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Applications of Ultrasound in Critical Care and Anaesthesia Radiology Basics Session Three 19/09/2024Session Plan Principles of Ultrasound Regional Anaesthesia and Pain Medicine Vascular Procedures Thoracic Ultrasound Abdominal Ultrasound EchocardiographyBasic Principles of US • High-frequency sound ( 2 – ~ 15 MHz) • Transducer produces ultrasound beam • Mechanical oscillations of crystalline structures • Piezoelectric effect: electrical --> kinetic/ sound energy • Propagates through different tissues • Returns to transducer as reflected echoes • Converted back into electrical impulsesby transducer crystals --> Ultrasound imagesBasics of Ultrasound • US waves are reflected at the surfaces between the tissues of different density • Greater difference = • ↑ proportion of reflectedsound • ↓ proportion of transmitted sound • If soundis completely reflected, = acoustic shadowing. • Bones • Calculi (kidneys,gallbladder,etc.) • tissue or between tissues.there is no difference in a • Homogenous Fluids – blood bile,urine, cysts, effusionUltrasound Machine/Techniques ProbeType → Probe Movements → Planes/Orientations Modes – B(rightness) andM (ovement),Doppler Buttons – Presets,Depth,Gain,Focus • US was initiallydevelopedin1950/60s • Access to andquality of US technologyhas greatly improved US in • Use as a small,portable, ‘point of care’ imagingdevice • Increasinglywidespreaduse of ultrasound in clinical practice Anaesthesia due to new applications and ICM • Corepart of trainingin ICM andAnaesthesia nowadaysVascular Procedures When do we need vascular access in patients?Vascular Procedures • Venous Catheterisation • Central – InternalJugular Vein,Femoral Vein, SubclavianVein,AxillaryVein • PeripheralVeins – IV Fluids,Drugs, Blood Transfusions • Peripheralinserted central catheter (PICC) • ArterialLines • Radial,Brachial, FemoralCentral Venous Cathether (CVC) • Intravenous(IV) access(especially if difficult peripheralaccess) • Central venouspressure(CVP) monitoring • Central venousoxygen saturation (ScvO2)monitoring/sampling • Infusionsof irritant substances (e.g.vasoactive agents, chemotherapyorparenteral nutrition administration) • Renal replacement therapy,plasmapheresisand apheresis (using a vascath) • Transvenouspacing • IVC Filter 1 2 3Arterial Lines/ Catheterisation Arterial blood (ABG) monitoring – pH,O2, CO2 Blood Pressure - Continuous systolic,diastolic, and meanarterial blood pressure monitoring Hemodialysis/ Plasmapheresis/ Apheresis Extracorporeal membrane oxygenation(ECMO) Cardiac andradiological interventionsVascular Assessments Venous thrombosis (upper and lower limb) Specialist (Transcranial,Renal Artery) Volume status from dynamic ultrasound imaging of inferior vena cavaRegional Anaesthesia and Pain • Infiltration of peripheral nerves with an anaesthetic agent Medicine • Blocks transmission to avoid or relieve pain. • Advantages over general anaesthesia • avoidance of airway manipulation • reduced doses • side effects of systemic drugs • faster recovery time • lowerpainlevels after surgery • Can be usedin conjunction withGA • Applications in acute and chronic pain conditions • Rib fracturesWhich nerves would you target?T ypes of Block Blockade of the Superficial cervical Interscalene brachial Supraclavicular block Infraclavicular block Suprascapular block Axillary brachial terminal peripheral plexus block plexus block plexus block nerves of the arm Rectus sheath block Transversus Ilio-inguinal / abdominis plane Fascia iliaca block Femoral nerve block Obturator nerve block Saphenous nerve Lateral cutaneous iliohypogastric block (TAP) block block nerve of thigh block Sciatic (trans-gluteal, Epidural – assessment sub-gluteal, anterior Popliteal sciatic nerve Blockade of the of spinal level, Caudal Catheter or mid-thigh) nerve block Ankle block terminal peripheral epidural depth and techniques Lumbar plexus block block nerves of the leg direction Real-time ultrasound- Deep cervical plexus Paravertebral block / guided epidural block (cervical nerve intercostal nerve puncture and spinal root) block anaesthesiaThoracic Ultrasound Pleural Effusions and Pneumothorax Thoracocentesis and Chest Drain Insertion Pleural and Lung Pathology Assessment and Biopsy Diaphragmatic function Ultrasound guided percutaneous tracheostomy and cricthyroidotomy Doppler assessment of thyroid vascularityPleural Effusion 1 2Pleural EffusionPneumothoraxThoracocentesis and Chest DrainsOther Applications of Thoracic USAbdominal Ultrasound • Detection of free intraperitoneal fluid • Assessment of the abdominal aorta • Assessment of the IVC including filling pressures • Bladder volume assessment • Assessment of the gall bladder • Assessment of the kidneysIntraperitoneal Fluid - eFAST - Blunt Force/Penetrating Trauma - HaemodynamicallyUnstable Patients - Rapidlydirect appropriate operative interventions (e.g. therapeutic laparotomy) inunstable patientsAorta AssessmentAorta AssessmentRenal UltrasoundRenal UltrasoundGallbladder UltrasoundEchocardiography • Assessment and diagnosis of significant cardiac pathology • severe left ventricular dysfunction • right ventricular dysfunction (massive pulmonary embolus) • pericardial effusion and tamponade • hypovolaemia • Peri-resuscitation echocardiography • Use of echocardiography to guide interventional procedures and monitor and assess the effects of interventions and therapies 7 1 6 2 5 3 4Left Ventricular Dysfunction Normal Ejection Fraction (55-69%) Severely Reduced Ejection Fraction (<30%)CardiacamponadeQuestions?Thank you