Ch19 Emergent Ultrasound Procedures

Potential life threatening emergencies

internal hemorrhage, ectopic pregnancy, pericardial tamponade, and ruptured AAA

surgical procedure used to sample the intraperitoneal space for damage to viscera and blood vessels

peritoneal lavage (1965)

First choice for examining patients, but requires patient transfer, and unsuitable for unstable patients

CT

What does “FAST” stand for

Focused Assessment with Sonography for Trauma

What is the FAST exam

evaluation for peritoneal or pericardial fluid in the 4 quadrants, pericardial sac, and highly susceptible cul de sacs for trauma

What is the most common site for fluid accumulation

Morrison’s pouch

WHat is ultrasound best a detecting

liver lacerations or contusions

initially appear hypoechoic with low level echoes from red blood cells

hematomas

In early bleed stages how does it look

hypoechoic with low leve lechoes

Over time how do bleeds look

much anechoic as the blood is broken down

free fluid in reproductive age is likely

physiologic

ultrasound may not depict injury to

diaphragm, pancreas, adrenals, and bone

What happens when you have a stone

posterior shadows behind the stone

More than 90% of stones are how big

<4mm

only stones greater than what size can be seen on ultrasound

5mm

Sudden onset of severe chest pain that radiates to arms, neck, or back. Syncope

Aortic dissection

tear on the inner layer of the aorta letting blood through

Aortic dissection

Where are 70% of aortic dissections located

ascending aorta

Most common disease requiring ER surgery

Appendicitis

Most common disorder 2 and older

Appendicitis

Intense RLQ pain, N/V fever, leukocytosis, and + McBurney’s sign

Appendicitis

lower abd pain, asymptomatic to mid discomfort palpable reducible mass

paraumbilical hernia

requires movement by valsalva

paraumbilical hernia

visceral contents can be returned to the normal location

reducible hernia

visceral contents cannot be reduced

incarcerated hernia

incarcerated with vascular compromise

strangulated hernia

When evaluating for acute pelvic pain you should look in

at least 2 planes