Clinical Ultrasound

A How-To Guide

Tarina Lee Kang, John Bailitz, Tarina Lee Kang, John Bailitz

• Publisher: CRC Press
• Year: 2015
• Print ISBN: 9781482221404
• eBook ISBN: 9780429585944
• Edition: 1
• Topic: Medicine
• Subtopic: Emergency Medicine & Critical Care

Clinical Ultrasound: A How-To Guide is targeted at the novice to intermediate clinician sonographer. The book's easy-to-follow style and visually appealing chapter layout facilitates the quick recall of knowledge and skills needed to use clinical ultrasound in everyday practice. Authored by experts in emergency medicine clinical ultrasound from acr

1	Trauma
	John Bailitz

INDICATIONS

• Evaluate blunt or penetrating trauma to torso for intra-abdominal or intrathoracic bleeding

• Perform serial abdominal exams for new or progressive bleeding

• Assess for pneumothorax of any etiology

IMAGE ACQUISITION AND INTERPRETATION

EQUIPMENT

• Phased array or curvilinear 2.5–5 MHz transducer

PREPARATION

• Perform prior to Foley placement to utilize the bladder as an acoustic window.

• Place the patient supine or in slight Trendelenburg when possible to increase the amount of dependent fluid in the hepatorenal fossa (Morison’s pouch).

RECOMMENDED VIEWS

Order determined by clinical context.

1. Subxiphoid

2. Right upper quadrant

3. Left upper quadrant

4. Pelvis

5. Thorax

SUBXIPHOID VIEW

TRANSDUCER PLACEMENT

• To visualize the pericardium, place the transducer in the transverse scanning plane just to the right of the xiphoid process aiming toward the left scapula with the indicator toward the patient’s right.

• With inadequate visualization, increase your depth and ask the patient to take a breath and hold in to bring the mediastinum toward the transducer.

• If view obscured by stomach gas, slide the transducer to patient’s right slightly, to use more of the liver as an acoustic window.

• A minority of patients require a parasternal long view.

NORMAL ANATOMY

Top of image to bottom:

a. Left lobe of the liver

b. Anterior pericardium

c. Right ventricle

d. Septum

e. Left ventricle

f. Posterior pericardium

PATHOLOGY

• Acute bleeding is visualized as an anechoic fluid collection within the pericardial sac, between the visceral and parietal anterior and posterior pericardium (*).

• With increasing bleeding, fluid surrounds the heart, becoming visible in the anterior pericardium.

• With time, clotting results with mixed echogenicity.

• The noncompliant pericardial sac may quickly tamponade venous return, visualized as diastolic right heart collapse (*), especially in the hypovolemic patient.

• A benign anterior pericardial fat pad will have a mixed echogenicity, not seen posteriorly or changing on repeat exam.

RIGHT UPPER QUADRANT VIEW

TRANSDUCER POSITION

• To visualize Morison’s pouch, place the transducer in the mid-axillary line in the coronal scanning plane, in the 9th to 11th intercostal space, aiming obliquely toward the retroperitoneum with the indicator pointing toward the patient’s head.

• Avoid rib shadows by slightly rotating indicator toward the bed in an oblique plane.

• To better visualize the subphrenic space and right thorax, slide the transducer up an intercostal space, or ask the patient to take a deep breath in and hold for 5 seconds. Alternatively, slide the transducer more anteriorly toward the axillary line at the 8th to 9th intercostal space, again fanning toward the retroperitoneum.

NORMAL ANATOMY

Left to right of image:

a. Thorax

b. Diaphragm

c. Liver

d. Morison’s pouch

e. Right kidney

PATHOLOGY

• Acute bleeding will fill the pelvis, then spill over the right paracolic gutter into Morison’s pouch, the most dependent portion of the abdomen above the pelvis.

• Fluid (*) will appear as an anechoic fluid collection below the diaphragm (*).

• Anechoic fluid may represent acute bleeding, urine from a bladder rupture, or pre-existing ascites. Serial exams and other tests will clarify.

LEFT UPPER QUADRANT VIEW

TRANSDUCER POSITION

• To visualize the splenorenal space, place the transducer in the posterior axillary line in the coronal scanning plane, in the 8th to 10th intercostal space, aiming obliquely toward the retroperitoneum with the indicator pointing toward the patient’s head. The probe should be more superior and posterior than in the right upper quadrant view.

NORMAL ANATOMY

Left to...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• Preface
• Introduction
• The Editors
• Contributing Authors
• Chapter 1 Trauma
• Chapter 2 Echo and IVC
• Chapter 3 Lung
• Chapter 4 Abdominal Aorta
• Chapter 5 Renal and Bladder
• Chapter 6 Biliary
• Chapter 7 First Trimester Pregnancy
• Chapter 8 Appendicitis
• Chapter 9 Ocular Ultrasound
• Chapter 10 Soft Tissue Procedures
• Chapter 11 Musculoskeletal
• Chapter 12 Lower Extremity Deep Vein Thrombosis
• Chapter 13 Vascular Access
• Chapter 14 Pediatric
• Chapter 15 Abdominal Procedures
• Chapter 16 Pericardiocentesis
• Chapter 17 Thoracentesis
• Chapter 18 US-Guided Peripheral Nerve Blocks
• Chapter 19 Lumbar Puncture
• Further Learning