bedside echo to assess volume status - denver, colorado · bedside echo to assess volume status...
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Bedside Echo to Assess Volume Status
Jessica Nelson, MD and Jason Brainard, MD
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“What’s the patients volume status?”
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Left Ventricular Size
• Useful predictor of fluid responsiveness• Small and hyperkinetic LV corresponds to low preload• Wall effacement• Use in context of entire clinical picture• Also evaluate for:
• Ejection fraction• Wall motion abnormalities• Pericardial effusion
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Volume Responsive- PS Long
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Volume Responsive- PS Short
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Volume Responsive- Apical 4
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Volume Overload- Parasternal Long
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Volume Overload- PS Short
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Volume Overload- R Heart
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Volume Overload- Apical 4
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Inferior Vena Cava Assessment
• Assess IVC diameter near hepatic veins• Respiratory variations of IVC>50% correspond to CVP
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Volume Overload- IVC
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Other Signs of Volume Overload
• RA and RV distension• Pleural effusions• Pulmonary Edema - B lines and comets on lung US
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Left Pleural Effusion
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Right Pleural Effusion
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Comet Tail Artifacts on Lung US
Bedside Echo to Assess Volume Status“What’s the patients volume status?”Left Ventricular SizeVolume Responsive- PS LongVolume Responsive- PS ShortVolume Responsive- Apical 4Volume Overload- Parasternal LongVolume Overload- PS ShortVolume Overload- R HeartVolume Overload- Apical 4Inferior Vena Cava AssessmentVolume Overload- IVCOther Signs of Volume Overload Left Pleural EffusionRight Pleural EffusionComet Tail Artifacts on Lung US