Intro to Critical Care Ultrasound

Dr. Haney Mallemat felt that specializing in emergency medicine, internal medicine AND critical care was too easy, and decided to become one of the leading experts in the use of ultrasound in the ICU. In this lecture, he explains how to take the ultrasound probe along with your clinical questions to the bedside, and virtually eliminate any guessing games. No longer will you need to wait for capnography to verify endotracheal tube placement. Gone are the days waiting for a chest CT to make decisions, in fact, when properly utilized you may even start leaving your stethoscope at home! This lecture may not make you a professional, but it might alleviate some tension when faced with a crashing patient.

Pearls

1. When intubating, reach for the linear (vascular probe), place the probe transverse on the left side of the neck and look for a “double trachea” sign to identify an esophageal intubation EARLY
2. Be aware of the location of the diaphragm, the “liver” you see could be hepatization of the lung or air-less lung. This can be from either an intrinsic process (pneumonia, mucus plug, foreign body) or an extrinsic process (large compressing effusion)
3. Unstable patient? Think HIMAP: look at the Heart, IVC, Morrison’s pouch, Aorta and Pneumothorax!!! In five mins you can focus your attention and truly make a difference!!
4. When performing an echo be simple, look in all 3 views and ask: Yes or No? Is the LV functioning properly? Is the RV dialated? Is that effusion collapsing the RA? Just how full is that IVC?