Echocardiography

The use of echocardiography in the critically ill patient is becoming increasingly essential skill that all emergency physicians should become familiar, competent and comfortable using.

The indications for its use are increasing as operator skill and proficiency improves and as ECHO is combined into algorithms with other scanning modalities.

Indications include:

  • The Undifferentiated Hypotensive Patient

  • Cardiac Arrest

  • Trauma

  • Chest Pain

  • Shortness of Breath

 

THERE ARE 5 MAIN ECHO VIEWS TO OBTAIN:

  • PARASTERNAL LONG AXIS

  • PARASTERNAL SHORT AXIS

  • APICAL 4 CHAMBER

  • SUBCOSTAL

  • SUBCOSTAL IVC VIEW

 

INTRODUCTORY SONOSITE HOW TO ECHO VIDEOS

Courtesy of www.emergencyultrasoundteaching.com

 

RUSH Examination

(Rapid Ultrasound in Shock and Hypotension)

 

ULTRASOUND IN SHOCK (5MIN SONO)

RUSH EXAM (EMCRIT)

In 2008 Weingart et. al. developed the RUSH exam for evaluation of the critically ill and hypotensive patient.

It incorporates elements of a basic echo exam, eFAST and vascular evaluation to narrow the differential diagnosis in the shocked patient.

RUSH ORIGINAL ARTICLE (EMCRIT)

This is an examination which can rapidly rule out or demonstrate causes of hypotension.

 

 

The sequence follows the HI-MAP acronym:

 

Heart

  • Parasternal long and then Apical 4 chamber cardiac views, with the general purpose or cardiac probe

IVC

  • View with the same probe

Morison's Pouch

  • If not already using it, switch to general purpose abdominal probe and scan Morison’s and splenorenal views with thorax images and then examine the bladder window.

Aorta

  • Increase your depth and find the Aorta above and below the renal artery with four views.

Pneumothorax

  • Scan both sides of the chest for Pneumothorax. LINEAR PROBE IS BEST.

 

 

Like anything, time to practise...