Trauma : Abdomen Trauma : Pelvis - WordPress.com · Basic Emergency POCUS Principles Pocketcard...
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Trauma : Pelvis Trauma : Abdomen Probe: curved*/phased Orient n : longitudinal AL : xiphoid/mid-ax line SL : double density kidney AOI : interface/’tips’/6:9 (L) ID landmarks several slow sweeps AOI clear entire AOI archive clips Pos : AOI free fluid (black) Neg : no free fluid, all areas Indet : missing any view Risk! : clot, midline scars Q : Free fluid ? (Y/N) Landmarks Checklist Findings Select OB : Trans-Abdominal Probe: curved*/phased Orient n : long. + trans. AL : symphysis pubis SL : bladder + adj. solid organ AOI : hyperechoic centre (ES/DR) Full bladder Keep probe at symphysis Find centre of solid organ 1 st ! Sweep slowly/clip Look for 3 findings +/- FF Pos : IUP : DR+GS+YS or FP : LIUP : FHR w/in discrete FP NDIUP : <3 criteria Risk! : must = 3 criteria for IUP : myometrial mantle < 1cm needs formal Q : IUP ? (Y/N) Landmarks Checklist Findings Select Trauma : Pelvis Probe: curved*/phased Orient n : long. + trans. AL : symphysis pubis SL : bladder AOI : ♂ RVS ♀UVS + RVS ID landmarks sweep AOI slowly! sweep in TWO planes archive clips Pos : AOI free fluid (black) Neg : no free fluid Indet : missing any view Risk! : clot, midline scars Q : Free fluid ? (Y/N) No Free Fluid Free Fluid Landmarks Checklist Findings Select OB : Trans-Vaginal Probe: endocavitary Orient n : sagittal + coronal AL : Gentle probe insertion SL : bladder + adj. solid organ AOI : hyperechoic stripe (ES/DR) Empty bladder for study To find bladder – relax probe Find centre of solid organ 1 st ! Sweep/clip slowly – rotate probe Look for 3 findings +/- FF Pos : IUP : DR+GS+YS/FP : LIUP : FHR w/in discrete FP NDIUP : <3 criteria Risk! : Must = 3 criteria for IUP : myometrial mantle < 1cm needs formal Q : IUP ? (Y/N) Landmarks Checklist Findings Select OB : Findings AOI °’Tips’ °Interface °6:9 (LUQ) 6 9 POS RUQ POS LUQ ♀ LONG. NEG ♀ LONG. POS ♂ LONG. NEG ♂ LONG . NEG ♂ LONG . POS ♀ TSV. POS ♀ TSV. NEG ♂ TSV. NEG ♂ TSV. POS IUP DR GS YS Mantle Sagittal Bladder Coronal Bladder IUP NDIUP IUP NDIUP DR+GS DR+GS+YS DR+GS+FP DR+GS DR+GS+YS DR+GS+FP FHR < 100 = concerning! FHR < 100 = concerning!
Transcript of Trauma : Abdomen Trauma : Pelvis - WordPress.com · Basic Emergency POCUS Principles Pocketcard...
Trauma : Pelvis Trauma : Abdomen
Probe: curved*/phased Orientn: longitudinal
AL : xiphoid/mid-ax line SL : double density kidney AOI : interface/’tips’/6:9 (L)
q ID landmarks q several slow sweeps AOI q clear entire AOI q archive clips
Pos : AOI free fluid (black) Neg : no free fluid, all areas Indet : missing any view Risk! : clot, midline scars
Q : Free fluid ? (Y/N)
Land
marks
Ch
ecklist
Find
ings
Se
lect
OB : Trans-Abdominal Probe: curved*/phased Orientn: long. + trans.
AL : symphysis pubis SL : bladder + adj. solid organ AOI : hyperechoic centre (ES/DR)
q Full bladder q Keep probe at symphysis q Find centre of solid organ 1st! q Sweep slowly/clip q Look for 3 findings +/- FF
Pos : IUP : DR+GS+YS or FP : LIUP : FHR w/in discrete FP NDIUP : <3 criteria Risk! : must = 3 criteria for IUP : myometrial mantle < 1cm needs formal
Q : IUP ? (Y/N)
Land
marks
Ch
ecklist
Find
ings
Se
lect
Trauma : Pelvis Probe: curved*/phased Orientn: long. + trans.
AL : symphysis pubis SL : bladder AOI : ♂ RVS ♀UVS + RVS
q ID landmarks q sweep AOI slowly! q sweep in TWO planes q archive clips
Pos : AOI free fluid (black) Neg : no free fluid Indet : missing any view Risk! : clot, midline scars
Q : Free fluid ? (Y/N) No Free Fluid
Free Fluid
Land
marks
Ch
ecklist
Find
ings
Se
lect
OB : Trans-Vaginal Probe: endocavitary Orientn: sagittal + coronal
AL : Gentle probe insertion SL : bladder + adj. solid organ AOI : hyperechoic stripe (ES/DR)
q Empty bladder for study q To find bladder – relax probe q Find centre of solid organ 1st! q Sweep/clip slowly – rotate probe q Look for 3 findings +/- FF
Pos : IUP : DR+GS+YS/FP : LIUP : FHR w/in discrete FP NDIUP : <3 criteria Risk! : Must = 3 criteria for IUP : myometrial mantle < 1cm needs formal
Q : IUP ? (Y/N)
Land
marks
Ch
ecklist
Find
ings
Se
lect
OB : Findings
AOI
°’Tips’ °Interface °6:9 (LUQ)
6
9
POS RUQ
POS LUQ
♀ LONG. NEG
♀ LONG. POS
♂ LONG. NEG
♂ LONG . NEG
♂ LONG . POS ♀ TSV. POS
♀ TSV. NEG ♂ TSV. NEG
♂ TSV. POS
IUP
DR
GS
YS
Mantle
Sagittal
Bladder
Coronal
Bladder
IUP NDIUP
IUP NDIUP
DR+GS DR+GS+YS DR+GS+FP
DR+GS DR+GS+YS DR+GS+FP
FHR < 100 = concerning! FHR < 100 = concerning!
Basic Emergency POCUS Principles
Pocketcard version 1.0. M. Moss, B. Hassani, D. Thompson (6/14)
Emergency Medicine
Point of Care Ultrasound Reference Card
Version 1.0
Machine Operation 1. Press “start & end” 2. Enter PIN & Cerner login 3. Select desired probe 4. Generate good images 5. Save clips or stills 6. Repeat 4+5 as necessary 7. Press “start & end” 8. Clean machine
Phased Array Curvilinear
Heart/Torso 3-5MHz
Abdomen 3-5MHz
Probes
AL : Anatomical Landmark SL : Sonographic Landmark AOI : Area of interest PCE : Pericardial Effusion RUQ : Right Upper Quadrant LUQ : Le= Upper Quadrant RVS : Rectovesicular Space UVS : Uterovesicular Space RUS : Rectouterine Space TA : Trans-‐abdominal TV : Trans-‐vaginal ES : Endometrial Stripe
* Preferred probe for applicaCon
IUP : Intrauterine Pregnancy LIUP : Live Intrauterine Pregnancy NDIUP : No Definite IUP DR : Decidual ReacCon
generalized endometrial thickening
GS : GestaConal Sac anechoic sac with a decidual reac4on
YS : Yolk Sac circular, echogenic structure at the edge of but dis4nct from the wall of GS
FP : Fetal Pole small mass at the margin of YS; dis4nct from GS; possible cardiac ac4vity
Aorta
AL : xiphoid SL : vertebral body + shadow AOI : outer wall aorta
q ID landmarks q AOI xiphoid to bifurcation q clip sequential sweeps q caliper AOI max. diameter
Q : AAA ? (Y/N)
Pos : outer diameter ≥ 3cm Neg : outer diameter < 3cm Indet : missing > 1 probe width Risk! : missing > probe width of visualization : not starting at xiphoid
Land
marks
Find
ings
Ch
ecklist
Select
Probe: curved*/phased Orientn: transverse
NEG
+ AAA
Cardiac (sub-xiphoid)
AL : above umbilicus SL : heart + echogenic envelope AOI : pericardial space
q ID landmarks q slide towards xiphoid q clip slow sweeps ant/post
Pos : anechoic fluid at AOI : no cardiac activity Neg : no anechoic fluid : vigorous cardiac activity Indet : unable to visualize SL / AOI Risk! : clinical context is key! : watch for false positives
Land
marks
Ch
ecklist
Find
ings
Se
lect
NEG
+ PCE
Q : PCE ? (Y/N) Q : Contractility? (Y/N)
Probe: phased*/curved Orientn: transv/coronal
Legend
² Inform patients re: limitations/benefits of POCUS
² Always interpret results w/in clinical context
² Move probe in one plane at a time
² Sweep è S-L-O-W-L-Y
² AOI is always white
Responsible POCUS
² Commit to seeing entire AOI – No False Negatives ² Do not overcall OB scans – No False Positives ² Stick to NDIUP/IUP/LIUP for OB studies ² Calling indeterminate studies equally important!
