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Integrating ultrasound into critical care teaching rounds

Overview Significant advancements have been made in the use of ultrasound technology since its inception in the early 1950s. These advances have revolutionized the practice of critical care medicine. Currently, clinicians in the intensive care unit (ICU) have at their disposal a tool at the bedside that augments the physical examination and is safe, portable, noninvasive, and readily available. Safety Ultrasound technology uses sound waves, and…

Ultrasonography: A basic clinical competency

Overview Ultrasonography has undergone a transformation in the past 2 decades that is fundamentally changing the way that medicine is taught and practiced. Technologic advances have taken ultrasound to the bedside or point of care in the form of laptop and pocket-sized devices that produce high-quality digital images that can be saved in multiple formats or sent anywhere in the world for review. Because of the…

The holistic approach ultrasound concept and the role of the critical care ultrasound laboratory

Overview The approaches to examination of patients by clinical providers has evolved with the growth of medical knowledge and expectations of quality care. Though still primarily relying on their senses, physicians have been adding basic equipment (e.g., scale, stethoscope) and more complex devices (e.g., scopes, sphygmomanometer) to patient evaluation standards. In the intensive care unit (ICU), the diagnostic process is rather complex and continuous, and physical…

Integrating picture archiving and communication systems and computerized provider order entry into the intensive care unit: The challenge of delivering health information technology–enabled innovation

Overview This chapter presents research evidence on the effective utilization of picture archiving communication systems (PACSs) and computerized provider order entry (CPOE) systems in the intensive care unit (ICU). PACSs provide a centralized communication repository for all imaging data that replaces previous film-based systems by delivering diagnostic images electronically to clinicians. CPOE systems allow clinicians to place orders (e.g., medication, imaging, and pathology) directly into computers…

Ultrasound in animals

Overview In 2004, in the first historical translational study of focused assessment with sonography for trauma (FAST) from humans to small animals, 101 dogs with severe blunt trauma after being hit by cars were evaluated. The authors reported that intraabdominal injury, specifically, hemoperitoneum, was more common than previously identified (pre-FAST rate of 12% to 23% versus a post-FAST rate of 45%). By imaging the thorax via…

Ultrasound in reconstructive microsurgery: (CONSULTANT-LEVEL EXAMINATION)

Overview Recent innovations in local tissue rearrangement and free tissue transfer have altered surgical approaches from simple wound care or amputation to optimal functional and aesthetic repair. Survival of transferred tissue remains a concern in trauma patients. , Apart from the surgical technique, various factors may influence microsurgical operations, such as defect location and size, functional characteristics and underlying disorders, types of affected tissue, anatomic variants,…

Ultrasound-guided regional anesthesia in the intensive care unit

Overview Peripheral regional anesthesia and neuraxial anesthesia are well established in postoperative pain management following major orthopedic, thoracic, and abdominal procedures. Benefits include pain control superior to that achieved with systemic opioids, improved lung function after thoracic and abdominal procedures, and decreased stress/inflammatory responses. Ultrasound (US) guidance for regional anesthesia has been used increasingly over the last decade because it allows precise positioning of the catheter…

Ultrasound-guided percutaneous tracheostomy

Overview Percutaneous tracheostomy (PT) is a common bedside procedure in the intensive care unit (ICU). Successful outcome requires midline needle puncture between the second and fourth tracheal rings and avoidance of posterior wall and vascular trauma. Kearney et al reported rates of perioperative morbidity of 6% and procedure-related mortality of 0.6%. Placement complications include hemorrhage, accidental extubation, pneumothorax, formation of a false passage, damage to tracheal…

Soft tissue, musculoskeletal system, and miscellaneous targets

Overview Besides encompassing specific focused techniques, the holistic approach (HOLA) ultrasound concept, introduced in Chapter 1 , promotes generic scanning of any body part (head-to-toe ultrasound imaging) as modulated by current clinical indications. Any ultrasound view obtained through the skin contains some information about soft tissues. While serving as an imaging window and as anatomic reference structures in focused techniques (e.g., the chest wall in lung…

Ultrasound imaging in space flight

Throughout the 5 decades of human space flight, the space medical support systems provided for onboard treatment of minor medical events and evacuation of the seriously ill or injured to Earth. In the absence of adequate objective information, however, it may be difficult to weigh the risks of onboard management against those of emergency return. A case of substantial trauma or illness would pose a serious…

Use of ultrasound in war zones

Overview War zones are unpredictable and austere environments that present unique challenges to medical providers. The hazards of combat as well as common nontraumatic pathology must be cared for in a diverse range of settings, from the combat medic caring for a wounded casualty while under enemy fire to the physician caring for critically ill patients in a forward-deployed temporary field hospital. During previous conflicts, as…

Integrating ultrasound in emergency prehospital settings

As previous and future chapters will attest, ultrasonography (US) is an indispensable modality in assessing patients in the hospital and outpatient setting. In the past few years, compact, robust, and portable US machines have been developed for use in various prehospital settings. Recent technologic advances have led to the development of battery-powered, light, handheld portable devices. In addition, ease of use, simplification of technology, and facilitated…

Ultrasound in the neonatal and pediatric intensive care unit

Overview Children and neonates are ideal candidates for the implementation of the holistic approach (HOLA) critical care ultrasound concept (see Chapter 1 ). This is mainly due to their small body size, which permits the fast application of all possible ultrasound techniques from head to toe. However, in the individual pediatric patient, only a part of the available ultrasound techniques will be clinically indicated, and many…

Use of ultrasound in the evaluation and treatment of intraabdominal hypertension and abdominal compartment syndrome

Overview Intraabdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are well-documented causes of morbidity and mortality in the critically ill. IAH and ACS may affect almost every organ system. The World Society of the Abdominal Compartment Syndrome ( www.wsacs.org ) has set forth a number of definitions based on clinical evidence and expert opinion. Intraabdominal pressure (IAP) is normally 5 to 7 mm Hg in adults.…

The extended fast protocol

Overview Ultrasound has become a permanent part of the evaluation of trauma patients ever since its first use in the emergency department more than 30 years ago. First used in Europe in the 1970s, abdominal ultrasound ultimately replaced diagnostic peritoneal lavage during the 1980s. Currently, bedside ultrasound is the initial imaging modality of choice for trauma care and is integrated into the Advanced Trauma Life Support…

Procedural ultrasound for surgeons: (CONSULTANT-LEVEL EXAMINATION)

Ultrasound (US) has become an indispensable part of the surgeon’s armamentarium, useful in both bedside assessment and operative treatment. Because the diagnostic and critical care applications of US are discussed elsewhere, this chapter will focus on intraoperative and US-guided surgical procedures. Intraoperative ultrasonography Intraoperative ultrasonography (IOUS) has been described extensively since the 1980s, and although its main applications are in hepatobiliary and pancreatic surgery, it also…

Point-of-care pelvic ultrasound

Overview This chapter illustrates the basic features of pelvic ultrasound by outlining the exploration of the female genital system, concluding thus the holistic approach (HOLA) ultrasound concept of the abdominal examination (see Chapters 1 and 44 ). Clinician-performed point-of-care pelvic ultrasound is an integral skill in a growing number of medical subspecialties. History and physical examination are not always reliable in the evaluation of possible pelvic…

Approach to the urogenital system

Anatomy The oval-shaped kidneys, measuring 9 to 15 cm in length and 4 to 6 cm in width, are located in retroperitoneum between the 12th thoracic and 4th lumbar vertebrae, just lateral to the psoas muscles. The kidneys are surrounded by the Gerota fascia (echogenic capsule) and a fat layer of variable thickness. Ultrasound examination, in both longitudinal and transverse planes, is performed using convex or…

Various targets in the abdomen (hepatobiliary system, spleen, pancreas, gastrointestinal tract, and peritoneum): (CONSULTANT-LEVEL EXAMINATION)

Overview Abdominal ultrasound can be used to obtain images of the hepatobiliary, urogenital, and pelvic structures. The approach to the urogenital system, point-of-care pelvic ultrasound, focused assessment with sonography for trauma, and other subjects are discussed in Chapter 42, Chapter 43, Chapter 44, Chapter 45, Chapter 46 . In this chapter, examination of various abdominal targets such as the hepatobiliary system, spleen, pancreas, gastrointestinal (GI) tract,…

Perioperative sonographic monitoring in cardiovascular surgery

Overview Despite the well-known advances in cardiovascular surgery over the last 50 years, it remains a high-risk procedure associated with significant morbidity and mortality rates. Currently, patients undergoing cardiovascular operations tend to be older and have more comorbid conditions. This could be attributed to the progress in surgical procedures, as well as to improved preoperative, perioperative, and postoperative care, which includes hemodynamic optimization by implementation of…