Cardiac

Introduction:

Bedside cardiac ultrasound is useful in the setting of trauma as well as medical illness. The most basic assessments of cardiac activity (or standstill) and the presence of pericardial fluid or tamponade can be made rapidly and alter patient management. Advanced cardiac ultrasound assessments can include a rough estimation of global cardiac contractility (normal vs. hypocontractile), or incorporation of ultrasound into ACLS algorithms (to confirm asystole or detect a possible cause for PEA).

Focused Questions:

  1. Is there cardiac activity?
  2. Is there a pericardial effusion?

Video Overview:

Required Views:

At least two views are required, taken from the following possible views.

1. Subxiphoid four-chamber view

Probe position Image
Probe position for subxiphoid cardiac view US subxiphoid- normal
Notes
  • Both the anterior and posterior pericardium should be visualized
  • Parasternal views should be attempted if the subxiphoid view is not adequate
Abnormal Studies (click to enlarge)
Subx2

2. Parasternal long axis view

Probe position Image
Probe position for parasternal long axis view USLongaxis
Notes
  • Both the anterior and posterior pericardium should be visualized
  • In the ideal plane, the mitral and aortic valves will be visible, as well as a long view of the left ventricle
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3. Parasternal short axis view

Probe position Image
Probe position for parasternal short axis view Short axis view
Notes
  • The left ventricle will generally appear as a ring, with the right ventricle more anterior
Abnormal Studies (click to enlarge)
effusion- short axis view

4. Apical four-chamber view

Probe position Image
Probe position for apical four-chamber view Apex
Notes
  • Though¬†rarely useful in the emergency department, this view allows easy comparison of left and right ventricles
  • All four chambers should be visible in this plane
Abnormal Studies (click to enlarge)
Apex-effusion