…Indications Infusion of vesicant solutions: vasopressors, concentrated potassium, cytotoxic drugs, parenteral nutrition. The need for several simultaneous, incompatible infusions. Haemodialysis, plasmapheresis or other extracorporeal therapy …

…targeted duplex ultrasound (DUS), pre operative assessment, or evaluation of other atherosclerotic disease. Routine population screening is not recommended because the prevalence of severe asymptomatic…

…shock, hypoxia and any other underlying cause immediately. 9. Request ultrasound of the kidneys and urinary tract when a postrenal cause cannot confidently be excluded…

…septum bulges into the left ventricle (i.e. septal bulging ). Bedside echocardiography allows for immediate recognition of tamponade. Typically, acute tamponade arises from aortic dissection…

…Reverberations artifacts Ultrasound waves can be reflected multiple times between dense structures ( i.e structures with high echogenicity). For each reflection, a portion of the…

…Figure 2, the ultrasound transducer contains several components. The transducer contains acoustic insulation that ensures that no other sound waves affect the transducer. The crystals…

…high frequency waves. The frequency of the ultrasound wave must generally be reduced in order to visualize objects located far away from the transducer. Hence…

…and ultrasound physics Unlike light waves, which can propagate through vacuum, sound waves can only propagate through a physical medium. This medium may consist of…

…frequency) . This is actually exploited to calculate the direction and speed of tissue and fluid movements. All structures in a medium can reflect ultrasound waves…

…ultrasound wave (cos θ). The Doppler equation is as follows: v = [c · (f r f e )] / [2 · f u · cos ϴ] The speed of…

…To create an image sector of 90° width and 15 cm depth, approximately 200 ultrasound lines are required and this takes about 40 milliseconds (ms…

…1). This is possible by using two different sets of piezoelectric crystals; one set for sending ultrasound and the other for analyzing reflected sound waves…

Echocardiography Pulsed Wave Doppler The pulsed wave Doppler (PW Doppler) sends short pulses of ultrasound and analyzes reflected sound waves between the pulses. This is…

…renal failure or simply deterioration. The procedure itself is straightforward: ultrasound to find the fluid, an insertion site in the left lower quadrant lateral to…

…and where no liver, lung or vessel lies in the path of the needle. Access Puncture site Direction Comment : : : : Subxiphoid 1–2 cm below and…

…puncture site Relative Mechanical ventilation with a high PEEP (an increased risk of pneumothorax; ultrasound guidance is mandatory) Relative A very small or loculated effusion …

…endothelial coverage. Complementary Characteristics IVUS and OCT are complementary rather than interchangeable. IVUS generally provides better visualization of overall vessel dimensions, plaque burden, large vess

…Ryan Lafollette and Bill Hinckley run this amazing website which includes everything from ultrasound knobology and emergency procedures to practice guidelines for emergency medicine (and…

…Ultrasound may reveal atherosclerotic plaques, thrombi, occlusions, and dissections. Stroke is subdivided into hemorrhagic stroke (13% of all cases) and ischemic stroke (87% of all…

…The ultrasound system automatically calculates RWT (Relative Weight Thickness), provided that the patient's weight, height and sex are entered. RWT is a measure of…

…single ultrasound line, its temporal and axial resolution is very high, as compared with 2D echocardiography. M mode is useful for quantifying the mobility of…

…during the examination. Work related musculoskeletal disorders are a common cause of pain and sickness absence for ultrasound practitioners (Harrison et al). When performing emergency…

…Ultrasound imaging, including echocardiography, has become a standard tool for clinicians worldwide (Narula et al). This chapter discusses the principles of the standard echocardiographic examination…

…shift. To analyze reflections from the myocardium, the ultrasound machine filters out all other reflected sound waves, such that only those representing myocardium are recorded…

…Orthopaedic surgeon Close to large vessels, in the groin or on the neck Bleeding, vascular injury, pseudoaneurysm Surgeon, ultrasound first Other situations that argue for…

…pressure in that leg ÷ highest arm pressure of the two arms Interpretation ABI Interpretation Action : : : 1.40 Incompressible vessels — medial sclerosis Measure the toe pressure…

…cardiac chamber or vessel. Other congenital anomalies include anomalous origin of a coronary artery from the pulmonary artery and anomalous origin of one coronary artery…

…Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) provide cross sectional information about plaque morphology and may clarify the mechanism of an acute coronary syndrome…

…hypertrophy, LV dysfunction, or other pathology that could affect the safety or interpretation of the examination. Evaluation and Physical Examination Before stress echocardiography, clinical assessment…

…multiplied by 100 to obtain percentage (%). Normal FS 25% (M Mode) 18% (Direct 2 D measurement) Tissue Doppler Tissue Dopplerrecords the speed and direction of…

…with regards to measuring ventricular dimensions, trabeculae and papillary muscles are considered part of the left ventricular cavity. Other dimensions– including atrial dimensions, mitral annulus…

…With regards to echocardiography and ultrasound imaging in general, v is the maximum velocity measured using Doppler. Moreover, the first part of the formula (0…

…and a warm, well perfused hand carry more weight. Choice of vessel The radial artery is the first choice : superficial, easy to compress, with a…

…A markedly raised GGT with the other tests normal is most often enzyme induction by alcohol or drugs and is often of no clinical significance…

…is flexed. The dorsum of the hand is suitable for finer cannulae. Avoid the lower limb in adults. In shock with collapsed vessels, the antecubital…

…of treatment: at least 3 months. Extended treatment in unprovoked pulmonary embolism, a persisting risk factor, or recurrence. Special situations Situation Comment : : Pregnancy Leg ultrasound…

…by radiography. Assessment should include consideration of associated vascular disease. In patients with AAA, duplex ultrasound screening for femoropopliteal aneurysms should be considered. Opportunistic screening…

…with atherosclerotic mediated myocardial infarction. A history of cigarette smoking may be present despite relatively few other conventional atherosclerotic risk factors. A substantial proportion present…

Echocardiography Color Doppler Velocities recorded in a sample volume of the pulsed wave Doppler can be presented with a color. A color scale from blue…

…to be detected and analyzed by the ultrasound machine. Figure 2. Reflections from an erythrocyte. Flowing erythrocytes will alter the frequency of reflected sound waves…

…endocarditis. With 2D and later 3D ultrasound, the technology has been greatly refined. Similarly, the development of transesophageal echocardiography (TEE) has been extremely valuable. Echocardiography…

…blood tests and other radiological examinations are most often required, in particular computed tomography (DT) and/or magnetic resonance imaging (MRI). Anatomy of the pericardium…

…orifice of the aortic valve and the ascending aorta can be regarded as a cylinder, and the same assumption can be made for the other…