Keterangan
Echocardiography is a fundamental tool for the management of patients in the intensive care unit, because it enables a thorough evaluation of cardiac anatomy, function, and hemodynamics and provides essential information for the diagnosis and treatment of the pathological conditions most frequently encountered in ICU patients, This noninvasive heart imaging device enables a thorough assessment of cardiac architecture, function, and hemodynamics and is a crucial management tool for patients admitted to intensive care units. This crucial information can be used by physicians to make proper diagnosis or direct treatment when considered in the context of a patient's presenting symptoms.
Ringkasan
- Echocardiography is a practical skill that can be a valuable, though often underutilized, tool in the Intensive Care Unit (ICU). It can reduce the need for CT scans and chest X-rays. It helps differentiate between cardiogenic, hypovolemic, and obstructive shock, aiding in emergency situations.
- The basics of echocardiography, including probe orientation and views, are crucial for intensivists. This involves understanding probe movements like tilting, rocking, sliding, and rotating to obtain different images. The common views include subxiphoid, apical, and parasternal (long and short axis) views.
- The parasternal long axis view, taken from the left third intercostal space with the probe marker towards the right shoulder, allows visualization of the aortic and mitral valves. Rotating the probe to point towards the left shoulder provides the parasternal short axis view, useful for assessing LV contractility.
- Apical four-chamber view, with the probe near the apex and facing the left or 3:00 position, displays all four chambers of the heart. It helps compare left and right ventricular dimensions, assess cardiac motion, and calculate ejection fraction. The subcostal view, achieved by placing the probe near the xiphoid process and directing it towards the thorax and left shoulder, helps evaluate chamber functions and detect pericardial effusion. It is also useful for assessing IVC size variations with respiration, indicative of fluid responsiveness.
- Limitations of bedside echocardiography include patient positioning, ventilation, and other equipment interference. Practical tips for obtaining images include maintaining perpendicularity to the structure being examined, using intercostal spaces as windows, and positioning the patient in the left lateral decubitus position.
- Key considerations during echocardiography in the ICU include the patient's ventilation status (spontaneous, non-invasive, or invasive), ventilation mode, PEEP level, and any use of inotropes or dialysis. It is essential to identify systole and diastole by observing the aortic and mitral valve closures and openings in the parasternal long axis view.
- Echocardiography helps identify pericardial effusion and assess LV contractility. The short axis view helps observe wall motion. Assess if the heart is collapsing in systole or diastole and aids differentiation of cardiogenic shock from septic shock.
- Fluid responsiveness can be assessed via IVC size measurement. A smaller IVC and greater than 50% collapsibility suggests fluid responsiveness, while a larger IVC with less than 50% collapsibility indicates low fluid responsiveness. The size of the IVC can be determined from a subcostal view.
- Doppler evaluation is also used to measure blood velocity and flow direction to assess for stenosis and regurgitation. Red color towards the probe indicates the blood is moving closer to the probe. This approach is complete when combined with lung ultrasonography. A-lines mean air and B-lines indicate consolidation.
- Lung ultrasonography, using a 4-12 MHz probe, helps identify A-lines and B-lines, where B-lines signify fluid overload. This is especially important following fluid resuscitation, where the presence of B-lines indicates the need to halt fluid administration.
Contoh Sertifikat
Tentang Pembicara
Komentar
Komentar
Anda harus login untuk meninggalkan komentar.