Atlas of Critical Care Echocardiography

196 Pages·2021·20.04 MB·english

by  Alexis Salerno

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
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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