Ultrasound Guided Volume Assessment Starr Knight, M.D. HIGH RISK - PowerPoint PPT Presentation

Ultrasound Guided Volume Assessment Starr Knight, M.D. HIGH RISK Hawaii Feb 14, 2014

Outline • IVC Ultrasound Technique • Clinical Use of IVC Ultrasound • Clinical Cases

IVC Ultrasound Exam • Exam Technique • Goals of the Exam • Pitfalls

Probe Selection

RA Liver IVC

RA Liver IVC

Hypovolemia Hypervolemia

Hypovolemia Hypervolemia

The “Sniff” Test Hypovolemia Hypervolemia

Caval Index

Ultrasound Protocols 1. Cardiac Ultrasound • RUSH 2. Lung Ultrasound • RADiUS • Triple Scan 3. IVC Ultrasound

Goals of the Exam Evaluate Pump Function Assess for Pulmonary Edema Interrogate IVC

Protocol 1. Cardiac Ultrasound 2. Lung Ultrasound 3. IVC Ultrasound

Clinical Cases

Septic

Before IVFs After 2L IVFs

CHF

Pulmonary Embolism

Cardiac Tamponade

Take Home Points • Distinguish IVC from Aorta • Eval IVC 2cm distal to RA-IVC junction • Use in conjunction with Cardiac and Lung ULS • Remember Conditions with ↑ R Cardiac Pressure • Serial Exams during resuscitation

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References • Volpicelli G, Mussa A, Garofalo G, et al. Bedside lung ultrasound in the assessment of alveolar- interstitial syndrome. Am J Emerg Med. Oct 2006;24(6):689-696. • Parlamento S, Copetti R, Di Bartolomeo S. Evaluation of lung ultrasound for the diagnosis of pneumonia in the ED. Am J Emerg Med. May 2009;27(4):379-384. • Cortellaro F, Colombo S, Coen D, et al. Lung ultrasound is an accurate diagnostic tool for the diagnosis of pneumonia in the emergency department. Emerg Med J. Oct 28 2010. • Lichtenstein D, Meziere G, Biderman P , et al. The comet-tail artifact: an ultrasound sign ruling out pneumothorax. Intensive Care Med. Apr 1999;25(4):383-388. • Lichtenstein D, Meziere G, Biderman P , et al. The comet-tail artifact. An ultrasound sign of alveolar- interstitial syndrome. Am J Respir Crit Care Med. Nov 1997;156(5):1640-1646. • Lichtenstein DA, Menu Y. A bedside ultrasound sign ruling out pneumothorax in the critically ill. Lung sliding. Chest. Nov 1995;108(5):1345-1348. • Alrajhi K, Woo M, Vaillancourt C. Test Characteristics of Ultrasonography for the Detection of Pneumothorax. CHEST.141(3) MARCH 2012 • Wu Ding W, Yuehong S ,Yang J. Diagnosis of Pneumothorax by Radiography and Ultrasonography.CHEST.140 (4) OCTOBER, 2011

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