Coffee cup cardiac anatomy
Bedside echo is becoming an integral part of intensive care medicine, offering real time haemodynamic evaluation. Although not everyone is expected to be an expert, every intensive care specialist should be able to obtain the basic views and perform a ‘level 1’ study.
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?
A 45 year old gentleman presents after 2 days of “indigestion” with a STEMI. He is admitted to ICU due to hypotension and an arterial line and pulmonary artery catheter are inserted. There are ongoing broad complex arrhythmias and urine output is poor. The first cardiac index is 1.5 l/min/m2 and the treating intensivist requests an echo….
A young woman being ventilated after surgery in ICU becomes more hypoxic as the PEEP is increased. An echo is performed to assess for a right to left shunt. Surface windows were poor, so we progress to a TOE…
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?
A 26 year old was in a high speed MVA, sustaining severe chest and pelvic injuries. The patient’s initial observations were BP 75/30, SaO2 91% on 10L NRB, and GCS 10.
A 54 year old lady presents to hospital with severe shortness of breath, and ST elevation on ECG. A preliminary echo shows severe LV dysfunction. She was rushed to the catheter lab but was found to have normal coronary arteries. Confused, you go back and look at her echocardiogram once again. Describe the features……
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.
Have you ever been on a ward round and pretended to know what everyone is talking about, nodded intelligently, used the right terminology and then proceeded to shamelessly ask what that was all about at the end of the day?
I know I have.
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