00:00:01 Lung sonography have some limitations.

Lung sonography has some

limitations. Diaphragmatic dialysis, Emphysematous bullae, Prior pleurodesis, Pleural
adhesion

00:00:34 Main-stem bronchus intubation, Severe chronic obstructive pulmonary disease

and other lung pathology inhibiting adequate visualization of lung sliding.

00:00:50 Lung sonographer have this limitation. This city finding is pleural calcification,
pleural calcification. This inhibit, though, examine the lung sonography.

00:01:10 Next is solid organ injury finding of echo. This is spleen injury, spleen injury.

00:01:27 Solid organ injury. This is spleen injury.

00:01:46 This is renal injury. Renal injury.

00:02:00 Perirenal, free fluid collection, Perirenal, free fluid collection.

00:02:16 Ok. This is not spleen injury, this is rib injury, this is a rib injury. This is a liver
of foreign kind, liver injury, liver injury. So this is not spleen injury.

00:02:30 This is liver laceration, liver deep laceration injury.

00:02:42 Not spleen injury, this is liver deep laceration injury.

00:03:00 This is perirenal fluid Collection. Perirenal Fluid Collection. Liver injury.
Perirenal injury, renal injury, liver injury.

00:03:20 How about this? The continuum of sternum bone, broken. The continuum of
sternal bone broken.

00:03:54 High energy mechanism injury, sternum fracture, sternum fracture. Sternum
fracture. This is break point, break point of sternum fracture.

00:04:22 The sonography finding of sternum fracture. You can't miss it. Very easy.
00:04:40 Sternum fracture means high energy mechanism injury. Sternum fracture
means high energy mechanism injury.

00:05:00 Traumatic shock, hypovolemic obstructive shock, cardiogenic shock and

distributive shock.

00:05:12 Hypovolemic shock hemorrhagic. Obstructive shock, cardiac tamponade or

tension pneumothorax. Cardiogenic shock, valvular failure. Distributive shock,
neurogenic shock.

00:05:25 Imperial vena cava size is very important, measuring the inferior vena cava
size. You can classify hypovolemic shock or obstructive shock.

00:05:45 Measuring inferior vena cava size, if the inspiration collapse and flat. Collapse
and flat, flat inferior vena cava size, this means hypovolemic shock. Hypovolemic shock.

00:06:08 Hypovolemic state inferior vena cava size is decreased, decreased decreased.
The inferior vena cava size is decreased, but in obstructive shock, in example, cardiac
tamponade or a tension pneumothorax imperial vena cava size slightly increased.

00:06:40 During inspiration, not collapsing, not collapsing. Imperial vena cava diameter
during inspiration, not collapsing, slightly increased or the same during inspiration,
before inspiration or after inspiration.

00:07:09 Imperial vena cava size, increased, slightly increased or saying this means
cardiac tamponade or a tension pneumothorax.

00:07:28 Collapse inferior vena cava, flat inferior black vena cava means hypovolemic
hemorrhagic shock, hypovolemic shock, hypovolemic state.

00:07:44 If you can find inferior vena cava size over 2.4 centimeter, not collapsing
during inspiration, you can think obstructive shock, cardiac tamponade or tendon
pneumothorax.
00:08:08 This is a very important finding of traumatic shock. You can classify
hypovolemic hemorrhagic, hypovolemic shock patient or cardiac tampon or tension
pneumothorax, obstructive shock.

00:08:30 You can classify. Find the imperial vena cava size. Flat inferior vena cava,
hypovolemic.

00:08:45 Imperial vena cava plethora, imperial vena cava diameter slightly increased.
Not collapsing during inspiration, this means obstructive shock, cardiac tamponade or
tension, pneumothorax. You first think.

00:09:12 Pitfalls, Mistaken for free fluid. How about this Echo? This is stomach.
Stomach

00:09:38 What is this, what is this? Anechoic or hypoechoic finding? This is fluid, free
fluid.?

00:09:44 This is stomach. Anechoic or hypoechoic echogenicity? What is this? This is

normal fluid in the stomach. Normal fluid in the stomach.

00:10:01 This is pitfall, for mistaken for fluid. This is not free fluid. This is normal finding
of fluid in the stomach.

00:10:15 Food material. Normal. This is normal, normal, finding of free fluid, normal
finding of fluid in the stomach. Food material.

00:10:32 In the stomach, food material, normal fluid in the stomach. How about this?

00:10:41 Not working. Food material. Food material. Normal Fluid in the stomach.

00:10:56 Next, pitfalls mistaken for fluid, free fluid, fluid in the stomach. Paranephric fat,
Perinephric fat, this is Kidney. This is kidney.

00:11:16 How about this? Free fluid? free fluid?

00:11:28 Liver, kidney. Paranephric fat, Perinephric fat. Hypo echogenicity. This is free
fluid? Not free fluid.

00:11:47 This is only Paranephric fat, Perinephric fat, not free fluid, not free fluid. Liver,
kidney, this finding hypoechoic, not free fluid, Paranephric fat or Perinephric fat.

00:12:10 Another mistake for free fluid. Epicardial fat pads, pericardial cyst, descending
aorta, pitfalls are mistaken for free fluid.

00:12:27 This echo is Paranephric fat. Paranephric or Perinephric fat.

00:12:39 Next, pitfall is all the blood clot, all the blood clot. This is diaphragm. This is
liver, and this is...

00:12:58 Hemothorax, hemothorax but in hemothorax patients, all the blood clot, all the
blood clot is sonography qualities similar to soft tissue.

00:13:16 So this is pitfall of all the blood clot. Hemothorax. Sonography findings similar
to soft tissue.

00:13:40 Emergency focused assessment of sonography for trauma is technically

limited by bowel gas, obesity, subcutaneous emphysema.

00:14:03 E-fast is limited technically by bowel gas, obesity, subcutaneous emphysema.

00:14:11 Another limitations stenography is hollow viscus injury has limitation. Solid
organ injury has limitations. Mesenteric vascular injury has limitations of sonography.

00:14:33 Intra-abdominal injury after isolated penetrating trauma has a limitation. Small
hemothoraces has limitations. Retroperitoneal hemorrhage has limitation.

00:14:53 Early or are slowly bleeding injury has limitations of sonograms.

Diaphragmatic rupture has the limitation of sonograms.
00:15:10 If you change. The patient's position like Trendelenburg and the sitting
position.

00:15:29 Trendelenburg and the sitting position change. You have more higher
sensitivity of sono finding. Trendelenburg and the sitting position have higher sensitivity
for ultrasonography.

00:15:47 Changes in the patient condition, changes in the patient condition, serial, serial
trauma. Emergency ultrasonography helps changes in the patient condition.

00:16:04 You must serial trauma emergency ultrasonography.

00:16:16 Checklist, all checklist of sono findings. Pneumothorax, yes or no? Right side,
left side, you can check.

00:16:30 Hemothorax presence or absence of Hemothorax, yes or no, right side, left
side, limited evaluation.

00:16:45 Hemoperitoneum yes or absence of Hemoperitoneum. If yes, right

hemoperitoneum, left hemoperitoneum, Douglas pouch, pelvis peritoneum or limited
evaluation, you can check

00:17:03 Hemopericardium, yes or no or limited evaluation.

00:17:11 Inferior vena cava, inferior vena cava collapsed, collapsed. Hemorrhagic
hypovolemic shock.

00:17:21 Inferior vena cava plethora, Inferior vena cava not collapsing or slightly
dilatation. Slightly increased size of inferior vena cava diameter during inspiration, not
collapsing imperial vena cava means inferior vena cava plethora.

00:17:49 You can check this. If you have limited evaluation, you can check this area.

00:18:01 Thank you.

00:18:14 Next topic is basic echocardiography in acute myocardial infarction. In acute
myocardial infarction, patient using only basic echocardiography in acute MI.

00:18:35 Acute coronary syndrome at emergency E.R. 30% of chest pain, acute
coronary syndrome. Chest pain cause gastroesophageal disease related, 42%.

00:18:58 Gastroesophageal disease related chest pain. 42% percent. Heart disease,
chest pain caused 31%. Chest wall syndrome, 28%

00:19:15 Pericarditis 4%. Pleuritis or pneumonia 2%. Pulmonary embolism, 2%. Lung
cancer, 1.5%. Aortic aneurysm, 1%. Aortic stenosis, 1%. Herpes zoster 1%.

00:19:42 Most common cause is not ischemic heart disease. The most common chest
pain causes gastroesophageal disease, GERD, gastroesophageal motility disorder

00:20:01 Peptic ulcer gallstone is the main cause of chest pain.

00:20:11 Echo finding of acute myocardial infarction. The key concept is regional wall
motion abnormality. Regional wall motion abnormality. If you cannot find regional wall
motion abnormality means, there is a lack of evidence in acute MI.

00:20:48 One more time. There is no evidence of regional wall motion abnormality. You
can rule out acute myocardial infarction.

00:21:05 Regional wall motion abnormality, if you can’t find regional wall motion
abnormality, this finding related of acute myocardial infarction.

00:21:26 Wall motion abnormality. Key concept is hypokinesis, Akinesis, Dyskinesis and
Aneurysmal finding.

00:21:48 Wall motion abnormality, key word is key concept is hypokinesis means less
than 30% wall motion increase.

00:22:06 Akinesis means no wall motion increase. Dyskinesia means paradoxical

outward movement.
00:22:20 Aneurysmal is bulging outward in systole and diastole.

00:22:28 This is a very important keyword in explaining wall motion abnormality.

00:22:41 Hypokinesis, Akinesis. Dyskinesis and Aneurysmal finding.

00:22:58 How about this echocardiogram? This is left ventricle. This is normal finding.
This is normal contractibility. Normal contractibility.

00:23:23 Contraction, contraction, contraction, contraction, even contraction, even

contraction, all regions are the same and the normal contracting ability, this is normal
finding.

00:23:49 How about this? How about this? How about this?

00:24:04 Where is the abnormality? Contraction, contraction, contraction, contraction,

but hypokineses, less than 30% wall motion increase.

00:24:29 This is normal findings but this is… This area, this area, this area, this area
has contractibility. But the contractibility is decreased.

00:24:59 All regions, contractibility is decreased, decreased. So this finding

echocardiogram means hypokinesis. Hypokinesis.

00:25:22 Normal contractibility. Hypokinesis contractibility. Hypokinesis. Hypokinesis

00:25:56 Next. Next. How about this echocardiogram? This area, this area and septal
area, septal area, apical area. The motion is very decreased

00:26:29 Akinesis means, akinesis means no wall motion increase, no wall motion
increase. Normal. Hypokinesis. Hypokinesis. Septal area, septal area, akinesis.
00:27:02 Septal area, akinesis. Apical area, slightly moved, slightly moved, so Apical
and Septal, akinesis.

00:27:21 This area, septal area, akinesis, this is intact. This area is intact, this intact, but
apical and septal area, akinesis. This is intact. This is intact.

00:27:42 Dyskinesia, dyskinesia, dyskinesia means. Dyskinesia means paradoxical

outward movement, paradoxical outward movement, dyskinesia.

00:27:58 Normal finding. Global hypokinesis, global hypokinesis.

00:28:16 Apical and septal, akinesis. How about this? This area, paradoxical outward
movement, paradoxical outward movement of left ventricular.

00:28:39 Dyskinesis. Outward, paradoxical outward movement left ventricle. Dyskinesis,

Dyskinesis, right atrium, right ventricle, left atrium mitral valve, left ventricular apex area
dyskinesia.

00:29:01 Paradoxical outward movement of Dyskinesis. How about this?

00:29:20 Aneurysmal. Bulging outward in systole and diastolic.

00:29:29 Normal hypokinesis. Global hypokinesis. Septal akinesis. Septal, apical septal
akinesis. Paroxysmal paradoxical outward movement of left ventricle, dyskinesia,
dyskinesia.

00:30:08 Aneurysm. Bulging outward is aneurysm. Aneurysmal, aneurysmal,

aneurysmal, aneurysmal.

00:30:38 Semi quantitative assessment, regional wall motion abnormality, 16 segment,

16 segment. This is 17 segment, 17 segment. One place 4 chamber, 2 chamber, long
axis view. Base Med-Apex, 17 segment divided 17 segments.
00:31:12 How about this echocardiogram? Light atrium, right ventricle, left atrium, left
ventricle. Right atrium, right ventricle, contractibility’s intact, but Antero Apical, Antero
apical and Septal area is not moving or very little moving.

00:31:50 So this finding is Anteroseptal. Anteroseptal acute myocardial infarction.

00:32:10 Apical Anteroseptal, Anteroseptal, Anteroseptal. Anteroapico Antero Septum

Area. Apico antero septal area. Antero septal area, acute myocardial infarction.

00:32:33 How about this? Where is abnormality of contractibility? Can you find?

00:33:07 Antero Septum, Antero Septum area. Decreased contract ability, regional wall
motion abnormality.

00:33:22 This area and anteroseptal, acute myocardial infarction echocardiogram. How
about this? This is the right ventricle, right ventricle.

00:33:47 This area. This area right ventricle. Right ventricle. Acute myocardial
infarction. This area contractibility is abnormal.

00:34:10 Complications of acute myocardial infarction. First, electrical heart block

arrhythmia, most common. Vascular complication recurrent ischemia, recurrent
infarction.

00:34:29 Myocardial complication, left ventricular aneurysm infarcts extension, diastolic

or systolic dysfunction, congestive heart failure, hypertension, cardiogenic shock.

00:34:49 Mechanical complications of myocardial infarction, free wall rupture,

ventricular septal rupture, papillary muscle rupture.

00:35:01 Pericardial complications of myocardial infarction, pericarditis, Dressler

syndrome pericardial effusion.

00:35:12 Thromboembolic complications of acute myocardial infarction is mural

thrombosis, pulmonary embolism.
00:35:26 Echocardiography in complications of acute myocardial infarction.
Hemodynamic state, you can find hypovolemia, right ventricular infarction, globally
reduced left ventricular contractility

00:35:50 Mechanical complication, you can find papillary muscle rupture, ventricular
septal rupture, free wall rupture and tamponade.

00:36:05 Others, left ventricular on the region or a mural thrombus.

00:36:12 Mechanical complication, ventricular septal rupture, papillary muscle rupture

and my mural regurgitation, free wall rupture.

00:36:25 Incidences like this, time to occur like this. Murmur, 90 %, 50% and risk and
risk.

00:36:38 Old age, underlying history of hypertension anthereal wall myocardial

infarction, lack of collateral circulation.

00:36:25 At risk of Ventricular septal rupture. Posteromedial rupture by inferior wall MI,
papillary muscle rupture and myocardial mitral regurgitation incidence is high

00:37:11 Old age, underlying history of hypertension. Female, first attack of myocardial
infarction, large Q wave infart.

00:37:25 High risk and risk of free wall rupture. Free wall rupture. Echocardiography,
find ventricular septal rupture, defect in ventricular septum, left to right to shunt.

00:37:43 Papillary muscle rupture and mitral regurgitation, echocardiogram, frail or

progressing leaflet regurgitation, jet to the left atrium.

00:37:59 In free wall rupture, echo findings are very important. Free wall rupture echo
finding is very important.
00:38:09 Just like pericardial effusion, pericardial effusion. Intrapericardial thrombus.
Free all rupture, just like pericardial effusion.

00:38:26 How about this? Right atrium, right ventricle, left atrium, left ventricle. How
about this? Can you find the abnormality? Can you find any abnormality?

00:39:07 This area. Ventricular septum rupture, ventricular septal rupture, ventricular
septal rupture, color Doppler find is shunt find. Color Doppler shunt find.

00:39:36 Ventricular septal rupture, echocardiogram depicting ventricular septum. Left

to right shunt.

00:39:45 Ventricular septal rupture and color Doppler. Left to right shunt, left to right
shunt. One more time ventricular septal rupture. Ventricular Septal Rupture Color
Doppler find is left to light to shunt, left to right shunt.

00:40:23 Ischemic Mitral regurgitation. This is left atrium. This is left atrium, left
ventricular. This is mitral valve, mitral valve where poster leaflet, anterior leaflet.

00:40:52 This is posterior medial papillary muscle, posterior media papillary muscle.
This is Anterolateral papillary muscle, Anterolateral papillary muscle. Posteromedial
papillary muscle.

00:41:11 This is Chordae, Chordae. This is apex, right, ventricle, aorta. Left atrium,
aorta, right ventricle.

00:41:27 This is displacement, displacement, directional. Posterior medial papillary,

muscle displacement, displacement of posteromedial papillary muscle, this direction or
this direction.

00:41:46 Antero papillary muscles is intact, but displacement of posterior medial

papillary muscle. Restricted reflect close. Mitral regurgitation. Mitral regurgitation.
00:42:04 Echo findings. How about this? left atrium, left ventricle, Mitral valve, mitral
valve, left atrium, left ventricular. Where is abnormality. Where is abnormality in this
echocardiogram?

00:42:42 Can you find?

00:42:51 Posterior medial papillary muscle rupture, posterior medial papillary muscle
rupture.

00:43:02 Left atrium, left ventricular, mitral valve, postero. This is posteromedial,
papillary muscle, posteromedial papillary muscle rupture.

00:43:22 So Color Doppler, finding is posteromedial papillary muscle rupture caused

mitral regurgitation, mitral valve regurgitation, mitral regurgitation.

00:43:43 One more time, left atrium, left ventricular mitral valve disease, posterior
media, papillary muscle rupture.

00:43:53 This induce papillary muscle rupture and color Doppler finding is mitral valve
regurgitation. Mitral valve regurgitation.

00:44:18 Posteromedial papillary muscle rupture. It can cause mitral regurgitation, mitral
regurgitation

00:44:31 Left ventricular aneurysm. Mural thrombus formation, mural thrombus

formation. Thinned out myocardial scar. This is in infarcted segment. This is in infarcted
area.

00:44:53 Mural thrombus formation, thinned out myocardial scar.

00:45:01 Transmural infarct with the rupture. Pericardium, large thrombus. Large
thrombus, pericardium, transmural infarct rupture.

00:45:15 Where is abnormality? Where is abnormality of echocardiogram? This is LV,

LV area, LV left ventricular area. Can you find? Can you find the abnormality?
00:45:53 Left ventricular aneurysm, left ventricular aneurysm.

00:46:05 Left ventricular aneurysm. How about this?

00:46:30 Global hypokinesis. Global hypokinesis. Right ventricular, left ventricular.

Global hypokinesis.

00:47:01 Mechanical complication of acute myocardial infarction, free wall rupture, free
rupture, echocardiogram, just like pericardial effusion, free wall rupture a cardiac
characteristic of echocardiography just like pericardial effusion.

00:47:27 Can you find this? Can you find this pericardial effusion for pericardial effusion
anechoic or hypoechoic echogenicity? In this area. This echo find is free wall rupture
just right, pericardial effusion.

00:48:03 Global, hyperkinesia and formation of pericardial effusion. It is the

complication of acute myocardial infarction, free wall, free wall rupture.

00:48:23 How about this? Right atrium, right ventricular, left atrium, mitral valve, left
ventricular. Where is abnormality of echocardiogram?

00:48:49 Can you find? Can you find the abnormality? Yes. Right atrium, right ventricle,
left atrium, left ventricular.

00:49:10 This this, this, this, this, this is left ventricular thrombus, left ventricular
thrombus formation.

00:49:38 Echo in complications of Acute M.I, others, mural thrombus, mural thrombus.

00:49:56 Left ventricular neural thrombus. How about this? This is mitral valve, right
ventricle, left ventricle. Where is abnormality where echocardiogram?

00:50:27 Can you find?

00:50:31 Left ventricular thrombus, left ventricular mural's thrombus, left ventricular
mural thrombus formation.

00:50:52 Thrombus. Thrombus. How about this? This is the right ventricle. And right
ventricle, this area.

00:51:18 This area RV, right, ventricular infarction area, right ventricular infarction area.

00:51:32 RV infarct. RV infarct. Treatment of choice, you know in RV infarct patient, you
know, RV infarct patient treatment of choice is hydration, hydration, hydration.

00:52:13 RV infarct patient treatment of choice is hydration, hydration, hydration,

volume, expansion, volume expansion, hydration.

00:52:24 RV infarct. 22 age male, post myocardial infarction five days, echo finding. 44
age male, post MI, five days’ echo finding.

00:52:47 What is your diagnosis? What is your diagnosis? This patient?

00:52:59 Where is abnormality echocardiogram. Can you find?

00:53:09 Right atrium, right ventricle, left atrium, left ventricle. Can you find this? left
ventricular thrombus formation post MI five days, post myocardial infarction, 5 days.

00:53:36 This patient has thrombus, thrombus, thrombus formation.

00:53:44 Thank you for listening. Thank you for listening.