Ebook Echocardiography for intensivists: Part 2
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Ebook Echocardiography for intensivists: Part 2
Part IVEchocardiography in the ICU and OR: Basic and Advanced ApplicationsEchocardiographic History, Echocardiographic Monitoring, and Goal-Directed, Ebook Echocardiography for intensivists: Part 2 Focus-Oriented, and Comprehensive ExaminationArmando Sarti, Simone Cipani, and Massimo Barattini2323.1What Kind of Examination?Echocardiography is applied in the emergency and ICU setting according to specific needs as follows.1Hirst, ultrasonographic examination of the patient. This assessment by Ebook Echocardiography for intensivists: Part 2transthoracic echocardiography (TTE) or transesophageal echocardiography (TEE) is performed systematically. according to a logical and reproducible seEbook Echocardiography for intensivists: Part 2
quence which includes all major cardiovascular structures and measurements from all echocardiographic views. Chronic findings, such as hypertrophy or Part IVEchocardiography in the ICU and OR: Basic and Advanced ApplicationsEchocardiographic History, Echocardiographic Monitoring, and Goal-Directed, Ebook Echocardiography for intensivists: Part 2rther examination to reassess the patient. This is more targeted to obtain more specific information and is done in order to follow the evolution of the clinical picture and the response to drugs and general treatment over time, including mechanical positive pressure ventilation.3Focus-oriented or g Ebook Echocardiography for intensivists: Part 2oal-directed clinical interrogation and assessment. Illis occurs any lime during the clinical course of hospitalization in order to resolve a specificEbook Echocardiography for intensivists: Part 2
question or problem. A focus-oriented or goal-directed examinationA. Sarti (EJ)Department of Anesthesia and Intensive Care.Santa Maria Nuova HospitalPart IVEchocardiography in the ICU and OR: Basic and Advanced ApplicationsEchocardiographic History, Echocardiographic Monitoring, and Goal-Directed, Ebook Echocardiography for intensivists: Part 2f quick decisions in relation to the diagnosis and treatment following a logical algorithm or predefined flowchart. This Chapter and Chaps. 24-41 deal with many focus-oriented and goal-directed assessments.4Rapid emergency examination. For very unstable patients the ultrasonographic assessment will Ebook Echocardiography for intensivists: Part 2only concentrate on the essential information that can be obtained in a few' minutes or even seconds. Examples are the focused assessment with sonograEbook Echocardiography for intensivists: Part 2
phy in trauma (FAST) examination (sec Chap. 46). designed to help in the diagnosis of and the treatment plan for the traumatized patient, and the focuPart IVEchocardiography in the ICU and OR: Basic and Advanced ApplicationsEchocardiographic History, Echocardiographic Monitoring, and Goal-Directed, Ebook Echocardiography for intensivists: Part 2 as the administration of epinephrine, a pericardium drainage, or a fluid bolus during advanced life support.23.2Operator's SkillAn inexperienced operator will be limited in terms of w hat hc/she is able to obtain and interpret and will need to seek help with any questions or doubts. As the intensiv Ebook Echocardiography for intensivists: Part 2ist's skills improve progressively, he/shc w ill be able to enhance his/ her ability to use diagnostic ultrasonography in assessing and treating critiEbook Echocardiography for intensivists: Part 2
cally ill or injured patients.A. Sarti and F. L. Lorini (cds.). Echocardiography for Intensivisls, DOI: IO.l()O7/978-88-47O-2583-7_23. © Springer-VerlPart IVEchocardiography in the ICU and OR: Basic and Advanced ApplicationsEchocardiographic History, Echocardiographic Monitoring, and Goal-Directed, Ebook Echocardiography for intensivists: Part 2vists. At the base there are the less experienced workers, ideally all 1CU physicians, who are required to recognize:•Large pericardial effusion.•lite diameter of the inferior vena cava and its changes throughout the respiratory cycle.•Right ventricular (RV) dilatation.•An evident left ventricular ( Ebook Echocardiography for intensivists: Part 2LV) dysfunction.•Basic ultrasonographic appearance of the pleura and lung.At the center of the pyramid we find operators with more advanced training wEbook Echocardiography for intensivists: Part 2
ho are able to:•Detect severe valvular dysfunction.•Measure RV (tricuspid annular plane systolic excursion. TAPSE) and LV (fractional shortening. fracPart IVEchocardiography in the ICU and OR: Basic and Advanced ApplicationsEchocardiographic History, Echocardiographic Monitoring, and Goal-Directed, Ebook Echocardiography for intensivists: Part 2monary pressure.•Assess “fluid responsiveness”.•Perform thoracic echography.Al the top of the pyramid we have the skilled operators, of which there is often just one or only a few in each 1CU. who have a substantial “background" in cardiology and who are able to use and integrate all the techniques, Ebook Echocardiography for intensivists: Part 2 including Doppler echocardiography and tissue Doppler imaging (TDI). and who can perform the full range of echocardiographic diagnoses and hemodynamiEbook Echocardiography for intensivists: Part 2
c assessments.In my opinion, junior intensivists should be trained and certified in performing at least basic heart and lung ultrasonography. The stanPart IVEchocardiography in the ICU and OR: Basic and Advanced ApplicationsEchocardiographic History, Echocardiographic Monitoring, and Goal-Directed, Ebook Echocardiography for intensivists: Part 2of ultrasound instrumentation, image acquisition, and cardiopulmonary anatomy, physiology, and pathology. Enough evidence from the literature shows that reading a b(M)k in advance, a TTE/TEE course involving both theoretical and practical training, and ongoing mentoring and supervision after the cou Ebook Echocardiography for intensivists: Part 2rse can provide a high standard of practice. Many scientific societies define procedural competency on the basis of a minimumnumber of supervised echoEbook Echocardiography for intensivists: Part 2
cardiographic examinations performed by the intensivist. However, regular reaccreditation and continuous comparison with adequate standards arc still Part IVEchocardiography in the ICU and OR: Basic and Advanced ApplicationsEchocardiographic History, Echocardiographic Monitoring, and Goal-Directed, Ebook Echocardiography for intensivists: Part 2ies |6|. states that there was a 100 % agreement among the participants that basic critical care echocardiography and general critical care ultrasonography should be mandatory in the curriculum of ICU physicians. Ebook Echocardiography for intensivists: Part 2Part IVEchocardiography in the ICU and OR: Basic and Advanced ApplicationsEchocardiographic History, Echocardiographic Monitoring, and Goal-Directed,Gọi ngay
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