Critical Care Ultrasound for Emergency Situations and Clinical Applications Pradeep D\'Costa, Jayant Shelgaonkar
INDEX
Page numbers followed by b refer to box, f refer to figure, and t refer to table.
A
Abdominal aorta 84f
normal appearance of 84f
scanning of 83
Abdominal aortic
aneurysm 83, 84f
ruptured 83
diameter 83
dissection 85
Abdominal trauma, penetrating 143
Abdominal wall hematomas 190
Abscesses 113
Absorption 9
Acalculous cholecystitis 96
Accidental esophageal intubation 26
Accurate puncture, rate of 192
Acoustic
impedance 8
shadowing 17f
Adductor magnus 186
Advanced trauma life support 140
Aeration loss
moderate 45
severe 45
Air 31, 96
bronchogram 37f
mucosal interface 22, 23f, 24f
Airway 141
assessment, probe orientation for 21f
for emergencies, ultrasound of 20
Akinesia 72
Allen test 165, 166
modified 166
Allograft kidney 112, 113
Allograft swelling prominent pyramids 112
American College of Radiology 108
Anesthesiologist anesthesia 175
Anesthesiology, fascinating aspects of 175
Anesthetists 141
Aorta 71, 98
and stroke volume, velocity-time integral of 55
long-axis of 84f
longitudinal section of 85f
Aortic regurgitation 71, 71f
Doppler assessment of 71f
Aortic sonography, limitations of 85
Aortic stenosis 6971
Aortic valve 49
Apical four-chamber view 49, 50f
Apical five-chamber view 49, 51f
Artefact, mirror image 19f
Arterial cannulation 173
Arterial margins 166
Artery 130, 164, 166, 167f
commonly accessed 165
Arytenoid cartilage 22
Ascites, cause of new-onset 190
Aspiration 188
Atrial contraction 74
Axial resolution 10, 10f
Axillary
artery 165, 179182
nerves 181
vein 180182
B
B-mode 11, 12f
Barcode sign 39f
Basilic vein 161, 163
Beads, string of 23
Bedside lung ultrasound in emergency 31, 46, 47
Bent-knee appearance 68, 69f
Biceps femoris muscle 184, 186
Bilateral lung fields 35
Biliary pathology identification 115
Bladder perforation 190
Block procedure 177
Blood 5
clots 107
vessel
compliance of 110
diameter 132
BLUE protocol 47f
Blunt abdominal trauma 142
Blunt trauma 144
Body of pancreas 98
Bone 5, 156
Bony structures, appearance of 157f
Bowel
gas 85
obstruction 104
perforation 190
ultrasound of 93, 102
wall, thickness of 102
with contents, dilated 104
Brachial artery 165
Brachial plexus 177179, 182f
block 178, 179, 179f, 181
interscalene approach 178f
interscalene 176
Brachiocephalic vein 163
Brain death 118, 135
Brain injuries, severe 118
Brainstem reflexes, assessing for 117
Breathing 142
Bronchial tube placement, double lumen 25
Bronchoscopic guidance 194
Bulky pancreas 100f
Bull's eye 168, 170f
C
Calcineurin inhibitor toxicity, acute 111
Cardiac interventional procedures 189
Cardiac output, measurement of 62
Cardiac probe 189
Cardiac tamponade 57
Cardiac trauma 144
Cardiac ultrasound, focused 49, 72
Cardiac valves, focused assessment of 65
Cardiopulmonary bypass 111
Carotid artery 165f
external 126, 127
internal 126, 127
plaque in 126f
Catheter placement 173
Cellular relengthening rates 74
Central nervous
catheter 173
system 137
Cephalic vein 162
Cerebral artery
anterior 127, 131f
middle 127, 129f, 133f
posterior 128
Cerebral circulatory arrest 133f, 135, 135f
Cerebrovascular disease, extracranial 125
Cervical, trauma visualization of 137
Chest trauma 145
Cholecystitis 93
Choledocholithiasis 93
Cholelithiasis 93
Circle of Willis 129f
part of 128f
Clavicle 177
Clots 113
Collapsibility index 60
Collapsibility, loss of 89f
Color Doppler 166
ultrasonography 108
Color flow 72f
imaging 13, 14
mapping 66, 68f
Comet-tail artifact 15, 16f, 21
Common bile duct 93, 9698, 101
Common carotid artery 126, 127, 163
Common femoral
artery 89, 164
vein 89
Communicating artery
anterior 127
posterior 128
Compression test 88
normal 89f
Computed tomography 83
Constricted pupil 121f
Contralateral temporal bone 129f
Coracobrachialis muscles 182
Cord, posterior 180
Cornea 118
Cortex, echoic nature of 107
Cortical tubular cells, necrosis of 107
Cost-effective imaging tool 188
Cranial nerves 117
Cricoid cartilage 20, 24
transverse view of 23f
Cricothyroid membrane 20, 24
Cricothyroidotomy 27
USG-guided 28
Cricothyrotomy 188, 194, 194f
Critical care
fellow, basic ultrasound physics for 4
ultrasound 1, 65
unit 57, 141
Critical pericardial effusion 193
Custom made probe sheaths 115
Cutaneous nerve, posterior 186
D
Dark ring-like structures 179
Deep needle procedure 188, 190
Deep vein thrombosis 83, 85
Dehydration 109
Diagnostic peritoneal lavage 142
Diaphragm 41, 146
anatomy, normal 43f
basic anatomy of 44f
movements 43f
Diastasis 74
Diastolic dysfunction 75, 76, 78f, 80f
progressive 76
Diastolic flow
blunted 135
reversal 133f, 135
Diastolic function, normal 75
Disaster management 141
Distensibility index 60
Distracting injuries 140
Diverticulitis 104
Doppler assessment 70f
Doppler ultrasound 13
Dorsal venous arch 161
Dorsalis pedis artery 165
Duplex scanning 13
Dyskinesia 73
E
E and A reversal 76f
Echocardiographic views, basic 49, 50f, 57
Echocardiography 65
Echogenic calcium deposits 107
Echogenicity 106
Eclampsia 107
Effusions, types of 41
Ejection fraction 6062
different values of 74t
Electrocardiography 80
Elliptical disks, stack of 61
Emphysema lines 35
Emphysematous pyelonephritis 112
End diastolic velocity 110, 127, 134
Endocardium, inward motion of 72
Endotracheal intubation 25
Endotracheal tube placement 20, 141
Enhancement artifact 16, 18f
Epicardium 193
Epiglottis 20
Equipment 160, 176
Esophageal intubation 26
Esophagus 20
Excessive lung water, B lines suggestive of 56f
Eye
to examine pupils 119
ultrasound of 119f
Eyeballing 72
principles, basic 57
F
Fascia iliaca compartment analgesia 185
Fascia lata 185
Fascial layers 156
Fascicle, pattern-like 186
Fast and efast views 145f
Fat 5
Femoral artery 163, 164f, 165, 165f, 185, 186
superficial 186
Femoral nerve 164f, 185
block 186
Femoral triangle 164f
Femoral vein 86, 163, 164, 164f, 165f, 173, 185
position for scanning 86f
right 87f
Fibrous tissue 106
Filling phase, rapid 74
First-pass success, high degree of 188
Flank view, right 146
Flow within vessels 115
Fluid
administration 31, 47
around gallbladder 96
color sign 41
identification of 190
mimics, presence of 190
Foley's catheterization 150
Foot and ankle surgeries 184
Footprint 6
Foreign body 156, 158
Four vessel angiography 136
Fractional shortening 61, 61f
Fractures 118, 156
Fungal infections 113
G
Gallbladder 93
calculi 95
capacity of 93
dimensions 95f
distension 95
lumen 96
pathology 93
ultrasound of 93
wall thickening 95
Gallstones 93
Gastroduodenal artery 98
Glasgow come scale 117
Glomerulonephritis 107, 111
Glove drains 115
Gluteus maximus
lies 186
muscle 183
Gosling's pulsatility index 134
Gout 107
Great saphenous vein 164, 165f
H
Heart 92
rate 64, 110
Hematoma 113, 167
Hemolytic-uremic syndrome 107
Hemopericardium, circulation assess for 142
Hemoperitoneum, circulation assess for 142
Hemothorax 142, 145, 155, 167
circulation access for 142
Hepatic artery 98, 116
Hepatic veins, accessory 116
Hepatorenal space 146
Hepatorenal syndrome 111
High frequency probe 189
Hockey stick probe 176
Hunter's canal 163
Hydronephrosis 108, 113
grades of 109f
severe 109f
with stent, severe 110f
Hyoid bone 158
Hypercontractile heart 60
Hyperechoic
interface 176
rim 176
structure 186
tissue, intervening 176
vocal ligament 22f
Hyperkinesia 73
Hyperparathyroidism 107
Hypoechogenic renal cortex 107
Hypoechoic vocalis muscle 22f
Hypokinesia 72
right ventricle free wall 91f
Hypoxemia 57
I
Infection 111
presence of 190
Inferior vena cava 38, 52, 54f, 56, 83, 84f, 9799, 152
diameter variation 54
long-axis view of 53f
size 54
Information, basic 31
Infraclavicular approach brachial plexus block 180f
Infraclavicular fossa 179
Infragluteal approach 186
Infragluteal region 186
Inspired oxygen, fraction of 45
Intensive care unit 57, 93
Intercostal space 192
Internal jugular vein, anatomic variations of 165f
Interscalene block 177
Interstitial nephritis, acute 107
Intestinal obstruction 104
Intra-abdominal injury 142
Intracranial pressure 117, 121, 123f, 142
estimations 132
Intraneural injections 175
Intraperitoneal hemorrhage 190
Intravascular filling, circulation access 142
Intravascular injections 175
Invasive intracranial monitors 117
Ipsilateral chest 192
Ischial tuberosity 183
Isovolumetric relaxation 74
IVC distensibility index 54
J
Jellyfish sign 41
Jugular vein
cannulation, internal 176
external 163
internal 163, 173
K
Kidney
disease
acute 110
chronic 107, 110
echogenic nature of 106
injury, acute 105107, 108b, 111b
left 149
right 146
Kissing sign 60
Kissing ventricle sign 60
L
Landmark technique 173
Laryngeal mask airway placement 20
Lateral in-plane technique 173
Lateral resolution 10f
Left atrium 50, 51, 53, 68, 72
Left ventricle 62
eyeballing of 62
Left ventricular
ejection fraction 60
end-diastolic area 60
assessment of 60
function
assessment of 60, 73
grading of 62t
internal diameter
end diastole 61
end systole 61
myocardium, 17-segment model of 73f
outflow tract 51
Leg raising, passive 58
Lens 118
dislocations 118
Lienorenal space 149
Life-threatening injuries 140
Linear transducer 161f
Liver 146
disease 116
pathologies of 116
transplant patient 115
ultrasound in 116
ultrasound 115
Local anesthetic, make sure 190
Long bone fractures 158
Longitudinal scans 175
Loss of aeration, quantification of 46t
Lower limb
blocks 183
compression ultrasound 91
deep veins of 164f
venous ultrasound 86
Lumbar plexus 176
branches of 183
Lumbar puncture 137, 188
compared 194
ultrasound-guided 194, 195f
Lumen, complete obliteration of 89f
Lung 92
aeration 45
anatomy of normal 34f
comets 35
consolidation 45
in pneumothorax 38
lower part of 146
normal 32
parenchyma, hepatization of 38
point 39, 39f
location of 39f
pulse 38
sliding, presence of 192
sonography 31
protocol 47
ultrasound 31, 33f, 44, 47, 55, 91
water component, extravascular 45
Lymph nodes 102
Lymphoceles 113
M
M mode 11
PLAX view 12f
Magnetic resonance imaging 25
Maxillary sinus 124f
haziness, complete left 125f
left 124f
McConnell's sign 91
Mechanical ventilation, controlled 59
Medial cord 180
Medial scalene 178
Medulla 106
Medullary nephrocalcinosis 107
causes of 107b
Medullary sponge kidney 107
Mesenteric artery, superior 83, 98
Mesenteric vein, superior 101
Metastasectomy 115
Mickey mouse sign 165f
Microconvex 7, 8f
Milk-alkali syndrome 107
Mitral annulus, longitudinal motion of 72
Mitral flow 80
Mitral regurgitation 69
chronic 69
severe 70f
Mitral stenosis 68, 69f, 70f
Mitral valve
annulus, tissue Doppler imaging of 78
inflow 74
normal 75f
Monofascicular nerves, small 176
Morison's pouch 146
Muscle 5, 156
Muscularis propria 103
Musculocutaneous nerve 181
block 182
Musculoskeletal injuries 156
Myeloma
kidney 107
multiple 107
Myocardium, thickening of 72
N
Nasal fracture 157
Neck and upper limb, major veins of 163f
Neck region plaque 126f
Necrosis 102
areas of 100
Needle entry, angle of 189
Needle, localization of 190
Nephrogenic diabetes insipidus 109
Nerve 164
block
failures of 175
perspective toward 187
procedure for 178, 180
ultrasound guided 175
identification 175
location, median 182f
real-time objective 187
ultrasound guided 177
Neurocritical care setting, ultrasound in 117
Neurotrauma 156, 158
Neurovascular bundle 156
Noncardiogenic pulmonary edema 46
Nonfunctioning obstructed kidney 109
O
Obesity 85, 160
Operation theaters 141
Optic nerve 118
injury 156
sheath 121, 122
diameter 121, 122, 123f, 142
dilated 123f
Orbital trauma, left 120f
Overdistended bladder 109
P
Pain, minimal 175
Pancreas
head of 98
locating 101f
normal 98f
tail of 98
transverse view of 99f
ultrasound of 93, 97
Pancreatic pseudocyst 101f
Pancreatic region 99
Pancreatitis 100f
acute 99
severe 107
Papillary necrosis 107
Paracentesis
mechanical complications of 190
needle 188, 190
ultrasound-guided 190, 191f
Paradoxical motion 90
Paradoxical systolic motion 90
Parasternal short-axis view 52, 52f
Parenchyma 106, 107
Peak systolic
velocity 110, 134
volume 127
Pelvic 145
longitudinal view 152f
view 149
Pelvis and renal parenchyma 112f
Penetrating trauma 144
Percutaneous cricothyroidotomy 27
Percutaneous dilatational tracheostomy, ultrasound guidance during 26
Percutaneous kidney biopsy 113f
Percutaneous nephrostomy 113
Percutaneous renal biopsy 113
Percutaneous tracheostomy 188, 194f
bronchoscopy guided 27
safety of 194
ultrasonography guided 27
ultrasound guided 27, 194
Pericardial fluid
accumulation, largest 193
distribution of 193
presence of 193
Pericardiocentesis 188, 193f
ultrasound guided 193
Pericardium 193
Pericholecystic fluid 96
Perigraft fluid collection, drainage of 113
Peripancreatic collection, identification of 100
Peripartum hemorrhage 107
Peripheral venous access 173
Peristalsis 102
Piezoelectric crystal arrangement 6
Pleura, appearances of normal 32
Pleural effusion, sonographic appearance of 40f
Pleural sliding sign 33
Pleural space, left 149
Pneumonia, ventilator-associated 45
Pneumothorax 39f, 142, 155, 167
diagnosis of 38
procedure-related 192
Popliteal area 184
Popliteal artery 88f, 183, 186
Popliteal sciatic nerve 183f
Popliteal vein 87, 88f
scanning 87f
Portal vein 84f, 101
identification of 96
undivided right 94
Positive end-expiratory pressure 25, 44
Posterolateral alveolar syndrome 47
Posterolateral pleural syndrome 47
Posterolaterally biceps femoris 186
Postextubation stridor 28
Pouch of Douglas 149, 151
Pre-Conception and Pre-Natal Diagnostic Techniques Act 2
Pregnancy, complications of 107
Pregnant uterus 190
Prerenal azotemia 111
Probe 5, 102
and scan 145
choice of 189
placement 94
positions 32, 32f
sterility 190
sterilization, different methods of 191f
Profunda femoris artery 186
Propagation velocities 5f
Proximal humerus 177
Proximal isovelocity surface area 68
Pseudoaneurysm 100
Pseudocyst 102
late phase 100
Pulmonary artery 90, 91
occlusion pressure, low 47
systolic pressure 72
Pulmonary embolism 83, 85, 88, 90, 91
evaluation of 57
Pulmonary venous flow 80
Pulsatile flow 167f
Pulsatility index 127
Pulse
drops 110
index continuous cardiac output 45
wave 49
Doppler 13, 66, 67f, 130, 166
Puncture 171
Pupil
and reaction 119
dilated 121f
Pyonephrosis 108
Pythagoras theorem 170f
Q
Quad sign 40
R
Radial artery 165
cannulation 173
Randomized study comparing point-of-care 190
Reaeration, quantification of 46t
Real-time
fashion 188
methods 189
technique 168
Red Doppler signal 130
Reflection 8, 9f
Reflector scattering strength 14
Refraction 10
Regional anesthesia 175
part of 175
Regional trauma 141
Regional wall motion abnormality 72
Relaxation, abnormal 79f
Renal anatomy, basic 106f
Renal tubular acidosis 107
Renal vein 98
Respiratory distress syndrome, acute 35
Restrictive pattern 80f
Retina 118
Retroperitoneal fibrosis 109
Retroperitoneal hemorrhage 85
Retrouterine pouch 149
Retrovesical pouch 149
Reverberation artifact 15f
Rib fractures 158f
Right atrium 50, 53, 56, 68, 72
Right upper quadrant 144146, 147f
Right ventricular
apex 195
dilatation 90, 90f
ejection fraction 65
function, assessment of 64
hypokinesia 90
studies for dysfunction 57
systolic pressure 72
Ring down artifact 16, 17f
Roentgenograms 140
S
Sacral plexus 183
branches of 183
Safe puncture 41
Saphenous nerve block 183
Sarcoidosis 107
Scalene muscles 177
Scanning medium 162f
Schmidt group 116
Sciatic and femoral blocks 183
Sciatic nerve 183, 185
block 183, 184, 186
Seashore sign 33, 34f, 39f
Segmental portal hypertension syndrome 100
Seldinger technique 170, 171
Semilunar tracheal ring, transverse view of 24f
Semimembranosus muscle 184
Sepsis 107
Septal position, abnormal 90
Septate effusion 41
Shock, rapid ultrasound in 92
Short axis technique 170f
Short axis view 164
Shred sign 37f, 38
Sickle cell disease 107
Simpson's method 73
Simpson's rule, modified 61
Sine wave 4
Sinus
normal 123
visualization of 122
Sinusogram 124
complete 125f
Sinusoid sign 40
Skin 156
Soft tissue 5, 189
Sound wave 4
Spleen 149
Splenic vein 98
Split liver transplants harvests 116
Starry night appearance 41
Static technique 168
Stenotic lesions 130
Sterile gels 160
Sterile gloves 160
Sterile probe covers 160
Sterile transducer cover 189, 190
Sternocleidomastoid muscle 177, 178
Stomach, assessment of 28
Strap muscle 22f
Stratosphere sign 38, 39f
Stroke volume 49, 55, 62, 64
Subarachnoid hemorrhage 2
Subclavian
artery 179, 180
vein 163, 173
Subcostal view 53f
Submucosa 103
Superinfection 100
Superior vena cava 58
Supine position 180, 181
Supraclavicular fossa 178
Swelling, develops 119
Systemic vascular resistance 110
Systolic flows, sharp 135
T
Target sign 168, 170f
TCD tracings 130f, 131f
Tegaderm 122
Temporal resolution 10
Tendons 156
Thoracentesis, ultrasound guided 192
Thoracocentesis 188
Thrombectomy 112
Thrombosed veins 160
Thrombosis 100
Thrombus formation 116
Thyroid
cartilage 20
inverted V-shaped 22
transverse section through 22f
gland 23
Tissue 8
Doppler 13, 64, 80
Doppler mode 14
harmonic imaging 13
Trachea, determine position of 141
Tracheal rings 20
Tracheal sign, double 26
Transabdominal ultrasound 116
Transcranial Doppler 117, 127, 130, 158
Transducer 6f
in neck, orientation of 21
Transvenous pacing, ultrsound-guided 195f
Trauma surgeons 141
Traumatic procedures 194
Trendelenburg position 168
Tricuspid annular
motion 64
plane systolic excursion 64
Tricuspid annulus peak systolic velocity 64
measurement of 65f
Tricuspid regurgitation 72, 72f
Tuberculosis 107
Tubular necrosis, acute 107, 111
Tumor 113
U
Ulnar artery 165
Ultrasonography 45, 140
guidance 188
Ultrasound 4, 8, 28, 47, 94, 140, 160
appearance 21, 98
assistance 190
beam 190
shape 6
findings 179, 180
guidance increased 192
guided cannulation, technique of 166
guided technique 173
image 189
utilized technique 173
modes of 11
monitor 168
point of care 20, 57, 188, 190
role of 141
scan 177
use of 83
vision, advanced under direct 189
Upper airway, applied sonoanatomy of 20
Upper extremity blocks 177
Upper limb, veins of 162f
Upper quadrant, left 145, 148, 148f, 150f
Urinary bladder 153f
Urine leaks 113
Urinoma abscesses 113
Urinomas 113
V
Valves, Doppler evaluation of 65
Valvular lesion 67
Vascular access, ultrasound guided 160
Vascular injuries 116
Vascular structures, left back 116
Vasculotoxic snake bite 107
Vasospasm 118, 132
diagnosis 132
mild-moderate 132
severe 132
Vein 164, 167f
appear anechoic 166
wall, tenting of 169f
Velocity, measurement of 55f
Velocity-time integral, measurement of 63f
Vena contracta 66, 68f
Ventilation, controlled 59
Ventricle, geometry of 72
Vesicoureteric reflux 109
Vessel, course of 168
Visceral pleura 40
Vitreous humor 118
Vocal cord 20
visualization 21
Volume responsiveness using ultrasonography, assessment of 54
Volume status, assessment of 57
W
Water 5
Wave Doppler, continuous 13, 14, 66, 66f, 70, 72f
Wet lung profiles 36f
Wire-in-needle technique 173
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