Lecture Notes: Importance of Ultrasound in Emergency Medicine

Overview

• Decision-making in medical emergencies requires prompt information gathering.
• Ultrasound (US) is crucial for assessing patients quickly, especially in critical care.
• It is important to use US yourself rather than relying on others.

Importance of Ultrasound

• DASH (Direct Assessment by Sonography in Hypotension): Emphasizes using US in shock assessment.
• RUSH Exam: Systematic point of care US for patients in shock.
  • Views: HASH, IVC, Morrison's pouch, eFAST, aorta, pneumothorax.

Systematic Approach in Ultrasound

• EGLS Protocol: Focus on IVC, lungs, heart.
  • Check for pneumothorax, tamponade, shock types, and ventricular dysfunction.
• Heart Evaluation: Differentiate right and left-sided heart failure for treatment.

Echocardiography Techniques

• Hold the Probe Correctly: Like a pen, stabilize it on the patient’s chest.
• Use of Jelly: Initially use more for better skin contact.

Pro Tips:

• Use dynamic maneuvers, patient positioning for better imaging.
• Focus on screen, not hand position, for probe movements.

Key Views in Ultrasound

• Subcostal View: Check pericardial effusions, LV/RV distension.
• Parasternal Long Axis: Evaluate RV, aorta, atria dimensions.
• Parasternal Short Axis: Examine LV and RV relationship.
• Apical Four Chamber: Assess LV, RV, atria, valve functions.

Identifying Shock Causes

• Tamponade Indicators: Collapses in RA and RV.
• Pulses Alternance: Visualized on ECG for tamponade.
• Case Studies: Examples of misdiagnosed shocks clarified with US.

IVC and Fluid Management

• IVC Assessment: Evaluate size for insight into fluid tolerance; not for fluid responsiveness.

E-FAST Exam

• Standard exam in emergency medicine.
• Right Upper Quadrant First: Identifies free fluid in trauma.

Aortic Assessment

• Common Aortic Issues: Identification through US; start from belly button towards bifurcation.

Pneumothorax and Ectopic Pregnancy

• Pneumothorax Identification: Lung sliding absence indicates presence.
• Ectopic Pregnancy Indicators: Empty uterus on US with positive HCG.

DVT Scanning

• Compression Test: Vein collapse indicates no clot.

Take-Home Points

• Incorporate US into Shock Protocols: Essential for reassessment.
• Reassess Using US: Check treatment effectiveness post-initial management.

Conclusion

• Ultrasound is a vital tool in emergency care.
• Regular practice and systematic approach improve diagnostic accuracy.

Resources

• QR code links to videos for further learning.