Summary bedside usg in the emergency department

POINT-OF-CARE ULTRASOUND (POCUS)
Position: Pt semi-recumbent at 45 degrees.
Transducer: Phased array

There are 4 views + IVC assessment
1. Parasternal long axis
2. Parasternal short axis
3. Apical 4 chamber
4. Subcostal

In general, structures must be within 2/3 of the screen.


1) PARASTERNAL LONG AXIS VIEW (PLAX)

Probe position: Start at 2nd – 3rd intercostal space, left parasternal edge. Probe marker
towards right shoulder.

Optimal view
Ensure septum is horizontal.
RV, Aorta and LA are equally proportionate in size (ratio 1:1:1).

Anatomy




Assessment
1. Left ventricular contractility
a. “Eyeballing”, from opened mitral valve tip to interventricular septum
i. E-Point Septal Separation (EPSS), <7mm normal, >10mm
suggestive of low EF.
b. Contractility are graded as good (>50%), moderate (20-50%), poor
(<20%).

, 2. Chamber size
a. RV, Aorta and LA sizes must be proportionate at 1:1:1 ratio.
b. Aortic root <3cm. If more => dilated.
3. Valve
a. Mitral valve – flailing, vegetation.
4. Descending aorta
a. Anechoic region in relation to descending aorta
i. Above = Pericardial effusion
ii. Below = Pleural effusion


2) PARASTERNAL SHORT AXIS VIEW (PSAX)

Probe position: From the point of PLAX, turn probe 90° with marker towards left
shoulder.

Optimal view
Mesti bulat-bulat. Structures should be in the centre of the image.
There are 4 levels of PSAX.

Anatomy Assessment
a) Aortic valve level

“Mercedes Benz”

Look for
! Cusps
! Vegetation




b) Mitral valve level

“Fish mouth”

Look for
! Cusps
! Vegetation

! RWMA

! D-sign = bowing of septum
into LV due to increased RV
pressure.