This book covers point of care ultrasound (POCUS) in a practical, problem oriented and illustrated manner. It begins with introduction to the basic principles of medical ultrasound imaging and ultrasound guided interventions and outlines point of care ultrasound in a lucid manner for rapid learning for medical students as well as practitioners. It contains chapters on ultrasound of the airways, thoracic ultrasound including lungs and transthoracic screening echocardiogram, vascular assessment, ultrasound of the abdomen for focussed trauma assessment, gastric volume assessment and ultrasound guided interventions such as vascular cannulations, pleurocentesis, etc. along with some of the latest point of care ultrasound techniques such as ocular assessment and assessment of the foetus and placenta in the operation theatre.
This book will help the intensivist, emergency physician and anaesthesiologist to learn the basics of POCUS, which ostensibly, is the future of medical practice. It also includes objective structured clinical examination (OSCE) questions after every chapter as well as multiple choice questions (MCQs) that will benefit the students greatly. The book also includes videos from some of the celebrated practitioners of POCUS providing a unique learning experience.
This book is suited for students, trainees and practitioners alike. The modules of POCUS described here are part of the curriculum of anaesthesiology in the UK, USA, Singapore, Australia/ New Zealand and most of the countries. The book also covers the curriculum of POCUS in critical care and emergency medicine courses.
Author(s): Arunangshu Chakraborty, Balakrishnan Ashokka
Publisher: Springer
Year: 2022
Language: English
Pages: 201
City: Singapore
Foreword
Preface
Contents
1: Basics of Point-of-Care Ultrasound
1.1 Basics of Ultrasound: Physics and Physiology
1.1.1 Mechanism of Action
1.1.1.1 Interactions of Ultrasound with Tissue
1.1.2 Reflection
1.1.3 Transmission
1.1.4 Attenuation
1.1.5 Echogenicity
1.1.5.1 Modes of Imaging
1.1.5.2 Transducers
1.1.5.3 Time Gain Compensation
1.1.5.4 Practical Aspects
Compound Imaging
Maneuvering the US Probe: PART
Needling Techniques
In-Plane
1.1.5.5 Out of Plane
1.1.5.6 Bioeffect and Safety
1.2 Point-of-Care Ultrasound: Concept and Limitations
Self Assessment Questions
References
2: Ultrasound-Guided Vascular Cannulation
2.1 Introduction
2.2 Principle of Vascular Cannulation
2.2.1 Identification of the Blood Vessel
2.2.2 Depth, Distance, and Angle
2.2.3 Selecting the Transducer and Mode
2.2.3.1 Transducer
2.2.3.2 Mode
2.2.4 Preparation
2.2.4.1 Preprocedural Evaluation
2.2.4.2 Positioning/Room Set Up/Ergonomics
Patient
Operator
Equipment
2.3 Central Venous Cannulation
2.3.1 Internal Jugular Vein Cannulation
2.3.2 Subclavian Vein Cannulation
2.3.2.1 Anatomy of Subclavian Vessels
2.3.2.2 Ultrasound Assessment of Subclavian Vessels
2.3.2.3 Ultrasound-Guided Subclavian Vein Cannulation Technique
Infraclavicular Approach
Supraclavicular Approach
Ultrasound Assessment of SCV in the Fossa Above the Clavicle
Ultrasound-Guided SCV Cannulation
2.3.3 Femoral Vein Cannulation
2.3.3.1 Systematic Approach for USG Central Venous Catheter Placement
2.3.3.2 Femoral Vein Cannulation
Limitations of Ultrasound-Guided Central Venous Catheter Placement
2.3.4 Confirmation of the Correct Position of the Central Venous Catheter Tip
2.3.4.1 The European Society of Anesthesiologists Recommends [40]
2.4 Peripheral Venous Cannulation
2.4.1 Indications
2.4.2 Procedure
2.4.2.1 Initial Scout
2.4.3 Confirm Vein
2.4.3.1 Identify the Appropriate Vein
2.4.3.2 Preparation
2.4.3.3 Needle Insertion
2.4.3.4 Confirmation of Cannulation
2.4.3.5 Complications
2.5 Arterial Cannulations
2.5.1 Scout Scan
2.5.1.1 Preparation
2.5.1.2 Needle Insertion
2.5.1.3 Confirmation of Cannulation
2.5.1.4 Complications
2.5.2 Radial Artery Cannulation
2.5.3 Femoral Artery Cannulation
2.5.4 Arteria Dorsalis Pedis Cannulation
2.5.5 Posterior Tibial Artery Cannulation
2.5.5.1 Technique
2.6 Recommendations for Ultrasound-Guided Vascular Access [1]
2.7 Recommendations for Prevention of Mechanical Trauma or Injury
2.7.1 Catheter Insertion Site Selection
2.7.2 Positioning the Patient for Needle Insertion and Catheter Placement
2.7.3 Needle Insertion, Wire Placement, and Catheter Placement
2.7.4 Guidance of Needle, Wire, and Catheter Placement
2.7.5 Verification of Needle, Wire, and Catheter Placement
2.8 Recommendations for Management of Arterial Trauma or Injury Arising from Central Venous Access
2.8.1 Resource Preparation
2.8.2 Prevention of Infectious Complications
2.8.2.1 Intravenous Antibiotic Prophylaxis
2.8.2.2 Aseptic Preparation
2.8.2.3 Selection of Antiseptic Solution
2.8.2.4 Catheters Containing Antimicrobial Agents
2.8.2.5 Catheter Fixation
2.8.2.6 Insertion Site Dressings
2.8.2.7 Catheter Maintenance
2.9 Aseptic Techniques Using an Existing Central Venous Catheter for Injection or Aspiration
2.10 Recognized Benefits and Concerns about Ultrasound-Guided Vascular Access
2.10.1 Recognized Benefits
2.11 Concerns and Limitations of us-Guided Vascular Access
2.12 Training
2.12.1 Training for Ultrasound-Guided Vascular Cannulations
2.13 Conclusion
Self Assessment Questions: (Answer Keys at the End of the Chapter)
References
3: Point of Care Ultrasound of the Airway
3.1 Indications
3.2 Normal Anatomy
3.2.1 Ultrasound Appearance of Airway Structures
3.2.2 Normal Ultrasound Appearance of the Airway
3.2.2.1 Transducer Selection
3.3 Airway Devices
3.3.1 Endotracheal Tube (ETT)
3.3.1.1 Extubation
3.3.2 Supraglottic Airway (SGA)
3.3.3 Double Lumen Endotracheal Tube (DLT)
3.4 Airway Nerve Block
3.5 Clinical Pearls and Applications
3.5.1 Focused Rapid Ultrasound Review of the Upper Airway
3.5.1.1 Goals
3.5.2 Potential Ultrasound Predictors of Laryngoscopy
3.6 Summary
MCQs: Chose the Single Best Answer
References
4: Point-of-Care Ultrasound of the Lungs
4.1 Introduction
4.1.1 Ultrasound Properties of Lung
4.1.2 Types of Ultrasound Transducers for LUS
4.1.3 Performing LUS
4.1.4 Blue Protocol (Four-Point Method)
4.1.5 Ultrasound Image of Normal Lung
4.1.6 Lung Sliding and Lung Pulse
4.1.7 Pneumothorax
4.1.8 Limitations for Identification of Pneumothorax
4.1.9 Pulmonary Edema and Interstitial Lung Disease
4.1.10 Pleural Effusion
4.1.11 Consolidation
4.1.12 Atelectasis
4.1.13 Asthma/Chronic Obstructive Pulmonary Disease
4.1.14 Pulmonary Embolism
4.1.15 Lung Ultrasound in COVID-19
4.1.16 Role of LUS in Thoracic Interventions/Procedures
4.1.17 Advantages of LUS
4.1.18 Limitations
Self-Assessment Questions: Select the Best Answer
References
5: Point-of-Care Ultrasound of the Heart: Transthoracic Echocardiogram
5.1 Echocardiography
5.1.1 Background
5.1.1.1 Sonography Principles and Instrumentation
5.1.1.2 Normal Transthoracic Echocardiography (TTE)
5.1.1.3 Normal Transesophageal Echocardiography (TOE)
5.1.1.4 Left Ventricular Systolic Function Assessment
5.1.1.5 Left Ventricular Diastolic Function
5.1.1.6 Right Ventricular Function Assessment
5.1.1.7 Pulmonary Artery Pressures
5.1.1.8 Volume Assessment
5.1.1.9 Cardiac Output
References
6: Vascular Ultrasound
6.1 Introduction
6.2 Carotid Artery
6.2.1 Anatomy of Carotid Artery
6.2.2 Ultrasound Assessment of Carotid Artery
6.2.3 Duplex Ultrasound of Carotid Artery
6.3 Internal Jugular Vein
6.3.1 Anatomy of Internal Jugular Vein
6.3.2 Ultrasound Assessment of IJV
6.3.2.1 Anatomy of Subclavian Vessels
6.3.2.2 Ultrasound Assessment of Subclavian Vessels
6.4 Anatomy of Inferior Vena Cava
6.4.1 Ultrasound Assessment of IVC
6.4.2 Assessment of IVC with Ultrasound
6.4.3 Clinical Applications and Limitations of IVC as a Tool for Predicting Fluid Responsiveness
6.5 Abdominal Aorta
6.5.1 Anatomy of Abdominal Aorta
6.5.2 Ultrasound Assessment of Abdominal Aorta
6.5.3 Ultrasound Technique of Abdominal Aorta
6.6 Role of Ultrasound in the Deep Vein Thrombosis (DVT)
6.6.1 Anatomy of Upper Limb Veins
6.6.2 Ultrasound Assessment of Upper Limb Veins for DVT
6.6.3 Anatomy of Lower Limb Vessels
6.6.4 Ultrasound Evaluation of Femoral Vessels
6.6.5 Role of Ultrasound in the Evaluation for Deep Vein Thrombosis
6.6.6 Ultrasound Evaluation of Chronic Venous Insufficiency
6.6.7 Pitfalls and Artifacts of Using Ultrasound for DVT
6.6.8 Limitations of Ultrasound for the Diagnosis of DVT
6.7 Outcome Studies Related to DVT Assessment with Ultrasonography
Questions
References
7: Focused Assessment with Sonography in Trauma (FAST) Exam
7.1 Definition
7.2 Introduction/Background
7.2.1 History of the FAST Exam
7.2.2 Anatomy and Physiology of Fluid Collection in Body Cavities
7.2.3 Diagnostic Peritoneal Lavage
7.2.4 CT Scan in the Trauma Patient
7.3 Focused Question in FAST Exam
7.4 Indications of FAST Exam
7.5 Contraindications
7.6 Preparation
7.7 Position of Patient
7.8 Probe and Machine Preset
7.9 Scanning Technique
7.10 Views
7.10.1 Right Upper Quadrant View
7.10.2 Left Upper Quadrant View
7.10.3 Pelvic Cavity: Sagittal and Transverse Views
7.10.4 Pericardium
7.11 Extended FAST or e-FAST Scan
7.12 Limitations of FAST Scan
7.13 FAST Scan Flowchart (Fig. 7.18)
7.14 Reporting a FAST Scan
7.15 FAST Scan vs. US Abdomen
7.16 Caution
7.17 Summary
Self-Assessment Questions: Chose the Single Best Answer
References
8: Miscellaneous POCUS: Gastric Ultrasound, Urinary Bladder Ultrasound, Ocular Ultrasound, Obstetric POCUS
8.1 Introduction
8.2 Gastric Ultrasound
8.2.1 Introduction
8.2.2 Indications [3]
8.2.3 Limitations
8.2.4 Scanning Technique
8.2.5 Applied Anatomy
8.2.5.1 Gastric Antrum
8.2.5.2 Gastric Wall
8.2.6 Ultrasound Image Correlation (Table 8.1)
8.2.6.1 Empty Stomach
8.2.6.2 Solid Early Stage
8.2.6.3 Solid Late Stage
8.2.6.4 Clear Fluid
8.2.6.5 Fluid with Air Bubbles
8.2.7 Gastric Volume Assessment (Clear Fluids)
8.2.7.1 Antral Grading System (Grades 0–2) [5] (Table 8.2)
8.2.8 Qualitative Versus Quantitative Assessment
8.3 Point-of-Care Ultrasound Examination of Urinary Bladder
8.3.1 Introduction
8.3.2 Indications
8.3.3 Following Topics Will Be Covered in this Description
8.3.4 Patient Position
8.3.5 Ultrasound Probe Selection
8.3.6 Technique [7]
8.3.7 Calculation of Bladder Volume
8.4 Point-of-Care Ultrasound Examination of Eye
8.4.1 Optic Nerve Sheath Diameter (ONSD)
8.4.1.1 Introduction
8.4.1.2 Anatomic Correlation
8.4.1.3 Advantages
8.4.1.4 Limitations
8.4.1.5 Procedure for Ocular Ultrasound
8.4.1.6 Conclusion
8.4.2 Consensual Light Reflex [12]
8.4.2.1 Introduction
8.4.2.2 Ultrasound Views
8.4.2.3 Assessment of Consensual Light Reflex
8.4.2.4 Central Retinal Artery Occlusion (CRAO) [13]
8.4.2.5 Vitreous Versus Retinal Detachment [14]
8.5 Point-of-Care Obstetric Ultrasound
8.5.1 Introduction
8.5.2 Anatomical Correlation
8.5.3 Scope of a POCUS in Second- or Third-Trimester Ultrasound Examination
8.5.4 Image Acquisition
8.5.5 Scanning Procedure for Transabdominal Examination Technique (Figs. 8.15 and 8.16)
8.5.6 Applications
8.5.7 Limitations
Questions
References
9: POCUS: What does the Future Hold?
9.1 Introduction
9.2 Artificial Intelligence
9.2.1 Deep Learning
9.3 Handheld Ultrasound (HHU)
9.4 Contrast-Enhanced Ultrasound (CEUS)
9.5 Tele-Ultrasound
9.6 Conclusion
Self-Test MCQ (20 Questions)
References
Answer Keys
Chapter 1
Chapter 2
Chapter 3
Chapter 4
Chapter 6
Chapter 7
Chapter 8
Chapter 9
