Ultrasound

Rapid Review

• Indications
  • Confirmation of ET tube placement
  • Identifying landmarks prior to cricothyroidotomy
• Common Findings
  • Confirming ET tube placement
    • One air-mucosal interface w/ comet-tail artifact and posterior shadowing indicates successful tracheal intubation.
    • Two air-mucosal interfaces (“Double tract sign”) indicates esophageal intubation
  • Cricothyrotomy landmarks
    • Longitudinal = dark, anechoic “string of pearls” represent tracheal rings
    • Transverse = “TACA method” (Thyroid, Air, Cricoid, Air). Thyroid will appear as a V-Shape. Air wil appear as hyperechoic white A-line. Cricoid appears as hypoechoic round arch-shaped structure.

Pearls

Deep Dive

• Airway Management with Point-of-Care-Ultrasound: A Breath of Fresh Air (FCEP)

Rapid Review

• Indications
  • Suspected AAA (abdominal pain, hypotension, pulsatile mass)
• Interpretation
  • Begin in the epigastric area. The abdominal aorta should taper as you track further distally. Be suspicious if the aorta begins to dilate. 
  • AAA is diagnosed when the diameter > 3 cm

Pearls

Deep Dive

• Abdominal Aortic Ultrasound (Core EM)

Rapid Review

Pearls

Deep Dive

• Biliary Ultrasound (CORE EM)

Rapid Review

• Indications
  • Chest pain/Palpitations
  • Significant EKG changes
  • Shortness of breath
  • Hypotension
  • New heart murmurs
  • Cardiac arrest
  • Dizziness
• Common Findings/Interpretation
  • Regional wall motion abnormality
    • Suggests ischemic heart disease
  • Poor squeeze
    • Decompensated HF
  • Hyperdynamic Squeeze
    • Sepsis, Pneumonia
  • McConnell’s Sign
    • Acute PE
  • D Sign
    • Acute PE
  • RA Collapse/RV Collapse
    • Cardiac tamponade
  • Pericardial effusion
    • Best found with parasternal long-axis and subcostal four-chamber view

Pearls

Deep Dive

• Scanning School – Cardiac (Taming the SRU)

Rapid Review

• Indications
  • Shortness of breath
  • Hypoxia
  • Pleuritic chest pain
  • Chest trauma
• Common findings/interpretation
  • A-lines
    • Normal lung
  • B-Lines
    • Sensitive for pulmonary edema
  • Absence of lung sliding; finding of “lung point”
    • Suggests pneumothorax
  • Shred sign
    • Sign of lung consolidation (pneumonia)

Pearls

Deep Dive

• BLUE Protocol (International Emergency Medicine Education Project)

Rapid Review

• Indications
  • Assessment of intravascular volume status during hypotensive states (sepsis, hemorrhage, heart failure, dehydration)
• Interpretation
  • IVC < 1 cm
    • In the setting of trauma, associated with high likelihood of hemorrhage requiring blood transfusion
  • IVC < 1.5 cm
    • Suggests volume depletion
  • IVC 1.5 – 2.5 cm
    • Normal finding
  • IVC > 2.5 cm
    • Suggests volume overload

Pearls

Deep Dive

• The Dark Art of IVC Ultrasound (LITFL)

Rapid Review

• Indications
  • Vision loss
  • Symptoms of increased ICP
  • Trauma
• Common Findings/Interpretation
  • Disruption of globe architecture or anterior chamber collapse
    • Globe rupture
  • Hypoechoic fluid posterior to globe
    • Retrobulbar hematoma
  • “Twinkle” or hyperechoic object
    • Foreign body
  • Posteriorly displaced lens
    • Lens detachment
  • Separation of hyperechoic linear structure from posterior choroid
    • Retinal detachment

Pearls

Deep Dive

• Ocular Ultrasound (CORE EM)

Rapid Review

• Indications
  • Suspected foreign bodies
  • Suspected soft tissue infection
• Common Findings/Interpretation
  • Cobblestoning
    • Suggests cellulitis
  • Hyperechoic ring, hypoechoic circular area, squish sign
    • Suggests abscess
  • Acoustic shadowing (ring down appearance)
    • Wood/splinter foreign body
  • Reverberation
    • Metal foreign body

Pearls

Deep Dive

• Ultrasound G.E.L – Ultrasound in Skin and Soft Tissue Infection (emDocs)

Rapid Review

• Indications
  • Evaluation of testicular/scrotal pain
• Interpretation
  • Testicular torsion
    • “Whirlpool sign”
    • Secondary findings (hydrocele, scrotal wall thickening)
    • Decreased/absent flow in the affected testical, utilizing color doppler
  • Testicular appendage torsion
    • Enlarged, rounded extra-testicular masses, with mixed hyperechoic/heterogeneous texture
    • Absent flow on color doppler
  • Epididymitis
    • Heterogeneous echogenicity
    • Enlargement
    • Secondary findings (hydrocele, scrotal wall thickening)
    • Increased flow in the affected testical,
  • Testicular Rupture
    • Disruption of tunica albuginea
    • Focal/diffuse loss of vascularity (color doppler)
  • Testicular tumors
    • Well-defined, hypoechoic/heterogeneous intratesticular lesion
  • Fournier Gangrene
    • Diffuse subcutaneous tissue thickening. 
    • Bright echogenic foci w/ dirty shadowing and reverberation artifacts (soft tissue gas)

Pearls

Deep Dive

• Scrotal Pain – Scrotal PoCUS in a nutshell (Emergency Medicine Saint John)

Rapid Review

• Indications
  • Blunt or penetrating trauma
• Common Findings/Interpretation
  • Absent lung sliding
    • Suggests pneumothorax
  • Anechoic area in pericardial space
    • Suggests pericardial tamponade
  • Anechoic area between liver and kidney
    • Suggests hemorrhage in morrison’s pouch
  • Anechoic area between diaphragm and spleen
    • Suggests hemorrhage
  • Anechoic area between spleen and kidney
    • Suggests hemorrhage
  • Anechoic area between superior and posterior to walls of bladder
    • Suggests hemorrhage

Pearls

Deep Dive

• How To Do E-FAST Examination (Merck Manual)