You are on page 1of 46

1

ACEP 2008 EUS guidelines

Ann Emerg Med. 2009;53:550-570

10

11

?
Hypovolemic shock Cardiogenic shock Obstructive shock Distributive shock

12

13

14

15

16

17

Goal of focused cardiac US in ED


Assessment for the presence of pericardial effusion Assessment of global cardiac systolic function Identification of marked right ventricular and left ventricular enlargement Intravascular volume assessment Guidance of pericardiocentesis Confirmation of transvenous pacing wire placement
J Am Soc Echocardiogr 2010;23:1225-30
18

Must-See for EPs


Bedside echocardiography: common views

Breitkreutz, Y et al. Crit Care Med 2007;35:S235-S249

19 19

CAUSE
Cardiac Arrest Ultra-Sound Examination
For non-arrhythmogenic cardiac arrest No or minimal interruption of CPR

2012/1/9 2012/1/9

Resuscitation 2007

20 20

CAUSE for Cardiac Arrest


Severe hypovolemia Tension pneumothorax Cardiac tamponade Massive pulmonary embolism

2012/1/9 2012/1/9

21 21

Apical Four Chamber View

2012/1/9 2012/1/9

22 22

Pneumothorax

2012/1/9 2012/1/9

23 23

CAUSE for Resuscitation

2012/1/9 2012/1/9

24 24

Focused Echocardiographic Evaluation in Resuscitation (FEER) Management

2012/1/9 2012/1/9

Breitkreutz, R et al. Crit Care Med 2007;35:S150-S162

25 25

FEER in Ten Steps

2012/1/9 2012/1/9

Breitkreutz, R et al. Crit Care Med 2007;35:S150-S162

26 26

Focused Abdominal Sonography in Trauma

FAST
Focused Assessment with Sonography for Trauma

27

(Undifferentiated Hypotensive Patient)

UHP Ultrasound Protocol

1. Free intraperitoneal fluid evaluation 2. Focused cardiac examination 3. Focused abdominal aorta evaluation
Am J Emerg Med 2001

3 Scanning of UHP protocol

Am J Emerg Med 2001

Goal-directed US for nontraumatic hypotension in ED


1. Subcostal view Cardiac tamponade 2. Inferior vena cava (IVC) view: Collapsibility 50% Intravascular volume status 3. Parasternal long cardiac view LV function and pericardial effusion 4. Apical four-chamber cardiac view Ventricular size and LV function 5. Hepatorenal recess view Free intraperitoneal fluid 6. The pelvis and retrovesical view Free intraperitoneal fluid 7. Abdominal aorta view Any diameter >3 cm CCM 2004

SBP <90 Shock index >1 One s/s of shock

Diagnosis accuracy 80% vs 50%

CCM 2004

Abdominal and Cardiac Evaluation with Sonography in Shock (ACES) protocol

EMJ. 2009;26;87-91

ACES protocol

EMJ. 2009;26;87-91

IVC & RAP

EMJ. 2009;26;87-91

EMJ. 2009;26;87-91

in the Evaluation of the Critically Ill ()

Rapid Ultrasound in SHock

The RUSH Exam

Step 1: The pump ( = ) Step 2: The tank ( = ) Step 3: The pipes ( = )


Emerg Med Clin N Am 28 (2010) 2956
36

RUSH 1: ()
A.
/

B. C.

37

RUSH 1: ()

evaluation of the pericardium


determination of global left ventricular function


assessment of right ventricular strain

Emerg Med Clin N Am 28 (2010) 2956

38

RUSH 2: ()
A. B. /

C. / D. / E. /

39

RUSH 2: ()

/



40

Emerg Med Clin N Am 28 (2010) 2956

RUSH 3: ()
A. B. C. D. E. F.

41

RUSH 3: ()

Emerg Med Clin N Am 28 (2010) 2956

42

43

Cardiac arrest & Shock

Ann Emerg Med. 2009;53:550-570


Juice119.pixnet.net Juice119@gmail.com
46