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Ultrasound GuidedVolume Assessment
Starr Knight, M.D.HIGH RISK Hawaii
Feb 14, 2014
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Outline
• IVC Ultrasound Technique• Clinical Use of IVC Ultrasound• Clinical Cases
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IVC Ultrasound Exam
• Exam Technique• Goals of the Exam• Pitfalls
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Probe Selection
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Liver
IVC
RA
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RA
Liver
IVC
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Hypovolemia Hypervolemia
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Hypovolemia Hypervolemia
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The “Sniff” Test
Hypovolemia Hypervolemia
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Caval Index
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Ultrasound Protocols
• RUSH• RADiUS• Triple Scan
1. Cardiac Ultrasound
2. Lung Ultrasound
3. IVC Ultrasound
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Goals of the Exam
Assess for Pulmonary Edema
Evaluate Pump Function
Interrogate IVC
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Protocol
1. Cardiac Ultrasound
2. Lung Ultrasound
3. IVC Ultrasound
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Clinical Cases
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Septic
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Before IVFs After 2L IVFs
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CHF
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Pulmonary Embolism
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Cardiac Tamponade
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Take Home Points
• Distinguish IVC from Aorta• Eval IVC 2cm distal to RA-IVC junction• Use in conjunction with Cardiac and Lung ULS• Remember Conditions with ↑R Cardiac Pressure• Serial Exams during resuscitation
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Thank You