Ultrasound for suspected thoracic dissection is an excellent tool to decrease time to diagnosis and treatment for this high mortality diagnosis. When scanning for suspected thoracic dissection, combine a parasternal long view with an abdominal aorta view for maximum sensitivity. Start with the parasternal view to look for dilation of the aortic root > 4 cm or a visible dissection flap. You should also look for a flap in the descending thoracic aorta (found just deep to the left atrium). A quick peek at the abdominal aorta can also give you valuable information. If there is visible dissection flap in the setting of chest pain, this suggests there’s also a thoracic dissection. If you have a positive scan for dissection that has fluid around the heart, this is extra bad and resources should be mobilized ASAP. Just like any test, you have to know its limitations. With sensitivities ranging from 77-96% it’s not a sufficient rule out test for dissection. Think of ultrasound as a rule in test that will save time to diagnosis and treatment for this life threatening condition, so pick up the probe the next time you think thoracic aortic dissection.
Even time you use too much depth a kitten dies…. or you greatly reduce your image quality and image the bed instead of the patient. Not only does it shrink the size of what you’re looking at, but it also moves your structure of interest out of the focal zone (you know the area of highest image resolution in the mid field of the ultrasound screen). Plus it adds poor quality images to the patient’s chart with your name, so don’t do it and think of the kittens.
Know your right from left heart. In a perfect world probe positioning would be right every time and you’d just know the right heart is on screen left. However no one is perfect and it’s important to know your right from left heart to prevent errors like calling right heart strain when there isn’t. Here are some tips to help (even when your image is flipped like this one):
Descending thoracic aorta is associated with the left atrium
Look for left ventricular outflow tract/aortic valve in left ventricle
Tricuspid valve insertion onto septum is more apical
Tapered right ventricle shape
Moderator band is sometimes visible in the right ventricle
Hemodynamically unstable, sick patient have high mortality and morbidity. Their physical exam findings can be misleading and the diagnosis still broad or unclear even after examination. When time counts and your patient is sick, bedside ultrasound can quickly make the diagnosis to help you provide appropriate and definitive care when it matters most. This is the basis for the SonoSave series, which examines ultrasound saves and the critically ill patients alive today because of point of care ultrasound.
Intro
Ultrasound is a lifesaver and luckily for a recent patient I mean this literally. Thanks to the early use of ultrasound a life was saved that would have been lost. A critical diagnosis was made within 5 minutes of arrival, preventing investment of precious time in ineffective treatments or delaying definitive care and making me look real slick in the process. The patient was successfully treated and admitted to the ICU. When I walk into work the next day, I find out the patient is not only alive but sitting up in bed talking to the team! With some simple ultrasound views and less than 2 minutes, the direction of our treatment completely changed and a man lived to see his family that I doubt would have otherwise. Two minutes to save a life… that’s some good stuff and even better ultrasound! These are the moments that make medicine worth it.
There are a few cases I could talk about… Ultrasound guided LPs have turned out to be a surprisingly useful skill. Lucky for you, I’ve restrained myself.
The first time I heard about ultrasound guided LPs was during a spectacular yearlong ultrasound elective in medical school. I was sitting in the doctor’s pod with THE ultrasound attending of ultrasound attendings. He casually asked “Have you ever heard of ultrasound guided LPs?” Never. “Do you want to see one?” Obviously. He explained how ultrasound guided LPs follow the principle of “Measure twice. Cut once.” He spent a minute (and I mean literally just one minute) visualizing the spinal landmarks and marking them on a somewhat altered, seriously chunky patient. He proceeded to get the LP in one stick! I remember thinking he was a wizard in that moment, a wizard who uses ultrasound to elevate patient care to another level; and that I want to be the badass attending that gets LPs on obese, altered patients in one stick. I had to learn this skill… Continue reading Getting to the Point of Ultrasound Assisted Lumbar Punctures→
The latest SonoMojo ultrasound cheat sheet has arrived! The Soft Tissue Ultrasound Cheat Sheet is a brief review of soft tissue ultrasound and it’s applications. Use it to quickly review the essentials before performing a scan or as an overview of soft tissue ultrasound before diving into the Soft Tissue Ultrasound Module.
In case you haven’t heard of “Ultrasound Cheat Sheets”… they’re all the basic info you need to review before performing (or teaching) a specific ultrasound scan. They are 1-2 pages long and consist of an brief check list of information on the application, image acquisition, and interpretation of a scan.
Hey sono enthusiasts! Exciting news! SonoMojo was recently featured on Critical Care Practioner Podcast! “Episode 37: How to Make Ultrasound Easier” features myself and the SonoMojo site in an episode discussing how to make learning ultrasound easier through #FOAMed resources and strategies for learning ultrasound. I’m so thrilled about the whole experience and getting to work with fellow FOAMer Jonathan Downham. Jonathan is a class act and he’s put together a great episode! Be sure to check it out!
That’s right! The Life in The eFAST Lane series is back!Last time we reviewed eFAST basics and half of the eFAST technique. Hopefully you’ve been practicing the heart, RUQ, and LUQ scans like my friend below. So without further adieu…. I give you eFAST Part Deux!
Figure 1 – An eFAST Rockstar in Action
Figure 1 – An eFAST Rockstar in Action
How to Do I Perform an eFAST? (Continued from Part 1)
Pelvis
Probe position
Probe marker towards patient’s head (longitudinal view) or towards patient’s right (transverse view).
Place the probe just above the pubic symphysis and look for the bladder in men and both the bladder and uterus in women.
If it’s not awkward, it’s not right and you’re not low enough.
Once you’ve completed the longitudinal view, turn your probe 90° for the transverse view. Both views should be evaluated to avoid false positives.
This curriculum is entirely FOAMed based! That means that all the education provided by these links is free. These resources are from the best of the best in ultrasound, so the education is some of the highest quality available. The curriculum is broken down into sections (like cardiac or procedures) with modules containing a collection of resources for a particular scan. This is by far the most useful SonoMojo resource and my favorite part of the site, so please enjoy! And as always, feedback is welcome!
