Description
Performing a comprehensive 2D echocardiogram in the ICU requires adherence to specific guidelines to ensure accurate and effective assessment. First, patient positioning is crucial; typically, a left lateral decubitus position is recommended if feasible. Second, standard views, including parasternal long and short axis, apical four-chamber, and subcostal views, should be systematically obtained. Third, image optimization using appropriate transducer frequency and depth settings is essential for clear visualization. Fourth, Doppler techniques should be employed to assess blood flow patterns and velocities, providing functional information. Finally, meticulous documentation and interpretation of findings, including measurements of chamber sizes, wall thickness, and ejection fraction, are critical for comprehensive patient evaluation.
Summary Listen
- The presentation focuses on the use of trans-thoracic 2D echocardiography in the Intensive Care Unit (ICU), emphasizing its role as a standard of care for rapid cardiac assessment. It highlights the non-invasive nature of the procedure, allowing for repeated examinations without patient or operator risk. Rapid assessment is crucial for critically ill patients, making point-of-care ultrasound invaluable when immediate insights are needed.
- The importance of understanding cardiac semiotics is explained, which includes probe manipulation, cardiac anatomy, principles of imaging, and the main trans-thoracic views. The use of sliding, tilting, rotating, and rocking motions with the phased array cardiac probe (3-5 MHz frequency) is necessary to visualize cardiac structures effectively. Precise probe movements are crucial for accurate image acquisition.
- The speaker highlights key cardiac windows for visualization: parasternal, apical, subcostal, and suprasternal. They are explained and which planes are best for using each window. The long axis (apex to base) and short axis (anterior to posterior) views are crucial for assessing different aspects of cardiac anatomy and function. It also described how to orient the patient and probe to get a clear picture.
- 2D imaging provides anatomical assessment, M-mode allows motion assessment over time, and color and pulse wave Doppler support hemodynamic evaluation. These techniques are vital for diagnosing circulatory failure, assessing both right and left heart function, and identifying lung-related causes of shock. All of which, are commonly used in the ICU.
- Limitations in ICU, like patient positioning challenges and image quality issues, are noted, along with the importance of operator experience. Visual assessment of left ventricular function, including ejection fraction, and right ventricular assessment, including dilation and TAPSE measurement, were mentioned. The speaker stated, TAPSE less than 17mm indicates RV dysfunction.
- The speaker mentions measurement of cardiac output through VTI (velocity time integral) measurement to measure the left ventricular function. The end goal for the intensivist is to visually inspect whether the chambers are normal, mildly reduced, moderately reduced or severely reduced.
Sample Certificate
About the Speakers
Dr. Rajesh Kasimahanti
Consultant, Department of Critical Care Medicine, Apollo Hospitals, Health City, Visakhapatnam
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