Atlas of Critical Care Echocardiography

Preface
Acknowledgments
Contents
Contributors
Part I: Imaging
Obtaining, Interpreting, and Using Echo
1 Introduction
2 Ultrasound Knobology
2.1 Echogenicity (Fig. 1)
2.2 Knobs and Terms (Table 1)
3 Ultrasound Scanning Modes
3.1 B Mode or Two-Dimensional (2D) (Fig. 2 Upper Panel, Video 1)
3.2 M Mode (Fig. 2 Lower Panel)
3.3 Doppler Modes (Fig. 3)
3.3.1 Types of Doppler
4 Ultrasound Transducers (Fig. 4)
4.1 Curvilinear
4.2 Linear
4.3 Phased Array
5 Transducer Movements (Fig. 5)
6 Exam Types and Presets (Fig. 6)
7 Measurements in Point-of-Care Ultrasound
Suggested Reading
Parasternal Long Axis
1 Introduction
2 Obtaining the PLA
2.1 Image Orientation (Fig. 2)
3 Assessments and Measurements
4 Ideal Image (Fig. 3)
5 Tips and Pointers
6 Special Considerations
Suggested Reading
Parasternal Short Axis
1 Introduction
2 Obtaining the Parasternal Short Axis
2.1 Image Orientation (Fig. 2)
2.2 Ideal Images
3 Assessment and Measurements
4 Tips and Pointers
Suggested Reading
Apical 4 Chamber and Apical 5 Chamber
1 Introduction
1.1 Obtaining the AP 4
1.2 Obtaining the AP 5
1.3 Image Orientation
1.4 Ideal Image (Fig. 2)
1.5 Assessments and Measurements
1.6 Troubleshooting/Pointers
Suggested Reading
Subxiphoid Cardiac and Inferior Vena Cava Views
1 Introduction
2 Obtaining the Subxiphoid View
3 Obtaining the IVC Window
4 Image Orientation Cardiac Presets
5 Image Orientation Abdominal Presets for the FAST and RUSH
6 Ideal Image
7 Assessments and Measurements
8 Tips and Pointers
Suggested Reading
Liver Doppler
1 Introduction
2 Obtaining the Hepatic PWD
3 Obtaining the Portal Pulsed Wave Doppler
4 Tips and Pointers
Suggested Reading
Renal Doppler
1 Introduction
2 Obtaining the Renal Doppler Image
3 Renal Venous Assessments
4 Renal Arterial Assessments
5 Troubleshooting and Pointers
Suggested Reading
Thoracic Ultrasound
1 Introduction
2 Uses for Thoracic Ultrasound in Shock
3 Obtaining the Thoracic Views
4 Normal Anatomical Structures (Fig. 4)
5 Artifacts (Fig. 5)
6 Tips and Pointers
7 Special Considerations
Suggested Reading
Part II: Measurements and Interpretation
Left Ventricular Ejection Fraction and E-point Septal Separation
1 Introduction
2 LVEF and EPSS
2.1 Uses for LVEF and EPSS
2.2 Obtaining the Views LVEF and EPSS
3 Visual Estimation of the LVEF
4 Measurement of EPSS
5 Special Considerations
References
Stroke Volume, Cardiac Output, and Systemic Vascular Resistance
1 Introduction
2 SV and SV Index (SVI)
2.1 Uses for SV
2.2 Measurement of SV
2.3 Tips and Pointers
2.4 Equation for SV
2.5 Special Considerations
3 Cardiac Output and Cardiac Index (CO and CI)
3.1 Uses for CO
3.2 Measurement of CO
3.3 Equations for CO and CI
4 Systemic Vascular Resistance (SVR) and SVR Index (SVRI)
4.1 Uses for SVR
4.2 Measurement of SVR
4.3 Equation for SVR
4.4 Measurement of SVRI
4.5 Special Considerations
Suggested Reading
Diastolic Function
1 Introduction
2 Diastolic Function
3 Obtaining the Measurements LV Diastolic Function
3.1 Pulsed Wave Doppler Through the Mitral Valve: E and A (Fig. 1)
3.2 Tissue Doppler at the Lateral Mitral Valve Annulus: e′ and a′ (Fig. 2)
4 Interpreting Measurements: Grading LV Diastolic Function (Figs. 3 and 4)
5 Obtaining Measurements of RV Diastolic Function
5.1 Pulsed Wave Doppler Through the Tricuspid Valve: ETRV and A TRV
5.2 Tissue Doppler Imaging at the Lateral Mitral Annuls: e′TRV and a′TRV
5.3 Interpreting RV Diastolic Dysfunction Measurements
6 Tips and Pitfalls
Suggested Reading
Right Ventricular Systolic Function
1 Introduction
2 RV Dysfunction
3 Uses for RV Assessment
4 Obtaining Views
4.1 Visual Estimation of the RV
4.2 Tips and Pointers
4.3 Measurement of Transannular Plane Systolic Excursion (TAPSE) (Figs. 2 and 3)
4.4 Measurement of Peak Systolic Velocity at the Tricuspid Valve (S′TRV)
5 Tips and Pointers for TAPSE and S′
6 Special Considerations
7 Normal and Reference Values
Suggested Reading
Pulmonary Hypertension
1 Introduction
2 Pulmonary Artery Pressures
3 Visual Inspection the RV and LV in All Windows (Fig. 1)
4 Assessment with the Tricuspid Regurgitant Jet (Fig. 2)
5 Assessment of Flow Through the Right Ventricular Outflow Tract
Suggested Reading
Inferior Vena Cava Respiratory Variation
1 Introduction
2 Obtaining the Views and Calculating Measurements
3 Interpreting Measurements
4 Tips and Pitfalls
Suggested Reading
Stroke Volume Variation
1 Introduction
2 SVV with Respiratory Peak Velocity Variation
3 Uses VTI RV
4 Window and Mode
5 How to Measure SVV with VTI Vpk Variation
6 Special Considerations When Using APV and VTI Variation for SVV Assessment
7 SVV with Passive Leg Raise
Suggested Reading
Pulmonary Findings
1 Introduction
2 Uses for Lung Assessment
3 B-Lines as Evidence of Pulmonary Edema
4 Tips and Pointers
5 Special Considerations
6 Pleural Effusion, Consolidation, and Collapse
7 Pneumothorax
8 Evaluation of Pneumothorax by M-Mode
9 Tips and Pointers
Suggested Reading
Right Atrial Pressure Assessment
1 Introduction
2 Estimation of RAP for Calculations of SVR and PA Systolic Pressure
3 Detection of Venous Congestion from Elevated RAP
4 Other Assessments
4.1 Right Ventricular Diastolic Function
4.2 Inferior Vena Cava
4.3 Special Considerations
Suggested Reading
Potpourri of Pathology
1 Introduction
2 Case 1: Cardiac Tamponade
3 Case 2: Pulmonary Embolism
4 Case 3: COVID-19 Pneumonia
5 Case 4 Severe Aortic Stenosis
6 Case 5 Endocarditis
Suggested Reading
Part III: Shock Protocols
The Focused Sonogram for Trauma (FAST)
1 Introduction
2 Uses
3 The FAST Protocol
4 Tips and Pointers
5 Special Considerations
Suggested Reading
The Rapid UltraSound in Shock (RUSH)
1 Introduction
2 Uses
3 FAST and RUSH Protocols
4 Tips and Pointers
5 Special Considerations
Suggested Reading
Cardiac Arrest Sonographic Assessment (CASA)
1 Introduction
2 Uses for CASA
3 CASA Protocol
4 Tips and Pointers
References
Part IV: The Focused Rapid Echocardiographic Evaluation (FREE)
There Is No @#$% Tank! It is a Pump!!
1 Introduction
2 There Is No @#$% Tank! It Is a Pump!!!
3 The Capillary Bed
Suggested Reading
Echo-Based Shock Physiology
1 Introduction
2 Presentation of Shock
3 Optimizing Perfusion vs. Resuscitation
4 Phases of Shock (Fig. 1)
5 Medical vs. Surgical Shock
6 Therapies to Optimize Perfusion in Shock
7 Hypotension vs. Shock
Suggested Reading
The Focused Rapid Echocardiographic Evaluation (FREE)
1 Introduction
2 Uses
3 FREE Protocol
4 Pre-imaging Assessment
5 Ultrasound Imaging in the FREE (Fig. 1)
6 Measurements and Analysis
7 Hemodynamic Profiles and Treatment Recommendations
8 Operationalizing the FREE
9 Tips and Pointers
10 Special Considerations
Suggested Reading
Fluid Strategies in the FREE
1 Introduction
2 Effects of a Fluid Bolus
3 Fluid Liberal vs Fluid Conservative (Figs. 1 and 2)
4 Surgical Patients
Suggested Reading
Hemodynamic Profiles in the FREE
1 Introduction
2 Hemodynamic Profiles
3 Assessing the Profiles
4 Normal × 3 (Happy Heart)
5 Underfilled (Hummingbird)
6 Vasodilated
7 Dysfunctional (Sad Heart)
8 Mixed Profiles
Suggested Readings
The Focused Rapid Echocardiographic Evaluation (FREE): Clinical Examples
1 Introduction
2 Quantitative Measurements in the FREE
3 Case 1: Trauma Patient with Decreased Urine Output
4 Case 2: Overdose with Respiratory Failure and Hypotension
5 Case 3: Postoperative from a Major Ventral Hernia Repair with Hypotension
6 Case 4: Hospital-Acquired Pneumonia and Hypotension
7 Case 5: COVID-19 Requiring ECMO with Hypotension and Worsening Hypoxia
Suggested Reading
Index