pocus Flashcards by Elisabeth Tribeck

what is the FATE exam

Focused assess transthoracic echocardiogram
IVC assessment

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what can be assessed in a pulm echo

normal lung
pnuemothorax
pulm edema
pleural effusion
diaphragm assessment

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what can be assessed in abdomen US

gastric
FAST
Bladder

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what are the three types of POCUS probes

linear
curvilinear
phased

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what is linear probe used for

central lines,
PIC,
lung ultrasound,
superficial structures,
crisp images,
high frequency
nerve blocks

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what is curvilinear probe used for

FAST exam,
gastric ultrasound,
deep 4-8 cm,
low frequency,
images not crisp but better depth

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what do we use phased array probes for

cardiac, pulmonary, gastric
smaller footprint
fewer PZE crystals activated in different phases to allow steering of the beam and a small footprint (in between ribs)
transthoracic

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how does a low gain present

darker

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how does a high gain present

white out

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what is TGC

Time gain compensation
helps keep the brightness of same tissues the same

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what are hyperechoic structures

dense structures are white:
bone, needle, nerve bundles

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what are hypoechoic structures?

grey, less dense structures:
lymph nodes, nerves

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what are anechoic structures

black: air and fluid

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what pattern do nerves appear as

hypoechoic areas separated by hyperechoic
honeycomb

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What is the seashore sign? in lungs

on M-mode structures above pleural line dont move (lines)
pleura below moves (sand)
normal finding

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what is stratosphere sign or barcode sign in lungs

straight lines all the way through, air in between parietal and visceral pleura
abnormal- pnueomothorax

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what is a lung pulse

small lung movements with cardiac pulsations

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when do you usually see lung pulse

apneic patients

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what does a lung pulse mean

lung that is aerated but not ventilated
also means there is no air between the pleura

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what are B-lines in lungs

hyperechoic beams emanating from the pleural line and extending through the field
moves with lung sliding

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what does 1-2 B lines and lower lobes tell you

normal in dependent areas

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what do many B lines suggest

pulm edema

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what are A-lines in lungs

normal horizontal artifact at regular intervals

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what are normal lung signs on US

lung sliding
A-lines
1-2 B lines
seashore sign

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what are pneumothorax lung signs

no lung sliding no B lines no lung pulse stratosphere sign LUNG POINT

how accurate is lung point sign for pneumo

95-100%

what is a lung point

interface between aerated and non-aerated lung seashore and barcode sign intermittent in M mode

what are the steps to determining pneumo on ultrasound

lung sliding (no=pneumo) B-lines (no=pneumo) Lung pulse (no=pneumo) Seashore (no=pneumo) stratosphere with Lung Point= pnemo

what probe do you use for a pleural assessment

linear at the axillary line

what is spine sign indicative of

pleural effusion

where do you find spine sign

axillary line, base of lung

how does spine sign present

dark anachoic triangle with spine visible is abnormal and indicative of pleural effusion

why is spine not usually visible through lung

ultrasound cant move through air

where do you perform diaphragm assessment

zone of apposition

how do you position the probe for diaphragm assessment

point it cephalad

what is a normal diphragm sign

30% thickening at end inspiration

what is occurring if the diaphragm does not thicken by 30%

diaphragmatic peresis

what would you do FATE exam for pre op

screen high risk volume assess

what would you use FATE exam for post-op

MI pulm embolism hypovolemia

what complication can FATE exam differentiate

MI, PE, Tamponade, LV failure

what is goal of FATE exam

abnormal vs normal exclude obvious pathology assess wall thickness assess contractility evaluate volume status

what probe is preferred for FATE exam

phased array

what are the four parts of FATE exam

1. subcostal 2. apical 4-chamber 3. PLAX (long Axis) 4. PSAX (LV short axis)

where do you place probe for subcostal 4-chamber view of FATE exam

below xiphoid pointed toward shoulder

how does pericaridal effusion appear

anachoic line around heart

how should legs be placed in abdomen

down so abd doesnt push on chest

what are you looking for in subcostal 4-chamber view of FATE

MV/TV disease pericardial effusion massive PE hypovolemia

what is viewable in the subcostal IVC view

IVC, RA, Liver

what are indications for subcostal IVC view

fluid status

how can you get CVP from FATE

max IVC- min IVC/maxIVC (after sniff) x100

a 50% change in IVC diameter with respiration indicated

hypovolemia

where do you put probe for apical 4C view

PMI then into axillary line, patient must be as much on left side as possible

what is the first strucutre you hit in apical 4C view

which direction does the IVS move in contraction

towards LV

what are indications for apical 4C view

cardiac function MV/TV pericardial defects septal wall defects massive PE hypovolemia

where do you place probe for PLAX (parasternal long axis) of FATE exam

2-3 ICS LSB orientation towards R shoulder

what is indication for PLAX

cardiac function AV/MV pericardial infusion aortic stenosis hypovolemia

how should RV diameter appear

<3.3 CM or it is dialated internal no more than 2/3 of LV apex no more than 2/3 of LV

where do you position probe for PSAX (parsternal short axis) view

2-3 ICS towards L shoulder

what are indications for PSAX view

cardiac function pericardial effusion massive PE hypovolemia

what are findings of a massive PE

enlarged RV flattened LV IVC (D sign) McConnel sign in apical 4c view

what is the goal of gastric ultrasound

decrease incidence of aspiration

when do you do gastric ultrasound

patient is not NPO delayed gastric emptying inability to communicate dishonest patient

what can you tell from gastric ultrasound

gastric volume participate load gastric function

what probe do you use for gastric ultrasound

curvilinear on abd setting, indicator toward head

how do you position patient for abd exam

start in supine position follow with the right lateral decubitus position

do you say a stomach is empty based on supine alone

what strucutres border the gastic antrum

L border of liver pancrease

what indicates an empty gastric antrum

donut look/bulleseye

how does clear liquid appear on US

anachoic

what does stary night appearance of antrum tell us

just drank carbonated liquid

how do you assess liquid volume from stomach

r lateral decubitus

what is a grade of 0 of antral grading

empty in both supine and TLD minimal volume low aspiration risk

what is a grade 1 of antral grading

empy in supine, clear fluid in RLD <1.5 ml/kg compatable with baseline gastric secretions low risk of aspiration

what is a grade 2 of antral grading

clear fluid visible in both positions >1.5 ml/kg in excess of baseline gastric secretions high risk of aspiration

how does recently ingested food appear on gastric US

frosted glass appearance due to ingested air with food

how does digested food appear on US

hypoachoic (grey)

what does a FAST exam identify

focused assess sonogram for trauma patients looking for blood

where does FAST exam look for fluid

peritoneal retroperitoneal pericardial

what is in the retroperitoneal space

kidney IVC aorta colon

What is in the infraperitoneal area?

bladder distal rectum

how much blood does FAST exam detect

>200ml

how much fluid is in 1 cm of hypoechoic space

150 ml

where does blood in upper abd collect

morisons pouch RUQ (from RUQ and LUQ down phrenicolic ligament)

what if you see blood in LUQ

then morisons pouch is full, lots of blood

where does blood from lower abd collect

bladder wall

where is morisons pouch

RUQ between liver and kidney

what structures do you look for in morrisons pouch

pleural space infradiphragmatic space caudal liver tip hepatorenal space (actual pouch)

what position is patient in for FAST

supine

where is probe for FAST EXAM

start MCL, slide to MAL 10th rib

what is the LUQ fast exam view

parasplenic view

what is the area of fluid accumulation around bladder

pouch of douglas or pelvic couldesac

where should orientation of probe be for pelvic FAST

right

where does fluid appear in pelvic FAST

around bladder

what is the sign of the ETT in tracheal lumen

double tract or double lumen sign

what is soft tissue value for US speed

1540

what is lung value for US speed

500