…cooperate — consider sedation, a different position or a different vessel. Choice of site Vessel Advantages Disadvantages : : : Internal jugular vein (right) Best ultrasound conditions, a straight…

…hypercholesterolaemia, and sedentary behaviour; family history, particularly in the broader assessment of peripheral arterial and aortic disease; planned surgery, especially carotid endarterectomy (CEA), coronary artery…

…other underlying cause immediately. 9. Request ultrasound of the kidneys and urinary tract when a postrenal cause cannot confidently be excluded. 10. Contact nephrology early…

…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…

…ultrasound machine for analysis. The reflected sound waves will have the same speed as the emitted sound waves, but the amplitude, frequency and angle of…

…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…

…Doppler (CW Doppler), ultrasound waves are continuously emitted from the transducer and the reflections of these waves are analyzed continuously (Figure 1). This is possible…

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…

…and peripheral embolization. Stroke is the third leading cause of death in Western countries, and ultrasound studies are now performed in the majority of patients…

…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…

…density of myocardium. It follows that myocardium generates reflections with high amplitude and low Doppler shift. To analyze reflections from the myocardium, the ultrasound machine…

…picture without a demarcated fluid collection. Ultrasound also shows the depth of the cavity and its distance to vessels. Contraindications and when to involve a…

Procedurer The ankle brachial index is the cheapest and most accessible method of objectively demonstrating peripheral arterial disease, and it is needed more often than…

…However, intravascular ultrasound has shown that delayed opening of the bridged segment may extend into diastole, so the physiological effect is not limited to systole…

…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…

…coronary artery disease (CAD). It combines echocardiographic assessment of left ventricular (LV) structure and function with exercise or pharmacological stress. The physiological basis is an…

…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…

…orientation of the index marker and the scanning plane through the heart. Figure 2. PLAX, Parasternal Long Axis View. Position of the transducer : The ultrasound…

…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…

…ultrasound of the liver and biliary tract . Go through the medication and any herbal preparations carefully — drug induced liver injury is the commonest cause of…

…risk of rapid deterioration. Intraosseous access: Cardiac arrest where venous access is not immediately available. Shock, severe trauma, burns or status epilepticus when peripheral access…

…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…

…are associated with increasing likelihood of symptoms, complications and rupture. Aneurysmal sacs may contain mural thrombus, which can contribute to peripheral embolization and may reduce…

…NSTEMI than in those presenting with STEMI. Approximately one third of patients with MINOCA may present with STEMI. Pathophysiology and causes MINOCA encompasses several distinct…

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…

…the myocardium. At the departures of the larger vessels, the visceral layer is folded back to cover the inside of the parietal layer. Between the…

…of recording these flow variations with high precision. To calculate flow across a valve, the Doppler line is placed in the valve orifice. The ultrasound…