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Emergency Medicine, An Issue of Ultrasound Clinics, E-Book

Emergency Medicine, An Issue of Ultrasound Clinics, E-Book

Mike Blaivas

(2014)

Abstract

Emergency Ultrasound is comprehensively reviewed by guest editors Michael Blaivas and Srikar Adhikari. Articles will include: introduction, history and progress of emergency ultrasound; airway and thoracic ultrasound; procedural guidance with ultrasound in the emergency patient; pearls and pitfalls: common ultrasound applications and risk management strategies; ultrasound protocol use in the evaluation of an unstable patient; pediatric emergency ultrasound; pelvic ultrasound; focused cardiac ultrasound in the emergent patient; vascular ultrasound in emergency medicine; symptom-based ultrasound; ENT ultrasound; superficial and MSK ultrasound: select applications, and more!

Table of Contents

Section Title Page Action Price
Front Cover Cover
Emergency Ultrasound\r i
copyright\r ii
Contributors iii
Contents vii
Ultrasound Clinics\r xi
Preface\r xiii
History, Progress, and Future of Emergency Ultrasound 119
Key points 119
References 120
Pitfalls and Pearls in Emergency Point-of-Care Sonography 123
Key points 123
FAST 123
Pitfalls 123
Pearls 123
Thoracic POCS 125
Pitfalls 125
Pearls 127
Aorta POCS 127
Pitfalls 127
Focused Cardiac Ultrasonography in the Emergent Patient 143
Key points 143
Case 144
Cardiac function assessment 144
Global Cardiac Contractility/Systolic Function 145
Chamber shape and size 145
Qualitative Assessment of Global LV Systolic Function 145
Quantitative Assessments of LV Systolic Function 145
Measurements 145
Cardiac Output 146
E-Point Septal Separation 147
Aortic Root Displacement 148
Case 149
Diastolic function 150
Assessment Methods 150
M-mode 150
Pulsed wave Doppler 150
Tissue Doppler used by comprehensive echocardiography 151
Normal diastolic LVF profile 151
Abnormal Diastolic Function Profiles 151
Impaired relaxation 151
Pseudonormalization 151
Restrictive pattern 152
Case 152
Pericardial effusion assessment 152
Pericardial effusion 152
Clinical Considerations 153
Rate of accumulation 153
Chronic Pericardial Effusions 153
False-Positive Results 153
False-Negative Results 153
Detection of tamponade 153
Case 154
RV size and function assessment 154
Normal anatomy 154
RV function assessment 156
Conclusion of Case 156
Case 156
Thoracic aortic disease 157
Case 158
Volume status assessment 159
Case 161
Case 163
Valvular assessment 163
Severe mitral regurgitation 163
Mitral Stenosis 164
Aortic Regurgitation 164
Aortic Stenosis 164
Procedural guidance 164
Pericardiocentesis 164
Transvenous Pacer placement 165
Case 165
Periarrest 165
Primary Goals of Periresuscitation Echo 167
Case 167
Hypotension 168
Summary 168
Supplementary data 168
References 168
Point-of-Care Pelvic Ultrasonography in Emergency Medicine 173
Key points 173
Introduction 173
Indications 173
Sonographic technique 173
The obstetric patient 174
Ectopic Pregnancy 175
Pregnancy of Unknown Location 177
Heterotopic Pregnancy 177
Nonviable Pregnancy 177
Spontaneous Abortion 177
Subchorionic Hemorrhage 178
Evaluating Fetal Heart Rate 178
The nonobstetric patient 178
Hemorrhage or Rupture of Ovarian Cyst 178
Ovarian Torsion 179
Pelvic Inflammatory Disease 180
Acute Appendicitis 181
Summary 182
Acknowledgments 182
References 182
Emergency Ultrasonography 185
Key points 185
Introduction 185
DVT 185
Clinical Problem/Statistics 185
Anatomy 186
Proximally to distally 186
Imaging Protocols 186
Transducer 186
Positioning 186
Diagnostic Criteria 187
Pathology 187
Pearls, Pitfalls, and Variants 187
What the Treating Physician Needs to Know 188
Ultrasonography for Upper Extremity DVT 188
Abdominal aorta 189
Clinical Problem/Statistics 189
Anatomy 190
Proximally to distally 190
Imaging Protocols 190
Positioning 190
Transducer 190
Technique 190
Diagnostic Criteria 190
Pathology 190
Pearls, Pitfalls, and Variants 193
What the Referring Physician Needs to Know 193
Summary 193
IVC 193
Clinical Problem/Statistics 193
Anatomy 194
Proximally to distally 194
Imaging Protocols 194
Transducer 194
Positioning 194
Technique 194
Pathology 194
Pearls, Pitfalls, and Variants 194
What the Treating Physician Needs to Know 195
Further vascular applications 195
Septic Thrombophlebitis 195
Clinical problem 195
Imaging 196
Carotid Artery Intima-Media Thickness 196
Clinical problem/statistics 196
Imaging and measurement 196
Summary 196
Supplementary data 196
References 196
Pediatric Emergency Ultrasound 199
Key points 199
Introduction 199
Applications of POCUS 200
Hypertrophic Pyloric Stenosis 200
Anatomy 200
Imaging protocols 200
Diagnostic criteria 201
The evidence 202
Intussusception 203
Anatomy 203
Imaging protocols 203
Diagnostic criteria 203
The evidence 204
Skull Fractures 205
Anatomy 205
Imaging protocols 205
Diagnostic criteria 205
The evidence 206
Hip Effusions 206
Anatomy 206
Imaging protocols 207
Diagnostic criteria 208
The evidence 209
Summary 209
Supplementary data 209
References 209
Airway and Thoracic Ultrasound 211
Key points 211
Introduction 211
Airway ultrasound anatomy 211
Sublingual (intraoral) scanning window 211
External ultrasound window 212
Suprahyoid 212
Infrahyoid 212
Clinical use 212
Assessment of the Airway for Difficult Intubation 212
Endotracheal Tube Verification 213
Identification of Anatomy for Surgical Airway 213
Evaluation of the Epiglottis 213
Thoracic ultrasound 214
Thoracic ultrasound anatomy 214
Pneumothorax 214
Interstitial syndrome 215
Lung consolidation 215
Pleural free fluid 215
Summary 215
Supplementary data 215
References 215
Procedural Guidance with Ultrasound in the Emergency Patient 217
Key points 217
Discussion of problem/clinical presentation 217
General approach 218
Transducers 218
Paracentesis 218
Background 218
Indications 218
Imaging and Technique 218
Pearls and Pitfalls 219
LP 220
Background 220
Indications 220
Imaging and Technique 220
Pearls and Pitfalls 221
Thoracentesis 221
Background 221
Indications 222
Imaging and Technique 222
Pearls and Pitfalls 222
Pericardiocentesis 222
Background 222
Indications 223
Imaging and Technique 223
Subxyphoid approach 223
Parasternal approach 223
Para-apical approach 223
Pearls and Pitfalls 224
Transvenous cardiac pacing 224
Background 224
Indications 224
Imaging and Technique 224
Pearls and Pitfalls 225
Summary 225
Supplementary data 225
References 225
Symptom-Based Ultrasonography 227
Key points 227
Introduction 227
Chest pain and dyspnea symptom complex 227
Chest pain and dyspnea in the hemodynamically unstable patient 228
Pericardial Effusion with Tamponade 229
Massive PE 229
Acute Aortic Dissection 229
Tension Pneumothorax 230
Acute Papillary Muscle Rupture/Severe Mitral Regurgitation 231
Hemopericardium 231
Hemothorax 232
Chest pain and dyspnea in the stable nontraumatic patient 232
CHF 232
Regional Wall Motion Abnormalities 233
Critical Aortic Stenosis 233
Pulmonary Interstitial Edema 234
Pneumonia 235
Pleural Effusion 235
Chronic Obstructive Pulmonary Disease/Asthma 235
Traumatic causes of chest pain in the stable patient 236
Rib Fractures 236
Sternal Fractures 237
Abdominal pain 237
Abdominal Pain in the Unstable Patient 237
Intraperitoneal hemorrhage 237
Ectopic pregnancy 238
Bowel perforation 238
Assessment of the Hemodynamically Stable Patient 239
Midline/generalized abdominal pain 239
Small bowel obstruction 240
Urinary retention 240
Right upper quadrant/left upper quadrant pain 240
Hepatobiliary disease 240
Renal disease 241
Right lower quadrant/left lower quadrant 244
Appendicitis 244
Diverticulitis 244
Summary 245
Supplementary data 245
References 245
Ultrasonography in Musculoskeletal Disorders 269
Key points 269
The nature of the problem 269
Imaging protocols 269
Sonographic diagnosis of fracture 269
Imaging technique 270
Clavicle 270
Extremity 271
Hand and wrist 272
Rib 273
Skull 273
Joint effusions 274
Imaging technique 274
Elbow 274
Knee 274
Hip 275
Ultrasonographic elastography 277
Tendon injury 279
Imaging technique 280
Rotator cuff 280
Achilles tendon 280
Flexor tenosynovitis 281
Joint dislocation 281
Technique 281
Shoulder 281
Elbow 282
Soft tissue ultrasound 284
Imaging technique 284
Necrotizing fasciitis 285
Sonographic findings 285
Summary 286
Pearls/Pitfalls 286
Acknowledgments 286
References 286
Ultrasound Protocol Use in the Evaluation of an Unstable Patient 293
Key points 293
Case 1 293
Discussion of the Problem/Introduction 293
Components of point-of-care ultrasound protocols and their interpretation 296
Cardiac: Evaluate for Pericardial Effusion, Tamponade, Assess Contractility, Chamber Size 296
IVC: Collapsibility and Plethora 297
Case 2 298
Aorta: Abdominal Aortic Aneurysm 299
Abdomen (Free Fluid/Hemoperitoneum) 299
Pleura: Sliding Lung Sign, B-Lines, Pleural Effusion 299
Lower Extremity Veins: Deep Venous Thrombosis 300
Ultrasound evaluation of the medically unstable patient 300
Undifferentiated Hypotensive Patient Protocol 300
Focus Assessed Transthoracic Echocardiographic Protocol 301
Bedside Echocardiographic Assessment for Trauma/Critical Care Examination 301
Abdominal and Cardiac Evaluation with Sonography in Shock Protocol 302
Rapid Ultrasound in Shock Protocol 302
Cardiac arrest 302
Focused Echocardiography Entry Level Protocol 302
Ultrasound evaluation of the unstable trauma patient 303
Focused Assessment with Sonography in Trauma and Extended Focused Assessment with Sonography in Trauma Protocols 303
Conclusion 304
Supplementary data 304
References 304
Index 307