L o o k L i s t e n F e e l S c a n. Your Pocus Cards For Your Every Day Scanning.
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1 L o o k L i s t e n F e e l S c a n Your Pocus Cards For Your Every Day Scanning
2 E-FAST Extended Focused Assessment by Sonography in Trauma Subcostal Heart View Pleural Sliding on M-mode (Sea-shore sign) Normal EFAST RV LV RA LA Right Pleural Space Left Pleural Space Diaphragm Diaphragm Spleen Liver Lung Lung Morrison s pouch Left Upper Quadrant Suprapubic-Horizontal Liver Kidney Bladder Spleen Kidney Suprapubic-Vertical Suprapubic-Vertical Bladder Bladder Uterus
3 Heart Ultrasound Parasternal Short Parasternal Long Apical D E F Dimensions Effort Fluid Subcostal Any obvious dimension abnormalities? RV is around 2/3 of LV, LV wall is thicker than the RV How is the heart contracting? LV should contract by at least 1/3. All the walls should contract equally Is there fluid around the heart? Small < 1cm, moderate 1-2cm, large > 2cm G Gradients Images courtesy C. Carl Jaffe, MD, and Patrick Lynch, Yale University Pressure gradients cause blood flow across valves: Do the valves look normal? Are they opening and closing normally?
4 IVC assessment Normal IVC Liver M-mode Collapsed IVC Dilated IVC Small <1.5cm Collapsing completely Tank is empty Fluids should be given Large >2.5cm Minimally collapsing Tank is probably not empty Fluids may not help Look for non-hypovolemic causes of shock
5 Abdominal Aorta Proximal Aorta Liver Normal Aorta= 3cm Normal Iliac arteries < 1.5cm Longitudinal view M-mode Mid Aorta Level of bifurcation
6 Biliary Ultrasound GB Long Axis Neck Fundus GB X-minus 7cm GB Short Axis Xyphoid GB Subcostal sweep CBD Long Axis Flattening the probe CBD Portal Vein CBD = 0.6 mm(+1mm /decade) GB wall > 3mm Acute Cholecystitis Findings GB distension >4cm short axis >9cm long axis CBD Short Axis Sludge Pericholecystic fluid + Sonographic Morphy s sign Acoustic shadows from stones
7 Renal Ultrasound Normal Rt Kidney Pyramids Calyx Cortex Medulla Pelvis Bladder Vertical a Bladder volume (ml) = a x b x c x 0.52 Bladder Horizontal b c Hydronephrosis Mild Moderate Severe Timberlake, Matthew D., and C.D. Anthony Herndon. "Mild to moderate postnatal hydronephrosis --grading systems and management." Nature Reviews Urology, vol. 10, no. 11, 2013, p Academic OneFile, Accessed 23 Apr. 2017
8 Bowel Ultrasound Normal Appendix Small Bowel Obstruction Liver Kidney ABCD-EF mnemonic Abnormal Appendix long axis Liver Kidney A. Activity (Ileus Vs Mechanical) B. Bowel Thickness > 3mm C. Colour Doppler D. Diameter > 3 cm EF. Extraintestinal Fluid by Dr. Hadiel Azzam Abnormal Appendix short axis Intussusception cross section Crescent in a doughnut sign Longitudinal section Outer Diameter > 6mm Non-compressible No peristalsis Appendicolith Target sign in short axis Increased vascularity with Color Flow Doppler Periappendiceal Fluid Collection Pseudokidney sign
9 DVT Assessment Common Femoral Vein Great Saphenous Vein CFA CFV CFA CFV GSV CFV Bifurcation SFA Superficial Femoral Vein DFA CFV SFA SFA Popliteal Vein DVT in Left CFV PV PA
10 Musculoskeletal US Fractures and Dislocations Left Shoulder Anatomy Scapula RV LV Shoulder Dislocation Bone longitudinal Cortex Elbow fractures Tendon Bone transverse Cortex
11 IV Access Differences between artery and vein Artery Smaller diameter Thicker walls (although difficult to appreciate by US) Pulsatile (pulses seen clearly and are sustained) Color Doppler: pulsatile flow Vein Larger diameter Thinner walls Can transmit pulses (pulses are more wavy may not be sustained) Flow may not be seen in smaller veins, and can be enhanced by squeezing calf muscles IV access: In plane IV access: out of plane
12 Soft Tissue Scan Foreign Bodies and Infections Normal Soft Tissue Anatomy Skin: Epidermis + Dermis Subcutaneous tissue Fascia Muscles Tips Scan from normal to normal area Apply Doppler when needed Bone Glass Metal Wood Abscess: different sonographic appearances Hypoechoic collection Anechoic collection with posterior acoustic enhancement Diffuse collection Cellulitis with cobble stone appearance Necrotizing fasciitis (STAFF) Subcutaneous thickening Air shadowing Images courtesy of Josef Minardi Fascial disruption & Sub-Fascial fluid
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General Anatomy of Urinary System URINARY SYSTEM ORGANS Kidneys (2) Ureters (2) Urinary bladder Urethra KIDNEY FUNCTIONS Control blood volume and composition KIDNEY FUNCTIONS Filter blood plasma, eliminate