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Point of Care Ultrasound UCSF Continuing Medical Education Cardiac - PowerPoint PPT Presentation

Point of Care Ultrasound UCSF Continuing Medical Education Cardiac Trevor Jensen, MD, MPH October 21-22, 2018 Disclosure I have no relevant financial relationships with any companies related to the content of this course. POCUS Cardiac and


  1. Point of Care Ultrasound UCSF Continuing Medical Education Cardiac Trevor Jensen, MD, MPH October 21-22, 2018

  2. Disclosure I have no relevant financial relationships with any companies related to the content of this course.

  3. POCUS Cardiac and IVC 


  4. Cardiac US • Keep it basic • Echocardiography is very complex • We will focus on the fundamentals that will help you care for your patients at the beside • These images will be used with the clinical history to make decisions on your patient

  5. Utility & Protocols • RUSH – Rapid Ultrasound in Shock – Patient is hypotensive or unresponsive • CLUE Protocol – Cardiopulmonary Limited Ultrasound Exam – Patient needs rapid assessment for heart failure • BLUE Protocol – Bedside Lung Ultrasound in Emergency – Patient is in respiratory failure

  6. Probe Selection Phased Array Low Frequency Small footprint to image between ribs

  7. How to Hold the Probe • Hold probe like a pencil • Brace hand on the patient • Larger motions that gradually become finer movements to improve image • Sufficient use of ultrasound gel

  8. Position of the Patient • Most likely will be supine in the ED/ Hospital/ICU • Left Lateral Decubitus will usually result in improved images

  9. Sonographic Windows • 3 Windows • Parasternal • Apical • Subcostal Slide adapted with permission from Arun Nagdev

  10. Parasternal Long Parasternal Short Subcostal Apical 4-Chamber

  11. Parasternal Long: Probe + Position

  12. Parasternal Long Anatomy Images obtained from echocardiographer.org

  13. Parasternal Long Axis View RV LV RV LV Ao Mitral Valve Leaflets DTA Slide adapted with permission from Arun Nagdev

  14. Parasternal Long: Interpretation • Utility – Effusion – LV Function • Indices – Movement of mitral valve leaflet tips (EPSS) – Movement of lateral mitral valve annulus – LV Wall Thickening – Change in chamber size • Functional Categories (all views) – Hyperdynamic – Normal – Mildly decreased – Severely decreased

  15. Parasternal Long: Normal

  16. Parasternal Long: Abnormal

  17. Parasternal Long Tips • Stay close to sternum • Sonographic windows and axes vary • Difficult in COPD • Look for the Mitral Valve

  18. Parasternal Short: Position

  19. Parasternal Short: Orientation

  20. Parasternal Short: Orientation

  21. Parasternal Short: Interpretation • Utility – Gross LV systolic function – Assessed at level of papillary muscles – Regional wall motion abnormalities – RV size

  22. Parasternal Short: Normal

  23. Parasternal Short: Abnormal

  24. Parasternal Short Tips • Stay close to sternum • Sonographic windows and axes vary • Difficult in COPD • Look for the Mitral Valve

  25. Subcostal View: Position

  26. Subcostal View: Orientation

  27. Subcostal View: Interpretation • Utility – LV Systolic Function – Pericardial Effusion – Right atrium and ventricle size

  28. Subcostal View: Normal

  29. Subcostal View: Abnormal

  30. Subcostal 4 Chamber View • Tips: • Firm pressure • Inspiratory hold • Bend the knees • Bowel Gas? Try right of midline • Great for COPD patients

  31. Apical 4 Chamber • Utility – Systolic function – Chamber size – Valvular abnormalities – Doppler measurements • Challenges – most difficult view to obtain – prone to errors in interpretation

  32. Apical 4 Chamber: Orientation

  33. Apical 4 Chamber: Normal

  34. Apical 4 Chamber: Abnormal

  35. Apical 4 Chamber • Tips : • Under the breast fold • Left lateral decubitus • End-expiratory hold • Aim sound waves 
 toward right scapula

  36. IVC: Position

  37. IVC: Orientation

  38. IVC: Measurement

  39. IVC: Interpretation • Location: • 2-3 cm caudal to RA or 0-1 cm caudal to hepatic vein • Metrics • Max diameter: 2.1 cm • Collapsibility: 50%

  40. Don’t fall for Aorta! IVC Aorta

  41. Fan IVC/Aorta/IVC •

  42. IVC: Abnormal

  43. Summary • Focus on the basic exams + basic interpretations first – Most evidenced based for non-cardiologists • Even basic exams have broad list of applications – Hypotension – Dyspnea – Volume overload – Unresponsiveness • Build towards more complex exams and protocols

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