← All decks
Anaesthesiology
Echocardiography and Point-of-Care Ultrasound
Built from Barash Clinical Anesthesia, 9th Edition
What’s inside
11 sections · 199 slides
Overview
- What this topic covers
- Scope of ultrasound in anesthesia practice
Physics of Sound
- Characteristics of a sound wave
- How depth is calculated from an echo
- Velocity of sound in different tissues
- Reflection and echolucent structures
- From electric pulse to screen image
Resolution and Image Optimization
- Temporal resolution and frame rate
- M-mode imaging
- Axial resolution and frequency
- Lateral and elevational resolution
- Acoustic shadow artifact
- Reverberation and mirror-image artifacts
- Double aorta from mirror-image artifact
Doppler Echocardiography
- The Doppler principle
- Pulsed wave Doppler
- Aliasing and the Nyquist limit
- Color Doppler imaging
- Aliasing on color Doppler
- Tissue Doppler imaging
- Continuous wave Doppler
- Choosing between pulsed and continuous wave Doppler
Hemodynamic Assessment
- Peak and mean pressure gradients
- Measuring velocity and using the gradient
- Derivations of cardiac chamber pressures
- Stroke distance, stroke volume and cardiac output
- Tracking cardiac output over time
- The continuity equation
- Deriving aortic valve area by continuity
Perioperative Echocardiography Imaging
- Choosing between TEE and TTE
- Indications for perioperative echocardiography in anesthesia practice
- Complications of transesophageal echocardiography
- Minor complications, risk factors and contraindications
- Common contraindications to transesophageal echocardiography
- Inserting the TEE probe
- TEE probe positions relative to the heart
- Advancing and withdrawing the probe
- Turning the probe left and right
- Anteflexion and retroflexion
- Lateral flexion of the probe tip
- Controls on the TEE probe handle
- Rotation of the ultrasound plane
- Image orientation on the screen
- Study sequences and how views are named
- Twelve planes of a focused TEE study
- Midesophageal four-chamber view
- Midesophageal two-chamber view
- Midesophageal long-axis view
- Midesophageal aortic valve short-axis view
- Midesophageal right ventricular inflow-outflow view
- Midesophageal bicaval view
- Midesophageal ascending aorta short-axis view
- Midesophageal ascending aorta long-axis view
- Transgastric midpapillary short-axis view
- Deep transgastric five-chamber view
- Descending aorta short-axis view
- Descending aorta long-axis view
- Probe movements in transthoracic scanning
- Basic focused cardiac ultrasound views
- Advanced focused cardiac ultrasound views
- Basic and advanced focused cardiac ultrasound views
- Basic and advanced focused cardiac ultrasound views (continued)
- Practical remarks on the focused cardiac views
- How 3D echocardiography works
- Clinical uses of 3D transesophageal echocardiography
- En face view of the mitral valve
The Left Ventricle
- Anatomy of the left ventricle
- Seventeen-segment model and coronary supply
- Foreshortening and sweeping through the walls
- Equivalent TEE and TTE views for important cardiac structures
- Equivalent TEE and TTE views for important cardiac structures (continued)
- Equivalent TEE and TTE views for important cardiac structures (continued)
- Qualitative assessment and careful tracing
- Fractional shortening and fractional area change
- Ejection fraction by volume tracing
- Mitral annular plane systolic excursion
- Assessment of dP/dt from the mitral regurgitant jet
- Myocardial performance index
- Assessment of left ventricular systolic function
- Regional wall motion assessment
- Assessment of regional wall motion
- Myocardial strain
- Normal diastole and how dysfunction develops
- Consequences of impaired ventricular relaxation
- The four components of diastolic assessment
- Four measurements used to grade diastolic function
- Measuring mitral inflow and annular velocities
- Left atrial volume index
- Tricuspid regurgitant peak jet velocity
- Algorithm for grading left ventricular diastolic dysfunction
- Grades of diastolic dysfunction and their features
- Ventricular aneurysm and pseudoaneurysm
- Distinguishing aneurysm from pseudoaneurysm
- Left ventricular dilation and hypertrophy
- Hypertrophic obstructive cardiomyopathy
- Perioperative outflow tract obstruction
The Right Ventricle
- Anatomy of the right ventricle
- Physiological differences from the left ventricle
- Right ventricular dimensions
- Tricuspid annular plane systolic excursion
- Right ventricular fractional area change
- Tissue Doppler measures of right ventricular function
Valvular Heart Disease
- Flow convergence and turbulence at a diseased valve
- Minimal leaflet motion in severe stenosis
- Anatomy of the aortic valve
- Common aortic valve pathologies
- Grading aortic stenosis and measuring valve area
- Grading the severity of aortic stenosis
- Causes of aortic regurgitation
- Quantifying aortic regurgitation
- Grading the severity of aortic regurgitation
- Mitral valve anatomy
- The mitral valve and the outflow tract
- Causes and appearance of mitral stenosis
- Associated features of mitral stenosis
- Measuring the severity of mitral stenosis
- Grading the severity of mitral stenosis
- Primary and secondary mitral regurgitation
- Carpentier classification of mitral regurgitation
- Carpentier types of mitral leaflet motion
- Cause and effects of mitral regurgitation
- Grading mitral regurgitation severity
- Grading the severity of mitral regurgitation
- Tricuspid regurgitation
- Grading the severity of tricuspid regurgitation
Aorta, Pericardium, Masses and Shunts
- Imaging the aorta
- Aortic aneurysm and dissection
- Telling the true lumen from the false lumen
- Stanford classification of aortic dissection
- Stanford classification of aortic dissection
- Aortic atheroma
- Normal pericardium and pericardial fluid
- Pericardial effusion
- Distinguishing tamponade from a simple effusion
- Echocardiographic progression of tamponade
- Constrictive pericarditis versus restrictive cardiomyopathy
- Cardiac masses
- Choosing the imaging test for cardiac masses
- Intracardiac shunt
Point-of-Care Ultrasound
- What point-of-care ultrasound is
- Point-of-care versus consultative ultrasonography
- Strengths and limits of POCUS
- Clinical questions generally answered using point-of-care ultrasound
- Clinical questions generally answered using point-of-care ultrasound (continued)
- Clinical questions generally answered using point-of-care ultrasound (continued)
- Clinical questions generally answered using point-of-care ultrasound (continued)
- Clinical questions generally answered using point-of-care ultrasound (continued)
- Clinical questions generally answered using point-of-care ultrasound (continued)
- Clinical questions generally answered using point-of-care ultrasound (continued)
- Causes of perioperative hypoperfusion found on focused cardiac ultrasound
- Assessing fluid status and venous congestion
- Evidence for preoperative and postoperative FOCUS
- What lung ultrasound detects, and how to scan
- The normal pleural line
- Common lung ultrasound findings
- M-mode signs and the lung point
- Interstitial syndrome and B-lines
- Effusion and consolidation on lung ultrasound
- Gastric ultrasound
- Diaphragm assessment and the FAST examination
- Ultrasound-guided vascular cannulation
- Ultrasound with mechanical circulatory support
- Epicardial and epiaortic ultrasound
- Echocardiography outside the operating room
- Route from training to certification
- Training in perioperative echocardiography
- Training standards in critical care echocardiography
- Broader critical care ultrasound competencies
- Certification in perioperative echocardiography
- Certification requirements in perioperative echocardiography and critical care
- Artificial intelligence in echocardiography
- Tele-ultrasound and intravascular ultrasound
- Summary: physics and Doppler
- Summary: hemodynamics and views
- Summary: clinical echocardiography
- Summary: POCUS and practice
- References
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- Barash, Cullen, and Stoelting's Clinical Anesthesia, 9th Edition