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3 - Echocardiography

Published online by Cambridge University Press:  10 August 2009

Vicki Noble ,
Bret Nelson  and
Nicholas Sutingco
Vicki Noble
Affiliation:
Massachussetts General Hospital, Harvard Medical School
Bret Nelson
Affiliation:
Mount Sinai School of Medicine, New York
Nicholas Sutingco
Affiliation:
Brigham and Women's Hospital, Harvard Medical School
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Summary

Introduction

One of the most exciting applications for bedside ultrasound is echocardiography. Differentiating between pulseless electrical activity (PEA) and asystole in patients with no pulse, identifying pericardial effusions in hypotensive patients, and estimating volume status or global cardiac function in hypotensive patients are all applications for bedside echocardiography that can make a difference in patient treatment and outcome. However, it is important to note that this manual is not meant to teach a noncardiologist to be an echocardiographer. Bedside echocardiography is a tool to be used by clinical practitioners who need quick answers to specific questions about cardiac function in critically ill patients. Any good physician must recognize the limitations of his or her knowledge and skill; in cases where ambiguity remains after bedside ultrasonography, follow-up testing should be consistent with normal practice patterns (1).

This chapter also reviews how to make estimations of global cardiac function and how to perform estimations of volume status by evaluating inferior vena cava (IVC) respiratory variation and collapse. Finally, images of a dilated right ventricle are reviewed so that in appropriate clinical settings, support for the diagnosis of pulmonary embolus can be made.

Echocardiography is essential in looking for wall motion abnormalities in ischemic heart disease and in evaluating valvular cardiac disease, but these applications can be complicated and require more extensive training. Again, knowing the limitations of bedside ultrasonography is essential for practicing safely.

Type
Chapter
Information
Manual of Emergency and Critical Care Ultrasound , pp. 53 - 84
Publisher: Cambridge University Press
Print publication year: 2007

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