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Группа авторов. Point-of-Care Ultrasound Techniques for the Small Animal Practitioner
Table of Contents
List of Tables
List of Illustrations
Guide
Pages
Point‐of‐Care Ultrasound Techniques for the Small Animal Practitioner
Dedication
List of Contributors
Foreword
Preface
Acknowledgments
About the Companion Website
Chapter One POCUS: Introduction
Veterinary POCUS (V‐POCUS) Defined
Terminology Updates
The “T 3” of Trauma, Triage, and Tracking
COAST 3 is Out, POCUS is In
FAST Survives and Continues
The Flash Exam is Not a FAST Exam
Radiologist and Cardiologist Studies
Other Terms
Recording Your Findings on Goal‐directed Templates
Echogenicity – Whites, Grays, and Blacks
How Ultrasound Behaves Relative to Tissues and Elements
Ultrasound Screen Orientation
Directional Terms for Orientation. Longitudinal and Sagittal
Transverse
References
Further Reading
Chapter Two POCUS: Basic Ultrasound Physics
Introduction
What POCUS Basic Ultrasound Physics Can Do
What POCUS Basic Ultrasound Physics Cannot Do
Indications
Basic Ultrasound Principles
Velocity
Acoustic Impedance
Absorption, Scatter, and Reflection
Attenuation
The Final Say
References
Further Reading
Chapter Three POCUS: Basic Ultrasound Artifacts
Introduction
What POCUS Basic Ultrasound Artifacts Can Do
What POCUS Basic Ultrasound Artifacts Cannot Do
Indications
Objectives
Artifacts of Attenuation: Strong Reflectors (Bone, Stone, Air) Shadowing, “Clean” and “Dirty”
Bone or Stone Interface: Clean Shadowing
Air Interface: Dirty Shadowing
Artifacts of Attenuation: Fluid‐Filled Structures. Edge Shadowing: Fluid‐Filled Structures
Acoustic Enhancement: Fluid‐Filled Structures
Artifacts of Velocity or Propagation. Mirror Artifacts: Strong Reflector (Air)
Reverberation or A‐Lines: Strong Reflector (Air)
Comet‐Tail or Ring‐Down Artifact: Strong Reflector (Usually Metal or Bone But Can Be Air)
B‐Lines: Strong Reflector (Air Immediately Next to Fluid)
Artifacts of Multiple Echoes. Side‐Lobe Artifact: Multiple Echoes
Slice‐Thickness Artifact: Multiple Echoes
Pearls and Pitfalls, The Final Say
References
Chapter Four POCUS: Basic Ultrasound Scanning
Introduction
What POCUS Basic Scanning Can Do
What POCUS Basic Scanning Cannot Do
Indications
Objectives
Understanding Features of the Ultrasound Image. Imaging Planes
Image Orientation
Ultrasonography Compared to Radiography
Probe Orientation and Reference Markers
Probe Maneuvers
Concept: Angle of Insonation
Maneuvers: Basic Probe Movements and Effects on Angle of Insonation. Rocking (Figure 4.6)
Fanning (Figure 4.7)
Rotating (Figure 4.8)
Sliding (Figure 4.9)
Sweeping (Figure 4.10)
Pressure/Compression (Figure 4.11)
Cardiac Orientation
Image Optimization: Using the “Big 4” Knobs of Depth, Gain, Frequency, and Focus
Depth
Gain
Frequency
Focal Position and Number
Presets, Abdominal, Cardiac, Small Parts, etc
Alternate Imaging Tools
M‐Mode
Color Flow Doppler
On the Horizon. Single Crystal Probes
Smartphone Applications
Documentation of POCUS and FAST Ultrasound Examination Findings
Ultrasound Machine and Probe Care
Deciding on an Ultrasound Machine. Selecting the Machine
Selecting the Probe: Linear, Curvilinear, and Phased‐array
Setting Up an Ultrasound Program
Pearls and Pitfalls, The Final Say
References
Chapter Five POCUS: Top Ultrasound Mistakes During Global FAST
Introduction
What POCUS Top Mistakes Can Do
What POCUS Top Mistakes Cannot Do
Indications
Objectives
Image Acquisition Mistakes. Not Recognizing Air Trapping
Failure to Keep the Patient’s Head and Ultrasound Screen in the Same Sightline
Understanding Your Hands
Consistently Maintaining the Screen Orientation of Head to the Left and Tail to the Right
Fan, Rock Cranially, and Return for AFAST Views
Playing on the Short‐axis and Long‐axis TFAST Lines
Failure to Maintain Probe–Skin Contact with the Patient
Other Probe–Skin Contact Issues. Not Being Aware of Drifting
Not Checking Where the Probe is Externally on the Patient
Not Visualizing the Path of the Beam from the Probe Head
Losing Track of the Probe Orientation Marker
Using More than One Probe Maneuver at a Time
Ultrasound Machine Optimization
Failing to be Aware of the Focus Cursor
Not Paying Attention to the Centimeter Scale
Not Using the Centimeter Scale
Pearls: Trouble Shooting a Poor Image
Not Knowing How to Freeze and Roll the Cine Ball
Image Interpretation. Lacking Awareness of Most Common Locations for Artifacts
Mirror Image
Side‐lobe, Slice‐thickness
Edge Shadowing
Pearls, Pitfalls, and The Final Say
References
Further Reading
Chapter Six POCUS: AFAST – Introduction and Image Acquisition
Introduction
What AFAST Can Do
What AFAST Cannot Do
Indications
Objectives
How to Perform an AFAST Exam. Ultrasound Settings and Probe Preferences
Optimizing Image Quality and Probe–Skin Contact
Patient Positioning. Lateral Recumbency
Modified Lateral‐Sternal
Standing/Sternal
Considerations When Performing AFAST in Standing or Sternal Positioning
Naming and Order of the AFAST Views
Probe Maneuvering is Standardized
AFAST Diaphragmatico‐Hepatic View
Typical DH Positives
Artifacts and Pitfalls of the DH View
Artifacts. Mirror Image Artifact
Acoustic Enhancement Artifact
Edge Shadowing, Side‐lobe, and Slice‐thickness Artifact
Pitfalls Creating False Positives
Gallbladder and Biliary System
Hepatic and Portal Veins
Caudal Vena Cava
Stomach Wall
Minimizing False Negatives
Serial AFAST Examinations Increase Sensitivity
AFAST Spleno‐Renal View
Typical SR View Positives
Artifacts
Air‐filled Stomach
Air‐filled Colon
False Mirror Image in Cats
Edge Shadowing
False Positives. Linear Anechoic Stripes
Retroperitoneal Fluid versus Peritoneal Fluid
False Negatives. Serial AFAST Examinations Increase Sensitivity
AFAST Cysto‐Colic View
Typical CC View Positives
Artifacts
Acoustic Enhancement Artifact
Mirror Image Artifact
Side‐lobe and Slice‐thickness Artifact
Probe Pressure Artifact
Reverberation and Dirty Shadowing Artifact
False Positives
False Negatives
Abnormalities of the Urinary Bladder
AFAST Hepato‐Renal Umbilical View
Typical HRU View Positives
False Positives. Gastrointestinal (GI) Tract
Midabdominal Masses
Fluid‐filled Uterus
False Negatives. Serial AFAST Increase Sensitivity
AFAST HR5th (SR5th) Bonus View
Typical HR5th Bonus View Positives
False Positives
False Negatives
AFAST‐Focused Spleen
Recording AFAST Findings on Goal‐directed Templates
Pearls and Pitfalls, The Final Say
Quick Reference of Normals and Rules of Thumb
References
Further Reading
Chapter Seven POCUS: AFAST – Clinical Integration
Introduction
What AFAST Clinical Integration Can Do
What AFAST Clinical Integration Cannot Do
Indications
Objectives
Final Note
Calculating the Abdominal Fluid Score
Modification of the Abdominal Fluid Scoring System – Using Maximum Dimensions
Applying the Abdominal Fluid Scoring System to the Hemoabdomen
Small‐Volume Bleeders: AFS 1 and 2 (AFS <3)
Large‐Volume Bleeders: AFS 3 and 4 (AFS ≥3)
Importance of the Serial Exam
Decision Making Using the AFS for the Hemoabdomen
Blunt Trauma (BT)
Penetrating Trauma (PT)
Postinterventional Trauma
Small‐Volume AFS 1 and 2 Bleeders
Large‐Volume AFS 3 and 4 Bleeders (AFS ≥3)
Nontrauma
Major AFAST Difference Between Blunt and Penetrating Trauma
How Long Does It Take for Cavitary Bleeding to Resolve?
Save All Cavitary Hemorrhage
How Long Does It Take for Lavage Fluid to be Resorbed?
Cats Don’t Survive Large‐Volume Traumatic Bleeds
Importance of Recording Locations of Where Patients are Positive
Most Common AFAST‐Positive Sites in Low‐Scoring AFS 1 and 2 Patients
AFAST Limitations for Intrapelvic Bleeding
Use of the AFAST AFS System as an Exit Exam Postintervention
Use of the AFAST AFS System in Nonhemorrhagic Effusions
Clinical Examples
The use of AFAST and AFS in Dehydrated and Hypovolemic Patients
Use of AFAST for Canine Anaphylaxis. Gallbladder Wall Edema – Sonographic Striation
Characterizing the Caudal Vena Cava. Measurements
Integrating Global FAST Information
Canine AX‐Related Heparin‐Induced Hemoabdomen – Single Witnessed or Unwitnessed Hymenoptera sp. Envenomation
Small‐Volume Bleeders/Effusions
Large‐Volume Bleeders/Effusions
Clinical Examples
Speculated Pathogenesis
Therapy for Canine Anaphylaxis
AFAST DH View for Pericardial Effusion. Anatomy and Advantages over TFAST Transthoracic Views
Use for Cardiac Tamponade
Prevalence of Pericardial Effusion
Causes of Pericardial Effusion
Nonhemoabdomen Ascites Carries a Better Prognosis
Clinical Signs and Signalment
Changes in the Paradigm – Recognizing Acute Pericardial Effusion
Pericardiocentesis Becomes a Core Skill
Use of TFAST for Accurate Diagnosis of Pericardial Effusion
Use of the DH View and TFAST for Accurate Diagnosis of Pleural Effusion
Use of the DH View and Vet BLUE for Deep Lung Lesions
AFAST Cysto‐Colic View Formula for Urinary Bladder Volume Estimation
AFAST and Its Target Organ Approach
Recording AFAST Findings on Goal‐directed Templates
Pearls and Pitfalls, The Final Say
Quick Reference of Normals and Rules of Thumb
References
Further Reading
Chapter Eight POCUS: Liver and Gallbladder
Introduction
What POCUS Liver and Gallbladder Can Do
What POCUS Liver and Gallbladder Cannot Do
Indications
Objectives
Ultrasound Settings and Positioning
How to Perform the POCUS Liver and Gallbladder Examination
Ultrasonographic Findings: Normal Liver and Gallbladder
Clinical Significance and Implications of Abnormal Focused Liver and Gallbladder Findings
Liver Masses
Liver Parenchymal Disease
Hepatic Vasculature
Gallbladder
Gallbladder Wall
Gallbladder Lumen
Biliary System
Routine Add‐on of AFAST and Abdominal Fluid Scoring System (or Global FAST)
Pearls and Pitfalls, The Final Say
Quick Reference of Normals and Rules of Thumb
References
Further Reading
Chapter Nine POCUS: Spleen
Introduction
What the POCUS Spleen Can Do
What the POCUS Spleen Cannot Do
Indications
Objectives
Patient Positioning and Probe Selection
How to Perform the POCUS Spleen
Ultrasonographic Findings in a Normal Spleen
Size and Shape
Echogenicity
Presence of Masses and Nodules
Vasculature
Clinical Significance and Implications of Abnormal Findings
Splenic Size
Splenic Mass Lesions. Masses and Nodules
Neoplasia
Echogenicity and Parenchymal Conditions
Vasculature
Routine Add‐on of AFAST and Its Abdominal Fluid Scoring System (or Global FAST)
Pearls and Pitfalls, The Final Say
Quick Reference of Normals and Rules of Thumb
References
Chapter Ten POCUS: Kidney
Introduction
What POCUS Kidney Can Do
What POCUS Kidney Cannot Do
Indications
Objectives
Patient Positioning and Probe Selection
Patient Preparation
How to Perform the POCUS Kidney
Ultrasonographic Findings in a Normal Kidney
Kidney Anatomy
Cortex
Medulla
Renal Pelvis
Kidney Size
Clinical Significance and Implications of Abnormal Kidney Findings
Kidney Parenchymal Disorders
Diffuse Parenchymal Disease
Focal Parenchymal Disorders
Mass Lesions
Renal Cysts
Perinephric Pseudocysts
Other Fluid‐filled Structures
Infiltrative Processes
Kidney Stones
Pyelectasia
Hydronephrosis
Kidney Infarcts
Perirenal and Retroperitoneal Fluid
Routine Add‐on of AFAST and Its Abdominal Fluid Scoring System
Pearls and Pitfalls, The Final Say
Quick Reference of Normals and Rules of Thumb
References
Further Reading
Chapter Eleven POCUS: Urinary Bladder
Introduction
What the POCUS Urinary Bladder Can Do
What the POCUS Urinary Bladder Cannot Do
Indications
Objectives
Patient Positioning and Probe Selection
How to do POCUS Urinary Bladder
Ultrasonographic Findings in a Normal Urinary Bladder
Urine
Ureters
Artifacts Associated with POCUS Urinary Bladder
Clinical Significance and Implications of Abnormal POCUS Urinary Bladder Findings
Abnormalities of the Bladder Wall
Diffuse Changes
Cystitis
Emphysematous Cystitis
Focal Irregularities
Benign Polyps
Neoplasia
Intraluminal Abnormalities
Calculi (Bladder Stones)
Thrombi
Sediment
Routine Add‐on of AFAST and Its Abdominal Fluid Scoring System (or Global FAST)
Pearls and Pitfalls, The Final Say
Quick Reference of Normals and Rules of Thumb
References
Chapter Twelve POCUS: Gastrointestinal Tract and Pancreas
Introduction
What POCUS Gastrointestinal Tract and Pancreas Can Do
What POCUS Gastrointestinal Tract and Pancreas Cannot Do
Indications
Objectives
Patient Positioning and Probe Selection. Peritoneal Effusion
Gastrointestinal Evaluation
Pancreas
Scanning Technique. Intestinal Tract
Pancreas
POCUS GIT and Pancreas Findings and Their Significance. Small Bowel
Foreign Bodies
Linear Foreign Bodies
Intestinal Obstruction
Intussusception
Septic Peritonitis and Pneumoperitoneum
Functional Ileus
Corrugated Intestine
Pancreatitis
Peritoneal Effusion
Pearls, Pitfalls, The Final Say
Quick Reference of Normals and Rules of Thumb. Gastrointestinal Tract
Pancreas
References
Further Reading
Chapter Thirteen POCUS: Reproductive – Male
Introduction
What the POCUS Reproductive – Male Can Do
What the POCUS Reproductive – Male Cannot Do
Indications
Objectives
Reproductive Conditions of the Male
The Prostate
Imaging the Prostate ‐ Dorsal and Standing Positioning
Prostate of the Castrated Male
Benign Prostatic Hypertrophy (BPH)
Prostatitis
Prostatic Abscesses and Cysts
Paraprostatic Cysts
Prostatic Neoplasia
Scrotum and Testicles
Cryptorchidism
Orchitis and Epididymitis
Testicular Torsion
Testicular Tumors
Miscellaneous Scrotal Swellings
Pearls and Pitfalls, The Final Say
Quick Reference of Normals and Rules of Thumb
References
Chapter Fourteen POCUS: Reproductive – Female
Introduction
What the POCUS Reproductive – Female Can Do
What the POCUS Reproductive – Female Cannot Do
Indications
Objectives
Reproductive Conditions of the Female
Patient Positioning and Probe Selection
Imaging the Normal Ovary
Imaging the Normal Uterus
Cystic Endometrial Hyperplasia‐Pyometra
Pyometra
Surgical versus Medical Management
Stump Pyometra
Uterine Torsion
Mounting of Postoperative Recently In‐heat Spayed Females
Pseudopregnancy
Pregnancy Diagnosis
Mammary Glands
Pearls, Pitfalls, The Final Say
Quick Reference of Normals and Rules of Thumb
References
Further Reading
Chapter Fifteen POCUS: Dystocia
Introduction
What the POCUS Dystocia Can Do
What the POCUS Dystocia Cannot Do
Indications
Objectives
Dystocia
Fetal Maturation: Imaging Puppies and Kittens In Utero
Fetal Stress. Determining Fetal Heart Rate
Fetal Heart Rates and Fetal Stress
Serial POCUS Dystocia during Medical Management
Pearls, Pitfalls, The Final Say
Quick Reference of Normals and Rules of Thumb
References
Further Reading
Chapter Sixteen POCUS: Pediatrics
Introduction
What POCUS Pediatrics Can Do
What POCUS Pediatrics Cannot Do
Indications
Objectives
Equipment
Patient Preparation
Ultrasound of the Normal Pediatric Abdomen
Common Pediatric Abdominal Disorders. Gastrointestinal Disease
Peritonitis/Peritoneal Effusion
Gastrointestinal Foreign Body: Nonobstructive versus Obstructive
Anatomical Obstruction
Bowel Perforation
Gastroenterocolitis
Intussusception
Enteric Parasites
Enteric Thrombosis
Congenital Herniation
Acquired Herniation
Metabolic Conditions of the Pediatric Patient. Congenital Portosystemic Shunts
Seizure Disorders
Genitourinary Disorders
Renal Agenesis
Renal Dysplasia
Urogenital Ectopia
Ureterocele
Urinary Tract Infection
Urolithiasis
Patent Urachus
Cryptorchidism
Pearls and Pitfalls, The Final Say
References
Chapter Seventeen POCUS: TFAST – Introduction and Image Acquisition
Introduction
What TFAST Can Do
What TFAST Cannot Do
Indications
Objectives
What Clinical Questions are Answered using TFAST. Binary Answers – Yes or No, Unremarkable or Abnormal
Cerebral Approach – Integrating Information
TFAST and Its Five Acoustic Windows
Peforming TFAST – General Set‐Up. Ultrasound Settings and Probe Preferences
Ultrasound Screen Orientation
Machine Positioning
Patient Positioning
Patient Preparation
To Shave or Not Shave
To Dim or Not Dim the Lights
Performing the TFAST Chest Tube Site View
Optimizing the Image at the CTS View and the Gator Sign. Pitfalls – Machine Settings. Depth Setting
Gain
Angle of Insonation
Pitfall – Probe Positioning and Orientation. Longitudinal or Perpendicular to Ribs
Transverse or Parallel to Ribs
Pitfall – Subcutaneous Emphysema and Fat
Pitfall – Lateral Recumbent Positioning. Being Over the Top
Double Lung Point
Tricks of the Trade for Imaging “Lung Sliding”
Troubleshooting Inconsistent Imaging of the Pulmonary‐Pleural Interface and “Lung Line”
Summary – How to Image the Chest Tube Site View Step by Step in Standing or Sternal Recumbency
Performing the TFAST Pericardial Views
Left Pericardial Site View. Finding the Heart at the Left Pericardial Site View
Right TFAST Pericardial Site View. Locating the Heart
Optimizing the TFAST Cardiac Image – Depth, Gain, Presets, and Focus Cursor. Depth
Gain
Presets
Focus Cursor
Freezing and Rolling the Cine Ball
Optimizing the TFAST Cardiac Image – Handling the Probe
Right TFAST Pericardial Site Echo Views and Clinical Relevance
Defining the Levels of the TFAST Echo Views and the Cardiac Ladder
TFAST Right Pericardial Site Short‐axis Views
Right TFAST Pericardial Site Long‐axis Views
Left TFAST Pericardial Site Short‐axis Views
How to Image the Right TFAST Pericardial Site View Step by Step. Right TFAST PCS Short‐axis Views
Right TFAST Pericardial Site Long‐axis Views
Pitfalls at the TFAST Pericardial Views. Machine Settings. Screen Orientation
Depth
Artifacts
Edge Shadowing
Mirror Image
Slice‐thickness and Side‐lobe
Anatomy – Left TFAST Pericardial Site View
Performing the TFAST Diaphragmatico‐Hepatic View
Soft Tissue Findings at the DH View
Pitfalls of the Diaphragmatico‐Hepatic View
Summary of TFAST Views and Their Clinical Utility
Recording TFAST Findings on Goal‐directed Templates
Pearls and Pitfalls, The Final Say
For the TFAST Chest Tube Site
For the TFAST Pericardial Sites
Eyeballing TFAST Echo Views
Quick Reference of Normals and Rules of Thumb
References
Chapter Eighteen POCUS: TFAST – Clinical Integration
Introduction
What TFAST Can Do
What TFAST Cannot Do
Indications
Objectives
Findings at the Chest Tube Site View. Concept of Wet versus Dry Lung. Lung Sliding and A‐lines Indicate Dry Lung and Rule Out Pneumothorax
B‐Lines and Wet Lung Rule Out Pneumothorax
Pseudo B‐lines. The “Shimmy Line” or Z‐line
Gastric “Pseudo B‐lines”
Nodule “Pseudo B‐lines”
Pseudo Lung Sliding
Pseudo Pleural Effusion
TFAST Pneumothorax: A‐lines with Absent “Lung Sliding”
Lung Point: Improves the Diagnosis, Semiquantifies the Degree, and Helps Monitor PTX (Figures 18.5 and 18.6) Effect of Positioning
Searching for the Lung Point Improves Sensitivity
Lung Pulse
The Lung Point Semiquantitates Degree of PTX
Use of the TFAST PTX 1/3s Rule for Pneumothorax Monitoring
Missing PTX on TFAST. Tricks of the Trade
False Negatives
False Positives
Use of M‐mode and Power Doppler for Detecting PTX
Use of M‐mode: Seashore Sign, Stratosphere Sign, and Rain Sign
Tweaking M‐mode
Use of Power Doppler and the “Power Slide”
Other Confounders. Subcutaneous Emphysema and Its Effects on TFAST
Obesity
The “Step Sign” of TFAST and the CTS View
Summary for the CTS View. Three Major Lung‐related Findings
Pitfalls and Pleural Effusion
Final Comments Regarding the TFAST Lung and Pneumothorax Evaluation
Pericardial Effusion. General TFAST Considerations Regarding Pericardial Effusion
Pericardial Effusion and Pleural Effusion are Quite Different
Accurate TFAST Diagnosis of Pericardial Effusion
Causes of Pericardial Effusion
Does My Patient have Cardiac Tamponade? Defining Cardiac Tamponade
Using the Characterization of the Caudal Vena Cava and Hepatic Veins
The Presence of Ascites ‐ Better or Worse?
When Should Emergent Pericardiocentesis Be Performed? Chronic versus Acute PCE
Other Pericardial Effusion Subsets. Left Atrial Rupture/Tear
Cardiac Chamber Rupture and Pericardial Effusion: Traumatic and Nontraumatic
Gallbladder Wall Edema: the “Cardiac Gallbladder”
Use of Radiography for the Diagnosis of Pericardial Effusion and Tamponade
Pleural Effusion. General TFAST Considerations Regarding Pleural Effusion
Accurate TFAST Diagnosis of Pleural Effusion
TFAST “Slide” for Pleural Effusion. Left PCS View
Pitfalls at the Left PCS View. Anechoic/Hypoechoic Stripes
Apical Hypoechoic Triangle
Right PCS View
Combining Views. DH View
Pleural Effusion: TFAST is a Better Option than the POCUS Thoracic or Flash Approach
Concurrent Pleural and Pericardial Effusion in Dogs
Concurrent Pleural and Pericardial Effusion in Cats
Use of Radiography for the Diagnosis of Pleural Effusion
Overall Pitfalls of Imaging the Heart
Definitive Characterization of Pleural and Pericardial Effusions Requires Sampling
Measuring and Monitoring Pleural Effusion
Other Pleural Cavity Findings During TFAST. Diaphragmatic Herniation
Masses
Additional Clinical Relevance of the DH View
TFAST Echo Views. TFAST Cardiac Evaluation
Integrating TFAST Echo Views with Nonecho Fallback Views for Volume Status and Congestive Heart Failure
The Global FAST Approach is Key to Averting Satisfaction of Search Error
Recording TFAST Findings on Goal‐directed Templates
Quick Reference of Normals and Rules of Thumb
Pearls and Pitfalls, The Final Say
References
Chapter Nineteen POCUS: Heart – Introduction and Image Acquisition
Introduction
What Focused Cardiac Ultrasound Can Do
What Focused Cardiac Ultrasound Cannot Do
Indications
Objectives
Ultrasound Settings and Probe Preferences
How to Perform a Focused Cardiac Ultrasound. Patient Positioning and Preparation
Performing the Focused Cardiac Ultrasound Exam and the Three Main Acoustic Windows
Right Parasternal Short‐axis Views
Right Parasternal Long‐axis Views
The Ventricles
The Atria
The Valves
Overall Long‐axis Assessment
Normal Canine Cardiac Chamber Dimensions
Fractional Shortening Values (FS%)
Left Parasternal Apical and Cranial Views
Left Parasternal Apical View
Left Parasternal Cranial View
Subxiphoid or Subcostal View
Pearls and Pitfalls, The Final Say
Quick Reference of Normals and Rules of Thumb
References
Chapter Twenty POCUS:Heart ‐ Abnormalitiesof Valves, Myocardium,and Great Vessels
Introduction
What Focused Cardiac Ultrasound Abnormalities Can Do
What Focused Cardiac Ultrasound Abnormalities Cannot Do
Indications
Objectives
Valvular Heart Diseases. Degenerative Mitral Valve Disease
Common FCU findings in MVD
Infectious Endocarditis
Common FCE findings in IE
Myocardial Diseases. Dilated Cardiomyopathy and Other Causes of Left Ventricular Myocardial Failure
Dilated Cardiomyopathy
Common FCU Findings in DCM
Hypertrophic Cardiomyopathy
Common FCU Findings in HCM
Cardiac Neoplasia
Common FCU Findings of Cardiac Neoplasia
Abnormalities of Great Vessels. Pulmonary Hypertension
Common FCU Findings in Severe Pulmonary Hypertension
Assessment of the Caudal Vena Cava
Cardiopulmonary Arrest
Pearls and Pitfalls, The Final Say
Quick Reference of Normals and Rules of Thumb
References
Chapter Twenty‐One POCUS: Heart – Pericardial Effusion and Pericardiocentesis
Introduction
What Focused Cardiac Ultrasound Pericardial Effusion Can Do
What Focused Cardiac Ultrasound Pericardial Effusion Cannot Do
Indications
Objectives
Pericardial Effusion
Common FCU findings in Pericardial Effusion
Pericardiocentesis
Ultrasound‐assisted Pericardiocentesis with an Over‐the‐Needle Catheter
Pearls and Pitfalls, The Final Say
Quick Reference of Normals and Rules of Thumb
References
Chapter Twenty‐Two POCUS: Vet BLUE – Introduction and Image Acquisition
Introduction
What Vet BLUE Can Do
What Vet BLUE Cannot Do
Indications
Objectives (Table 22.1)
Patient Preparation. To Clip or Not?
Lights On or Off?
Patient Positioning. Standing and Sternal are Safest
Machine Positioning
Ultrasound Settings and Probe Preferences. Curvilinear Probe on Abdominal Preset versus Other
How to Do a Vet BLUE Exam. Lung Orientation and the Gator Sign
Probe Orientation: Rotate or Not
Image Optimization of the “Lung Line”
Vet BLUE and Its Nine Acoustic Windows
Naming of the Nine Acoustic Windows
Defining the Locations of the Nine Acoustic Windows (Views) Transthoracic Views. Caudodorsal Lung Region (Cd, point 1)
Perihilar Lung Region (Ph, point 2)
Middle Lung Region (Md, point 3)
Cranial Lung Region (Cr, point 4)
The Ninth Acoustic Window
Performing the Vet BLUE. Order of Vet BLUE
Performing Vet BLUE Step by Step (Figure 22.16)
Trouble Shooting. Avoiding the Phenomenon of Drifting
Confounders of Lung Ultrasound
Imaging Outside the Boundaries of the Pleural Cavity. Caudally
Dorsally
Ventrally
Cranially
Craniodorsal
Subcutaneous Emphysema
Fat and Excessive Soft Tissue
Vet BLUE Six Lung Ultrasound Signs. Dry Lung versus Wet Lung, A‐lines, “Lung Sliding,” and B‐lines
Comparison of Vet BLUE to Other Lung Ultrasound Protocols
Four‐Quadrant Approach
Zigzag Intercostal Continuum Approach
Recording Vet BLUE Findings on Goal‐directed Templates
Pearls and Pitfalls, The Final Say
Quick Reference of Normals and Rules of Thumb
References
Further Reading
Chapter Twenty‐Three POCUS: Vet BLUE – Clinical Integration
Introduction
What Vet BLUE Can Do
What Vet BLUE Cannot Do
Indications
Objectives
Important Considerations and Limitations of Vet BLUE and Lung Ultrasound
Vet BLUE Visual Lung Language. Most Normal to Least Normal
Dry Lung versus Wet Lung: A‐lines, Lung Sliding, and B‐lines
Shred Sign, Tissue Sign, Nodule Sign, and Wedge Sign
Lung Ultrasound Artifacts Further Defined: “Lung Sliding,” A‐lines, and B‐lines
Expectations for Frequency of Wet Lung Artifacts in Normalcy
Vet BLUE B‐line Scoring System. Counting B‐lines During Vet BLUE
Other B‐line Scoring Systems. Volpicelli Strong Positive Model ‐ Cardiac Bias
Why are They Called B‐lines?
Why are They Not Comet‐tails?
Comet‐tail Artifact
Six Signs‐Further Information. Shred Sign – Air Bronchogram
Tissue Sign – Hepatization of Lung
Nodule Sign
Use of Vet BLUE for Detecting Pulmonary Nodules
Wedge Sign
Summary
Other Lines: Are They Really Lines?
C‐lines
E‐lines
I‐lines
Z‐lines
Clinical Use of Regional Pattern‐based Vet BLUE Approach
“Dry Lung” Conditions
“Wet Lung” Conditions. Left‐sided Congestive Heart Failure
Numbers of B‐lines Guide Loop Diuretic Usage
Noncardiogenic Pulmonary Edema
Aspiration Pneumonia and Bacterial Pneumonias
Nodular Disease
Pulmonary Thromboembolism
Other Diffusely Wet Conditions
Differentiating Causes of “Wet Lung” Requires Clinical Integration
Using the Vet BLUE “Wet Lung” versus “Dry Lung” Concept for Monitoring During Fluid Therapy
Lung Contusions and Vet BLUE. Using Vet BLUE for Scoring Severity of Lung Contusions in Trauma
Comparative Imaging: Vet BLUE, Radiography, and Computed Tomography
Pitfalls, False Negatives, False Positives, and Limitations. False Negatives, Limitations
False Positives, Limitations
Vet BLUE Examples. Dogs. Heart Disease Patient Before and After Anesthesia
Choked on Rawhide
Cats. Abdominal Breathing and Nostril Flaring
Feline Pleural Effusion – Get Over the Flash Mentality
Look for Pericardial Effusion
Look at the “Lung Line”
Considering Pressure Atelectatic Lung
Monitoring Applications for Vet BLUE. Vet BLUE for Left‐sided Congestive Heart Failure and Volume Overload
Vet BLUE for Pulmonary Hypertension
Vet BLUE for Pneumonias
Vet BLUE for Nodular Disease
The Future of Proactive Vet BLUE and Lung Ultrasound in Small Animals
Recording Vet BLUE Findings on Goal‐Directed Templates. Case Examples of Vet BLUE Advantage over Thoracic Radiography
Aspiration Pneumonia and Other Bacterial Pneumonias
Vet BLUE Template (Caudodorsal [Cd], Perihilar [Ph], Middle [Md], Cranial [Cr])
Old Dog Lungs
Vet BLUE Template (Caudodorsal [Cd], Perihilar [Ph], Middle [Md], Cranial [Cr])
Lung Nodules – Fungal Granulomas
Vet BLUE Template (Caudodorsal [Cd], Perihilar [Ph], Middle [Md], Cranial [Cr])
Determining Whether a Lung Lobe Aspirate Would Be a Productive Test
Vet BLUE Template (Caudodorsal [Cd], Perihilar [Ph], Middle [Md], Cranial [Cr])
Pearls and Pitfalls, The Final Say
Quick Reference of Normals and Rules of Thumb
References
Chapter Twenty‐Four POCUS: Central Venous and Arterial Catheterization
Introduction
Veterinary Central Venous Catheterization
Veterinary Arterial Catheterization
Applications for Peripheral Vessels
Recent Training Advancements
What POCUS Central Venous and Arterial Catheterization Can Do
What POCUS Central Venous and Arterial Catheterization Cannot Do
Indications
Objectives
Placement of an Ultrasound‐guided Central Venous Jugular Catheter. Equipment and Materials. Probe
Central Venous Catheter Selection
Central Venous Catheter Line Length
How to Place an Ultrasound‐guided Central Venous Jugular Catheter. Static versus Dynamic and One‐ versus Two‐person Techniques
Static Technique
Dynamic Technique
Honing Your Skills
Anatomy
Patient Preparation
Orientation
Transverse Orientation
Longitudinal Orientation
Sensible Use of a Short Temporary Jugular Catheter
Placement of Ultrasound‐guided Femoral Arterial Catheters and Sampling. Ultrasound Settings and Probe Preferences
Equipment
Procedure
Anatomy
Patient Preparation
Orientation
General Comments regarding Transverse versus Longitudinal Orientation
How to Make a Realistic Practice Phantom
Supplies
Assembling the Chicken Breast Phantoms
Pearls and Pitfalls, The Final Say
References
Further Reading
Chapter Twenty‐Five POCUS: Vascular – Veins and Arteries
Introduction
What POCUS Vascular Can Do
What POCUS Vascular Cannot Do
Indications
Objectives
Equipment, Materials, and General Preparation. Probe
Patient Preparation
General Principles and Compression Technique
Color Doppler
Vessel Orientation and Slice‐thickness Artifact
Porta Hepatis Anatomy
Venous and Arterial Thromboembolism. Central and Deep Venous Thrombosis
Hepatic Venous and Caudal Vena Cava Thrombosis
Splenic Venous Thrombosis
Portal Venous Thrombosis
Renal Vein Thrombosis
Deep Venous Thrombosis
Pulmonary Thromboembolism
Arterial Thromboembolism and Thrombosis
Pearls and Pitfalls, The Final Say
References
Further Reading
Chapter Twenty‐Six POCUS: Caudal Vena Cava
Introduction
What POCUS Caudal Vena Cava Can Do
What POCUS Caudal Vena Cava Cannot Do
Indications
Objectives
How to Do a POCUS Caudal Vena Cava. Ultrasound Settings and Probe Preferences
Patient Positioning and Preparation
The Three Methods for POCUS Caudal Vena Cava
Subxiphoid Caudal Vena Cava View
Intercostal Caudal Vena Cava View
Paralumbar Caudal Vena Cava View
Image Acquisition and Measurements for POCUS Caudal Vena Cava. Subxiphoid Caudal Vena Cava View
Intercostal Caudal Vena Cava View
Paralumbar Caudal Vena Cava View
Use of Allometric Scaling Formulas for CVC Assessment
Integration of POCUS CVC Findings
Inherent Differences Between Volume Status in People and Small Animals
Pearls and Pitfalls, The Final Say
References
Further Reading
Chapter Twenty‐Seven POCUS: Eye
Introduction
What POCUS Eye Can Do
What POCUS Eye Cannot Do
Indications
Objectives
Ultrasound Settings
Patient Eye Preparation
How to do the POCUS Eye
Ultrasonographic Findings in a Normal Eye
Clinical Significance and Implications of Abnormal Findings. Anterior Lens Luxation. Clinical Findings
Ultrasonographic Findings
Actions
Posterior Lens Luxation. Clinical Findings
Ultrasonographic findings (Figure 27.17)
Actions
Retinal Detachment. Clinical Findings
Ultrasonographic Findings
Actions
Intraocular Masses. Clinical Findings
Ultrasonographic Findings
Actions
Intraocular Hemorrhage. Clinical Findings
Ultrasonographic Findings
Actions (Table 27.3)
Suspected Retrobulbar Masses/Exophthalmos
Clinical Findings of Exophthalmos (Pushed‐Out Eye)
Clinical Findings Supportive of Buphthalmos (Large Eye)
Ultrasonographic Findings of Retrobulbar Mass/Exophthalmos
Actions
Suspected Globe Rupture. Clinical Findings
Ultrasonographic Findings
Actions
Pearls and Pitfalls, The Final Say
References
Further Reading
Chapter Twenty‐Eight POCUS: Brain – Image Acquisition
Introduction
What POCUS Brain Can Do
What POCUS Brain Cannot Do
Indications
Objectives
How to do POCUS Brain. Probe Type
Acoustic Windows for POCUS Brain
Rostral Acoustic Window
Temporal and Suboccipital Acoustic Windows
Technique for POCUS Brain
Ultrasonographic Anatomy
Pearls and Pitfalls, The Final Say
References
Further Reading
Chapter Twenty‐Nine POCUS: Brain – Clinical Integration
Introduction
What POCUS Brain Can Do
What POCUS Brain Cannot Do
Indications
Objectives
How to do POCUS Brain. Probe Type
Acoustic Windows for POCUS Brain
Rostral Acoustic Window
Temporal and Subocciptal Acoustic Windows
Technique for POCUS Brain
Transcranial Ultrasonography without Color Flow Doppler – Imaging the Parenchyma
Transcranial Ultrasonography with Color Flow Doppler – Imaging the Vasculature
Sonographic Features of Traumatic Brain Injury from Trauma
Sonographic Features of Brain Pathology from Nontrauma. Hydrocephaly
Strokes
Encephalitis
Pearls and Pitfalls, The Final Say
References
Chapter Thirty POCUS: Nerve Blocks – Forelimb
Introduction
What POCUS Nerve Blocks – Forelimb Can Do
What POCUS Nerve Blocks – Forelimb Cannot Do
Indications
Objectives
How to Perform POCUS Nerve Blocks – Forelimb. Approaches and Locations
Relevant Anatomy of the Brachial Plexus
Probe Type Used to Perform Forelimb Blocks
Materials Needed to Perform Forelimb Blocks
Ultrasound‐guided Brachial Plexus: Paravertebral Approach
Ultrasound Probe Placement and Block Technique
Drugs and Volume Administered
Scan of Brachial Plexus at the Paravertebral Space. Scanning of the Paravertebral Spaces C5–6 and C6–7
Scanning of the C8–T1 Complex
Ultrasound‐guided Brachial Plexus Block through a Subscalene Approach
Ultrasound Probe Placement and Block Technique
Drugs and Volume Administered
Scan of the Ventral Branches of the Brachial Plexus at the Subscalene Level
Ultrasound‐guided Brachial Plexus Block through an Axillary Approach
Ultrasound Probe Placement and Block Technique
Drugs and Volume Administered
Scan of the Axillary Space
Ultrasound‐guided Radial, Ulnar, Median, and Musculocutaneous (RUMM) Nerve Block
Relevant Anatomy of the Radial, Ulnar, Median, and Musculocutaneous Nerves
Ultrasound‐guided Radial Nerve Block. Ultrasound Probe Placement and Block Technique
Drugs and Volume Administered
Scanning of the Radial Nerve
Ultrasound‐guided Musculocutaneous, Median, and Ulnar Nerves Block. Ultrasound Probe Placement and Block Technique
Drugs and Volume Administered
Scanning of the Musculocutaneous, Median, and Ulnar Nerves
Pearls and Pitfalls, The Final Say
References
Further Reading
Chapter Thirty‐One POCUS: Nerve Blocks – Pelvic Limb
Introduction
What POCUS Nerve Blocks – Pelvic Limb Can Do
What POCUS Nerve Blocks – Pelvic Limb Cannot Do
Indications
Objectives
How to Perform POCUS Nerve Blocks – Pelvic Limb. Approaches and Locations
Relevant Anatomy of the Lumbar Plexus
Materials Needed to Perform Pelvic Limb Blocks
Ultrasound‐guided Femoral Nerve Block in the Psoas Compartment
Probe Type
Ultrasound Probe Placement and Block Technique for the Psoas Compartment
Drugs and Volume Administered
Scan of Lumbar Plexus at the Psoas Compartment
Ultrasound‐guided Femoral Nerve Block in the Inguinal Region
Probe Type
Ultrasound Probe Placement and Block Technique
Drugs and Volume Administered
Scan of the Femoral Triangle
Ultrasound‐guided Saphenous Nerve Block in the Distal Thigh Region
Probe Type
Ultrasound Probe Placement and Block Technique
Drugs and Volume Administered
Scan of the Saphenous Nerve
Ultrasound‐guided Sciatic Nerve Block
Relevant Anatomy of the Sacral Plexus
Ultrasound‐guided Lumbosacral Trunk Block
Probe Type
Ultrasound Probe Placement and Block Technique
Drugs and Volume Administered
Scan of the Lumbosacral Trunk at the Parasacral Space
Ultrasound‐guided Sciatic Nerve Block in the Lateral Thigh Region
Probe Type
Ultrasound Probe Placement and Block Technique
Drugs and Volume Administered
Scan of the Sciatic Nerve at the Lateral Thigh Region
Pearls and Pitfalls, The Final Say
References
Further Reading
Chapter Thirty‐Two POCUS: Nerve Blocks – Trunk
Introduction
What POCUS Nerve Blocks – Trunk Can Do
What POCUS Nerve Blocks – Trunk Cannot Do
Indications
Objectives
Ultrasound‐guided Thoracic and Abdominal Wall Blocks. Relevant Anatomy of the Truncal Nerves
Ultrasound‐guided Thoracic Paravertebral Block
Probe Type
Materials Needed
Ultrasound Probe Placement and Thoracic Paravertebral Block Technique
Drugs and Volume Administered
Scan of the Thoracic Paravertebral Space
Ultrasound‐guided Intercostal Block
Probe Type
Materials Needed
Ultrasound Probe Placement and Intercostal Block Technique
Drugs and Volume Administered
Scan of the Intercostal Space
Ultrasound‐guided Transversus Abdominis Plane Block
Probe Type
Materials Needed
Ultrasound Probe Placement and Transversus Abdominis Plane Block Technique
Drugs and Volume Administered
Scan of the Abdominal Wall
Pearls and Pitfalls, The Final Say
References
Further Reading
Chapter Thirty‐Three POCUS: Nerve Blocks – Neuroaxial
Introduction
What POCUS Nerve Blocks – Neuroaxial Can Do
What POCUS Nerve Blocks – Neuroaxial Cannot Do
Indications
Objectives
Sonoanatomy of the Spine
Longitudinal Ultrasound Scan of the Lumbosacral Area
Probe Type
Materials Needed
Ultrasound Probe Placement
Transverse Ultrasound Scan of the Lumbosacral Area
Ultrasound Probe Placement
Longitudinal Scan of the Thoracolumbar Area
Ultrasound Probe Placement
Ultrasound‐guided Epidural Approach
Ultrasound‐guided Lumbosacral Epidural Approach
Ultrasound‐guided Thoracolumbar Epidural Approach
Ultrasound‐guided Intrathecal Approach
Probe Type
Materials Needed
In‐plane Approach
Ultrasound Signs of Epidural/Intrathecal Injection
Color Flow Doppler Test
Collapse of the Dural Sac
Epidural Space Enlargement
Pearls and Pitfalls, The Final Say
References
Chapter Thirty‐Four POCUS: Musculoskeletal – Soft Tissue
Introduction
What POCUS Musculoskeletal – Soft Tissue Can Do
What POCUS Musculoskeletal – Soft Tissue Cannot Do
Indications
Objectives
Equipment and Settings for POCUS Musculoskeletal – Soft Tissue
Transducer
Settings
Patient Preparation
How To Do the POCUS Musculoskeletal – Soft Tissue
Ultrasonographic Findings of Common Soft Tissue Structures. Dermis and Epidermis
Fascia
Muscle
Bone
Salivary Gland
Parotid Salivary Gland
Mandibular Salivary Gland
Sublingual Salivary Gland
Zygomatic Salivary Gland
Common Soft Tissue Lesions. Cellulitis and Edema
Seroma
Hematoma
Abscess
Foreign Body
Sialadenitis and Sialocele
Abdominal Wall Injury or Hernia
Neoplasia of Superficial Structures. Benign Neoplastic Masses
Malignant Neoplastic Masses
Pearls and Pitfalls, The Final Say
References & Further Reading
Chapter Thirty‐Five POCUS: Musculoskeletal – Bones and Joints
Introduction
What POCUS Musculoskeletal – Bones and Joints Can Do
What POCUS Musculoskeletal – Bones and Joints Cannot Do
Indications
Objectives
Equipment and Settings. Clipping Hair and Coupling Medium
Transducer (Probe) Types
Stand‐off Pads
Settings
Minimizing MSK‐related Artifacts. Anisotropy and Off‐axis Side‐lobe Artifacts
Acoustic Shadowing, Acoustic Enhancement, and Reverberation Artifacts
Ultrasonographic Findings in the Normal Bone, Muscle, and Tendon. Transducer Orientation
Normal Bone
Normal Joint
Normal Skeletal Muscle
Normal Tendon
Normal Ligament
Normal Nerve
Normal Cartilage
Normal Subcutaneous Tissue
Ultrasonographic Findings in Diseased Bone, Muscle, and Tendon. Fracture
Osteomyelitis and Bone Tumors
Assessment of Fracture Healing Using Ultrasound
Muscle Injuries
Tendon Injuries
Common Sites of Muscle and Tendon Injuries in Small Animal Patients. Supraspinatus Muscle (Supraspinatus Tendinopathy)
Biceps and Achilles Tendon Rupture
Iliopsoas Muscles
Muscle Atrophy
Muscle Masses
Pearls and Pitfalls, The Final Say
References
Further Reading
Chapter Thirty‐Six POCUS: Global FAST – Patient Monitoring and Staging
Introduction
What Global FAST – Patient Monitoring and Staging Can Do
What Global FAST – Patient Monitoring and Staging Cannot Do
Indications
Objectives
Ultrasound Settings, Probe Preferences, Patient Positioning, and Preparation. Ultrasound Settings and Probe Preference
Optimizing Image Quality and Probe–Skin Contact
Patient Positioning and Most Efficient Ways to Perform Global FAST
Lateral Recumbency
Standing or Sternal
Why Start Left and then Move Right for the Global FAST Blend?
Never Dorsal Recumbency
Global FAST for Patient Monitoring
Global FAST for Volume Status. Clarity, Rapidity, Standardization
Integrating Echocardiography and the “Global FAST Nonecho Fallback Views”
TFAST Cardiac Imaging
Short‐axis Views
Volume and Contractility
Left‐sided Strain/Failure/Overload
Long‐axis Views
Right‐sided Strain/Failure/Overload
Abnormalities within the Ascending Aorta
Nonecho Fallback Strategies for Right‐sided Heart Problems. FAST DH View and Its Right‐sided Cardiac Markers
Caudal Vena Cava
Hepatic Veins
Gallbladder Wall Edema (Lisciandro et al. 2019b)
Ascites (Nelson et al. 2010; Lisciandro and Armenise 2014; Vientós‐Plotts et al. 2019)
Ruling Out Right‐sided Congestive Heart Failure
Nonecho Fallback Strategies for Left‐sided Heart Problems. Vet BLUE for Lung and Wet Lung Versus Dry Lung Findings
Assessing and Measuring the Caudal Vena Cava and Assessing Hepatic Venous Distension. Where to Evaluate the Caudal Vena Cava?
Characterizing the Caudal Vena Cava and Hepatic Veins – “Eyeball Method”
Measuring the Caudal Vena Cava
Global FAST for Volume Loss. The Leak in the Tank
Global FAST Automatically Surveys for the Leak in the Tank. Four Spaces Plus Lung and Maybe More
Maybe More – Other Leaks and Plugs
Summary
Global FAST Monitoring Tools. Use of the AFAST‐applied Abdominal Fluid Scoring System for Ascites
Use of TFAST for Estimating Pleural and Pericardial Effusion. Pleural Effusion
Pericardial Effusion
Use of Global FAST for Estimating Urine Output
Use of Global FAST for Estimating Pneumothorax Using The “Lung Point”
Use of the Vet BLUE B‐line Scoring System
B‐line Scoring for Estimating Degrees of Alveolar‐Interstitial Edema and Extravascular Lung Water
B‐line Scoring System for Guiding Diuretic Usage
B‐line Scoring System for Lung Contusions
Global FAST for Staging Disease – Localized Versus Disseminated Disease
Staging the Hemoabdomen. Canine Hemoabdomen
AFAST
TFAST
Vet BLUE
Feline Hemoabdomen
Staging for Urinary Bladder Mass. Canine Bladder Masses
AFAST
TFAST
Vet BLUE
Feline Bladder Masses
Staging Pericardial Effusion. Canine Pericardial Effusion
AFAST
TFAST
Vet BLUE
Feline Pericardial Effusion
Global FAST Approach Case Examples
Case 1
Case 2
Case 3
Global FAST for Urinary Obstruction and Renal Failure
Global FAST for Pulmonary Thromboembolism
Global FAST and Anesthesia. Global FAST as a Preanesthetic Test
Global FAST Perioperatively
Lung Atelectasis and Gallbladder Wall Edema
Use of Global FAST as Geriatric Health Screening
Global FAST and Saving Images
Pearls and Pitfalls, The Final Say
References
Chapter Thirty‐Seven POCUS: Global FAST – Rapidly Detecting Treatable Forms of Shock, Advanced Life Support, and Cardiopulmonary Resuscitation
Introduction
What Global FAST for Treatable Shock, ALS, and CPR Can Do
What Global FAST for Treatable Shock, ALS and CPR Cannot Do
Indications
Objectives
Ultrasound Settings, Probe Preferences, and Patient Positioning and Preparation. Ultrasound Settings and Probe Preference
Optimizing Image Quality and Probe–Skin Contact
Patient Positioning and Most Efficient Ways to Perform
Lateral Recumbency
Standing or Sternal Recumbency
How to Do Global FAST
The Hs Covered by Global FAST. Hypotension/Hypovolemia
Hyperkalemia
Hypocontractility – Dilated Cardiomyopathy
Hypertension – Pulmonary Hypertension
The Ts Covered by Global FAST. Tension Pneumothorax
Trauma – Hemorrhage
Thromboembolism – Pulmonary Thromboembolism
Tamponade – Pericardial Effusion
Toxin – Canine Anaphylaxis
Comparison of Global FAST and the RUSH Examination
Global FAST for Rapidly Detecting Treatable Forms of Shock
Final Comments on the Global FAST Approach
Global FAST and Saving Images
Global FAST and Goal‐Directed Templates
Global FAST for Advanced Life Support and Patient Management
Pearls and Pitfalls, The Final Say
References
Chapter Thirty‐Eight POCUS: VetFAST‐ABCDE
Introduction
What POCUS: VetFAST‐ABCDE Can Do
What POCUS: VetFAST‐ABCDE Cannot Do
Indications
Objectives
Ultrasound Settings, Probe Preferences, and Patient Positioning
How to do the POCUS: VetFAST‐ABCDE Exam. Airway (A)
Breathing (B)
Circulation (C) Thoracic
Abdominal
Disability (D)
Exposure (E)
Clinical Significance and Implications of Abnormal VetFAST‐ABCDE Exam Findings
Differences Between VetFAST‐ABCDE and Global FAST
Airway (A)
Breathing (B)
Circulation (C)
Disability (D)
Exposure (E)
Ultrasound‐Guided and ‐Assisted Procedures
POCUS: VetFAST‐ABCDE in Shock Syndrome, CPR, and ALS
Pearls and Pitfalls, The Final Say
References
Chapter Thirty‐Nine POCUS: Feline Differences – Abdomen and Thorax
Introduction
What POCUS: Feline Differences – Abdomen and Thorax Can Do
What POCUS: Feline Differences – Abdomen and Thorax Cannot Do
Indications
Objectives
Feline Abdomen
AFAST in Cats
Liver and Gallbladder. Hepatic Echogenicity
Differences in Falciform Fat
Differences in Hepatic Venous System
Differences in Gallbladder Shape and Lumen
Differences in Gallbladder Common Bile Duct
Differences in Gallbladder Sludge
FAST Diaphragmatico‐Hepatic (DH) View. Differences in Heart and Gallbladder next to the Diaphragm
Differences in the Caudal Vena Cava
Differences in Gallbladder Wall Edema –Halo Sign
Spleen. Differences in Splenic Vessels, Echogenicity, Size, and Location
Kidney. Differences in Renal Size, Echogenicity, and Location. Renal Size
Echogenicity
Location
AFAST Spleno‐Renal and Hepato‐Renal Views. Differences in Spleen next to the Left Kidney
Differences in Imaging the Left and Right Kidneys
Imaging Feline Ureters
Urinary Bladder, Urine, Urethra, and Reproductive Structures. Differences in Urinary Bladder, Urethra, and Reproductive Structures. Artifacts
Urethra
Prostate
Ovaries
Uterus
Differences in Urine
AFAST Cysto‐Colic View. Differences between Cats and Dogs
Estimating Urinary Bladder Volume
Gastrointestinal Tract. Differences in Stomach
Differences in Pancreas
Differences in Small Intestine
Differences in Ileocolic Junction
Differences in Large Intestine
AFAST Hepato‐Renal and Spleno‐Renal Umbilical View. Differences in Spleen and Small Intestine
AFAST‐Applied Abdominal Fluid Scoring System
Modifications of the Abdominal Fluid Score
Use of the AFS in Bleeding Felines
Autotransfusion in Cats
Feline Thorax – TFAST and Vet BLUE
Safe Positioning for Felines
Safer Acoustic Coupling Medium for Felines
Assessing Chamber Size (LVSA)
Left Atrial to Aortic Ratio on Short Axis
Left Ventricular Short‐axis View for Volume Status and Contractility
Right Ventricular to Left Ventricular Ratio (RV:LV) on Long‐axis Four‐Chamber View
Differences in Echo Assessment
Differences in the Sonographic Diagnosis and Causes of Pericardial Effusion
Differences in Detecting “Lung Sliding” and Pneumothorax during TFAST (Figure 39.31)
Differences in Vet BLUE
Differences in Applications of the Vet BLUE B‐line Scoring System
Performing Global FAST in a Cat
Goal‐Directed Templates
Pearls and Pitfalls, The Final Say
References
Further Reading
Chapter Fourty POCUS: Exotic Companion Mammals
Introduction
What POCUS: Exotic Companion Mammals Can Do
What POCUS: Exotic Companion Mammals Cannot Do
Indications
Objectives
Anatomy. Gastrointestinal Tracts
Spleen
Reproductive
Patient Positioning and Probe Selection
Imaging the Normal Exotic Companion Mammal
POCUS‐Detected Conditions
Ferrets. Urinary
Gastrointestinal and Hepatobiliary
Spleen
Pancreas
Neoplasia
Other
Rabbits. Urinary
Gastrointestinal and Hepatobiliary
Reproductive
Abscesses
Guinea Pigs. Urinary
Reproductive
Chinchillas. Reproductive
Hamsters. Gastrointestinal and Hepatobiliary
Hedgehogs. Reproductive
Neoplasia
Normal Reference Ranges for Various Exotic Companion Mammals
Pearls and Pitfalls, The Final Say
References
Chapter Fourty‐One POCUS: Marine Mammals
Introduction
What POCUS: Marine Mammals Can Do
What POCUS: Marine Mammals Cannot Do
Indications
Objectives
Equipment, Probe Type, and Settings
Environment, Machine, and Sonographer Location
Patient Positioning, Restraint, and Breathing
Signs of Dolphin Stress
Dolphin Restraint and the Trainer
The Global FAST Examination. AFAST
Diaphragmatico‐Hepatic View
Questions Asked at the DH View
Comments
Marginal Lymph Nodes
Confounders at the DH View
Spleno‐Renal and Hepato‐Renal Views
Questions Asked at the SR and HR Views
Comments
Cysto‐Colic Reproductive View
Questions Asked at the CCR View
Comments
Umbilical View
Questions Asked at the Umbilical View
Comments
AFAST‐Applied Fluid Scoring System
Modification in Abdominal Fluid Scoring
TFAST
Questions Asked at TFAST
Detecting Pleural and Pericardial Effusion
TFAST Echo Views and Using Global FAST Fallback Views
Vet BLUE. Lung Orientation: The “Gator Sign”
Artifacts and Vet BLUE Lung Ultrasound Signs. A‐lines
B‐lines
Vet BLUE Lung Ultrasound Signs
Performing Vet BLUE Step by Step
Pitfalls – Probe Positioning and Orientation. Longitudinal or Perpendicular to Ribs
Transverse or Parallel to Ribs
Comments
Most Efficient Ways to Perform Global FAST
Other POCUS – Venipuncture, Thyroids, Testicles, Eyes, and Fetus
Global FAST Goal‐Directed Template
Pearls and Pitfalls, The Final Say
Acknowledgments
References
Further Reading
Chapter Fourty‐Two POCUS: Birds and Reptiles
Introduction
Avian. What POCUS Birds Can Do
What POCUS Birds Cannot Do
Indications
Objectives
Anatomy. Lungs and Air Sacs
Coelomic
Patient Positioning and Probe Selection
Imaging the Normal Coelom
Conditions of the Coelom. Ascites
Organomegaly and Masses
Reproductive
Reproductive in Chickens
Cardiac Abnormalities
Ocular Conditions
Reptile
What POCUS Reptiles Can Do
What POCUS Reptiles Cannot Do
Indications
Objectives
Defining Species
Patient Positioning and Probe Selection
Imaging the Normal Coelom
Conditions of the Coelom. Distension
Ascites
Organomegaly and Masses
Kidney and Urinary Bladder
Reproductive and Sexing
Reproductive Conditions
Liver
Cardiac Abnormalities and Aneurysms
Ocular Conditions
FAST Ultrasound in Birds and Reptiles
Pearls and Pitfalls, The Final Say
References
Chapter Fourty‐Three POCUS: Ultrasound‐Guided Procedures – Abdominocentesis, Thoracocentesis, and Pericardiocentesis
Introduction
Pericardiocentesis. Introduction
Ultrasound‐guided versus Blind Pericardiocentesis
Indications for Pericardiocentesis
Scanning Technique for Pericardiocentesis
Materials Checklist for Pericardiocentesis
Procedure for Performing Pericardiocentesis
Indirect Ultrasound‐guided Pericardiocentesis
Free‐hand Ultrasound‐guided Pericardiocentesis
Completing Both the Indirect and Free‐hand Ultrasound‐guided Pericardiocentesis Techniques
Postpericardiocentesis Use of Ultrasound for Tracking (Monitoring)
Pearls and Pitfalls regarding Ultrasound‐guided Pericardiocentesis
Thoracocentesis. Introduction
Indications for Thoracocentesis
Contraindications to Thoracocentesis
Potential Complications of Thoracocentesis
Scanning for Pleural Effusion to Perform Thoracocentesis
Materials Checklist for Thoracocentesis
Procedure for Performing Thoracocentesis
Perpendicular Probe Placement Thoracocentesis
Parallel Probe Placement Thoracocentesis
Postthoracocentesis Use of Ultrasound for Tracking (Monitoring)
Abdominocentesis. Introduction
Indications for Abdominocentesis
Scanning Technique for Abdominocentesis
Materials Checklist for Abdominocentesis
Procedure to Perform Abdominocentesis
Modified Ultrasound‐guided Diagnostic Peritoneal Lavage. Ultrasound‐guided versus Blind Diagnostic Peritoneal Lavage
Indications for MUG‐DPL
Scanning Technique for MUG‐DPL
Ultrasonographic Findings
Materials Checklist for MUG‐DPL
Procedure to Perform MUG‐DPL
Pearls and Pitfalls, The Final Say
Factors Involving Needle Visualization
Needle Size
Needle Bevel
Needle Angle
Needle Movement
Paying Attention to Needle and Probe
Software Assistance
References
Further Reading
Chapter Fourty‐Four POCUS: Ultrasound‐Guided Lung and Thoracic Sampling
Introduction
What POCUS: Ultrasound‐Guided Lung and Thoracic Sampling Can Do
What POCUS: Ultrasound‐Guided Lung and Thoracic Sampling Cannot Do
Indications
Objectives
Performing Ultrasound‐Guided Lung and Thoracic Sampling. Holding the Probe
Probe Orientation and Maneuvers
Relevant Artifacts
Distal Acoustic Enhancement
Reflection
Reverberation
Edge Shadowing
Mirror Artifact
Optimizing Image Quality
Optimizing Imaging and Tracking the Needle: In‐Plane and Out‐of‐Plane
Two Methods of Ultrasound Guidance: Free‐hand and Using Probe Guides. Patient Preparation and Planning
Skin Preparation
Probe Hygiene
Needle Selection
Probe Selection
Chemical Restraint and Local Anesthetics
Lowering the Risk of Hemorrhage and Pneumothorax
Lesion Identification
Shape of Lesions
Lesion Size
Slide Preparation for Sample Submission
Special Echogenic Enhanced Needles
Special Needle Guides
Ultrasound‐Guided Biopsies
Building Skills on Phantoms
Pearls and Pitfalls, The Final Say
Pitfalls – Most Common Errors
References
Further Reading
Chapter Fourty‐Five POCUS: Setting Up Successful POCUS and FAST Ultrasound Programs
Introduction
What POCUS: Setting Up Successful POCUS and FAST Ultrasound Programs Can Do
What POCUS: Setting Up Successful POCUS and FAST Ultrasound Programs Cannot Do
Indications
Objectives
Proper Training. Standardized Methodology
Where Should I Learn Ultrasound?
Accessibility. Accessible Machine
Accessible Fees
Coding
Keeping the Initial Fee General
Bundling Fees
Bundle Global FAST into All Triaged Examinations
Bundle Global FAST into Patient Rounds for All Hospitalized Cases
Bundle Global FAST into Your Preanesthetic Evaluation
Bundle Global FAST into Pre‐ and Postprocedural Evaluation
Bundle Global FAST into Geriatric Annual Assessment
Bundle Fees with Complete Studies. Global FAST + Complete Echocardiography
Global FAST + Complete Abdominal Ultrasound
Replacements and Loaners
Communicating Value to Clients. The Spiel
Example 1 – Trauma and Triage
Example 2 – Preanesthetic Testing
Example 3 – Hospitalized Cases
Example 4 – Pre and Post Procedure
Example 5 – Geriatric Annual Evaluation
Example 6 – POCUS of a targeted‐organ
Addendums to the Spiel
Explaining Your Findings. Don't Undervalue a Negative Global FAST
Don't Fear a Positive Global FAST or POCUS Examination
Use of Goal‐Directed Templates
Establish Clear Objectives
Qualifiers for Your Templates. AFAST
TFAST
Vet BLUE
Global FAST
POCUS of X, Y, or Z
You Must Record Your Findings
Recording and Archiving Images
Quality Control
Establishing a Program Director or Point Person
Establishing a Consensus
Ensuring Quality Control and Periodical Reviews
Saving Images. Why Save Images?
What Time Frame and How Long Should I Make the Video Clips?
Labeling Images
Reviewing Images
Training Techniques
Pearls and Pitfalls, The Final Say
Reference
Further Reading
Appendix I Goal‐Directed Templates for Medical Records. AFAST®
POCUS – Liver and Gallbladder
POCUS Spleen
POCUS Kidney
POCUS Urinary Bladder
POCUS Gastrointestinal & Pancreas
POCUS Reproductive
Female – Uterus
POCUS Reproductive Dystocia
TFAST®
Vet BLUE® – Simple Version
Vet BLUE® – Detailed Version
POCUS Echo (Heart)
POCUS Pediatrics
POCUS Eye
Vet FAST‐ABCDE
Global FAST® (GFASTSM)
Appendix II Abbreviations, Terminology and Glossary. Abbreviations and Acronyms
Others
Terminology and Glossary
Appendix III Quick References of Normal Values and Rules of Thumb
AFAST®
Author’s Treatment and Monitoring Guidelines for Canine Anaphylaxis (AX) in All AFAST Fluid‐Positive Cases to Prevent and Treat AX‐related Heparin‐Induced Hemoabdomen
POCUS Liver and Gallbladder
POCUS Spleen
POCUS Kidney
POCUS Urinary Bladder
POCUS Gastrointestinal and Pancreas. Gastrointestinal
Pancreas
POCUS Reproductive
TFAST®
Vet BLUE®
POCUS Heart
Fractional Shortening Values (FS%)
POCUS Caudal Vena Cava
POCUS Pediatrics
POCUS Felines
POCUS Exotic Companion Mammals
VetFAST‐ABCDE Exam
POCUS Marine Mammals
Global FAST®
References and Further Reading. AFAST®
POCUS Liver and Gallbladder
POCUS Spleen
POCUS Kidney
POCUS Urinary Bladder
POCUS Gastrointestinal and Pancreas
POCUS Reproductive
TFAST®
Vet BLUE®
POCUS Heart
POCUS Pediatrics
POCUS Felines
POCUS Exotic Companion Mammals
VetFAST‐ABCDE Exam
POCUS Marine Mammals
Global FAST®
Index
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