Bedside Echocardiography

imagesIdentifying the presence or absence of cardiac activity in cardiac arrest


imagesIdentifying the presence or absence of pericardial effusion and differentiating from pleural effusion


imagesIdentifying the presence or absence of cardiac tamponade


imagesAssessing regional wall motion abnormalities in the diagnosis of myocardial infarction


imagesAssessing right ventricular size and function in cases suspicious for pulmonary embolism


CONTRAINDICATIONS



imagesNone: No contrast or radiation involved


PROBE SELECTION AND IMAGING



imagesUse a standard 2.0- to 5.0-MHz microconvex or phased-array probe


imagesAt least two of the four views of the heart are required for diagnosis and billing


imagesOrient the probe marker to the top left of the screen


imagesMethods of enhancing image acquisition include the following:


   imagesKeep the complete ultrasound probe in contact with the chest wall and angle, rotate, and tilt the ultrasound probe as necessary


   imagesUse an adequate amount of gel during bedside echocardiography


   imagesTry alternative cardiac echocardiography views


   imagesTurn the patient in the left lateral decubitus position to bring the heart closer to the anterior chest wall


LANDMARKS: FOUR STANDARD VIEWS



imagesSubxiphoid (Sx) View: (FIGURE 11.1)


   imagesPlace the probe in Sx position of abdomen, facing toward the patient’s left shoulder, with the probe marker toward the patient’s right


   imagesIf the heart is not adequately viewed, move the probe to the patient’s right using the liver as an acoustic window. Asking the patient to take a deep breath will push the heart inferior toward the probe


   imagesA moderate amount of pressure may be required for optimal viewing; however, this view is limited by body habitus and pain


   imagesThis view’s utility is predominantly to assess for cardiac activity or pericardial effusion in the setting of trauma (as a part of the focused abdominal sonography for trauma [FAST] examination)


imagesParasternal Long (PSL) View: (FIGURE 11.2)


   imagesPlace the probe just left of the sternum in the third/fourth intercostal space and directed toward the patient’s heart, with the probe marker directed toward the patient’s left elbow


   imagesThis view should be your main view—other views can be obtained by slight changes in probe positioning from here


   imagesA proper PSL view requires the apex of the left ventricle (LV), the mitral valve, and the aortic valve to be in view


   imagesJust deep to the posterior pericardium is the descending aorta


   imagesIn this view you can assess regional wall motion, valve function, septal movement, and proximal aorta size, and differentiate pericardial effusion from pleural effusion


imagesParasternal Short-Axis (PSA) View: (FIGURE 11.3)


   imagesFrom a PSL view, rotate the probe 90 degrees clockwise (toward the patient’s right hip)



images


FIGURE 11.1 Subxiphoid view.

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Aug 9, 2016 | Posted by in EMERGENCY MEDICINE | Comments Off on Bedside Echocardiography
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