Point-of-Care Ultrasound Guide for Landmarks, Recording, and Report Content. TJUH/MHD EM Ultrasound Division 2012
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1 Point-of-Care Ultrasound Guide for Landmarks, Recording, and Report Content TJUH/MHD EM Ultrasound Division 2012
2 Table of Contents 1 - Objectives 2 - Procedural 3 - AAA 4 - Abdominal OB 5 - Transvaginal OB 6 - Echo 7 - Hepatobiliary 8 - DVT 9 - FAST 10 - Cellulitis / Abscess 11 - Other (bladder, MSK, IVC) 12 - Other (lung, ocular)
3 Objectives 1 Review landmarks for POC ultrasound applications NOT a comprehensive manual of POC ultrasound Outline expectations for image recording Outline expectations for report content to be typed into machine by clinician for education/qa/credit NOT intended as a guide for Wellsoft documentation Important!! If a required image cannot be obtained/interpreted, the report should state unable to obtain image or indeterminate due to (eg. bowel gas, etc.).
4 Procedural 2 (eg. IV, paracentesis, etc.) needle vein Always cover the transducer when bodily fluids are present -Still or clip of target prior to procedure -For IVs, an image of the catheter in the vessel after placement -Successful or unsuccessful procedure name -Documentation of complications (eg. artery/nerve puncture)
5 AAA 3 splenic v. portal v. celiac trunk splenic v. SMA common iliac arteries IVC aorta vertebral body (VB) IVC aorta VB VB Celiac Level SMA Level Bifurcation -Clip of aorta in transverse and longitudinal plane from celiac down to the bifurcation -+/- AAA *Remember...outer to outer wall! -Stills of aorta diameter measured at opposing outer* walls in the transverse plane at the celiac, SMA, and just above the bifurcation Correct Incorrect!
6 Abdominal OB 4 uterus gest. sac bladder vag. stripe yolk sac Transverse -Clips of longitudinal AND transverse views of the following: -bladder -vaginal stripe -uterus -Pouch of Douglas -Clips of bilateral adnexae -Still of EGA and FHR (if avail.) uterus Pouch of Douglas cervix Longitudinal -IUP or NDIUP (no definitive IUP) -If present, note free fluid and complex andexal masses
7 Transvaginal OB 5 gest. sac endo. stripe uterus yolk sac intrauterine sac P. of Douglas uterus -Clips of longitudinal AND transverse views of the following: -bladder -vaginal stripe -uterus -Pouch of Douglas -Clips of bilateral adnexae -Still of EGA and FHR (if avail.) -IUP or NDIUP (no definitive IUP) -If present, note free fluid and complex andexal masses
8 Echo = indicator direction Subxyphoid PSLA RV RA RV LV LV LA LA 6 PSSA RV LV Apical-4-C RV LV RA LA - pericardial effusion -/+ (small, medium, large) -Tip- Placing pt in L lat decub position - EF wnl / depressed (mild/mod./sev.) - RV LV* or RV > LV* will almost always improve images *based on greatest diameter (enddiastole) -Clips of all 4 views
9 Hepatobiliary 7 portal v. longitudinal GB transverse GB wall thickness portal v. (long. axis) cbd -Clip of the entire gallbladder (GB) in both short and long axis -Still of GB wall thickness measurement -+/- GB stones -+/- sludge -+/- SM (Sonographic Murphy s), -+/- PCF (pericholecystic fluid) -Still of CBD diameter
10 DVT 8 great. saph. vein Lateral Pop V. Pop A. CFA Femoral Region tibial plateau CFV Popliteal Fossa Medial -Common femoral vein - Clip of compression from saphenofemoral junction to bifurcation into femoral vein (formerly superficial femoral vein--a deep vein) and profunda femoral vein. -Tip- curvilinear transducer may help landmarks identification in larger patients -Popliteal vein - Clip of compression of popliteal vein until trifurcation -+/- DVT in R/L LE **Reminder: If study (-), pt needs a repeat in 5-7 days to eval for proximal extension of distal dvt (eg. calf dvt)
11 Subxyphoid 9 pericardium RUQ LUQ subphrenic inf. pole subphrenic hepatorenal pleural inferior pole FAST Pelvis bladder pleural splenorenal seminal vesicles -Clips of all 10 potential spaces: -RUQ (4)- pleural, subphrenic, hepatorenal, inferior pole of kidney -Pericardial space (1) (anterior and posterior) -LUQ (4)- pleural, subphrenic, hepatorenal, inferior pole of kidney -Pelvis (1) - Male = retrovesicular space; - +/- FAST - If + FAST, specify where free fluid seen
12 Cellulitis / Abscess 10 cellulitis { ( cobblestoning ) superficial muscle fascia muscle abscess superficial muscle muscle -Cellulitis- Clip - Abscess- Clip of entire abscess cavity with sufficient depth to clearly visualize deepest border -Still of abscess dimensions - +/- cellulitis of _(body part)_ - +/- abscess of _(body part)_ -Tip- consider using curvilinear transducer for larger abscesses
13 Other 11 Bladder Volume: Inferior vena cava*: *Always perform with echo Trans. Required images- Still of all 3 dimensions Report- Volume (ml) Musculoskeletal: Long. rib fx Required images- Clip or still of target Report- +/- (pathology and location) (eg. + R ant. rib fx) Required images- Clip of IVC in transverse or longitudinal axis; Still image of measurements Report- -IVC max & min diameter -IVC collapse-index (IVC-CI) [IVC-CI = (IVCmax-IVCmin)/(IVC max)]
14 Other 12 Thorax: Pneumothorax- Required images- Clip of pleural line sliding or m- mode still; Type in area being scanned (left/right & ant./axillary/post.) Report- +/- pneumothorax B-lines- Required images- Still or clip of pleural line with enough depth to confirm B-lines (appx. 15cm); Type in area being scanned (as detailed above) Report- +/- B-lines Pleural effusion- Required images- Still or clip of pleural space; Type in which hemithorax is being evaluated Report- +/- pleural effusion Ocular: Acute ocular pathology- Required images- Transverse and longitudinal clips of entire eye. Report- +/- pathology of interest (eg. lens dislocation, retinal detachment, vitreous hemorrhage) Evaluation of elevated ICP- Required images- Measure R/L optic nerve sheath in transverse and longitudinal plane at 3mm Report- R / L ONS mm (ONS = optic nerve sheath)
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