FOCUSED ECHOCARDIOGRAPHY DURING ACLS · FOCUSED ECHOCARDIOGRAPHY DURING ACLS ......

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© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY WINFOCUS BASIC ECHO (WBE) FOCUSED ECHOCARDIOGRAPHY DURING ACLS S. PATRICK BENDER MD

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Page 1: FOCUSED ECHOCARDIOGRAPHY DURING ACLS · FOCUSED ECHOCARDIOGRAPHY DURING ACLS ... WINFOCUS’**CRITICAL CARE ECHOCARDIOGRAPHY! Rationale • Cardiac Activity Strongly Associated With

© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

WINFOCUS BASIC ECHO (WBE)!

FOCUSED ECHOCARDIOGRAPHY

DURING ACLS

S. PATRICK BENDER MD

Page 2: FOCUSED ECHOCARDIOGRAPHY DURING ACLS · FOCUSED ECHOCARDIOGRAPHY DURING ACLS ... WINFOCUS’**CRITICAL CARE ECHOCARDIOGRAPHY! Rationale • Cardiac Activity Strongly Associated With

© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

!

Outline

• Rationale for the use of echocardiography during ACLS

• Algorithm

• Implementation

• Interpretation

• Questions and Cases

Page 3: FOCUSED ECHOCARDIOGRAPHY DURING ACLS · FOCUSED ECHOCARDIOGRAPHY DURING ACLS ... WINFOCUS’**CRITICAL CARE ECHOCARDIOGRAPHY! Rationale • Cardiac Activity Strongly Associated With

© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

!

Rationale

Page 4: FOCUSED ECHOCARDIOGRAPHY DURING ACLS · FOCUSED ECHOCARDIOGRAPHY DURING ACLS ... WINFOCUS’**CRITICAL CARE ECHOCARDIOGRAPHY! Rationale • Cardiac Activity Strongly Associated With

© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

!

Rationale

Page 5: FOCUSED ECHOCARDIOGRAPHY DURING ACLS · FOCUSED ECHOCARDIOGRAPHY DURING ACLS ... WINFOCUS’**CRITICAL CARE ECHOCARDIOGRAPHY! Rationale • Cardiac Activity Strongly Associated With

© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

!

Rationale

Page 6: FOCUSED ECHOCARDIOGRAPHY DURING ACLS · FOCUSED ECHOCARDIOGRAPHY DURING ACLS ... WINFOCUS’**CRITICAL CARE ECHOCARDIOGRAPHY! Rationale • Cardiac Activity Strongly Associated With

© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

!

Rationale

Causes of “Pseudo-PEA”

Pericardial Effusion with Tamponade

Hypovolemia

Pulmonary Embolism

Severe Ventricular Dysfunction

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© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

!

Rationale

“True-PEA” “Pseudo-PEA”

Severe Ventricular Dysfunction

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© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

!

Rationale

“True-PEA” “Pseudo-PEA”

Severe Ventricular Dysfunction

Page 9: FOCUSED ECHOCARDIOGRAPHY DURING ACLS · FOCUSED ECHOCARDIOGRAPHY DURING ACLS ... WINFOCUS’**CRITICAL CARE ECHOCARDIOGRAPHY! Rationale • Cardiac Activity Strongly Associated With

© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

!

Rationale

Page 10: FOCUSED ECHOCARDIOGRAPHY DURING ACLS · FOCUSED ECHOCARDIOGRAPHY DURING ACLS ... WINFOCUS’**CRITICAL CARE ECHOCARDIOGRAPHY! Rationale • Cardiac Activity Strongly Associated With

© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

!

Rationale

Page 11: FOCUSED ECHOCARDIOGRAPHY DURING ACLS · FOCUSED ECHOCARDIOGRAPHY DURING ACLS ... WINFOCUS’**CRITICAL CARE ECHOCARDIOGRAPHY! Rationale • Cardiac Activity Strongly Associated With

© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

!

Rationale

Page 12: FOCUSED ECHOCARDIOGRAPHY DURING ACLS · FOCUSED ECHOCARDIOGRAPHY DURING ACLS ... WINFOCUS’**CRITICAL CARE ECHOCARDIOGRAPHY! Rationale • Cardiac Activity Strongly Associated With

© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

!

Rationale

Page 13: FOCUSED ECHOCARDIOGRAPHY DURING ACLS · FOCUSED ECHOCARDIOGRAPHY DURING ACLS ... WINFOCUS’**CRITICAL CARE ECHOCARDIOGRAPHY! Rationale • Cardiac Activity Strongly Associated With

© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

!

Rationale

Page 14: FOCUSED ECHOCARDIOGRAPHY DURING ACLS · FOCUSED ECHOCARDIOGRAPHY DURING ACLS ... WINFOCUS’**CRITICAL CARE ECHOCARDIOGRAPHY! Rationale • Cardiac Activity Strongly Associated With

© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

!

Rationale

• Cardiac Activity Strongly Associated With Return of Spontaneous Circulation

• 8/11 Patients With Cardiac Activity Had ROSC

• 0/23 Patients Without Cardiac Activity Had ROSC

Page 15: FOCUSED ECHOCARDIOGRAPHY DURING ACLS · FOCUSED ECHOCARDIOGRAPHY DURING ACLS ... WINFOCUS’**CRITICAL CARE ECHOCARDIOGRAPHY! Rationale • Cardiac Activity Strongly Associated With

© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

!

Rationale

• Cardiac Activity Strongly Associated With Return of Spontaneous Circulation

• 8/11 Patients With Cardiac Activity Had ROSC

• 0/23 Patients Without Cardiac Activity Had ROSC

Page 16: FOCUSED ECHOCARDIOGRAPHY DURING ACLS · FOCUSED ECHOCARDIOGRAPHY DURING ACLS ... WINFOCUS’**CRITICAL CARE ECHOCARDIOGRAPHY! Rationale • Cardiac Activity Strongly Associated With

© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

!

Rationale

• Cardiac Activity Strongly Associated With Return of Spontaneous Circulation

• 8/11 Patients With Cardiac Activity Had ROSC

• 0/23 Patients Without Cardiac Activity Had ROSC

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© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

!

Algorithm

Page 18: FOCUSED ECHOCARDIOGRAPHY DURING ACLS · FOCUSED ECHOCARDIOGRAPHY DURING ACLS ... WINFOCUS’**CRITICAL CARE ECHOCARDIOGRAPHY! Rationale • Cardiac Activity Strongly Associated With

© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

!

Algorithm

When to apply

Page 19: FOCUSED ECHOCARDIOGRAPHY DURING ACLS · FOCUSED ECHOCARDIOGRAPHY DURING ACLS ... WINFOCUS’**CRITICAL CARE ECHOCARDIOGRAPHY! Rationale • Cardiac Activity Strongly Associated With

© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

!

Algorithm

Page 20: FOCUSED ECHOCARDIOGRAPHY DURING ACLS · FOCUSED ECHOCARDIOGRAPHY DURING ACLS ... WINFOCUS’**CRITICAL CARE ECHOCARDIOGRAPHY! Rationale • Cardiac Activity Strongly Associated With

© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

!

Algorithm

Page 21: FOCUSED ECHOCARDIOGRAPHY DURING ACLS · FOCUSED ECHOCARDIOGRAPHY DURING ACLS ... WINFOCUS’**CRITICAL CARE ECHOCARDIOGRAPHY! Rationale • Cardiac Activity Strongly Associated With

© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

!

Algorithm

Page 22: FOCUSED ECHOCARDIOGRAPHY DURING ACLS · FOCUSED ECHOCARDIOGRAPHY DURING ACLS ... WINFOCUS’**CRITICAL CARE ECHOCARDIOGRAPHY! Rationale • Cardiac Activity Strongly Associated With

© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

!

Page 23: FOCUSED ECHOCARDIOGRAPHY DURING ACLS · FOCUSED ECHOCARDIOGRAPHY DURING ACLS ... WINFOCUS’**CRITICAL CARE ECHOCARDIOGRAPHY! Rationale • Cardiac Activity Strongly Associated With

© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

!

Page 24: FOCUSED ECHOCARDIOGRAPHY DURING ACLS · FOCUSED ECHOCARDIOGRAPHY DURING ACLS ... WINFOCUS’**CRITICAL CARE ECHOCARDIOGRAPHY! Rationale • Cardiac Activity Strongly Associated With

© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

!

Page 25: FOCUSED ECHOCARDIOGRAPHY DURING ACLS · FOCUSED ECHOCARDIOGRAPHY DURING ACLS ... WINFOCUS’**CRITICAL CARE ECHOCARDIOGRAPHY! Rationale • Cardiac Activity Strongly Associated With

© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

!

Page 26: FOCUSED ECHOCARDIOGRAPHY DURING ACLS · FOCUSED ECHOCARDIOGRAPHY DURING ACLS ... WINFOCUS’**CRITICAL CARE ECHOCARDIOGRAPHY! Rationale • Cardiac Activity Strongly Associated With

© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

!

Algorithm

Page 27: FOCUSED ECHOCARDIOGRAPHY DURING ACLS · FOCUSED ECHOCARDIOGRAPHY DURING ACLS ... WINFOCUS’**CRITICAL CARE ECHOCARDIOGRAPHY! Rationale • Cardiac Activity Strongly Associated With

© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

!

Algorithm

Echocardiography Performed in Parallel With Pulse Checks -‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐

Less Than 10 seconds of Compression Interrup?on

Page 28: FOCUSED ECHOCARDIOGRAPHY DURING ACLS · FOCUSED ECHOCARDIOGRAPHY DURING ACLS ... WINFOCUS’**CRITICAL CARE ECHOCARDIOGRAPHY! Rationale • Cardiac Activity Strongly Associated With

© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

!

Implementation

Page 29: FOCUSED ECHOCARDIOGRAPHY DURING ACLS · FOCUSED ECHOCARDIOGRAPHY DURING ACLS ... WINFOCUS’**CRITICAL CARE ECHOCARDIOGRAPHY! Rationale • Cardiac Activity Strongly Associated With

© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

!

ImplementationPreparation

Page 30: FOCUSED ECHOCARDIOGRAPHY DURING ACLS · FOCUSED ECHOCARDIOGRAPHY DURING ACLS ... WINFOCUS’**CRITICAL CARE ECHOCARDIOGRAPHY! Rationale • Cardiac Activity Strongly Associated With

© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

!

Implementation

• Perform High Quality Compressions - At Least 5 cycles

Preparation

Page 31: FOCUSED ECHOCARDIOGRAPHY DURING ACLS · FOCUSED ECHOCARDIOGRAPHY DURING ACLS ... WINFOCUS’**CRITICAL CARE ECHOCARDIOGRAPHY! Rationale • Cardiac Activity Strongly Associated With

© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

!

Implementation

• Perform High Quality Compressions - At Least 5 cycles

• Announce “We are going to do an echocardiogram during next pulse check.”

Preparation

Page 32: FOCUSED ECHOCARDIOGRAPHY DURING ACLS · FOCUSED ECHOCARDIOGRAPHY DURING ACLS ... WINFOCUS’**CRITICAL CARE ECHOCARDIOGRAPHY! Rationale • Cardiac Activity Strongly Associated With

© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

!

Implementation

• Perform High Quality Compressions - At Least 5 cycles

• Announce “We are going to do an echocardiogram during next pulse check.”

• Prepare Probe

Preparation

Page 33: FOCUSED ECHOCARDIOGRAPHY DURING ACLS · FOCUSED ECHOCARDIOGRAPHY DURING ACLS ... WINFOCUS’**CRITICAL CARE ECHOCARDIOGRAPHY! Rationale • Cardiac Activity Strongly Associated With

© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

!

Implementation

• Perform High Quality Compressions - At Least 5 cycles

• Announce “We are going to do an echocardiogram during next pulse check.”

• Prepare Probe

• Prepare Patient by Removing Any Barriers to Image Acquisition

Preparation

Page 34: FOCUSED ECHOCARDIOGRAPHY DURING ACLS · FOCUSED ECHOCARDIOGRAPHY DURING ACLS ... WINFOCUS’**CRITICAL CARE ECHOCARDIOGRAPHY! Rationale • Cardiac Activity Strongly Associated With

© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

!

ImplementationExecution

Page 35: FOCUSED ECHOCARDIOGRAPHY DURING ACLS · FOCUSED ECHOCARDIOGRAPHY DURING ACLS ... WINFOCUS’**CRITICAL CARE ECHOCARDIOGRAPHY! Rationale • Cardiac Activity Strongly Associated With

© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

!

ImplementationExecution

• Place Probe on Patient

Page 36: FOCUSED ECHOCARDIOGRAPHY DURING ACLS · FOCUSED ECHOCARDIOGRAPHY DURING ACLS ... WINFOCUS’**CRITICAL CARE ECHOCARDIOGRAPHY! Rationale • Cardiac Activity Strongly Associated With

© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

!

ImplementationExecution

• Place Probe on Patient

• Announce a Pulse Check and Echo Exam Will be Done in 10 Seconds

Page 37: FOCUSED ECHOCARDIOGRAPHY DURING ACLS · FOCUSED ECHOCARDIOGRAPHY DURING ACLS ... WINFOCUS’**CRITICAL CARE ECHOCARDIOGRAPHY! Rationale • Cardiac Activity Strongly Associated With

© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

!

ImplementationExecution

• Place Probe on Patient

• Announce a Pulse Check and Echo Exam Will be Done in 10 Seconds

• Countdown 10 Seconds

Page 38: FOCUSED ECHOCARDIOGRAPHY DURING ACLS · FOCUSED ECHOCARDIOGRAPHY DURING ACLS ... WINFOCUS’**CRITICAL CARE ECHOCARDIOGRAPHY! Rationale • Cardiac Activity Strongly Associated With

© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

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ImplementationExecution

• Place Probe on Patient

• Announce a Pulse Check and Echo Exam Will be Done in 10 Seconds

• Countdown 10 Seconds

• Perform and Record Echo While Code Leader Counts Down to Resume Compressions

Page 39: FOCUSED ECHOCARDIOGRAPHY DURING ACLS · FOCUSED ECHOCARDIOGRAPHY DURING ACLS ... WINFOCUS’**CRITICAL CARE ECHOCARDIOGRAPHY! Rationale • Cardiac Activity Strongly Associated With

© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

!

ImplementationResumption of Compressions

and Echo Interpretation

Page 40: FOCUSED ECHOCARDIOGRAPHY DURING ACLS · FOCUSED ECHOCARDIOGRAPHY DURING ACLS ... WINFOCUS’**CRITICAL CARE ECHOCARDIOGRAPHY! Rationale • Cardiac Activity Strongly Associated With

© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

!

ImplementationResumption of Compressions

and Echo Interpretation

• Resumption of Compressions

Page 41: FOCUSED ECHOCARDIOGRAPHY DURING ACLS · FOCUSED ECHOCARDIOGRAPHY DURING ACLS ... WINFOCUS’**CRITICAL CARE ECHOCARDIOGRAPHY! Rationale • Cardiac Activity Strongly Associated With

© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

!

ImplementationResumption of Compressions

and Echo Interpretation

• Resumption of Compressions

• Interpretation of Images During Continuation of ACLS

Page 42: FOCUSED ECHOCARDIOGRAPHY DURING ACLS · FOCUSED ECHOCARDIOGRAPHY DURING ACLS ... WINFOCUS’**CRITICAL CARE ECHOCARDIOGRAPHY! Rationale • Cardiac Activity Strongly Associated With

© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

!

Implementation

Page 43: FOCUSED ECHOCARDIOGRAPHY DURING ACLS · FOCUSED ECHOCARDIOGRAPHY DURING ACLS ... WINFOCUS’**CRITICAL CARE ECHOCARDIOGRAPHY! Rationale • Cardiac Activity Strongly Associated With

© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

!

Implementation

Page 44: FOCUSED ECHOCARDIOGRAPHY DURING ACLS · FOCUSED ECHOCARDIOGRAPHY DURING ACLS ... WINFOCUS’**CRITICAL CARE ECHOCARDIOGRAPHY! Rationale • Cardiac Activity Strongly Associated With

© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

!

Implementation

• Immediately Resume Compressions

• Attempt Again, Possibly in Different Echocardiographic Window

Difficult Image Acquisition

Page 45: FOCUSED ECHOCARDIOGRAPHY DURING ACLS · FOCUSED ECHOCARDIOGRAPHY DURING ACLS ... WINFOCUS’**CRITICAL CARE ECHOCARDIOGRAPHY! Rationale • Cardiac Activity Strongly Associated With

© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

!

ImplementationDifficult Image Acquisition

Page 46: FOCUSED ECHOCARDIOGRAPHY DURING ACLS · FOCUSED ECHOCARDIOGRAPHY DURING ACLS ... WINFOCUS’**CRITICAL CARE ECHOCARDIOGRAPHY! Rationale • Cardiac Activity Strongly Associated With

© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

!

ImplementationDifficult Image Acquisition

Page 47: FOCUSED ECHOCARDIOGRAPHY DURING ACLS · FOCUSED ECHOCARDIOGRAPHY DURING ACLS ... WINFOCUS’**CRITICAL CARE ECHOCARDIOGRAPHY! Rationale • Cardiac Activity Strongly Associated With

© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

!

InterpretationTrue-PEA

Absence of Cardiac Activity

Page 48: FOCUSED ECHOCARDIOGRAPHY DURING ACLS · FOCUSED ECHOCARDIOGRAPHY DURING ACLS ... WINFOCUS’**CRITICAL CARE ECHOCARDIOGRAPHY! Rationale • Cardiac Activity Strongly Associated With

© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

!

InterpretationTrue-PEA

Absence of Cardiac Activity

Page 49: FOCUSED ECHOCARDIOGRAPHY DURING ACLS · FOCUSED ECHOCARDIOGRAPHY DURING ACLS ... WINFOCUS’**CRITICAL CARE ECHOCARDIOGRAPHY! Rationale • Cardiac Activity Strongly Associated With

© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

!

Interpretation

Pericardial Tamponade

RV CollapseEffusion

Page 50: FOCUSED ECHOCARDIOGRAPHY DURING ACLS · FOCUSED ECHOCARDIOGRAPHY DURING ACLS ... WINFOCUS’**CRITICAL CARE ECHOCARDIOGRAPHY! Rationale • Cardiac Activity Strongly Associated With

© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

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Interpretation

Pericardial Tamponade

RV CollapseEffusion

Page 51: FOCUSED ECHOCARDIOGRAPHY DURING ACLS · FOCUSED ECHOCARDIOGRAPHY DURING ACLS ... WINFOCUS’**CRITICAL CARE ECHOCARDIOGRAPHY! Rationale • Cardiac Activity Strongly Associated With

© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

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InterpretationPulmonary Embolism

Hypokinetic and Dilated RV

Underfilled LV

Page 52: FOCUSED ECHOCARDIOGRAPHY DURING ACLS · FOCUSED ECHOCARDIOGRAPHY DURING ACLS ... WINFOCUS’**CRITICAL CARE ECHOCARDIOGRAPHY! Rationale • Cardiac Activity Strongly Associated With

© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

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InterpretationPulmonary Embolism

Hypokinetic and Dilated RV

Underfilled LV

Page 53: FOCUSED ECHOCARDIOGRAPHY DURING ACLS · FOCUSED ECHOCARDIOGRAPHY DURING ACLS ... WINFOCUS’**CRITICAL CARE ECHOCARDIOGRAPHY! Rationale • Cardiac Activity Strongly Associated With

© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

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Interpretation

Hypovolemic RV

Hypovolemic LV

Hypovolemia

Page 54: FOCUSED ECHOCARDIOGRAPHY DURING ACLS · FOCUSED ECHOCARDIOGRAPHY DURING ACLS ... WINFOCUS’**CRITICAL CARE ECHOCARDIOGRAPHY! Rationale • Cardiac Activity Strongly Associated With

© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

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Interpretation

Hypovolemic RV

Hypovolemic LV

Hypovolemia

Page 55: FOCUSED ECHOCARDIOGRAPHY DURING ACLS · FOCUSED ECHOCARDIOGRAPHY DURING ACLS ... WINFOCUS’**CRITICAL CARE ECHOCARDIOGRAPHY! Rationale • Cardiac Activity Strongly Associated With

© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

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Interpretation

Severely Hypokinetic LV

Severe Ventricular Dysfunction

Page 56: FOCUSED ECHOCARDIOGRAPHY DURING ACLS · FOCUSED ECHOCARDIOGRAPHY DURING ACLS ... WINFOCUS’**CRITICAL CARE ECHOCARDIOGRAPHY! Rationale • Cardiac Activity Strongly Associated With

© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

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Interpretation

Severely Hypokinetic LV

Severe Ventricular Dysfunction

Page 57: FOCUSED ECHOCARDIOGRAPHY DURING ACLS · FOCUSED ECHOCARDIOGRAPHY DURING ACLS ... WINFOCUS’**CRITICAL CARE ECHOCARDIOGRAPHY! Rationale • Cardiac Activity Strongly Associated With

© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

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Summary

Page 58: FOCUSED ECHOCARDIOGRAPHY DURING ACLS · FOCUSED ECHOCARDIOGRAPHY DURING ACLS ... WINFOCUS’**CRITICAL CARE ECHOCARDIOGRAPHY! Rationale • Cardiac Activity Strongly Associated With

© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

!

Summary

• Focused Echo During ACLS Can Be Both Diagnostic and Prognostic

• Differentiating “True-PEA From “Pseudo-PEA” Can Guide Treatment

• Focused Echo Is Easily Integrated Into ACLS

• REMEMBER TO MINIMIZE INTERRUPTIONS IN CHEST COMPRESSIONS!

Page 59: FOCUSED ECHOCARDIOGRAPHY DURING ACLS · FOCUSED ECHOCARDIOGRAPHY DURING ACLS ... WINFOCUS’**CRITICAL CARE ECHOCARDIOGRAPHY! Rationale • Cardiac Activity Strongly Associated With

© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

!

Summary

• Focused Echo During ACLS Can Be Both Diagnostic and Prognostic

• Differentiating “True-PEA From “Pseudo-PEA” Can Guide Treatment

• Focused Echo Is Easily Integrated Into ACLS

• REMEMBER TO MINIMIZE INTERRUPTIONS IN CHEST COMPRESSIONS!

Page 60: FOCUSED ECHOCARDIOGRAPHY DURING ACLS · FOCUSED ECHOCARDIOGRAPHY DURING ACLS ... WINFOCUS’**CRITICAL CARE ECHOCARDIOGRAPHY! Rationale • Cardiac Activity Strongly Associated With

© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

!

Summary

• Focused Echo During ACLS Can Be Both Diagnostic and Prognostic

• Differentiating “True-PEA From “Pseudo-PEA” Can Guide Treatment

• Focused Echo Is Easily Integrated Into ACLS

• REMEMBER TO MINIMIZE INTERRUPTIONS IN CHEST COMPRESSIONS!

Page 61: FOCUSED ECHOCARDIOGRAPHY DURING ACLS · FOCUSED ECHOCARDIOGRAPHY DURING ACLS ... WINFOCUS’**CRITICAL CARE ECHOCARDIOGRAPHY! Rationale • Cardiac Activity Strongly Associated With

© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

!

Summary

• Focused Echo During ACLS Can Be Both Diagnostic and Prognostic

• Differentiating “True-PEA From “Pseudo-PEA” Can Guide Treatment

• Focused Echo Is Easily Integrated Into ACLS

• REMEMBER TO MINIMIZE INTERRUPTIONS IN CHEST COMPRESSIONS!

Page 62: FOCUSED ECHOCARDIOGRAPHY DURING ACLS · FOCUSED ECHOCARDIOGRAPHY DURING ACLS ... WINFOCUS’**CRITICAL CARE ECHOCARDIOGRAPHY! Rationale • Cardiac Activity Strongly Associated With

© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

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Cases/QuestionsDuring a PEA Arrest, the below image is obtained. The patient remains pulseless.

1.

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© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

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Cases/QuestionsDuring a PEA Arrest, the below image is obtained. The patient remains pulseless.

1.

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© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

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Cases/Questions

What is the appropriate next step?

A. Attempt Parasternal View

B. Immediately Resume Compressions

C. Bolus Normal Saline

D. Administer Thrombolytics

1.

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© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

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Cases/Questions

What is the appropriate next step?

A. Attempt Parasternal View

B. Immediately Resume Compressions

C. Bolus Normal Saline

D. Administer Thrombolytics

1.

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© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

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Cases/Questions!

B. Immediately Resume Compressions

Poor Image Quality

1.

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© WINFOCUS’ CRITICAL CARE ECHOCARDIOGRAPHY

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Cases/Questions!

B. Immediately Resume Compressions

Poor Image Quality

1.

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Cases/Questions2.

A patient is admitted to the Emergency Department in PEA Arrest. The below image is obtained.

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Cases/Questions2.

A patient is admitted to the Emergency Department in PEA Arrest. The below image is obtained.

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Cases/Questions

What is the most likely cause of the arrest?

A. Pulmonary Embolism

B. Pericardial Tamponade

C. Severe Hypovolemia

D. Myocardial Infarction

2.

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Cases/Questions

What is the most likely cause of the arrest?

A. Pulmonary Embolism

B. Pericardial Tamponade

C. Severe Hypovolemia

D. Myocardial Infarction

2.

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Cases/Questions

Severely Hypokinetic

LV

2.

D. Myocardial Infarction

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Cases/Questions

Severely Hypokinetic

LV

2.

D. Myocardial Infarction

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Cases/Questions

During a Cardiac Arrest, what is the maximum amount of time that cardiac compressions should be interrupted to allow for pulse check and focused echocardiography? !

A. 10 seconds

B. 15 seconds

C. 20 seconds

D. 30 seconds

3.

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Cases/Questions!

A. 10 seconds

3.

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Thank You!

Focused Ultrasound Simulator Education (FUSE) WORKSHOP ... · and cardiac surgery. For the Peri-arrest course basic training in focused cardiac ultrasound (transthoracic echocardiography

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