Ultrasound in Critical Care Puneet Khanna
INDEX
Page numbers followed by f refer to figure, fc refer to flowchart, and t refer to table.
A
Abdomen, regions of 184f
Abdominal transverse 155f
Abdominal ultrasound 25
Abscess, spread of 193
Acalculous cholecystitis 191f
Accessory inspiratory muscles 241
Acinetobacter 276, 277
Acoustic enhancement, posterior 47
Acoustic impedance 35, 35t
Acoustic shadow 72
posterior 47
Acute hypotension, causes of 154
Acute respiratory
distress syndrome, prognosis of 111
failure
causes of 15fc
differential diagnosis of 3
Adenomyomatosis 49f
Advancing needle 173f
Air 35
bronchogram 103f, 270f
mucosal
interface 72, 74
surface 84f
Airway
anatomy 68
imaging, challenges of 68
management 78, 158
during resuscitation 158
pathology 78
prediction of difficult 74
ultrasonography of 13
ultrasound 68
imaging of 70
American College of Chest Physicians 261
American Society of Anesthesiologists 57
Analgesia 169
Anechoic stripe 145
Aneurysm 182
formation 188
Antibiotic 169
prophylaxis 188
Aorta
abdominal 147, 223, 223f, 224f
ascending 118f
discending 19
Aortic aneurysm, abdominal 154
Aortic blood velocity 142
Aortic dissection, suspected 115
Aortic opening 239
Aortic root 118f
Aortic stenosis 121
Aortic valve 118, 118f, 119f, 121, 126f
morphology of 118
open 125
Apical approach 182
Apical four-chamber view 120
Apical pneumothorax 98f
Arcuate ligament 238
lateral 238
medial 238
Arm, muscle of 253
Arterial cannulation 65
Arterial vasculature 147
Artery 60
Artifact
attenuation-related 47
mirror-image 48
propagation-related 47
resolution-related 47
ring-down 48
ultrasound beam-related 47, 50
Ascites, ultrasonographic appearance of 185f
Asthma 112
Atelectasis 173, 239
Atrial collapse, right 133
Atrial contraction 127
Atrial fibrillation 163
Atrial septal defect 129
Atrial thrombus, left 118
Axillary vein puncture 63f
Azimuthal resolution 44
B
Bacillus 277
Bacteremia 193
Barcode sign 98f, 157f
Bat sign 95f, 230
Beck's triad 268
Bedside lung ultrasound in emergency 3, 14, 15f, 108, 229
Black hypoechoic stripe 145
Bladder 220f
Blood muscle 35
Body mass index 87, 252
Bone 35
muscle 35
Bowel injury and infections 187
Brachial artery 53f, 55f
Brain
death 196
midline shift of 199
Branch pulmonary arteries 119f
Breast, ultrasound image of 45f
Breathing pattern, deep 248f
Breathing, apposition during normal 245f
C
Candida albicans 277
Candida parapsilosis 277
Cannulation during resuscitation 158
Cardiac abnormalities 136
Cardiac arrest 150, 158
causes of 151
etiology for 150, 158
situation 150
application in 4
ultrasound exam 159
victim, ultrasound in 159
Cardiac chambers 234
Cardiac compression 158, 159
Cardiac critical care ultrasound 111
Cardiac evaluation, ultrasonography in 115
Cardiac failure 173, 183
Cardiac output, measurement of 21, 122
Cardiac preload 140
Cardiac pump failure 229
Cardiac standstill 158
Cardiac tamponade 151, 152, 152f, 156, 161, 178
Cardiogenic pulmonary edema 112
Cardiopulmonary
arrest 160fc
cerebral resuscitation 268, 271
resuscitation 76, 161, 235
ultrasound in 150
Cardiothoracic surgery 240
Carotid artery 59
common 13f, 61
internal 74
Carotid jugular vessels 70
Catheter
in situ 63f, 172f
management 193
selection 168
size, correct 194
Cellular debris, sedimentation of 101f
Cellular effusions 269
Central nervous system 196
Central tendon 239
Central venous
access, history of 57
catheter 268
placement of 173
pressure 138140
Cerebral artery 201f
anterior 202
Cerebral blood flow 196, 199
velocity 196
Cerebral circulatory arrest, diagnosis of 202
Cerebral ischemia, delayed 200
Cerebral spinal fluid 197
Cerebrocirculatory arrest 196
Chamber pressures, measurement of 22
Chest
conditions 229
drainage tube 270
radiography 241
ultrasound 110
wall 99f
anterior 235
X-ray 270f
diagnosis with 271
Cholecystitis, acute 190
Classic Beck's triad 178
Classic Seldinger technique 170
Clostridium difficile 277
spores 276
Coagulase-negative staphylococci 277
Collapsed bladder 222f
Color Doppler flow imaging 52
Comet tail
artifact 72, 48
image 14
Contrast-enhanced computed tomography 20
Coronary artery
disease 129
puncture 182
Coronary cusp, right 19
Coronary embolus 151
Coronary thrombosis 151
Corticomedullary differentiation, loss of 222f
Corynebacterium diphtheriae 277
Corynebacterium species 277
Costophrenic angle, right 271f
Cricoid cartilage 69f, 70, 72, 72f
Cricothyroid membrane 69f, 70, 72, 77, 88
Cricothyrotomy
role of ultrasound in 88
technique 87
ultrasound-guided 82, 87
Critical care
basic views in 19
echocardiography 31
basic 31
training in advanced 32
medicine, applications in 10
ultrasound 31
ward, echocardiography in 19
Critically ill
hypotensive patients 138
patient 78
echocardiography in 115
Curtain sign 100
Curvilinear low frequency probe 242
Curvilinear transducers 37
D
Deep femoral veins, confluence of 265f
Deep vein thrombosis 4, 23, 24f, 233, 260, 262t, 264, 272
diagnosis of 261
in pregnancy 263
of lower limbs 262
ultrasonography in 260
Diagnostic peritoneal lavage 208
Diaphragm 238, 255, 258
anatomy of 238f
applied anatomy of 238
change in thickness of 245
dysfunction 240
in intensive care unit, echogenicity of 248
peripheral part of 239
thickening fraction, role of 258
thickness of 243, 245
ultrasonography for 255
ultrasound of 238
with intercostal approach 245f
Diaphragmatic palsy
bilateral 241
unilateral 240
Diaphragmatic slip 239
Diaphragmatic velocity 248
Diastasis 127
Diastolic collapse 153f, 269f
of right ventricle 133
Diastolic dysfunction 5
characterization of 127
Diastolic function 122
of left ventricle, assessment of 127
Diffuse reflection 36
Distensibility index 143
Doppler imaging 51
modes of 51
Doppler phenomenon 34
Drainage technique 170
Drug over dosages 151
Duplex scanning 52
Dynamic air bronchograms 110
Dynamic parameters 138
Dynamic range compensation 38
Dysfunction, causes of 129
Dysrhythmias 182
E
Echocardiography 115
in intensive care unit
advantages of 116, 116t
disadvantages of 116, 116t
Echogenic muscle, less 256f
Ejection fraction, normal 120
Electrolyte 151
Electromyography 241, 252
Elevation resolution 44
Emergency medicine residents 209
Emphysema 103f
Empyema 229, 230
End diastolic velocity 200
Endocavitary probe 64f
Endothelial growth factor 273
Endotracheal intubation 158
Endotracheal tube 75
placement, confirmation of 76
End-systolic volume 125f
Enterococci 277
Epiglottis 70, 71, 73
Escherichia coli 276, 277
Esophageal mesentery 242
Esophageal opening 239
Esophageal transducer 241
Esophagus 70, 74, 239
European Society of Intensive Care Medicine 31
Euvolemia 148
Evaluating diaphragm, techniques for 241, 241t
Extravascular lung water 18, 22, 104, 111, 139
Exudative pleural effusion 102f
Eyeball 198f
junction of 198f
F
Fat 35
muscle 35
interface, superficial 254f, 255f
Female feticide 278
Femoral artery 24f
common 264
deep 264
superficial 264
Femoral vein 264
cannulation 64
normal sonography of 24f
Fibroadenoma 45f
Fibrous pericardium 239
Fistulous communications 193
Flapping lung 100
Floor of mouth 71
Floor of tongue, muscle of 70
Fluid bolus 268
Fluid collection 145f
abnormal 187
Fluid optimization 139f
Fluid replacement 154
Fluid response 132
Fluid responsiveness 138
prediction of 139f, 143, 144
Fluoroscopy 241
Foley's catheter balloon 222f
Fractal sign 231f
G
Gallbladder 48f, 49f, 190, 225
Gallstone 48f
sludge 190
Gastric
content, evaluation of 78
transducer 241
Gastroesophageal reflux 240
Glaucoma 199
Global ejection fraction 139
Global end-diastolic volume 140
index 140
Gray myocardium 144
Great saphenous vein 264
Guidewire in situ 171f
Guiding therapeutic procedures 226
H
Heart
evaluation of 5
failure 273
Heart-lung interaction, physiological basis of 141
Hematocrit sign 100, 101f, 271
visible 271f
Hematoma formation 188, 193
Hemidiaphragm, right 239
Hemodynamic edema 234
Hemodynamic instability 187
Hemodynamic monitoring 139f, 186
Hemoglobin 139
Hemoperitoneum 275
Hemorrhage 186, 193
Hemothorax 178, 182, 229, 268, 271, 274, 275
Hepatic abscess 189, 190f
Hepatic cirrhosis 183
Hepatorenal space, scanning 145
Herpes zoster 240
Hiccups 240
Hockey stick probe 62, 64f
Homogeneity 111
Homogenous interstitial opacities 272f
Hydronephrosis, severe 192f
Hydrothorax 271
Hyoid bone 70, 71
Hyperdynamic left ventricle 140
Hyperechoic fibroadipose septae 242
Hyperechoic pericardium 144
Hyperkinetic left ventricular 154
Hyperthyroidism with exophthalmos 199
Hypertrophic crus 239
Hypervolemia 138
Hypoalbuminemia, severe 183
Hypoechoic muscle fibers 242
Hypoglycemia 151
Hypoperfusion 229
Hypopharynx 70
Hypotension 144, 178, 268
causes of 4f
rapid ultrasound for 154f
Hypotensive patient 22
approach to 24fc
Hypothermia 151, 240
Hypovolemia 131, 138, 140, 151, 152f, 154, 229
assessment of 22
Hypovolemic left ventricle 120
Hypovolemic shock 235
Hypovolemic ventricle
in diastole 132f
in systole-cavity 132f
Hypoxemia
acute 229
causes of 114, 234
etiologies of 113fc
severe 230
severity of 112
Hypoxia 151
I
Infection 178, 240
control 276
Infective pathologies 173
Inferior vena cava 3, 4, 10, 23f, 24, 32, 41f, 122, 133f, 142, 147f, 155, 155f, 208, 223, 225, 225f
calculation of 148f
diameter 142
view, subcostal 122
Inflammatory disorders 240
Inguinal ligament 265f
Inhaled nitric oxide, dose of 113
Injury severity score 209
Intensive care unit 1, 32, 117, 216, 229, 252
abdominal ultrasonography in 216
fever in 5
sonography, legal issues in 278
Interatrial septum 120f, 121f
Intercostal chest drainage 274
Intercostal nerves 239
Interstitial edema 229, 232, 234
indicate 232
Interstitial pneumonitis 102
Interstitial syndrome 102
Interventricular septum 118f, 120f, 121f
Intra-abdominal collections, percutaneous drainage of 187
Intraabdominal pressure 240
Intracranial pressure 3, 5, 10, 196
Intracranial vasospasm 200
Intravascular volume, assessment of 148
Isovolumetric relaxation 127
J
Jellyfish sign 100
Jugular engorgement 268
Jugular vein
cannulation, external 64
external 64
internal 11, 13f, 59, 61
ultrasound assessment of 13f
Jugular vessels, internal 70
K
Kidney 35
hydronephrosis of 222f
right 121f
ultrasound of 221
Kissing papillary muscles 132f
Kissing ventricles 140
Kissing walls 131
Klebsiella 277
pneumoniae 270
L
Lead zirconate titanate 35
Left ventricle
end of systole 123
end-diastolic
area 140
diameter 123
volume 138, 140
outflow tract 121
Left ventricular
end-diastolic 154
area 163
end-systolic area 163
outflow tract 3, 19, 20
Leg
raising, passive 143
veins 143
Limb muscles 253
Liver 35
muscle 35
Local skin site infection 193
Lower limb 263
venous system of 264
Lumbar vertebrae 238
Lung 32, 159
collapse 230
comet 18
consolidations 230
hepatization of 103f
interfaces 229
morphology 110
normal 14, 94, 146
profiles 233
re-expansion of 177
right 99f
sliding 16f, 230
sonography of 4, 18f, 234
surface, anterior 233
ultrasonography 146f, 230, 269f
ultrasound 93, 94, 99, 111, 234
equipment for 93
in intensive care unit 105
limitations of 108
physics of 93
Lyme disease 240
M
Malecot catheter 168, 169f
Massive pulmonary embolism 229
McConnell's sign 133
Mean arterial pressure 139, 141
Mechanical ventilation 107
Mediastinal tumors 240
Metabolic imbalances 151
Methicillin-resistant Staphylococcus aureus 276, 277
Mitral valve 118, 118f121f, 124
leaflet
anterior 19
posterior 19
Mixed echogenic appearance 242
Morrison's pouch 26, 218
Morrison's space 209, 210
Motor neuron disease 240
Mucosal interface 69f
Muffled heart sound 268
Multidrug-resistant
bacteria 276
pseudomonas 277
Multiorgan failure 187
Multiple organ failure 187
Muscle 35, 238
assessment of 257
dysfunction 252
ultrasonography of 252
echogenicity 248
function 253
assessment of 252, 253, 257
in intensive care unit, assessment of 258
surrogate of 253
ultrasonography of 253
mass 259
decreased 252
primary 240
thickness 253, 254f256f
Muscular body wall 242
Muscular echotexture 242
Mycobacterium tuberculosis 277
Myocardial disease 115
Myocardial infarct, acute 163
Myocardial infarction 229
N
Nasogastric tube 226
placement 226, 227
confirmation of 78
Neck
surgery 240
ultrasonographic anatomy of 83
Needle selection 168
Needle tip 59
Needle tracking 171
Neoplasms 173
Nerve blocks related to airway 78
Neurocritical care, ultrasonography in 196
Neuromuscular junction, diseases of 240
Neurovascular bundle 176
injury to 176f
New York Heart Association 18
Non-coronary cusp 19
Nonstarling pulmonary edema 111
Nontraumatic cardiac arrest, causes of 159
Normokinetic apex 133
Nosocomial infection 252, 276
O
Obstructive pulmonary disease, chronic 15, 112, 234
Optic nerve 11f, 198f
atrophy 199
junction of 198f
sheath 5
diameter 10, 196
diameter, measurement of 196
method of 197
Optic neuritis 199
Orbital hematoma 199
Orbital trauma 199
Oxygen
consumption 139
delivery 139
P
Palate 71, 72
Papillary muscle 118f, 120f
level of 154f
Paracentesis 183
complications 186
contraindications 184
indications 184
needle insertion for 185f, 186f
postprocedure care 186
technique 184
Paralysis 239
Parapneumonic effusion 102f, 173
Parasternal sternal short-axis view 119f
Pearl technique, string of 89
Pelvic
abscess 189
cavity 275f
Percutaneous cholecystostomy 189, 191f
Percutaneous dilatational
technique 82
tracheostomy 77, 82
ultrasound-guided 82
Percutaneous nephrolithotomy 273
Percutaneous nephrostomy 189, 192
Percutaneous transhepatic biliary drainage 48
Pericardial effusion 21, 118, 121, 133, 152, 153, 153f, 162, 179, 236
Pericardial fluid 32
Pericardial space, scanning 144
Pericardial tamponade 32, 134f, 229, 236, 268
incidence of 268
Pericardiocentesis 178, 181f
clinical pearls 183
complications 182
contraindications 179
indications 179
kit 181
postprocedure care 182
technique 179
Pericholecystic fluid 190
Perihepatic fluid 100f
Perimysium 242
Periosteum 255f
Peripartum cardiomyopathy 272
Peripheral muscle 253, 258
ultrasonography for 253
Peripheral venous cannulation 65
Phrenic nerve 240
palsy 239
Pigtail catheter 168
in situ 190f
Pigtail shaped distal loop 169f
Pigtail thoracocentesis, representation of 177f
Plankton sign 100
Pleth variability index 141
Pleura 70
thickened 269
ultrasound of 93
Pleural cavity 208
Pleural effusion 17, 99, 111, 175f, 229, 230, 231f, 271f, 274
in right lung 145f
large right-sided 46f
Pleural fluid 99f
producing hematocrit sign 101f
Pleural space, right 145
Pleural syndrome 108, 111, 112
Pleural ultrasound 14f
Pleuroperitoneal folds 242
Pneumonia 111, 112, 229, 269
diagnosis of 270
postoperative 272
Pneumoperitoneum, detection of 226
Pneumothorax 15, 98, 112, 146, 156158, 178, 182, 208, 229, 230, 235, 268, 271, 271f, 274
diagnosis of 79
presence of 233
Point-of-care ultrasound 1, 2
characteristics of 1
history of 1
Polyvinylidene difluoride 37
Poor quality of life 252
Popliteal artery 264, 265
Popliteal fossa 265
vein position in 265f
Popliteal vein 264, 265
Portal venous flow 53f
Positive end-expiratory pressure 107
Positive pressure ventilation 140
Posterolateral alveolar syndrome 108, 111, 112
Postextubation stridor, prediction of 78
Postsurgical fluid collections 187
Pre-natal Diagnostic Techniques Act 278
Pretest probability scores 262
Pre-tracheal tissue 84f
Probes, types of 242t
Propagation velocity 34
Pseudomonas aeruginosa 277
Pulmonary
artery 119f, 133
bifurcation of 119f
catheters 148
hypertension 129
occlusion pressure 138, 140
pressure 134
systolic pressure 136f
wedge pressure 140
blood volume 140
edema 18, 18f, 102, 229, 232, 234, 272, 272f
re-expansion 178
embolism 20, 112, 118, 260, 264, 272
acute 20, 133
embolus 151, 152f, 156
fibrosis 102, 111, 270
function test 241
hypertension 134, 135
masses 111
regurgitation 129
thromboembolism 260
valve 118, 119f
vascular dysfunction 112, 139
vein 120f, 121
normal 130f
pulsed-wave doppler 127
Pulse
Doppler 52
pressure variation 141
repetition frequency 43
Pulsed-wave doppler 127
Pulseless electrical activity 151, 158
Pupillary light reflex 196, 203
Pupillary reaction 10
Pupillary size 12f
Q
Quad sign 231
Quinones method 124
R
Rectovesicular space, scanning 145
Reflection 36
Refraction 36
Renal failure 183
Renal pelvis, dilated 222f
Respiratory distress 272
syndrome, acute 17, 106, 110, 111, 234
Respiratory failure
acute 108
causes of 111, 234
Resuscitation, causes during 152
Reverberation artifact 96f, 97f, 227f
Rib cage 241
Right atrium, draining into 155f
Right ventricle
dilatation of 129
dilatation, causes of 129
end-diastolic volume 138, 140
in pericardial tamponade 153f
thrombus in 135f, 156f
Right ventricular
dilation 21f
dysfunction 112
ejection fraction 129, 131
function, assessment of 129
size and contractility 32
S
Safety considerations 38
Salmonella typhi 277
Salmonella typhimurium 277
Saphenous vein
normal sonography of 24f
superficial 264
Sarcopenia 252
Seagull sign 224, 224f
Seashore sign 96f, 230, 269f
Seldinger technique 88, 170, 177, 182, 188, 191
of catheter insertion 171f
Sepsis 193
severe 136
Sesame protocol 235
Shock 144, 229
and hypotension, rapid ultrasound for 4, 146, 159
causes of 163t, 229
evaluation of 4
rapid ultrasound for 154f
type of 163
Simpson's method 125f
of discs, modified 124
Sinusoid sign 100, 231
Sliding sign 269f
Sniff test 143
Society of Interventional Radiology 188
Sonographic air bronchograms 103f
Sonography 10
of trauma, focused assessment 208
Sound, velocity of 35t
Spaulding classification 278t
Specular reflector 36
Splenorenal recess 218f
Splenorenal space, scanning 145
Spontaneously breathing adults 143
Staphylococcus aureus 270
Static parameters 138
Sternocleidomastoid 74
Strap muscles 7274
Streptococcus pneumoniae 270, 277
Streptococcus pyogenes 277
Stroke volume 139
increase in 138
variation 139, 141
Subarachnoid hemorrhage 200
Subclavian vein 10, 11, 63f
cannulation 62
Subcostal approach, posterior 246f
Subcostal four-chamber view 121
Subcostal transverse 144
Subdiaphragmatic fluid 100f
Subglottic stenosis 89
Sublingual approach 70
Submandibular sagittal view, extended 71f
Subphrenic space 211
Subpleural consolidation 106f
Subpulmonic effusion 239
Substantial pericardial effusion 234
Subxiphoid cardiac view 220f
Sunken eyes 138
Superficial veins, confluence of 265f
Superior vena cava 122, 140
collapsibility index 143
Suprasternal notch 13f, 74f, 75
Swinging heart 154
Systemic vascular resistance 139
index 139
Systolic dysfunction 273
Systolic function 122
of left ventricle, assessment of 123
Systolic pressure variation 141
Systolic spikes 202, 203f
T
TACA technique, transverse 88
Tachycardia 274
Tachypnea 274
Tandem trocar technique 170
Target sign 65
Technological advancement in medicine 151
Temporal resolution 44
Tendon 238
Tension pneumothorax 151, 153, 156
Therapeutic procedures, ultrasound-guided 167
Thigh muscle 254
anterior 255f
Thoracic aorta 147
Thoracic cavity 275f
Thoracocentesis 173, 176f
ultrasound-guided 173
Thoracotomy, indications of 271
Thromboembolic pulmonary hypertension, chronic 118
Thrombus in main pulmonary artery 135f, 157f
Thyroid 69
cartilage 70, 71, 73
gland 70, 74
isthmus 75
Tissue
Doppler imaging 125, 131, 131f, 224f
harmonic imaging 44, 45
like sign 232f
Tongue 7072
Torulopsis glabrata 277
Toxicity 151
Trachea 13f, 84f
anterior 85f
localization of 77
Tracheal lumen 84f
Tracheal rings 69, 69f, 70, 84
Transcranial color Doppler 202
Transcranial Doppler 11, 201f
Transcranial sonography 196
Transdiaphragmatic pressure 241
Transducer material 35
Transesophageal echocardiography 32, 113, 148
Transmitral pulse wave Doppler 128f
Transthoracic echocardiogram 32
Transthoracic echocardiography 4, 117f, 148, 236
common 117
probe 116, 117f
subcostal 147f, 148f
Transudative pleural effusion 49f
Transverse submandibular view 72f
Trauma 105
examination, sonography for 145f, 146
sonography of 4, 10, 25, 106, 144, 208, 217, 220
victims 153
Traumatic brain injury 199
Traumatic pericardial effusion 144
Tricuspid annular plane systolic excursion 114, 121, 129, 131
normal 130f
Tricuspid regurgitation 118, 129
Tricuspid valve 118, 120f, 121f
Trocar technique 170
Typical reflection factors 35t
U
Ultrasonography 10, 82, 196, 216, 241
limitations of 249
modes of 39
recognizing primary 16f
Ultrasound 261
artifacts 47
imaging of upper airway, advantage of 68
instrumentation, basic 37
of airway, structures visualized in 70
profiles, accuracy of 112t
properties of 34
stethoscope 1
Ultrasound-guided management 151
Upper airway 69f
ultrasound 74
interpretation of 70
Upper eyelid 197f
Urethral catheterization 227
Urinary bladder, ultrasound of 221
Uterus 220f
V
Valsalva maneuver 240
Valvular heart diseases 229
Valvular incompetence, severe 32
Vascular injury 178
Vascular probes 93
Vein 60
Velocity time integral 24
Venous disease, chronic 260
Venous thromboembolic events 260
Venous thromboembolism 260
Venous thrombosis, diagnosis of 32
Ventricular function, assessment of 20, 122
Ventricular septal defect 118, 129
Vertebral body 74
Vesicouterine space, anterior 145
Vigileotm 139f
monitor, use of 139f
Vocal cords 70, 73, 75
W
Wells’ score 262t
White lung 105f
appearance 105f
X
X-ray absorptiometry, dual energy 253
Z
Zirconate titanate 37
Z-track
method 186
technique 186, 186f
×
Chapter Notes

Save Clear