/556e3f81d8b42a16278b4ccc/html5/thumbnails/12.jpg)
Transducer Positions
![Page 13: Point of Care Cardiac U/S](https://reader038.vdocuments.net/reader038/viewer/2022110308/556e3f81d8b42a16278b4ccc/html5/thumbnails/13.jpg)
Imaging Planes
![Page 14: Point of Care Cardiac U/S](https://reader038.vdocuments.net/reader038/viewer/2022110308/556e3f81d8b42a16278b4ccc/html5/thumbnails/14.jpg)
Imaging Windows
![Page 15: Point of Care Cardiac U/S](https://reader038.vdocuments.net/reader038/viewer/2022110308/556e3f81d8b42a16278b4ccc/html5/thumbnails/15.jpg)
Parasternal LA View
What is seen?
Mid portion & base of the LV, MV leaflets, non-coronary & RV leaflets of AoV, Aortic Root, RA, RV
Imaging plane aligned parallel to the Long Axis of LV
With medial angulation/rotation of transducer RV/TV/RA brought into view
![Page 16: Point of Care Cardiac U/S](https://reader038.vdocuments.net/reader038/viewer/2022110308/556e3f81d8b42a16278b4ccc/html5/thumbnails/16.jpg)
Parasternal LA View
![Page 17: Point of Care Cardiac U/S](https://reader038.vdocuments.net/reader038/viewer/2022110308/556e3f81d8b42a16278b4ccc/html5/thumbnails/17.jpg)
Parasternal LAX View
![Page 18: Point of Care Cardiac U/S](https://reader038.vdocuments.net/reader038/viewer/2022110308/556e3f81d8b42a16278b4ccc/html5/thumbnails/18.jpg)
Detailed Anatomy - Parasternal LAX View
![Page 19: Point of Care Cardiac U/S](https://reader038.vdocuments.net/reader038/viewer/2022110308/556e3f81d8b42a16278b4ccc/html5/thumbnails/19.jpg)
Detailed Anatomy - PLAX
RV Wall
RV
Interventricular Septum
LV
Posterior Wall
MV
Papillary Muscles
Chordae Tendinae
LA
AoV
Ascending Aorta
![Page 20: Point of Care Cardiac U/S](https://reader038.vdocuments.net/reader038/viewer/2022110308/556e3f81d8b42a16278b4ccc/html5/thumbnails/20.jpg)
RV Inflow Tract View
![Page 21: Point of Care Cardiac U/S](https://reader038.vdocuments.net/reader038/viewer/2022110308/556e3f81d8b42a16278b4ccc/html5/thumbnails/21.jpg)
Parasternal SAX (AoV Level)
RVOT
TV
PV
PA
AoV
RA
LA
Intra-atrial Septum
![Page 22: Point of Care Cardiac U/S](https://reader038.vdocuments.net/reader038/viewer/2022110308/556e3f81d8b42a16278b4ccc/html5/thumbnails/22.jpg)
Parasternal SAX (AoV Level)
![Page 23: Point of Care Cardiac U/S](https://reader038.vdocuments.net/reader038/viewer/2022110308/556e3f81d8b42a16278b4ccc/html5/thumbnails/23.jpg)
Parasternal SAX (MV Level)
RV Free Wall
IVS
LV
MV orifice
LVPW
Pericardium
![Page 24: Point of Care Cardiac U/S](https://reader038.vdocuments.net/reader038/viewer/2022110308/556e3f81d8b42a16278b4ccc/html5/thumbnails/24.jpg)
RV Free Wall
RV Cavity
IVS
LV Cavity
Papillary Muscles
Posterior LV Wall
Pericardium
Parasternal SAX (Papillary Level)
![Page 25: Point of Care Cardiac U/S](https://reader038.vdocuments.net/reader038/viewer/2022110308/556e3f81d8b42a16278b4ccc/html5/thumbnails/25.jpg)
Apical 4-ChamberLV Apex
RV Cavity
IVS
Intra-atrial Septum
LV Cavity
LV Lateral Wall
MV
TV
Papillary muscles
Chordae Tendinae
Pulmonary Veins
LA
RA
Pu
![Page 26: Point of Care Cardiac U/S](https://reader038.vdocuments.net/reader038/viewer/2022110308/556e3f81d8b42a16278b4ccc/html5/thumbnails/26.jpg)
Apical 5-chamber
LV Apex
RV Cavity
IVS
Intra-atrial Septum
LV Cavity
LV Lateral Wall
MV
TV
AoV
LV Outflow Tract
Pulmonary Veins
LA
RA
Pu
![Page 27: Point of Care Cardiac U/S](https://reader038.vdocuments.net/reader038/viewer/2022110308/556e3f81d8b42a16278b4ccc/html5/thumbnails/27.jpg)
Apical 2 Chamber
LV Apex
Anterior Wall LV
Inferior Wall LV
LV Cavity
MV
LA
Pulmonary Veins
![Page 28: Point of Care Cardiac U/S](https://reader038.vdocuments.net/reader038/viewer/2022110308/556e3f81d8b42a16278b4ccc/html5/thumbnails/28.jpg)
LV Apex
AntSeptal LV
InferiorLat LV
LV Cavity
MV
LA
AoV
LV outflow tract
RV Infundibulum
Apical Long Axis or 3-Chamber View
![Page 29: Point of Care Cardiac U/S](https://reader038.vdocuments.net/reader038/viewer/2022110308/556e3f81d8b42a16278b4ccc/html5/thumbnails/29.jpg)
Cardiac Valves
![Page 30: Point of Care Cardiac U/S](https://reader038.vdocuments.net/reader038/viewer/2022110308/556e3f81d8b42a16278b4ccc/html5/thumbnails/30.jpg)
Septal Walls - Apical 4Chamber
![Page 31: Point of Care Cardiac U/S](https://reader038.vdocuments.net/reader038/viewer/2022110308/556e3f81d8b42a16278b4ccc/html5/thumbnails/31.jpg)
Wall Seg - Coronary Artery Relationships
![Page 32: Point of Care Cardiac U/S](https://reader038.vdocuments.net/reader038/viewer/2022110308/556e3f81d8b42a16278b4ccc/html5/thumbnails/32.jpg)
RUSH Protocol Probe Positions
![Page 33: Point of Care Cardiac U/S](https://reader038.vdocuments.net/reader038/viewer/2022110308/556e3f81d8b42a16278b4ccc/html5/thumbnails/33.jpg)
Rush Protocol Probe Positions
Evaluate ‘The Pump’
![Page 34: Point of Care Cardiac U/S](https://reader038.vdocuments.net/reader038/viewer/2022110308/556e3f81d8b42a16278b4ccc/html5/thumbnails/34.jpg)
Rush’ed Exam
![Page 35: Point of Care Cardiac U/S](https://reader038.vdocuments.net/reader038/viewer/2022110308/556e3f81d8b42a16278b4ccc/html5/thumbnails/35.jpg)
“The Pump”
Severe LV Systolic Dysfunction
![Page 36: Point of Care Cardiac U/S](https://reader038.vdocuments.net/reader038/viewer/2022110308/556e3f81d8b42a16278b4ccc/html5/thumbnails/36.jpg)
“The Pump”
Large Pericardial Effusion
![Page 37: Point of Care Cardiac U/S](https://reader038.vdocuments.net/reader038/viewer/2022110308/556e3f81d8b42a16278b4ccc/html5/thumbnails/37.jpg)
“The Pump”
Hemorrhagic Tamponade
![Page 38: Point of Care Cardiac U/S](https://reader038.vdocuments.net/reader038/viewer/2022110308/556e3f81d8b42a16278b4ccc/html5/thumbnails/38.jpg)
“The Pump”
Acute RV Strain => Pulmonary Embolism
![Page 39: Point of Care Cardiac U/S](https://reader038.vdocuments.net/reader038/viewer/2022110308/556e3f81d8b42a16278b4ccc/html5/thumbnails/39.jpg)
“The Pump”
RA Thrombus => Pulmonary Embolism
![Page 40: Point of Care Cardiac U/S](https://reader038.vdocuments.net/reader038/viewer/2022110308/556e3f81d8b42a16278b4ccc/html5/thumbnails/40.jpg)
Rush Probe Positions
Evaluate ‘The Tank’
![Page 41: Point of Care Cardiac U/S](https://reader038.vdocuments.net/reader038/viewer/2022110308/556e3f81d8b42a16278b4ccc/html5/thumbnails/41.jpg)
‘The Tank’
Evaluate IVC with Sniff Test
![Page 42: Point of Care Cardiac U/S](https://reader038.vdocuments.net/reader038/viewer/2022110308/556e3f81d8b42a16278b4ccc/html5/thumbnails/42.jpg)
‘The Tank’
Eval IVC with ‘Sniff test’ m-mode
![Page 43: Point of Care Cardiac U/S](https://reader038.vdocuments.net/reader038/viewer/2022110308/556e3f81d8b42a16278b4ccc/html5/thumbnails/43.jpg)
‘The Tank’
Eval IVC with ‘Sniff Test’ in case of High Filling Pressures
![Page 44: Point of Care Cardiac U/S](https://reader038.vdocuments.net/reader038/viewer/2022110308/556e3f81d8b42a16278b4ccc/html5/thumbnails/44.jpg)
‘The Tank’‘The Tank’
Fast Exam - Fluid in Morrison’s Pouch
![Page 45: Point of Care Cardiac U/S](https://reader038.vdocuments.net/reader038/viewer/2022110308/556e3f81d8b42a16278b4ccc/html5/thumbnails/45.jpg)
‘The Tank’
e-FAST Eval - Pleural Effusion
![Page 46: Point of Care Cardiac U/S](https://reader038.vdocuments.net/reader038/viewer/2022110308/556e3f81d8b42a16278b4ccc/html5/thumbnails/46.jpg)
‘The Tank’
e-FAST eval R/O PTX
![Page 47: Point of Care Cardiac U/S](https://reader038.vdocuments.net/reader038/viewer/2022110308/556e3f81d8b42a16278b4ccc/html5/thumbnails/47.jpg)
‘The Tank’
e-FAST Eval Pulm Edema
![Page 48: Point of Care Cardiac U/S](https://reader038.vdocuments.net/reader038/viewer/2022110308/556e3f81d8b42a16278b4ccc/html5/thumbnails/48.jpg)
RUSH Exam - Probe Sites
‘The Pipes’
![Page 49: Point of Care Cardiac U/S](https://reader038.vdocuments.net/reader038/viewer/2022110308/556e3f81d8b42a16278b4ccc/html5/thumbnails/49.jpg)
‘The Pipes’
Large Abdominal Aortic Aneurysm
![Page 50: Point of Care Cardiac U/S](https://reader038.vdocuments.net/reader038/viewer/2022110308/556e3f81d8b42a16278b4ccc/html5/thumbnails/50.jpg)
“The Pipes’
Acute Abdominal Aortic Dissection
![Page 51: Point of Care Cardiac U/S](https://reader038.vdocuments.net/reader038/viewer/2022110308/556e3f81d8b42a16278b4ccc/html5/thumbnails/51.jpg)
‘The Pipes’
Acute Thoracic Arch Dissection
![Page 52: Point of Care Cardiac U/S](https://reader038.vdocuments.net/reader038/viewer/2022110308/556e3f81d8b42a16278b4ccc/html5/thumbnails/52.jpg)
‘The Pipes’
Acute DVT of Femoral Vein
![Page 53: Point of Care Cardiac U/S](https://reader038.vdocuments.net/reader038/viewer/2022110308/556e3f81d8b42a16278b4ccc/html5/thumbnails/53.jpg)
Levels of Echo Competence
![Page 54: Point of Care Cardiac U/S](https://reader038.vdocuments.net/reader038/viewer/2022110308/556e3f81d8b42a16278b4ccc/html5/thumbnails/54.jpg)
Conclusions
POC U/S is a Wholistic Tool
We have Discussed the Available Cardiac U/S Views
We have Discussed in Detail the Rush Protocol for Shock
The Key to Mastery Is To ‘Probe’ Every Patient - This Requires Discipline in a Busy ED