ISCCM Manual of Critical Care Ultrasound Deepak Govil, Shrikanth Srinivasan, Sachin Gupta
INDEX
ABCDEFGHIJKLMNOPQRSTUVWXZ
Page numbers followed by f refer to figure, fc refer to flowchart, and t refer to table
A
Abscess
drainage 229
splenic 215f
Acidosis 188
Acoustic enhancement 27
principle of 27f
Acoustic impedance 10
concept of 19
Acoustic shadowing 27, 27f
Acoustic windows 112
Acute coronary syndrome 232
Acute myocardial infarction pump failure 189
Acute respiratory distress syndrome 4, 58, 82, 84, 85f, 90f, 263
ultrasound features of 85
Adjacent portal vein 212
Advanced cardiovascular life support 195
recommendations and limitations 196
Aeration
progressive loss of 86
quantification, principle for 83
Agonal rhythm 189
Air
bronchogram 75, 76f
denote presence of 63
filled antrum 43f
movement 63
mucosa interface 34f, 36f, 38f, 39f, 43
shadow, loss of 190f
Airway
assessment of 33, 47f
patency 4
related procedures 46
size 33
American College of Chest Physicians 4
American College of Emergency Physicians 4
American Institute of Ultrasound in Medicine 4
American Society of Echocardiography 4
classification 154
Ancillary test 262
Anechoic 21
space 69
Aneurysm
aortic 131, 242
apical 158f
Angiography, computed tomographic pulmonary 180
Anterior mitral valve leaflet 158f
Antrum 41, 41f, 42, 43
Aorta 42, 43, 237f, 239f
abdominal 233, 239, 241
aneurysmal dilation of 242f
ascending 113, 233, 234f
dissection of 241, 241f
measurement 148f
techniques 240f
parts of 243t
plane of 237f, 238f
reference range of 240
standard measures of 147
transverse plane of 238f, 239f
ultrasonography of 232
Aortic dissection 234, 242f
presence of 232
Aortic regurgitation 152
assessment of severity of 153
Aortic root 242
measures of 147
size of 234
Aortic valve 113, 115, 122, 234f
cross-sectional image of 233
level of 115f, 234
Apical five-chamber 235f
view 119
Apical four-chamber 119f
view 118
Apposition view
optimization, zone of 103
probe
location and orientation, zone of 103
zone of 103
Arch, aortic 236f
Arterial access 279
Arterial inflow 178
Arteriovenous malformation 259
Artery 176f, 269
carotid 267, 270
common
femoral 174
hepatic 237f
iliac 239f
popliteal 175
posterior communicating 258
right pulmonary 122
splenic 237f
subclavian 276
superior mesenteric 42, 43, 237f, 238f
Artifacts 25
mirror image 26
Ascites 224
Asepsis 269
Assessing hemodynamic impact 160
Atelectasis 69, 76, 76t
compressive 76
obstructive 76
types of 76
Atrial contractility, loss of 166
Atrial fibrillation 166
Atrial septal defect 130
Atrophy, diaphragmatic 106
Attenuation
coefficient 10
concept of 19
Automatic gain compensation 23
B
Beam steering 23
Bedside lung ultrasound 58, 83
Biliary dilation, presence of 210
Biliary radicles 211
Bladder
anatomy of 209
pathology of 209
Bleed, intra-abdominal 207
Blind
paracentesis 224
spots 244
Blood vessels, absence of 224f
Bones, temporal 256f
Bony rib cage 112
Bowel
anatomy of 209
loops 222
ultrasound evaluation of 220
pathology of 209
Brain
death 255, 262
injury, traumatic 255
pathology 260
Bull's eye 42f
C
Calculous cholecystitis 223
Calculus 218
Carbon dioxide, partial pressure of 259
Cardiac arrest 187, 278
cause of 188, 188t
correct diagnosis of 194
Cardiac chambers 132
collapsibility of 160
Cardiac disorders 196
Cardiac output 164, 168
Cardiac tamponade 160f, 161, 161f, 189, 196, 206
Cardiac thrombi 157
Cardiac windows, basic 112f
Cardiopulmonary resuscitation, established 187
Cardiorespiratory failure 33
Carotid
artery, internal 260
Doppler flow 165
Cavity, abdominal 201
Celiac artery 237f
Center for Disease Control and Prevention guidelines 275
Central venous cannulation, technique of 267
Cerebellar stroke 263
Cerebral
angiogram 258f
arterial blood flow, velocity of 259t
artery 260t
anterior 258f, 260
ipsilateral anterior 258
ipsilateral middle 257
middle 258f, 260, 262
posterior 258f, 260
blood flow 259
Cerebrospinal fluid, flow of 249
Chest
compressions
monitoring quality of 194
phase of 188
pain 232
wall 70f
Chlorhexidine solution 268
Cholecystostomy, percutaneous 225, 226f
Cholelithiasis 212f, 214f
Chronic obstructive pulmonary disease 77, 78, 105, 180
Circle of Willis 258f
Circulation 189
Classical hockey stick appearance 155f
Collapsibility index 165, 166f
Color Doppler 14
Color flow Doppler, color signals in 179
Color M-mode flow propagation velocity 143
Comet tail artifacts 26, 26f
Common bile duct 210
Complete sterilization, purpose of 28
Compression ultrasound technique 180
Computed tomography 57
Consolidation 69, 76t
Continuous renal replacement therapy 128
Cor pulmonale, chronic 131f
Cortex, echogenicity of 218
Cricoid cartilage 38, 38f, 39f, 52
level of 38f
Cricothyroid membrane 37, 38f, 53
Cricothyroidotomy 4, 33
percutaneous 50
Critical care echocardiography 149
Curtain sign 98f
Curvilinear array 17
Cylinder tangent effect 240f, 244
D
Debakey's and Stanford classification 241f
Deep femoral
arteries 174
vein 174
Deep vein thrombosis 4, 78, 174, 176, 185
incidence of 174
Defibrillator pads 92
Dengue 214f
Depressed left ventricular function 191
Descending thoracic aorta, segment of 233
Deviation, signs of 4
Diagnostic peritoneal lavage technique 201
Diaphragm 70f, 96
ultrasound 105, 106
Diaphragmatic
excursion 102
measurements 106
thickening fraction 105
Diastolic dysfunction
grades of 144f
phases of 144f
suggestive of 144
Dicrotic notch 169
Different scoring systems 85
Disks, biplane method of summation of 132
Display modes 12
Dissection 131
Disseminated intravascular coagulation 224
Distal augmentation test 177
Distensibility index 166, 166f
Doppler imaging 254
Double tract sign 49f
Duodenum 42
Dynamic air bronchograms 75f, 92
Dynamic scanning technique 269
Dyspnea 155
E
Echocardiography 124, 151, 164
advanced 124
applications of 188
basics of 109, 124
cardiac 171
role of 187
transesophageal 194
Edema
lesional 59
pulmonary 59, 69, 76
eFAST
advantages 205
extended fast 205
impact on clinical decision making of 207
scan 201
Electrodes, transesophageal 194
Elevated left atrial pressures 144
Embolic disorders 216
Emphysema, subcutaneous 66f
End expiratory thickness 105
End-diastolic velocity 258, 260
Endocarditis 214
infective 216
Endotracheal intubation 47, 195
Endotracheal tube 48
placement, confirmation of 195
size, prediction of 47
Epiglottis 33, 35
Equipment
disinfection of 28
sterilization of 28
Esophageal intubation 48, 49
Esophagus 40
European Society of Cardiology guidelines 159
European Society of Intensive Care Medicine 4
Extracorporeal membrane oxygenation 124
Extravascular lung water 65, 77
Eye, ultrasonographic appearance of 247f
Eyeballing 132
F
False vocal cords 36f
False-negative inner-to-inner method 244
False-positive fast scan 203f
FAST
and eFAST, learning curve for 207
examination 201
ventricular rate 166
Femoral artery 175, 176, 278f, 280f
cannulation 280f
Femoral vein 174, 176, 176f, 278, 278f, 280f
cannulation 278f
Fibrinolysis 224
Fluid
abnormal collection of 224
administration limited by lung sonography 58, 79, 170
dynamic measurements of 165
filled structures 269
hepatorenal pouch for 210
overload 146
responsiveness 164
carotid Doppler for 169
echocardiographic measures of 165
status assessment 4
therapy 87, 171
Focal lesions 210, 216
Foley's bulb in situ 219f
Fractional area change 132, 136
Frank-Starling
curve 164
relationship 164
Frosted glass appearance 43f
Fundus 41, 41f
Fungal septicemia 214
G
Gallbladder 209, 222
anatomy of 209, 211f
contents 213
distension 213
pathology of 209, 214f
posterior wall of 27f
Global left ventricular contractility 132
Global longitudinal strain 133
Gloved finger appearance 42, 42f
Glutaraldehyde 28
Gosling's pulsatility index 259
Granulomas 215f
Great saphenous vein 174–176
Guidewire entering peritoneal cavity 224f
H
Heart
apex of 110f
lung interactions 164
Hematochezia 232
Hematoma, abdominal wall 225
Hematuria 229, 232
Hemidiaphragm 98, 102f
Hemodynamic augmentation 261
Hemoperitoneum 206
Hemorrhage
chronic vitreous 252
subarachnoid 136, 255
visualize 252, 252f
Hemothorax 190f, 201, 206
detection 205
High level disinfection 28
Homolateral tympanism 191
Hydrogen ion 188
Hydrogen peroxide mist device 29
Hydronephrosis 218
Hyoid bone 34f, 35
Hyperdynamic circulation 259
Hyperechoic point 270
Hyperemia 259
Hyperkalemia, severe 189
Hyperplasia, benign prostatic 218
Hypertension
augmentation 261
intracranial 250
permissive 261
severe pulmonary 131f
Hypertrophy, benign prostatic 219f
Hypoechoic 21
abscess cavity 230f
Hypotension, severe 278
Hypothermia 188
Hypovolemia 131, 165, 188, 189, 196
cause of 196
identification of 196
severe 165, 189
Hypoxia 188
I
Implantable cardioverter defibrillator 92
Infarction, myocardial 191
Inferior vena cava 42, 121f, 148, 148f, 149f, 165, 188, 210
assessment: 161
measures of 148
Injury, retroperitoneal 207
Inner-to-inner method 239
Intensive care unit 3, 33, 57, 82, 174, 209, 248, 263
Interatrial septum, significance of 130
Intercostal space 203
Interstitial syndrome 76
Interventricular septum 130, 136, 140, 180, 181
significance of 130
Intra-abdominal free fluid 207
Intra-abdominal organs 222t
anatomy of 209
pathology of 209
Intra-aortic balloon pump 124
Intracranial arterial stenosis increasing age 259
Intracranial arteries 260
Intracranial pressure 255, 259
estimating 261
monitoring 261
Intrahepatic biliary radicle dilatation 210, 222
Intraperitoneal collections 4
Intrathoracic area change method 98
Intubation 33
Invasive abdominal procedures 230
Ischemia, myocardial 180
J
Jugular vein, internal 267, 270, 273
K
Kidney 222
anatomy of 209
left 203f
pathology of 209
ultrasound evaluation of 216
L
Landmark technique 274, 278
Large lobar consolidation 71f, 72t
Laryngeal mask airway, position of 33
Laryngoscopy 33
Larynx 35
Leading edge-to-leading edge method 239
Left atrial enlargement, degree of 154
Left atrium 113, 115, 119, 120, 120f, 122, 145
Left upper quadrant 202f, 203
ultrasound evaluation of 215
Left ventricle 113, 116, 119, 120, 120f, 128, 181, 185
cavity size measurement 137
hypertrophy 141
Left ventricular
apex view 114
apical thrombus 158f
contractility 132
outflow 152
tract 116, 131, 133, 134, 134f, 135, 165–167, 167f, 168, 189
wall size 140
Lens dislocation 252
Leukemia, acute myeloid 214
Linear array 17
Linear transducer 267, 268f
Liver 70f, 209
abscess
drainage 229, 230f
pyogenic 229
anatomy of 209, 211f
disease, chronic 211, 212f
echotexture of 210, 211
left lobe of 43
lesions, focal 213
mirror artifact of 26f
outline of 210, 213
pathology of 209, 212f
small shrunken 212f
span 210
Low gain settings 24f
Lower limb, vessels of 175f
Luminal air 38f, 39f
Lump, palpable abdominal 232
Lung
aeration 4
daily monitoring of 87
monitoring of 83
quantification of 83
artifacts 98f
consolidations 84
diagnosis of 4
floating 70f
parenchyma, normal 63
point 73f
detection of 73
pulse 67, 68f
absent 91
M mode 67
presence of 67
sliding 62
during ventilation 191
sonography 79fc
ultrasonography 57, 59, 62
applications of 58b
basic 57
physics of 58
ultrasound 57, 59f, 69, 74fc, 80, 85, 92, 190f
advantage of 57
score 86
volumes, assessment of 99f
M
Magnetic resonant imaging 209
Major trauma victims 201
Masses
cardiac 157
intracardiac 151
Massive pericardial effusion 190f
McConnell's sign 182, 182f
Mechanical circulatory support 124
Mechanical ventilation 125
invasive 125
setting of 87
Medical annulus diastolic movements 143
Medulla, echogenicity of 218
Meningitis, bacterial 259
Mercedes Benz sign 115, 235f
Mild pulmonary arterial hypertension 156
Minimally invasive procedure 224
Mitral regurgitation 152
assessment of severity of 152
causes of 152
severe 151
Mitral stenosis 153
grading of severity of 154
severe 155f
Mitral valve 113, 116f, 143f
area, measuring 154f
function 116
leaflet 155f
level 114, 116
M-mode diaphragmatic excursion view 99
Morison's pouch 202f
Mouth, floor of 34, 34f
Multiple observational studies 162
Multiple organ dysfunction syndrome 220
Myocardial abscess formation 158
Myocardial performance, right ventricular index of 136
Myocardial segments 117
Myxoma, left atrial 159f
N
Nasogastric tube, position of 33
Neck, strap muscles of 36f
Nerve block 33
Net zero oscillatory flow 262
Neurocritical care 254
units 263
Noncardiac ultrasound, use of 196
O
Obstruction 189
One-person versus two-person technique 272
Optic nerve 247, 249
complex 249
sheath
anatomy of 249
diameter 247, 248, 249f
Optimum orientation 272
Oral cavity 34f
Organ systems 188
Outer-to-outer method 239
P
Pain, abdominal 232
Pancreas 42, 43
Papillary muscle
level 124, 126f, 130
view 114
Paracentesis, abdominal 223, 224, 224f
Paradoxical emboli, monitoring for 263
Paralysis, complete 98
Parasternal long-axis 112, 113f, 125f, 126f, 138f, 234
Parasternal short-axis 114, 116, 117, 125f, 234
Paratracheal scan 48f
Patent foramen ovale 130
Peak systolic velocity 258, 260
Peak tricuspid regurgitation velocity 155
Percutaneous catheter insertion 229
Pericardial effusion 128, 131, 131f, 159, 207
moderate 161f
presence of 190
Pericardiocentesis 162
drainage 162
emergent 124
site 162
technique 162
Pericardium 151
Peripheral inserted central catheter 280, 281f
Peripheral venous access 281
Perisplenic view 203
Peritoneal cavity 224
Pigtail catheter 227f
Pleural effusion 4, 69, 70f, 71f, 210
Pleural fluid, quantification of 72t
Pleural line 62, 62f, 63
Pleural syndrome 71, 77, 78
Pneumonia, ventilator-associated 91, 92
Pneumoperitoneum 221
Pneumothorax 4, 69, 72, 72f, 73f, 91, 192f, 206, 207
assessment 205
diagnosis of 74fc
generates 72
identification of 201
US signs of 91
Point-of-care
abdominal ultrasonography 209
arterial blood gas 188
echocardiography 155
monitoring, echocardiographic 109
ultrasound 3, 4, 44, 46, 185, 187
concept of 3
Positive-end-expiratory pressure 88, 90fc
Post-myocardial infarction 157
Power Doppler 14
Pressure, left atrial 141
Probe
movements of 110
selection and
patient's position 109
rationale 34
Progressive aeration loss 83f
Prostate, enlarged 219f
Prosthesis, dehiscence of 158
Pseudonormal left ventricle filling 142
Pseudo-pea arrest, identification of 193
Pulmonary arterial pressure 155
assessment of 155, 156
Pulmonary artery systolic pressure 147, 155
Pulmonary complications, lung ultrasound-guided detection of 91
Pulmonary embolism 185fc, 192
sign of 184f
Pulmonary valve 115
function 115
Pulmonary vascular resistance 180
Pulmonary vein inflow 143
Pulsatility index 260
Pulse
duration 11
repetition
frequency 11
period 11
wave 11f
Doppler 14f, 143f, 166
use of 124
Pump failure 189
Pupillary reactivity, assessment of 253
Pupillary reflex 251f
ultrasonographic evaluation of 250
Pupillary size, determination of 250
Pyelonephritis, chronic 217
Pylorus 42
Pythagorean theorem 271f
principle of 269
Q
Quad sign 69, 70f
Qualitative diaphragm 97f
movement assessment view 96
R
Radial artery 23f
cannulation 279, 279f
Doppler of 23f
Raised intracranial pressure 248
Real time ultrasonography guidance, use of 223
Reflection 20
Regional left ventricular function 136
Regional wall motion abnormality 128
presence of 191
Regurgitant lesions 151
Regurgitation, acute valvular 191
Renal artery
left 238f
right 238f
Renal calculus 217f
Renal lesions, focal 218
Renal vein 238f
Respiratory failure, acute 77
Respiratory variations and collapse 149f
Restrictive left ventricle filling 143
Retinal detachment 251
complete 251f
Reverberation artifact 25, 25f, 36f, 38f, 39f, 192f
Ribcage overlies abdominal contents 104
Right atrial pressure 147
guidelines 156
Right atrium 115, 119, 120, 120f, 121, 160f, 193f
Right hemidiaphragm 102f
Right upper quadrant 202f, 203
ultrasound examination of 209
Right ventricle 113, 116, 119, 120, 120f, 121f, 180, 181f, 185, 193f
cavity size measurement 139
outlet tract 183
systolic function, measure of 137f
Right ventricular
contractility 136
diastolic collapse 161f
dilation during cardiac arrest, interpretation of 193
dysfunction, echocardiographic signs of 180
global systolic function 136
inflow tract 115
outflow tract 115f
size and shape 180
systolic dysfunction
moderate 181f
severe 181f
systolic pressure 130, 147
volume 136
wall measure 147
S
Scanning technique
patient position 175
probe 175
scan 175
Scoustic impedances 20t
Seagull sign 237f
Seashore sign 63f, 73f
Second tracheal ring, level of 39f
Seldinger technique 225, 226
Selecting right positive-end-expiratory pressure 88
Shock 155
etiologies of 164
Shred sign 74f
Sickle cell
anemia 255, 259
disease 216
Simpson's method, modified 132
Single cardiac phase array probe 187
Sinotubular junction 147
Sinusoid sign 69, 70f, 75
Skin asepsis, principle of 278
Small footprint 109f
Sodium-channel blocker toxicity 189
Sonographic airway assessment needs 44
Sonographic signs 69
Sound wave 9
attributes 9
Spatial pulse length 11, 11f
Spatial resolution 20
Spleen 215, 222
anatomy of 209
normal 215f
pathology of 209
size 216
Splenic infarct 215f, 216
Spontaneous circulation, return of 187
Spontaneous hemorrhagic transformation, development of 261
Spontaneous venous flow 178f
Standard ultrasound machine 255
Starry night appearance 43f
Static air-tissue interface with artifacts 72f
Static scanning technique 269
Stenosis
aortic 154
severe 116
Stenotic lesions 153
Sterile
sheath 29
Tegaderm film 29
tissue 28
Stomach, parts of 41
Stratosphere sign 73f
Stridor, postextubation 33
Stroke 255
acute 261
volume 132, 168
measurement of 164
Subclavian vein 275, 276, 276f, 281f
cannulation 277f
long-axis for 276f
supraclavicular approach of 277f
Subglottic upper airway, diameter of 47
Subphrenic collections 210
Subxiphoid view 120, 204
Supraclavicular approach 275
Suprapubic catheterization 223, 227
kit 229f
Suprasternal view 121
Suprasternal window 121
Systolic arterial pressure 164
Systolic dysfunction 146
T
Tamponade
pericardial 196
physiology, presence of 159
Temporal resolution 21
Tension pneumothorax 191
Thoracoabdominal injuries
evaluation of 201
life-threatening 201
Thorax, ultrasound zones of 61f
Thrombocytopenia 33
Thromboembolism, pulmonary 174, 180, 196
Thrombolysis 232
Thrombus 183
direct visualization of 179
presence of 267, 269
Thyrohyoid membrane 35
Thyroid
cartilage 35, 36f, 38f, 52
level of 36f
gland 40
isthmus of 39f
lateral lobe of 39f
level of 38f
Time gain compensation 23
Tissue Doppler imaging 145f
Titrate positive-end-expiratory pressure 89fc
Tongue, base of 34f
Trachea, surface identification of 40
Tracheal air 38f
Tracheal ring 39, 39f
Tracheostomy
percutaneous 4
dilatation 33, 49
Transcranial Doppler 254f, 255f, 260–263
assessment 254
clinical applications of 260
Transducer 46, 51, 52, 270
decontamination 28
position 112, 114, 210
predetermines, frequency of 22
selection 59
types of 16f
Translobar consolidation 74
Transmission 20
Transperitoneal approach 225
Transportation, risk of 157
Transthoracic
echocardiography 157, 184
echotransducers 243
Transverse wave propagation 9f
Trauma, sonography for 4, 58
Tricuspid
annular plane systolic excursion 136, 182, 183, 185
measure 137f
regurgitation 147, 182
valve 115, 116
Trocar technique 226
True vocal cords 36f, 38f
Tumors, cardiac 159
Typhoid fever 220
U
Ultrasonography 33
ocular 247
physics of 9
Ultrasound
abdomen 232
aortic 244
guided
arterial catheter insertion 279
central venous catheter insertion 273
peripheral venous catheter insertion 280
procedure 272
vascular access, benefits of 267
vascular access, pitfalls of 282
vascular cannulation 282
venous and arterial cannulation 267
machine 24, 109
modes 12
ocular 247, 252
probe, decontamination of 28
role of 49
scanning techniques 177
through tissues, propagation of 10
transducer 16
use of 195, 267
view, abdominal 236
waves 22
additional characteristics of 10
attenuation of 19f
frequency of 18
penetration of 18
Upper airway 46
applied sonoanatomy of 46
ultrasound, use of 50
Urinary bladder 222
contents 220
distended 228f
normal 219f
ultrasound evaluation of 218
V
Valves 151
Valvular assessment 151
Valvular regurgitation 146
Vascular access 267
Vascular malformations 255
Vascular structure 269, 282
Vasospasm 259, 261
grades of 262t
Vein 176f, 269
common femoral 174, 175
noncompressible 179
popliteal 174, 175, 177f
superficial femoral 174
Velocity time
integral, ratio of 152
interval 134, 135, 165, 167, 168
Vena cava
inferior 42, 121f, 148, 148f, 149f, 165, 188, 210
superior 122
Ventilatory support, form of 106
Ventricle 165
free wall collapse 160
interdependence of 160
Ventricular assist device 124
Ventricular fibrillation 194
Vessels, intrahepatic 203
Vitreous humor 251
Vocal cords 36
movement of 33
Volatile anesthetic agents 259
Volume status, assessment of 164
W
Wall motion abnormalities 136
Wall thickness 213, 219, 220
Wave propagation, types of 9f
Wavelength 10
Wrist, volar aspect of 23f
X
Xylocaine jelly 268
Z
Z lines 66
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