ER Ultrasound

    Hypotension Ultrasound

    • Causes of hypotension
      • Hypovolemic
        • JVP: use small probe to check for the JVP and see where it collapses.
          • Can be considered 4 zones.  Zones 1 and 2: deficient.
        • IVC: Good central venous pressure monitor: Check IVC next to liver.  If <2cm or collapses >50% w/ respiration, consider reduced CVP.
        • Aorta: Check for aneurism.  Aneurism if >3cm, high risk of rupture if >5cm.
      • Obstructive
        • R heart: check for CVP elevation (see JVP and IVC U/S above)
        • L heart: cardiac tamponade (check for pericardial fluid), and LV failure such as MI (check for symmetric cardiac motion).
      • Cardiogenic (ECG, enzymes, LV contractility).
      • Septic
      • Distributive - anaphylaxis, drugs

    FAST Ultrasound

    • Look at 4 areas:
    1. Morrison's Pouch (Btwn Liver and R kidney)
    2. Splenorenal Space (Btwn Spleen and L kidney)
    3. Bladder (two dark spaces on sides deep to the bladder?)
    4. Cardiac: (either under sterum or across the ribs)
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