An echo in Pulmonary Embolus (PE)

A 40 year old man presents with near syncopal events and has low oxygen saturations in the emergency department, on a past history of systemic hypertension. His blood pressure is low-normal and the chest X ray is clear, so he goes on to have an urgent CTPA which shows bilateral PE with a large burden of clot in both the left and right main pulmonary artery. Low dose thrombolysis is considered to minimise the risk of long term pulmonary hypertension. The patient is transferred to ICU and an urgent echo is performed to assess the right ventricle.


Here are the first loops, can you spot any subtle pathology on these initial scans?

Continue reading

Big, Bad, Leroy Brown

A shocked 50 year old diabetic man in the emergency department presents after months of malaise and reduced exercise tolerance, and is hypotensive in the ED. His heart appears enlarged on a CXR, so you perform a brief bedside echo to assess biventricular size and function and look for the presence of pericardial fluid.

What do you see?


PLAX: Dilated LV. (>5.5cm); Severely reduced LV systolic function (walls should come in by 1/3); LA enlarged (should be approximately the same size as the RV and proximal aorta ~2cm); and small pericardial effusion (small <1cm, moderate 1-2cm, large >2cm).

Continue reading

ICET NEPEAN – An exciting echo resource

A free online echo resource originating from Nepean Intensive care unit with excellent physics tutorials that will be useful for those sitting for the DDU and Focused Cardiac Ultrasound  (FCU) topics that are relevant to the critical care trainees who have registered with the college after 2014. Check it out here.

The ICET team also conduct a number of echo courses including RACE and RACE+ during the year.

Dr Sam Orde is an intensivist and echo expert at Nepean Hospital who has worked at the Mayo Clinic as an echo fellow.