SonoPearls… from Stanford Bedside Ultrasound Course… for FAST, Echo and RUSH

Teaching US with fellow US lovers is just too fun. What I appreciated most – multi-specialty!! …

…with Sarah Williams (EM), me (EM), Zoe Howard (EM), Brie Zaia (EM), Darrel Sutijono (EM), Phil Perera (EM/IM), Yoshi Mitarai (EM-ICU), MyPhuong Mitarai (EM), Viveta Lobo (EM), Anne-Sophie Beraud (Cards), John Kugler (IM):

Multi-dept instructors: EM, IntMed, ICU, Cards.
Multi-dept learners: Anesth, IntMed, Peds, Surg, EM, NPs

US Pearls:

FAST scan RUQ: Use xiphoid process as your landmark and start in the midaxill line lateral to it for probe placement, angle down. Mult rib spaces needed. Stop/stay/slowly fan in each space: above/below diaphrgm, Morrisons, inf pole/paracolic gutter

FAST scan LUQ: xiphoid as landmark again; angle down; stomach in view? rotate probe: indicator to gurney, in plane with ribs. First area free fluid pooling: subdiaphragm (betw spleen and diaphragm) -also most difficult to eval due to stomach

SX view for echo and FAST – use liver to see heart! it’s acoustic window-slide probe laterally if needed to get liver in view

FAST, SP view-angle down, decr gain (brightness) bc will be bright where free fluid may be; slowly fan: transv/sagittal planes. You should see pelvic organs when you fan! If you can’t, it’s too bright – decrease your gain

ECHO -PSL/PLAX view – start high, next to sternum, stop at each rib space, angle up & down when there, tarvel down until see heart. PSL view (& vis desc aorta) is best in diff pleur eff (fluid behind desc aorta) from pericard eff (fluid above desc aorta)

RUSH protocol (by P Perera himself!) – eval Pump (PSL is best), Tank (EFAST/IVC/lungs), Pipes (Aorta +/- DVT) for etiol of shock. – you’ll be able to assess whether a patient needs fluids or pressors when seeing Pump fxn and IVC. IVC -start in short axis & then do long; dont undershoot size by ensuring you’re in mid section of IVC by fanning. Can use M Mode to evaluate LV contractility (PSL) and IVC collapsibility – can measure the delta change

Most importantly: Know what normal looks like-why its impt 2 practice – when you then see pathlgy, you may not know what it is, but you know its abnormal

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