ACOEP Ultrasound Course November 2nd, 2019

Cardiac PLAX:

3rd or 4th intercostal space. Probe marker towards patient’s right shoulder Structures to visualize: LA, MV, LV, LVOT, RV, Descending Thoracic Aorta (DTA) Can use E-point septal separation for estimating EF DTA can differentiate pericardial (anterior) vs pleural effusion (posterior)

PSAX: Probe Marker towards patient’s left shoulder True short axis at level of papillary muscles Good for “eyeball method” for estimating EF

Apical 4: Indicator to patient’s left 4th or 5th intercostal space at PMI Best for looking at Right Ventricle Normal: RV 2/3 of LV. Abnormal when > 1:1 ratio

Subxiphoid: Indicator to patient’s left Use liver as acoustic window View often used in FAST exams

EPSS: E point Septal Separation E wave: mitral valve opening in diastole A wave: atrial kick <7mm normal >1cm depressed EF Caveats: Mitral valve pathology, severe LVH

IVC: Look for IVC dumping into Right Atrium If measuring IVC measure 1cm past hepatic vein or 2-3cm past right atrium

Aorta: Proximal – “Seagull Sign”

Mid – “mantle clock sign” Splenic Vein, SMA, Left Renal Vein, Mid Aorta

Distal – Proximal to Bifurcation

Normal Measurements: < 2 cm normal 2-3 cm ectactic > 3 cm aneurysmal (Iliac Vessels are half – Iliac Aneurysms are >1.5cm)

Ultrasound Guided Peripheral IVs: Vein – thin walled, fully collapsible, no arterial pulsations

Procedure Steps: Find Vein to Cannulate Place Probe Cover* and Sterile Gel on Probe Clean skin Center Vein on Screen Advance Needle - Probe - Needle - Probe *Always being aware of needle tip Confirm Correct Placement and secure Line

Fascia Iliaca compartment nerve block Main Indication: Hip fracture Keep needle tip at least 1 cm away from femoral artery to avoid vascular injury. Be aware of possible complications: Local Anesthetic systemic Toxicity ( LAST)