Bedside Echocardiography

Bedside Echocardiography – Jamie Pfaff

Finding an Ultrasound

  • MICU: radiology room behind charge nurse’s desk in middle hallway
  • VA ICU: In front of resident workspace
  • 8N: Behind nurses station before entering cleaning supply room
  • 8S: in the supply closet to left of the nurses station (code is 1-3-5)
  • 6MCE: Middle hallway by service center, ask nursing for sign-out
  • CCU/5N only: supply room on left as entering CCU
  • Round wing: 5th floor, ask nurses

 

Echo views

 

Parasternal long:  Anatomy: RV, LA, MV, LV, AV, Aortic outflow tract

  • Probe position: Start with indicator of probe pointing toward patient’s right shoulder (~10 o’ clock), midclavicular in 2nd - 3rd intercostal space
  • Make sure probe is centered over mitral valve (Should see MV and AV)

 

Quick EF estimation -> E-Point Septal Separation (EPSS): distance separating the anterior MV leaflet from the septal wall as measure of LV systolic function

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  • Place M mode spike at tip of mitral leaflet and hit M mode (perpendicular to septum)
  • Identify E point (passive filling of LV) and determine distance from interventricular septum
    • <7mm = Normal
    • >10mm = Reduced EF
  • Confounders that elevate EPSS: AR, MS
  • Probe position: Rotate probe 180 degrees with right edge of probe/probe marker pointing toward patient’s left shoulder

 

Echo tracing and view

 

 

Apical four chamber:  Anatomy: RA, RV, LA, LV

  • Probe position: Slide down and look near patient’s left nipple (or in the intermammary fold after lifting up breast tissue if needed) (At PMI if can find)

 

Subxiphoid:  Anatomy: RA, RV, LA, LV

  • Probe position: Push probe head into patient’s abdomen just below xiphoid and flatten probe to make nearly parallel to patient’s position
  • Troubleshooting: shift probe slightly left of midline (toward patient’s right) and angle toward heart/right to use liver as acoustic window or ask patient to take big breath (moves heart closer to probe)

 

IVC

  • Probe position: subxiphoid area with probe marker facing toward patient’s head slightly left of midline, trace IVC into RA to verify correct vessel (center on RA, then rotate 90°)
  • IVC Size and collapsibility used as surrogate for CVP and RAP
    • < 2.1 cm in size, > 50% collapsible: RAP ~3 mmHg
    • < 2.1cm in size, < 50% collapsible OR IVC > 2.1 cm, > 50% collapsible: RAP ~8 mmHg
    • >2.1 cm in size, < 50% collapsible: RAP > 15 mmHg

 

Resources:

  • FATE CARD app
  • 5minuteSono.com
  • echocardiographer.org
  • pie.med.utoronto.ca/tte/