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Atlas of Critical Care Echocardiography PDF

196 Pages·2021·20.04 MB·english
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Alexis Salerno · Daniel J. Haase Sarah B. Murthi Editors Atlas of Critical Care Echocardiography 123 Atlas of Critical Care Echocardiography Alexis Salerno • Daniel J. Haase Sarah B. Murthi Editors Atlas of Critical Care Echocardiography Editors Alexis Salerno Daniel J. Haase Department of Emergency Medicine Department of Surgery, Program in Trauma University of Maryland School of Medicine and Critical Care Baltimore, MD University of Maryland School of Medicine USA Baltimore, MD USA Sarah B. Murthi Department of Surgery, Program in Trauma and Critical Care R Adams Cowley Shock Trauma Center Baltimore, MD USA ISBN 978-3-030-74685-8 ISBN 978-3-030-74687-2 (eBook) https://doi.org/10.1007/978-3-030-74687-2 © Springer Nature Switzerland AG 2021 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This Springer imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland I’d like to dedicate this book to a special mentor (who also happens to be creator of this book), Sarah B. Murthi. Your mentorship, friendship, and support have meant more than you could understand. Thank you for pushing me further than I could have anticipated. This book is also dedicated to the fellows, faculty, and staff at the R Adams Cowley Shock Trauma Center, especially Dr. Thomas Scalea. Your excellence and dedication to the care of the critically ill and injured have motivated this book and so many other achievements. Thank you for supporting our vision of ultrasound and echocardiography. Lastly, this book is dedicated to a close friend who has encouraged me, but also kept me grounded throughout everything – Ashley Aitken. You have supported me throughout my many personal and professional challenges. Thank you for telling me the perspective I always need to hear. Daniel J. Haase This book is dedicated to the residents and medical students who I have worked with over the last few years. The excitement of ultrasound learners when they see incredible pathology or learn new techniques keeps me energized in a field many describe as exhausting. This book is also dedicated to the University of Maryland Department of Emergency Medicine; our department chair Dr. Brian Browne, who has always supported ultrasound education; and our department ultrasound director Dr. Brian Euerle, who has mentored me since medical school. I would also like to thank Dr. Sarah B. Murthi for the opportunity to collaborate with her on this project and for the wealth of knowledge I have learned from her through our numerous “nerdy talks” over the last 2 years. Lastly, I would like to dedicate this book to my wonderful husband who helps me edit and even serves as an ultrasound model at times. And of course, our German Shephard puppy Kaiser! Alexis Salerno This book is dedicated to the Critical Care Fellows who I have worked with and learned from over the last 15 years. It is ultimately a collaboration between all of us. It came from years of picking through echocardiography and ultrasound to extract and develop new tools for taking care of critically ill patients. Two of them are my co-editors without whom this NEVER would have happened. The collaboration has been a true pleasure. The book is also dedicated to The R Adams Cowley Shock Trauma Center and more specifically Thomas M. Scalea. He encourages all of us to blaze a trail while leaving a path to help others who have taken on the difficult task of acute care medicine. Finally, the book is dedicated to my family: my husband Anand, our children Valon and Nina, and our two dogs Griffin and Ollie, whose warmth and support kept me sane. The dogs and I spent hours tucked in my office early in the morning and late at night bringing this project to completion. Sarah B. Murthi Preface Point-of-care ultrasound is a growing discipline in acute care. As we were writing this book, the relevant metrics grew and grew, expanding outside of traditional echocardiography into vascular and body imaging. This new tool of hemodynamic ultrasound has the potential to improve how we manage shock and resuscitation along the continuum of care from pre- hospital management through recovery and on to hospital discharge. Also, the images you will obtain are beautiful and learning it will fundamentally change your understanding of the car- diovascular system. There is a steep learning curve, but we swear climbing it is rewarding – and it will make you a better doctor. The book is designed to learn hemodynamic ultrasound and to refresh as needed. The first part describes how to obtain the windows and images. The second part outlines how to do measurements and analyze images. The final two parts are protocols which incorporate echo- cardiography into acute care medicine. The format is modular, and the parts are short, so you can tailor your experience to needs. Enjoy! We loved writing it. Baltimore, MD, USA Alexis Salerno Baltimore, MD, USA Daniel J. Haase Baltimore, MD, USA Sarah B. Murthi vii Acknowledgments This is a collaboration between artists and physicians. Most of the illustrations were created by Vondel Mahon, Medical Illustrator. Misty Paccao also contributed figures and diagrams. Gary Wind, MD, FACS was deeply involved in the original conception of the project and created some of the images used. The Department of Emergency Medicine granted us use of several images as did the Program in Trauma in the Department of Surgery at the University of Maryland. Also, we would like to acknowledge the hard work and expertise of Syeda (Hina) Fatima, the cardiac sonographer who advised us throughout all aspects of manuscript conception and production. ix Contents Part I Imaging Obtaining, Interpreting, and Using Echo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Alexis Salerno and Sarah B. Murthi Parasternal Long Axis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Sarah B. Murthi and Syeda Fatima Parasternal Short Axis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Allison Lankford Apical 4 Chamber and Apical 5 Chamber . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Erin Niles, Ann Matta, and Sarah B. Murthi Subxiphoid Cardiac and Inferior Vena Cava Views . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Rhea Votipka and Shannon Gaasch Liver Doppler . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 David Gordon and Sarah B. Murthi Renal Doppler . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Sarah B. Murthi Thoracic Ultrasound . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Emily Hart and Sarah B. Murthi Part II M easurements and Interpretation Left Ventricular Ejection Fraction and E-point Septal Separation . . . . . . . . . . . . . . . . 47 Brandon Masi Parker Stroke Volume, Cardiac Output, and Systemic Vascular Resistance . . . . . . . . . . . . . . . 53 Sarah B. Murthi and Syeda Fatima Diastolic Function . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 Alexis Salerno and Sarah B. Murthi Right Ventricular Systolic Function . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 Alexis Salerno Pulmonary Hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 Alexis Salerno, Allison Lankford, and Sarah B. Murthi Inferior Vena Cava Respiratory Variation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 Shannon Gaasch and Alexis Salerno Stroke Volume Variation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85 Michelle F. Dawson and Alexis Salerno xi xii Contents Pulmonary Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 Alexis Salerno and Sarah B. Murthi Right Atrial Pressure Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95 Sagar B. Dave and Sarah B. Murthi Potpourri of Pathology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .103 Alexis Salerno, Daniel J. Haase, and Sarah B. Murthi Part III S hock Protocols The Focused Sonogram for Trauma (FAST) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .117 Kevin Flanagan and Sarah B. Murthi The Rapid UltraSound in Shock (RUSH) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .123 Kevin Flanagan and Alexis Salerno Cardiac Arrest Sonographic Assessment (CASA) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .129 Ahmed Al Hazmi Part IV The Focused Rapid Echocardiographic Evaluation (FREE) There Is No @#$% Tank! It is a Pump!! . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .137 Sarah B. Murthi Echo-Based Shock Physiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .151 Sarah B. Murthi The Focused Rapid Echocardiographic Evaluation (FREE) . . . . . . . . . . . . . . . . . . . . .159 Sarah B. Murthi Fluid Strategies in the FREE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .165 Brooke Anderson and Sarah B. Murthi Hemodynamic Profiles in the FREE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .169 Sarah B. Murthi The Focused Rapid Echocardiographic Evaluation (FREE): Clinical Examples . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .177 Sarah B. Murthi Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .189

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