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Point-of-Care Ultrasound Techniques for the Small Animal Practitioner

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Страница 1 Table of Contents List of Tables List of Illustrations Guide Pages Страница 7Страница 8Страница 9Страница 10 Foreword Страница 12Страница 13Страница 14Страница 15 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 Страница 133 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 {buyButton}

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