SADIK GİRİŞGİN, MD, EP, Assoc. Prof of EMSADIK GİRİŞGİN, MD, EP, Assoc. Prof of EM
Necmettin Erbakan Uni. Meram Medicine School KONYANecmettin Erbakan Uni. Meram Medicine School KONYATaksim Gaziosmanpasa E&R Hospital ISTANBULTaksim Gaziosmanpasa E&R Hospital ISTANBUL
11/11/13 11. ICC&EMC 6-8 OCT 2013
• American College of Radiology (ACR) • American Institute of Ultrasound in
Medicine (AIUM)• Ultrasound Imaging by Emergency
Physicians: ACEP Policy Statement
11/11/13 21. ICC&EMC 6-8 OCT 2013
Why can we use US in ICU?
Portable Probe variety Real time imaging Cost effective No radiation Repeatable ……
US suitable for ICU patients
Bedridden Diagnosis variety Real time treatment Costly, expensive Weak immunity Nonstable condition ……
11/11/13 31. ICC&EMC 6-8 OCT 2013
How can we use US in ICU?
11/11/13 41. ICC&EMC 6-8 OCT 2013
What is the ICU US?What is the ICU US?
Abdominal & Retroperitoneal Ultrasound
Abdominal vasculature, Bladder, Spleen, Liver Kidney
(Left kidney longitudinal view with splenorenal space, Right kidney longitudinal view with hepatorenal recess, Abdominal aorta longitudinal view, Bladder transverse view)
11/11/13 51. ICC&EMC 6-8 OCT 2013
What is the ICU US?What is the ICU US?
Pulmonary /Pleural Ultrasound
Pleural effusion (any size) Pneumothorax (Sliding lung) Infiltrates with ultrasound (Consolidation)
11/11/13 61. ICC&EMC 6-8 OCT 2013
What is the ICU US?What is the ICU US?
Cardiac Ultrasound
Parasternal long axis view Parasternal short axis view Apical four-chamber view Subcostal long axis view Inferior vena cava longitudinal view
◦ to find a pericardial effusion.
11/11/13 71. ICC&EMC 6-8 OCT 2013
What is the ICU US?What is the ICU US?
Ultrasound Guided Procedures
This topic covers how to use ultrasound to assist the performance of multiple procedures, from central lines to thoracentesis…
11/11/13 81. ICC&EMC 6-8 OCT 2013
DVT Evaluation
This topic covers how to use ultrasound to assess your patients for life threatening DVT's
(common femoral vein, saphenous intake, superficial femoral vein, popliteal vein with compression)
What is the ICU US?What is the ICU US?11/11/13 91. ICC&EMC 6-8 OCT 2013
Ultrasound Guided Resuscitation
◦ How to use all the information you gain with ultrasound to guide your management of the critically ill patient.
◦ This topic helps you put the whole picture together and is full of great case examples to help solidify your understanding.
What is the ICU US?What is the ICU US?11/11/13 101. ICC&EMC 6-8 OCT 2013
Ultrasound-Guided Vascular Access
◦ An overview of how to use ultrasound to help guide central venous access and peripheral venous access.
What is the ICU US?What is the ICU US?11/11/13 111. ICC&EMC 6-8 OCT 2013
Advanced USAdvanced US
Critical Care Echocardiography
◦ Integrating general critical care ultrasonography with bedside echocardiography.
11/11/13 121. ICC&EMC 6-8 OCT 2013
AdvancedAdvanced US US
Advanced Hemodynamic Measurements Advanced Evaluation of Left Ventricular and Right Ventricular Systolic Function Pulmonary Edema Pneumonia
11/11/13 131. ICC&EMC 6-8 OCT 2013
Valvular Assessment in the Critically Ill Focused Echocardiography Evaluation in
Life Support (FEEL Algorithm) Pitfalls and Limitations of Echocardiography
in the ICU
Advanced USAdvanced US11/11/13 141. ICC&EMC 6-8 OCT 2013
Abdominal evaluation with US for Abdominal evaluation with US for ICU patientICU patient
11/11/13 151. ICC&EMC 6-8 OCT 2013
11/11/13 161. ICC&EMC 6-8 OCT 2013
11/11/13 171. ICC&EMC 6-8 OCT 2013
11/11/13 181. ICC&EMC 6-8 OCT 2013
Left Upper - PerisplenicLeft Upper - Perisplenic
11/11/13 191. ICC&EMC 6-8 OCT 2013
11/11/13 201. ICC&EMC 6-8 OCT 2013
11/11/13 211. ICC&EMC 6-8 OCT 2013
Pelvic - SuprapubicPelvic - Suprapubic
11/11/13 221. ICC&EMC 6-8 OCT 2013
11/11/13 231. ICC&EMC 6-8 OCT 2013
11/11/13 241. ICC&EMC 6-8 OCT 2013
11/11/13 251. ICC&EMC 6-8 OCT 2013
Pulmonary evaluation with US for Pulmonary evaluation with US for ICU patientICU patient
11/11/13 261. ICC&EMC 6-8 OCT 2013
11/11/13 271. ICC&EMC 6-8 OCT 2013
11/11/13 281. ICC&EMC 6-8 OCT 2013
Direct graphy specificity for pneumothorax %53
Gold standart is “CT”
11/11/13 291. ICC&EMC 6-8 OCT 2013
Lung is not suitable for US Thoraks US pnomothorax sensitivity
(relative CT) %92 US has some technical superiority 4-12 MHz probe
11/11/13 301. ICC&EMC 6-8 OCT 2013
• Normal
11/11/13 311. ICC&EMC 6-8 OCT 2013
Pnomothorax?
11/11/13 321. ICC&EMC 6-8 OCT 2013
A line
Pleura
Normal
11/11/13 331. ICC&EMC 6-8 OCT 2013
11/11/13 341. ICC&EMC 6-8 OCT 2013
Lung pointLung point11/11/13 351. ICC&EMC 6-8 OCT 2013
11/11/13 361. ICC&EMC 6-8 OCT 2013
11/11/13 371. ICC&EMC 6-8 OCT 2013
11/11/13 381. ICC&EMC 6-8 OCT 2013
11/11/13 391. ICC&EMC 6-8 OCT 2013
11/11/13 401. ICC&EMC 6-8 OCT 2013
11/11/13 411. ICC&EMC 6-8 OCT 2013
11/11/13 421. ICC&EMC 6-8 OCT 2013
Cardiac evaluation details with US Cardiac evaluation details with US for ICU patientfor ICU patient
11/11/13 431. ICC&EMC 6-8 OCT 2013
11/11/13 441. ICC&EMC 6-8 OCT 2013
11/11/13 451. ICC&EMC 6-8 OCT 2013
ULTRASOUND GUIDED ULTRASOUND GUIDED PROCEDURES PROCEDURES
11/11/13 461. ICC&EMC 6-8 OCT 2013
Intravenous lines◦ Internal jugular◦ Femoral◦ Deep brachial
Paracentesis Thoracentesis• Bladder aspiration• Transvenous pacemaker • Abscess drainage• Lumbar punction• Artrocentesis
11/11/13 471. ICC&EMC 6-8 OCT 2013
Pericardiosynthesis
11/11/13 481. ICC&EMC 6-8 OCT 2013
11/11/13 491. ICC&EMC 6-8 OCT 2013
PROTOCOLSPROTOCOLS11/11/13 501. ICC&EMC 6-8 OCT 2013
11/11/13 511. ICC&EMC 6-8 OCT 2013
Bedside ◦ Heart◦ Inferior Vena Cava◦ Morison’s/FAST, lower thorax ( or abdominal thorax window)
◦ Aorta◦ Pneumothorax
These components can be recalled with the mnemonic: HI-MAP
11/11/13 521. ICC&EMC 6-8 OCT 2013
Heart in RUSH
◦ Pericardial effusion/tamponade; ◦ Right ventriculer failure (pulmonary embolism)
◦ Left ventriculer function (parasternal long axis and the four chamber view)
11/11/13 531. ICC&EMC 6-8 OCT 2013
Estimate fluid necessesity
◦ IVC diameter of <1.5 cm (complete inspiratory)
low CVP (<5)
◦ IVC diameter of >2.5 cm (no inspiratory collapse)
high CVP (> 20) and fluid loading.
11/11/13 541. ICC&EMC 6-8 OCT 2013
Like FAST ◦ right upper quadrant, ◦ left upper quadrant, ◦ suprapubic area
ectopic pregnancy, massive ascites, ruptured viscus, spontaneous intraabdominal bleeding, intraperitoneal rupture of an AAA, etc.
11/11/13 551. ICC&EMC 6-8 OCT 2013
AAA 4 level (Xiphoid to umblicus) Near heart Suprarenal Infrarenal Above iliac bifurcation
Aorta diameter >5 cm (+ hypotension =AAA)
11/11/13 561. ICC&EMC 6-8 OCT 2013
Think tension pnx Central line Pacemaker placement Thoracentesis
Bi-hemithorax anterior 3. intercostal space (begin)
high frequency probe M-mode
◦ ocean/beach or seashore – no pneumothorax ◦ continuous ocean or stratosphere sign
pneumothorax
11/11/13 571. ICC&EMC 6-8 OCT 2013
11/11/13 581. ICC&EMC 6-8 OCT 2013
11/11/13 591. ICC&EMC 6-8 OCT 2013
Acad Emerg Med. 2010 Apr;17(4):464-5. Epub 2010 Mar 8.
Emergency ultrasound for the detection of esophageal intubation.Hoffmann B, Gullett JP.Department of Emergency Medicine Johns Hopkins University Baltimore, MD Johns Hopkins Bayview Medical Center Baltimore, MD,
11/11/13 601. ICC&EMC 6-8 OCT 2013
11/11/13 611. ICC&EMC 6-8 OCT 2013
11/11/13 621. ICC&EMC 6-8 OCT 2013
11/11/13 631. ICC&EMC 6-8 OCT 2013
11/11/13 641. ICC&EMC 6-8 OCT 2013
11/11/13 651. ICC&EMC 6-8 OCT 2013
11/11/13 661. ICC&EMC 6-8 OCT 2013
WHAT IS THE NEW?WHAT IS THE NEW?11/11/13 1. ICC&EMC 6-8 OCT 2013 67
11/11/13 681. ICC&EMC 6-8 OCT 2013
11/11/13 691. ICC&EMC 6-8 OCT 2013
11/11/13 701. ICC&EMC 6-8 OCT 2013
11/11/13 711. ICC&EMC 6-8 OCT 2013
11/11/13 721. ICC&EMC 6-8 OCT 2013
11/11/13 731. ICC&EMC 6-8 OCT 2013
11/11/13 741. ICC&EMC 6-8 OCT 2013
IF YOU ASK ME “WHICH SOUND IS BEST IN THE ICU”
I SAY “ULTRASOUND”
11/11/13 1. ICC&EMC 6-8 OCT 2013 75
