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Echo is one of the more skilled ultrasound exams you can do. Having learnt it and now teaching it, I see the same mistakes being made over and over again. I have put together thread on beginner mistakes in echo. #tweetorial #POCUS #FUSIC #askpocus
Before the specifics, the basics (which I won't go into too much detail about):
- Optimise depth and gain
- Position your patient if possible
- Hold the probe low and rest some part of your hand on the patient for stability
- If in doubt more jelly and press a little harder
- Optimise depth and gain
- Position your patient if possible
- Hold the probe low and rest some part of your hand on the patient for stability
- If in doubt more jelly and press a little harder
This is the commonest mistake on PLAX I see. People struggle to revert to a PLAX from this RV inflow view (which in itself is useful beyond basic echo). An RV inflow view is obtained by tilting the tail up from the PLAX point. So, to get back to PLAX just do the reverse motion.
So what does a #POCUS guided fluid assessment look like? #tweetorial #askpocus @IMPOCUSFocus @DRsonosRD @KalagaraHari @SonoSerious @tsquaredmd @jaffa_md @nick_wroe @EM_RESUS @coreultrasound @kyliebaker888
Let’s start of the with the lungs! Normal dry lungs are represented by an A line profile. These are horizontal lines that are equidistant from each other and are reverberations artefacts of the pleural line.
B lines are vertical artefacts arising from the pleural propagating all the way down. When widespread and bilateral can be an indication of interstitial/alveolar oedema.
Train the eye - part 4. McConnell’s sign! #askpocus #echofirst #pocus @NephroP @Wilkinsonjonny @icmteaching @IMPOCUSFocus @dr_benoy_n_shah @cianmcdermott @EmergencyEcho @KalagaraHari @RJonesSonoEM @DRsonosRD @SonoSerious @iceman_ex @daniel_opazo
So what actually is McConnells sign?
It is a pattern of RV dysfunction characterised by Mid RV free wall akinesia and RV apical hyperkinesia
#askpocus case. Indigestion type chest pain with some pleuritic nature. Troponin ++. Lateral TWI. Initially suspected ACS but CTPA showed PE so treated accordingly. @askpocus @daniel_opazo @NephroP @Wilkinsonjonny @iceman_ex @cianmcdermott @nick_wroe @IMPOCUSFocus @The_echo_lady
So why was troponin so raised? Bedside echo! Not the greatest of views but enough to comment. PLAX...
PSAX...
Train the eye - part 3. Cardiac tamponade! #askpocus #echofirst #pocus @NephroP @Wilkinsonjonny @icmteaching @IMPOCUSFocus @dr_benoy_n_shah @cianmcdermott @EmergencyEcho @KalagaraHari @RJonesSonoEM @DRsonosRD @SonoSerious @iceman_ex @daniel_opazo
There are several sonographic signs of cardiac tamponade...
Right ventricular end diastolic collapse – relatively low sensitivity, relatively high specificity
Another train the eye thread. This time - Takutsubos cardiomyopathy 🐙! #POCUS #askpocus #echofirst @iceman_ex @cianmcdermott @icmteaching @load_dependent @daniel_opazo @KalagaraHari @DRsonosRD @tsquaredmd @coreultrasound @IMPOCUSFocus @nick_wroe @askpocus @The_echo_lady
Also known as stress induced cardiomyopathy/takutsubos syndrome/broken heart syndrome
Classically you get apical ballooning and akinesis with basal preservation.
