Ultrasound

  • Cardiac Ultrasound
  • Lung Ultrasound
  • Ocular Ultrasound
  • Soft Tissue Ultrasound
  • Trauma Ultrasound (E-Fast)

Cardiac Ultrasound

  • 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
Video Credit: POCUS Geek

*Deep Dive: Scanning School – Cardiac (Taming the SRU)

Lung Ultrasound

  • 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)
Video Credit: EM:RAP

*Deep Dive: BLUE Protocol (International Emergency Medicine Education Project)

Ocular Ultrasound

  • 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
Video Credit: Anna Pickens

*Deep Dive: Ocular Ultrasound (CORE EM)

Soft Tissue Ultrasound

  • 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
Video Credit: BC Emergency Medicine Network

*Deep Dive: Ultrasound G.E.L – Ultrasound in Skin and Soft Tissue Infection (emDocs)

Trauma Ultrasound (E-FAST)

  • 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
Video Credit: POCUS Geek

*Deep Dive: How To Do E-FAST Examination (Merck Manual)

Brandon Simpson, PA-C
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