Ultrasound


Airway 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

Video Credit: InterAnest


Abdominal Aorta Ultrasound

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

Video Credit: EMRAP
Video Credit: EMRAP


Biliary Ultrasound

Rapid Review

Pearls

Video Credit: AMBOSS


Cardiac Ultrasound

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

Video Credit: POCUS Geek


Lung Ultrasound

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

Video Credit: EM:RAP


Inferior Vena Cava Ultrasound

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

Video Credit: Clarius Mobile Health


Ocular Ultrasound

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

Video Credit: Anna Pickens


Soft Tissue Ultrasound

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

Video Credit: BC Emergency Medicine Network


Testicular/Scrotal Ultrasound

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

Video Credit: 123radiology


Trauma Ultrasound (E-FAST)

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

Video Credit: POCUS Geek

Brandon Simpson, PA-C
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