https://ultra-sono.com/cases daily 0.75 2023-04-25 https://ultra-sono.com/cases/airwayobstruction monthly 0.5 2023-04-25 https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1682419851781-CXBRT1GK3W3FC5ENX2ZF/PLAX.gif Cases - Airway obstruction? https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1682419891762-PF60E83H7UN6Z80QZXZ6/IVC.gif Cases - Airway obstruction? https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1682419889864-VB9IVQUKFFA2NZ3M0UJE/PSAX.gif Cases - Airway obstruction? https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1682419851829-1OWVQFJ9E9W7AXLNM8WB/A4C.gif Cases - Airway obstruction? https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/4d6d3e03-40c0-476f-8fee-8179f9954c58/MassiveBilatPE.gif Cases - Airway obstruction? - Make it stand out CTPA demonstrated massive bilateral PE. Notice the opacified (darker) areas in both branches of the pulmonary artery. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1682417662237-ZTJFIZB81H4N9LCZW72C/PLAX.gif Cases - Airway obstruction? - PLAX https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1682417729543-ZLN1LB7YPZV39WR4QMVP/PSAX+Mitral.gif Cases - Airway obstruction? - PSAX Mitral https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1682417749824-CUL05SRXYX4B8ZPWO6RH/PSAX+Papillary.gif Cases - Airway obstruction? - PSAX Papillary https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1682417763859-EOFL0FGMU9JVZDTYXNNB/A4C.gif Cases - Airway obstruction? - A4C https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1682417775831-P8ZAK00XPY4J49WYLCUZ/A4C+%28rt+chambers%29.gif Cases - Airway obstruction? - A4C (Right Atrium) https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1682417796264-LVWQZX0C4QNJGKOJDXEI/SX.gif Cases - Airway obstruction? - SubXiphoid https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1682417818411-DPC830SCPTZOVIFC83QG/IVC.gif Cases - Airway obstruction? - IVC https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/77b5f4a4-9a48-4797-af5a-613eb57e407e/F_CHEST_20230226_085051.jpg Cases - Airway obstruction? - Make it stand out Tracheal tube sitting above the bifurcation. The tracheal curve is now corrected, yet the trachea is still deviated to the right. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/c1b7d842-58bf-40eb-967f-437eec1c41a0/F_CHEST_20230226_085011.jpg Cases - Airway obstruction? - Make it stand out Severe tracheal deviation to the right. There is no evidence of atelectasis, consolidation, effusion or pneumothorax. https://ultra-sono.com/cases/acuteblindness monthly 0.5 2023-04-25 https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1682435600374-7X0AYF3TM8HKB8YKSA82/1.gif Cases - Acute blindness https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1682435609469-HIF4D3OKKLKDXRF17GRL/2.gif Cases - Acute blindness https://ultra-sono.com/cases/notyourclassicbluntnecktrauma monthly 0.5 2022-10-13 https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/8fddfc43-ecfd-46bf-8ae5-354fdb20cac5/Right+Submandibular+Gland+Fragmentation.gif Cases - Not your classic blunt neck trauma A closer look to the right submandibular gland reveals a deep end with heterogeneous borders. There is also significant edema and free fluid invading deeper structures. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/84834f05-4269-4c7e-b7b5-ddd443da86f4/Right+Submandibular+Gland+Doppler.gif Cases - Not your classic blunt neck trauma colour doppler shows an absence of flow in the deeper anechoic level and apparent indemnity in the glands vasculature. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/05d78a2f-ea48-4c79-bd93-0df4e88c8ea5/SMG.png Cases - Not your classic blunt neck trauma - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/c338113b-b6dd-4490-a765-4c762ae5030b/Traquea+%26+Right+Submandibular+Gland.gif Cases - Not your classic blunt neck trauma Trachea, and the pulsatile carotid arteries with no obvious signs of injury. Sliding the probe to the right submandibular region revealed a well defined isoechoic structure compatible with an enlarged submandibulary gland https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/e1f2ccbd-e450-4b84-a360-458186576dbd/Right+Submandibular+Gland+Fragmentation+2.gif Cases - Not your classic blunt neck trauma - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://ultra-sono.com/the-basics daily 0.75 2023-04-22 https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1654193425423-GMUO6VRZNJGJPV4DRQPT/McQuade_Genius_Spot_Illo_1-copy.jpeg The Basics https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/f0ea04b1-950b-4c92-9b31-e272d1ce7e6c/InvertedPiezoElectricGIF.gif The Basics - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1662912875658-PUFGOC77BXYC5727876Z/Resolution%2B.jpg The Basics Resolution is the capacity to distinguish two close objects as such and is related to frequency. As frequency increases, the resolution improves, but the ability to penetrate deeper structures diminishes. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1654193425428-4UZRNJ4JCXSAY4WPS7ZZ/escala-de-grises.jpg https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/045eddf4-723e-4b2e-abc6-4b919fe8a6f8/Ecogenicity.png https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/0938cd74-1e91-4ff8-ae50-2a071aff42dc/BehaviourUSwaves.png https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1663533451313-7WTHH3EJA2OH2IO2FU9M/tiger-woods.gif The Basics Attenuation is the ‘weakening’ of sound waves due to energy dissipation as heat, or wave scattering in different directions. It is often a result of increasing travelling distance through body tissues or the presence of highly reflective media. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1654193425431-4J4G60Q41VUOQC8ZZ044/9781119473596-fg0102-copy.jpeg The Basics Anatomical Planes: 1. Transversal 2. Sagital 3. Coronal / Frontal https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1654193425477-QK81Y5PSFXJA1FE9LJRA/USMachines1.jpg The Basics https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1654193425493-4NATGGC4CKHRQPF2RZUP/linear.gif The Basics - Make it stand out Linear https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1654193425484-PVUKH9YWKZBRK6RO9WFQ/probes.jpg The Basics - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1654193425505-YMDRONXPZ20A388RTAZQ/phased.gif The Basics - Make it stand out Phased https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1654193425499-XGHL6L30SO801RV3LXGB/curved.gif The Basics - Make it stand out Curved https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/82354935-6da6-4c23-898f-b529b66f9518/ButterflyLinear.gif The Basics - Make it stand out Linear https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/4a9d0cb6-69a2-4c79-8f82-15fe1ded273e/ButterflyCurve.gif The Basics - Make it stand out Curved https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/7d21fbbf-59d8-401d-a5f7-c92affad5c4d/ButterflyPhased.gif The Basics - Make it stand out Phased https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1654193425612-ORKJURISOOC8EIXOM3O0/15_FBP.png https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1654193425639-UHS56O89GFR98TAC9YH2/a%2Blines%2Bc.gif The Basics - A-Lines | Gain Reducing the gain can help in visualising A-lines more clearly. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1654193425649-QYEUVZA7SIN7HCK7H7TU/Alines%2BLS.gif The Basics - A-Lines | Normal Multiple parallel lines caused by the sound echoes between the pleural layers and the transducer https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1654193425665-D50RQ1V45FF9VC3SA97G/normal%2Blung%2Bb.gif The Basics - A-Lines | Normal A-lines are a reflection of the pleural line. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1654193425656-D0I6AL4LPJGDNOZA6YLI/Pulmonary+a+felipe.gif The Basics - A-Lines | Normal https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1654193425696-36SVTEIVUVV118DLPSX1/mirro%2Bimage%2Bfor%2Bdummies.gif The Basics - Mirror Image | Liver A mirror image of the liver cephalic to the diaphragm and into the normal lung. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1654193425703-K7NRMLY6AOLLU4B6O50O/mirror%2Bartifact%2Bliver+2.gif The Basics - MIrror Image | Liver A mirror image of the liver cephalic to the diaphragm and into the normal lung https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1654193425711-2CP5Q4UPTNX7DUQIKWAG/mirror%2Bartifact%2Bliver.gif The Basics - Mirror Image | Liver A mirror image of the liver cephalic to the diaphragm and into the normal lung https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1654193425718-DCL62HE2FXNM804UX39M/cardiac%2Bmirror%2Bimage.gif The Basics - Mirror Image | Heart Cardiac mirror image due to soundwave reflection by the pericardium. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1654193425775-16NY0K6D3VG2VIM6L6F9/AcousticEnhancementBladderTrans.gif The Basics - Acoustic Enhancement Transverse view of the bladder. The abundance of liquid content allows the passage of ultrasound waves. As a result, the tissues lying deep after the bladder are enhanced and appear white or hyperechoic. Dr Felipe Urriola | Resuscitation Fellow - Emergency Department | The Royal London Hospital https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1654193425809-RXF4VFM3PDMD6QYPCFUZ/AcousticEnhancementBladderLong.gif The Basics - Acoustic Enhancement Longitudinal view of the bladder. The abundance of liquid content allows the passage of ultrasound waves. As a result, the tissues lying deep after the bladder are enhanced and appear white or hyperechoic. Dr Felipe Urriola | Resuscitation Fellow - Emergency Department | The Royal London Hospital https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1654193425752-WMIR2U6HVWB7SE1LWV8R/1+GB%2BRHA.gif The Basics - Acoustic Enhancement The gallbladder filled with liquid (black) produces acoustic enhancement to the deeper structures. Note the brighter white aspect of the tissue lying directly distal and deeper to the gallbladder. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1654193425761-6DFBXRTA7QEELIKDFGEF/2+posterior%2Benhancement.gif The Basics - Acoustic Enhancement The gallbladder filled with liquid (black) produces acoustic enhancement to the deeper structures. Note the brighter white aspect of the tissue lying directly distal and deeper to the gallbladder. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1654193425837-HKXVRJQMSXMX2713YGNC/3.gif The Basics - Acoustic Shadowing Acoustic shadowing produced by the ribs https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1654193425844-U1SSWS2NPCIX5A8V57DU/Alines%2BLS.gif The Basics - Acoustic Shadowing The two oval-shaped, black structures are ribs in a transverse cut. Notice how they cast a shadow into deeper structures. Dr Felipe Urriola | Resuscitation Fellow - Emergency Department | The Royal London Hospital https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1654193425853-GXS6BPX55WXJBK8V4V5K/2%2Bstones.gif The Basics - Acoustic Shadowing Two large, hyperechoic structures can be appreciated in this gallbladder. These are likely two stones given the degree of echogenicity and posterior shadowing. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1654193425860-CVVKQ0X7QEA2VL10KEY4/1.gif The Basics - Acoustic Shadowing This clip clearly demonstrates a stone in the gallbladder neck as a hyperechoic structure with posterior shadowing (anechoic). https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1654193425895-YQXVGVHAW4EYQKRUDVCW/2.gif The Basics - Edge Shadow From left to right the superficial femoral artery and vein are visualized. Dismiss the clot inside this vein and notice how the round surface casts edge shadow artefacts in both these vessels. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1654193425908-Y19NGGKQHT2TB99I1YXB/1.png The Basics - Edge Shadow ill image demonstrating edge shadow due to the round surface of a blood vessel. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1654193425916-7J1U06CLVPG26XXQC41A/3.jpg The Basics - Edge Shadow Still image of edge shadow due to the round edges of the gallbladder. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1654193425928-DX5XT5WGNRAROKSEBECN/4.jpg The Basics - Edge Shadow Still image of edge shadow due to the round edges of the gallbladder. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1655160715657-I4YAISQRC2EKSE74B7Q7/Slide.Gif The Basics https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1655160790474-ELF1EP5KAFXTOZSQWWU4/Sweep.Gif The Basics https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1655160829984-8G59D1A60L3T2V5NU72W/Fan.Gif The Basics https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1655160863446-1AB3IZFGS8EOFQ1TTKBY/Rock.Gif The Basics https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1655160900815-R92XE3UMI5SUTYO5BMBR/Rotation.Gif The Basics https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1655160936458-5NTESZA4N27LBVELP7XF/Compression.Gif The Basics https://images.squarespace-cdn.com/content/v1/5ec321c2af33de48734cc929/1618497259178-6XJGK9GR6YAVBQL5L519/20140301_Trade-151_012-2.jpg The Basics https://images.squarespace-cdn.com/content/v1/5ec321c2af33de48734cc929/1607694583486-2PQT0LQ193RL7MCB6DX4/20140228_Trade+151_0046.jpg The Basics https://images.squarespace-cdn.com/content/v1/5ec321c2af33de48734cc929/1607694644871-IC85FNH781UNZSZEGHDR/Aro+Ha_0428.jpg The Basics https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1660115015608-R0TL20XJYIYB7CZ4AN2I/NotchTrans.gif The Basics https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1660115244781-YMSN4UVNJBTFFO0CXVHR/NotchLongi.gif The Basics https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1660415009967-0NYKRBCTBZ666JHPJ5WT/Trans.gif The Basics https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1660415326682-93OWACODY70EF6QRT4U2/Long.gif The Basics https://ultra-sono.com/contact daily 0.75 2022-09-12 https://ultra-sono.com/meet-the-team daily 0.75 2023-12-08 https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/85abdd31-e42c-4960-8ffa-9dc3047ce720/IMG-0149.jpg https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/5081cf36-b753-486a-a52e-ca7cf5cd299d/3CF07A87-7137-4507-AD71-4B00CB4375AA.jpg https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/9c0ffae8-f8d5-423d-85e3-3aaf4915c595/Captura+de+pantalla+2023-12-08+a+la%28s%29+19.35.01.png https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/fd0cd4ad-2e27-4ed4-b165-3cd4ab7db452/IMG_2361.JPG https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/c418f7f2-dd8e-46e5-88f5-1f01c2e98d5e/TimHarris.png https://ultra-sono.com/overview daily 1.0 2025-12-04 https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/c9bfc739-0860-4fad-9056-1a0a905a849e/kinked+wire.gif https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/a8634d3d-dbc9-4e7b-8f0f-ccd06398738f/1%3A3Longi.gif https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/700072d5-8edc-4111-b47e-f782333b9187/Rt+Lung+Mid+Clav.gif https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/2e1a408a-ddfd-41c2-a048-66476e326e49/DVT+Banner.gif https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/3da3f9bb-1e61-486f-aabd-6401972383b2/Renal+Banner.gif https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/dcff493b-c4d4-4900-8647-a38c978fc827/RUQ%2BMorison.gif https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/28f7e7fa-d526-46a6-8633-4a84aa67fbfa/Biliary.gif https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/af4084c3-bd34-40d9-8d11-5cc89c52520b/Effusion.gif https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/f4ff0695-72df-44d1-a8fc-cd8afbaf91a3/PLAX.gif https://ultra-sono.com/privacy-policy daily 0.75 2022-06-02 https://ultra-sono.com/terms-of-service daily 0.75 2022-08-14 https://ultra-sono.com/friends daily 0.75 2023-03-26 https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/427e28f4-ea40-4e87-9636-0fc56bd2661c/PonderMed_RGB+%282%29.png https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1a442a20-f1b2-49d7-ba87-b02b55379cf2/The%2BPOCUS%2BATLAS%2Blogo-18+%281%29.png https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/f58b14d1-1905-49e9-9f13-9c47755b07d2/ACCU_logo_tiny.jpeg https://ultra-sono.com/accreditation daily 0.75 2023-12-08 https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1656961659029-84AIVXHPTRC3V0068P6T/the-rcem-logo.jpeg Accreditation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1656962196921-OYWMSIB6OQM12V2ZECB5/ead732_c681a7e161ec4c188de85d5c1e874c95_mv2_d_2788_1822_s_2.jpg Accreditation https://ultra-sono.com/rcem daily 0.75 2023-12-08 https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/024ff265-754d-40c2-9805-4ef6cd7fa0bf/default.jpeg RCEM https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/839a8aa7-0d44-4dd1-9815-8f8ad8ebf924/anatomia_RBAI077_0304.jpg RCEM https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/f6e4261a-cc23-4314-ad42-7cbe25abd765/anatomia_RBAI078_0026.jpg RCEM https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/e17fabf9-1a8a-476b-897d-ee66dd264119/anatomia_RBAI077_0276.jpg RCEM https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/7c79212c-f907-4048-bee9-e01b555f5095/anatomia_RBAI077_0281.jpg RCEM https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/a201f082-3a4c-436d-a390-f8a42616ef06/anatomia_RBAI077_0233.jpg RCEM https://ultra-sono.com/dvt daily 0.75 2022-12-02 https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/7c6f3795-51d0-45c4-9d65-4bc09b673f76/DVT+Algorithm+Basaure+et.+al+.jpeg DVT - Make it stand out POCUS-based algorithm for DVT assessment in the ED. Basaure et. al [2] https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1663146911366-BPYMS6NFQIT4YUIE58VR/Lower%2BLeg%2B-%2BMedial%2Bsuperficial%2Bnerves%2Band%2Bveins.jpg DVT The superficial medial region of each leg drains into the Saphena Magna, which ascends along the leg and into the thigh to join the proximal femoral vein (saphenofemoral junction) below its entrance to the inguinal canal. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1663145363187-O1N2H2PHSL3X95DBEJ72/Thigh+-+Anterior+superficial+nerves%2C+arteries+and+veins..png DVT The superficial medial region of each leg drains into the Saphena Magna, which ascends along the leg and into the thigh to join the proximal femoral vein (saphenofemoral junction) below its entrance to the inguinal canal. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1663145326575-QQIQ7EZ69NU45KZR1KQI/Lower+Leg+-+Posteriorr+superficial+nerves+and+veins.png DVT Meanwhile, the lesser saphenous vein, which then joins the popliteal vein, gathers blood from the superficial, posterolateral region of the leg. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1663145497630-MBKCFFZFKI8ABU8Q30QU/Lower+Leg+-+Nerves+and+blood+vessels.png DVT The popliteal vein begins behind the knee as the confluence of the deep calf veins. In the popliteal fossa, it lies superficial to the popliteal artery and ascends through the adductor canal into the thigh, becoming the femoral vein. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1663145460380-8PUOOPYGFYACVXCHL3A7/Popliteal+Fossa+-+Nerves+and+blood+vessels.png DVT The popliteal vein begins behind the knee as the confluence of the deep calf veins. In the popliteal fossa, it lies superficial to the popliteal artery and ascends through the adductor canal into the thigh, becoming the femoral vein. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1663145405749-MWWSI9I1YUHDOKDYB1TS/Thigh+-+Nerves+and+blood+vessels+3.png DVT The femoral vein lies anteromedially in the thigh: initially deep to the femoral artery and medial to it as it ascends. The confluence of the profunda femoris (approximately 4 cm below the inguinal ligament) forms the common femoral vein which transforms into the external iliac as it passes superiorly under the inguinal ligament. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1663145427609-OZQJB9SIFSXG9QZNDMDA/Thigh+-+Nerves+and+blood+vessels+2.png DVT The femoral vein lies anteromedially in the thigh: initially deep to the femoral artery and medial to it as it ascends. The confluence of the profunda femoris (approximately 4 cm below the inguinal ligament) forms the common femoral vein which transforms into the external iliac as it passes superiorly under the inguinal ligament. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1663145434512-U5XUIJD8QAG27EJGDIGE/Thigh+-+Nerves+and+blood+vessels+1.png DVT https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/42eb0a37-a687-430a-a51e-129be003d5a9/Femoral.gif https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1663149087076-9EPEYY5OY5TT9WE5PQ7K/Mickey+Mouse.gif DVT - Saphenofemoral Junction From left to right: common femoral artery, common femoral vein, and greater saphena conforming the “Mickey Mouse” sign (normal saphenofemoral venous confluence and femoral artery). Gentle compression will appose the anterior and posterior walls of normal veins; arteries are relatively incompressible. Notice how the femoral artery is thick-walled and pulsating lateral to the femoral vein, while the saphenofemoral venous confluence presents thinner-walls and transmitted pulsation only. Dr. Felipe Urriola P. | EM Doctor, Resuscitation Fellow | The Royal London Hospital https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1663149095362-42V0LZMQX7T7XFOXPTFT/Mickey+Mouse+Doppler.gif DVT - Saphenofemoral Junction Saphenofemoral confluence under Colour Doppler. The colours represent the flow direction in relation to the probe and do not differentiate between arterial or venous vessels. Dr. Felipe Urriola P. | EM Doctor, Resuscitation Fellow | The Royal London Hospital https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1663149115334-PLZQCS417Z1NV89B3DN5/CommonFemoral+to+Femoral+Slide.gif DVT - "Superficial" Femoral Vein While traversing distally, the “superficial” femoral vein lies posterior to the femoral artery. Despite the name, this vessel is part of the deep venous system and a continuum with the common femoral vein. Dr. Felipe Urriola P. | EM Doctor, Resuscitation Fellow | The Royal London Hospital https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1663149135049-5MS4KZ8AOX38NVMWFKH4/Distal+Femoral+Vein.gif DVT - Distal Femoral Vein Follow the femoral vein distally compressing and releasing, ideally until the entire length has been visualized to the adductor hiatus. Dr. Felipe Urriola P. | EM Doctor, Resuscitation Fellow | The Royal London Hospital https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/beebf4ff-dde8-4508-9c77-6e925477f667/Popliteal+1.gif https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/85bfb24b-fb23-46c3-996c-b57ae505635f/Popliteal+2.gif https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1663332100452-BMDL4236143UPZ6M16HI/Popliteal+Single+Compression.gif DVT - Popliteal Segment Compression and collapse of the popliteal vein. Notice how the vein locates superficial to the artery at the popliteal segment. Dr. Felipe Urriola P. | EM Doctor, Resuscitation Fellow | The Royal London Hospital https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1663332258139-591HZXCU4LB61A9DNX33/Popliteal+Multi+Compression.gif DVT - Popliteal Segment Compression and collapse of the popliteal vein. Notice that when sliding inferiorly to the calf it is usually more difficult to identify the popliteal vein, this can be overcome by compressing the region. Dr. Felipe Urriola P. | EM Doctor, Resuscitation Fellow | The Royal London Hospital https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1663332446640-NPPOW9QPR8JV54LKR3E4/Popliteal+Doppler+Compression.gif DVT - Popliteal Segment Graded compression under colour doppler shows venous collapse and flow interruption. Dr. Felipe Urriola P. | EM Doctor, Resuscitation Fellow | The Royal London Hospital https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1663332372201-Q7CEBNRNCMKX9BP5L59C/Popliteal+Doppler.gif DVT - Popliteal Segment Colour doppler flow. Notice the difference between continuous (venous) and pulsatile (arterial) flow. Dr. Felipe Urriola P. | EM Doctor, Resuscitation Fellow | The Royal London Hospital https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1663335950270-DS84Y5ZR4SSCLISNOFA1/Right+Femoral+DVT.gif DVT - Right Femoral DVT 69-year-old male patient with no relevant past medical history presents to the ER complaining of two-day right inguinal pain and swollen lower extremity. Direct interrogation reveals one-month subacute mild dyspnea upon physical exertion. POCUS showed this image. The contractile femoral artery lies superficial and to the left of the screen. The common femoral vein is not fully compressible, and an isoechogenic structure can clearly be identified in its interior. Subsequent angio-CT confirmed a massive bilateral PE, although the patient remained stable and did not require invasive interventions. Dr. Felipe Urriola P. Emergency Unit, Puerto Aysen Hospital. Chilean Patagonia. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1663336618008-9HLZ8FREDWNLOEQAQM6G/Right+Distal+Femoral+DVT+01.gif DVT - Partial Femoral Compression A healthy 21-year-old male presents to ED with unilateral lower limb pain 15 days after an 8-hour flight. On physical examination, there is no oedema or swelling nor skin colour changes. Both legs appear symmetrical and have the same circumferential diameter. POCUS below the saphenofemoral junction shows an initially compressible common femoral vein. However, sliding the probe distally reveals partial compression of the femoral vein. Dr. Felipe Urriola P. Emergency Unit, Puerto Aysen Hospital. Chilean Patagonia. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1663337261452-DL2BU17MVZYKTXIO4UGB/Right+Distal+Femoral+DVT+02.gif DVT - Large Femoral Thrombus The same 21 y/o patient. Sliding the probe farther along reveals a large, extensive thrombus towards the distal femoral vein. Remember this patient presented exclusively with pain. Dr. Felipe Urriola P. Emergency Unit, Puerto Aysen Hospital. Chilean Patagonia. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1663338064216-S7PIEI2BDGMVT23O33JC/Right+Distal+Femoral+%26+Popliteal+DVT+01.gif DVT - Saphenofemoral Junction A 61-year-old male presents to ED with a 2-week swollen, painful right leg and raised D-dimer. Saphenofemoral junction with normal compression. Notice the femoral vein dilation as the probe slides down. Dr. Felipe Urriola | EM Doctor, Resuscitation Fellow | The Royal London Hospital https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1663338689521-7ZJ7CYGPCVX85QKX9VMR/Right+Distal+Femoral+%26+Popliteal+DVT+02.gif DVT - Distal Femoral DVT A 61-year-old male presents to ED with a 2-week swollen, painful right leg and raised D-dimer. Scanning the distal femoral vein shows a complete lack of venous collapse upon compression with the probe, highlighting the importance of 3-point exploration as a minimum. Dr. Felipe Urriola | EM Doctor, Resuscitation Fellow | The Royal London Hospital https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1663339165793-KESC2DMSPI5G6OBOJM0K/Right+Distal+Femoral+%26+Popliteal+DVT+03.gif DVT - Popliteal DVT A 61-year-old male presents to ED with a 2-week swollen, painful right leg and raised D-dimer. Popliteal exploration shows venous distention and complete absence of venous collapse upon compression, confirming extensive right leg DVT. Dr. Felipe Urriola | EM Doctor, Resuscitation Fellow | The Royal London Hospital https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/697c1583-4a97-49a0-95af-e94e712189ca/Limb%2Bswelling%2Bby%2BDr%2BCilein%2BKearns%2B%28artibiotics%29%2Bv01%2Bs1024px.jpeg https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1663342341944-YRAKSJLIQOZLOYVVDJT2/Cobblestone.gif DVT - Cellulitis Cobblestone Sign. Dr. Felipe Urriola https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1663341858722-PMQYPXEMR9JQLPX6OYEA/ezgif.com-optimize%2B%281%29.gif DVT - Cobblestone Sign The differential diagnosis for lower extremity oedema and/ or pain is broad. Confusion between soft tissue infection and DVT is not rare, as the clinical presentation is potentially similar. Cellulitis generates thickening and swelling of the subcutaneous layer, which is portrayed by ultrasound as the typical cobblestone image. Image courtesy of Dr. Gordon Johnson. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1663341989460-CSFKLMUJFHIYGKMERZYK/ezgif.com-optimize-5.gif DVT - Panniculitis Diffuse cobblestoning is typically seen with cellulitis. In this case, its biopsy proved panniculitis. Dr. Gordon Johnson. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1663342115625-GLC0OJ4WAYJ3JHCAI7NU/abcess.gif DVT - Soft Tissue Abscess An organised soft tissue infection can lead to abscess formation, which could be mistaken for a blood vessel. Notably, abscesses won’t have flow and are circumscribed. The image below demonstrates a well-circumscribed fluid collection in the soft tissue consistent with an abscess. Note the scattered punctate echogenic densities moving within the abscess fluid which suggest high cell/protein content of the fluid. Image courtesy of 5 minute sono. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1663342261982-55CXPK30LXFUI3D4T3OQ/baker%27s%2Bcyst.gif DVT - Ruptured Baker's Cyst A longitudinal view of a ruptured Baker's cyst. When performing a DVT scan, always look out for incidental findings that may explain the patient's presentation! Dr. Michael Trauer https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1663342100540-PL8ISVCA93AM9QQN9W61/popliteal-pocus-cyst-bakers-clinical-original.gif DVT - Unruptured Baker's Cyst https://images.squarespace-cdn.com/content/v1/5ec321c2af33de48734cc929/1618497259178-6XJGK9GR6YAVBQL5L519/20140301_Trade-151_012-2.jpg DVT https://images.squarespace-cdn.com/content/v1/5ec321c2af33de48734cc929/1607694644871-IC85FNH781UNZSZEGHDR/Aro+Ha_0428.jpg DVT https://images.squarespace-cdn.com/content/v1/5ec321c2af33de48734cc929/1589847767761-J2M1HI20BXRQ9XCR0HUD/Large+JPG-Aro+Ha_0387.jpg DVT https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/e2047c4c-0e91-47bb-957f-74efc5cad2e4/anatomia_RBAI078_0049.jpg DVT https://ultra-sono.com/vascular-access daily 0.75 2022-12-02 https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1662910434535-8ZKIXGMM4P8Z8QWV3S3F/default.jpeg Vascular Access https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1662910452015-TNU3RH6ZL5U29IN9R4MF/s-l1600.jpeg Vascular Access https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1662910624067-OZ4L3T4QJJUEOK7UG0F7/2134_Thoracic_Upper_Limb_Veins.jpeg Vascular Access https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669044005463-MM93RJXNABRED71FVBLN/undefined.gif Vascular Access - Out of Plane Out of plane / short axis approach courtesy of Dr Dan Bradford, Royal London Hospital https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1662992293401-53T71N8IADLEGUU4KNAM/2022.08.11+%7C+%236.gif Vascular Access https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1662992395604-KEE2I0WAOPLG3T3B6BM5/2022.08.11+%7C+%237.gif Vascular Access https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1662992783547-WBJ9F1UHHEKO9PA5NN4H/2022.08.17+%7C+%238a.gif Vascular Access https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1662992929686-QE29VOA6R92KVAW3CNR6/2022.08.17+%7C+%238b.gif Vascular Access https://images.squarespace-cdn.com/content/v1/5ec321c2af33de48734cc929/1618497259178-6XJGK9GR6YAVBQL5L519/20140301_Trade-151_012-2.jpg Vascular Access https://images.squarespace-cdn.com/content/v1/5ec321c2af33de48734cc929/1607694583486-2PQT0LQ193RL7MCB6DX4/20140228_Trade+151_0046.jpg Vascular Access https://images.squarespace-cdn.com/content/v1/5ec321c2af33de48734cc929/1607694644871-IC85FNH781UNZSZEGHDR/Aro+Ha_0428.jpg Vascular Access https://images.squarespace-cdn.com/content/v1/5ec321c2af33de48734cc929/1589847767761-J2M1HI20BXRQ9XCR0HUD/Large+JPG-Aro+Ha_0387.jpg Vascular Access https://ultra-sono.com/blocks-fib daily 0.75 2023-03-26 https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/668eb210-48c8-489d-a465-66a607a2d18b/anatomia_RBAI077_0222.jpg https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669998511179-2ZBJGMMPYOYYWXAEVHEJ/anatomia_RBAI077_0233.jpg Blocks: FIB https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669998884858-0K2GXOKZBDD85BOG0BBV/anatomia_RBAI079_0047.jpg Blocks: FIB https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/a9a64173-ce64-4d3d-bb3f-28a2e1afce68/FICB+Anatomy.gif https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/325ee35e-05de-4329-9e8c-66d8dd008e72/image-asset+%281%29.gif https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/a880d334-1d49-4534-bc9a-f6e86b645312/Fascia+iliaca+injection.gif https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/e9825188-d585-4e42-89e6-2cc298925e8e/Infra-inguinal+FICB.gif https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/74459b77-642f-42c9-90d6-7845bcacdc78/image-asset+%282%29.gif https://images.squarespace-cdn.com/content/v1/5ec321c2af33de48734cc929/1618497259178-6XJGK9GR6YAVBQL5L519/20140301_Trade-151_012-2.jpg Blocks: FIB https://images.squarespace-cdn.com/content/v1/5ec321c2af33de48734cc929/1607694583486-2PQT0LQ193RL7MCB6DX4/20140228_Trade+151_0046.jpg Blocks: FIB https://images.squarespace-cdn.com/content/v1/5ec321c2af33de48734cc929/1607694644871-IC85FNH781UNZSZEGHDR/Aro+Ha_0428.jpg Blocks: FIB https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/6257cd97-0357-44fa-a627-9f45c54b5893/anatomia_RBAI077_0233.jpg Blocks: FIB https://ultra-sono.com/felipe-urriola daily 0.75 2025-08-29 https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/6ca52931-0d7f-43a3-9c0d-6549417ddf4d/IMG_2361.JPG Felipe Urriola - Felipe Urriola I am a dynamic, creative, and passionate Chilean Doctor with substantial experience in Emergency Medicine and Acute Critical Care. I grew up in Santiago, where I completed medical school and foundation training in 2013. During my early medical career, I joined the Chilean Air Force, participated in the UN peace mission in Haiti, flew my first retrieval missions, and underwent core Emergency Medicine training in Chile. My passion for the resuscitation element of EM became evident during this period. Looking for adventure, in 2020, I moved to the Chilean Patagonia, where I split my time between a rural ED, the Regional Fixed-Wing Retrieval Service, lake swimming, mountain walking, PoCUS development, and creating https://ultra-sono.com/ I've been living in the UK since 2022, where I've worked as a Resuscitation/EM/ICM Senior fellow in London, Plymouth, and Nottingham. More recently, I've completed a full-time HEMS fellowship with Lincs & Notts Air Ambulance, where I continue to work as a contractor. https://ultra-sono.com/cristina-sorlini daily 0.75 2022-09-12 https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/20243d7f-9a77-42e8-8e02-e8d2582bcd63/3CF07A87-7137-4507-AD71-4B00CB4375AA.jpg Cristina Sorlini - Cristina Sorlini Cristina is an Italian consultant in Emergency Medicine, currently working as a senior clinical fellow with a special interest in Ultrasound at the Royal London Hospital in London. Starting November 2022, she will undertake on a second fellowship in Community Emergency Medicine, which will imply working as an Emergency Medicine doctor both in the Physician Response Unit and the Emergency Department. Cristina is also an Advanced Life Support Instructor for the Italian Resuscitation Council (IRC) and part of the IRC board for the years 2021-2023 Her main interests are Point-of-Care Ultrasound, Simulation and Community Emergency Medicine, but also running and practising yoga. https://ultra-sono.com/renal daily 0.75 2022-12-02 https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1665688312040-MAMI6JSM87I8FO492YG3/retroperitoenum.jpg Renal https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1665482737647-052HUTMVMNLUGA99S7H5/Kidneys.jpg Renal https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1665482739549-XVJAY0MR0W1UVRMMBRB5/Kidney.png Renal https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1665688398463-AGRDY28LVRYCA7OBUTFX/Rt+Long.gif Renal - Right Longitudinal https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1665688414269-NTB0NDIA97N8D240FQ0X/Rt+Trans.gif Renal - Right Transversal https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1665688448671-V9XJD5ZLH7DGTLQGGNHE/Lt+Long.gif Renal - Left Longitudinal https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1665688475259-4RM2JVT5GYB5JECGGEZ5/Lt+Trans.gif Renal - Left Transversal https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/9f18f723-9ef7-4928-a958-a13ec7eee9b6/RT+Long.png https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/2f1f77aa-d8fb-42b0-a443-99014b2806f8/LT+Lomg.png https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/fca160b9-6e43-4e90-b030-3f1c48d70913/LT+Trans.png https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/e52231d3-3726-4736-9b2a-9bec8e0146ae/RT+Trans.png https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1665689085682-AZNWUMHAI83O8UY8M9Q5/Rt+Long.gif Renal - Right Longitudinal https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1665689087342-PJ41KLEZSHV1N9EKG8ZP/Rt+measure.png Renal - Measure https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1665689992465-QJDIKW2O6IIAHY8LTIH7/Lt+Long.gif Renal - Left Longitudinal Notice the hypoechoic pyramids (renal medulla), in this case, more noticeable on the left than. This represents a normal finding. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1665689994025-Q7JEUJF24I84VPRHASNK/lt+measure.png Renal - Measure https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1665690770398-Q5B5IQHB3C00G3GLNYB0/Rt+Normal.gif Renal - Right Kidney: Normal 30 y/o male. Sudden onset, intense left flank pain radiating to the left groin. Nausea and vomiting. No previous similar symptoms. No dysuria or frank haematuria. Urinalysis without blood. CRP <1, WBC 15000 Creat 83, Urea 3.9. GFR>90. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1665690793047-WA18IVULOMLBM7LT45L8/Lt+Mild+hydro+%2B+Stones+long.gif Renal - Left Kidney: Longitudinal View 30 y/o male. Sudden onset, intense left flank pain radiating to the left groin. Nausea and vomiting. No previous similar symptoms. No dysuria or frank haematuria. Urinalysis without blood. CRP <1, WBC 15000 Creat 83, Urea 3.9. GFR>90. POCUS Longitudinal View: There is prominence and mild dilation of the left renal pelvis and two intrarenal stones. Dr. Felipe Urriola P. | The Royal London Hospital ED | London. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1665690814738-COXRSP403X2ZTR9CW5OJ/Lt+Mild+hydro+%2B+Stones+trans.gif Renal - Left Kidney: Transverse 30 y/o male. Sudden onset, intense left flank pain radiating to the left groin. Nausea and vomiting. No previous similar symptoms. No dysuria or frank haematuria. Urinalysis without blood. CRP <1, WBC 15000 Creat 83, Urea 3.9. GFR>90. POCUS: There is prominence and mild dilation of the left renal pelvis and two intrarenal stones. CT KUB: partially obstructive left VUJ renal calculus, measuring 5mm. There is mild prominence of the renal pelvis and fullness of the posterior mid-pole calyx. There are two further non-obstructive left renal stones, up to 4mm. Dr. Felipe Urriola P. | The Royal London Hospital ED | London. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1666298449939-0E2T4WLNZ5S2RRP7Q6SU/mild%2Bhydro%2Bstill.jpeg Renal - Mild Hydronephrosis Mild (grade 2) hydronephrosis with dilation of the renal pelvis and some of the calyces. Grade one would not include dilated calyces. Courtesy of The Pocus Atlas https://www.thepocusatlas.com/hydro-and-obstruction https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1666298567602-I0RQZ11K63X4R9TIYWYG/mild%2Bhydro%2Bcomp.gif Renal - Mild Hydronephrosis 21 y/o female post-op emergency hysterectomy post uterine rupture with rising creatinine in surgical ICU. POCUS revealed right-sided mild Grade I hydronephrosis with appreciable dilated major calyces and renal pelvis. Initial concern is for obstructive process or ureter injury. Dr. Sathya Subramaniam, Pediatric EM Fellow - Kings County/SUNY Downstate https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1666298694228-3M48IZNVMNKDJ5UD5IRX/ezgif.com-optimize%28left_hydro%29.gif Renal - Mild Hydronephrosis Mild - grade two hydronephrosis with dilation of the renal pelvis and dilation of the calyces. Grade one would not include dilated calyces. Courtesy of The Pocus Atlas https://www.thepocusatlas.com/hydro-and-obstruction https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1665691322142-P0WOSZO775KP0IB4101I/Rt+Normal.gif Renal - Right: Normal https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1665691335839-I39Y3SN1MGUZK2KJKQKD/Lt+Mild.+Prominent+Pyramid.gif Renal - Left: Hydronephrosis? Notice that here, the difference between both kidneys does not represent a pathological finding. The hypoechoic medullary pyramids are normal and, in this case, more prominent and noticeable on the left than on the right. However, there is no dilation of the chalices or renal pelvis and, therefore, no hydronephrosis. Dr. Felipe Urriola P. | The Royal London Hospital ED | London. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1666298952070-NU72LHMBWITZ286U38MO/ezgif.com-gif-maker.gif Renal - Moderate Hydronephrosis The degree of hydronephrosis is determined by a grading system. Grade 0 (none) means there's no dilation of the renal pelvis. Grade 1 (mild) means there's mild dilation of the renal pelvis without any dilation of the calyces. Grade 2 means there's moderate dilation of the renal pelvis that extends to a few calyces. Grade 3 (moderate) means the renal pelvis dilation extends to all the calyces. Grade 4 (severe) means there's extension of the dilation to all the calyces with the addition of thinning of the renal parenchyma. In this clip, the renal pelvis calyces are dilated, but there is no thinning of the renal parenchyma, making this mild to moderate or grade 2. Sukh Singh, MD Caption by Matthew Riscinti, MD https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1666299108206-CD1Y4R3JMDVFI7CS66R1/ezgif.com-optimize%2B%282%29.gif Renal - Hydroureter with Moderate Hydronephrosis This young lady presented with clinical features of pyelonephritis - fever, rigors and right flank pain. Renal US shows moderate hydronephrosis and hydroureter. CT showed a 5.7mm right mid ureteric stone. Nephrostomy tube was placed to decompress obstructive uropathy. Ultrasound is insensitive for pyelonephritis - most patients have normal scans. POCUS can be used to check for hydronephrosis, renal abscess, pyonephrosis or emphysematous pyelonephritis as these findings will alter management. Images recorded by Dr. Khaled Taha Submitted by Dr Cian McDermott Mater University Hospital, Dublin, Ireland https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1666299170528-17R4Y0RWP27DZKEZC7EA/ezgif.com-optimize%2B%288%29.gif Renal - Moderate Hydronephrosis This young female presented with colicky left flank pain worsening over the previous 24 hours. POCUS showed moderate hydronephrosis with rounding of the calyces of the left kidney collecting system. The stone is seen at the ureteropelvic junction (UPJ) as a hyperechoic structure with posterior acoustic shadowing measuring 7mm on CT. At ureteroscopy, the stone was retrieved, fragmented and a double J stent was placed Dr Cian McDermott, Mater University Hospital, Dublin, Ireland https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1666299221675-QQNHJIAVYYITJ23D2VFG/ezgif.com-optimize%2B%281%29.gif Renal - Moderate Hydronephrosis Moderate (grade three) hydronephrosis can be appreciated here with dilation of both the renal pelvis and calcyces. The renal cortex is also thinned. There is not gross atrophy. Dr. Justin Bowra et al. (Dr. Yogi) https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1666299272600-GG8PB3RYMI6XD1J00HN5/shan%2Bpam%2Bhydro2.gif Renal - Moderate Hydronephrosis 66 yo M with hx of congenital single kidney and prostate cancer presents with suprapubic discomfort x 1 week. Found to be in urinary retention. POCUS allows grading of hydronephrosis based off of the severity of the dilation of the renal pelvis and calyces. Here we see dilated pelvis, ballooning calyces, and cortical thinning. This represents Grade 3, moderate hydronephrosis. Grade 4, severe, would demonstrate further atrophy and loss of borders, occurs with severe hydronephrosis. Rushabh Shah, MD, MBA and Maria-Pamela Janairo, MD - Kings County/SUNY Downstate Emergency Medicine https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1666299327089-ZY1ZNE70NL9NRTS5KFG1/image-asset.gif Renal - Moderate Hydronephrosis 30s M with no past medical history presented with acute onset right-sided flank pain. POCUS demonstrated moderate hydronephrosis of the right kidney with evidence of hydroureter as well. Moderate hydronephrosis is seen here with distension of the renal pelvis as well as distension of most of the renal calyces, with intact renal cortical thickness. This patient had his symptoms controlled and was able to be discharged. Dr. Mark Serpico, PGY3 Denver Health Residency in Emergency Medicine https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1665690597311-IE9E95QCCR0X3WMVQ6Q0/Rt+Severe+HUN+long.gif Renal - Right Kidney: Longitudinal 89 y/o female. Background of ovarian cancer with a right ureteral stricture. Ureteric stent in 2020 and recently changed two weeks ago. Presents with vomiting, abdominal distention and pain. Worsening on renal function. POCUS shows Severe HUN. Notice the disruption of the renal anatomy and the cortical thinning. Dr. Felipe Urriola P. | The Royal London Hospital ED | London. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1665690623223-TFLTPN8NX456XLZTRTKW/Rt+Severe+HUN+trans.gif Renal - Right Kidney: Transverse 89 y/o female. Background of ovarian cancer with a right ureteral stricture. Ureteric stent in 2020 and recently changed two weeks ago. Presents with vomiting, abdominal distention and pain. Worsening on renal function. POCUS shows Severe HUN. Notice the disruption of the renal anatomy and the cortical thinning. Dr. Felipe Urriola P. | The Royal London Hospital ED | London. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1666124924960-I6MIK45TJ971AIN92W9X/L+sided+hydronephrosis.jpg Renal https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1666124951541-HV1GPF6LNCPR29IE4VM5/L+sided+hydroneprosis.jpg Renal https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1666299593165-947JYYAXQ9FC8SMVMT93/image-asset+%281%29.gif Renal - Bear Paw Sign A 43-year-old female presented to the ED reporting fever and left-sided flank and low back pain. HPI was notable for recurrent urinary tract infections. POCUS performed on the Left Upper Quadrant revealed severe hydronephrosis, with hypdronephrotic collections in the region of the calyces resembling the outline of a bear’s paw (referred to as “bear paw sign”). Subsequent abdominal CT confirmed severe hydronephrosis secondary to stenosis of the ureteroplevic junction (UPJ). Josiane Almeida https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1666299636163-5NTHZ3YJONR405FGHJD5/image-asset.gif Renal - Severe Hydronephrosis POCUS evidence of severe right renal hydronephrosis, as identified in a patient who had an ipsilateral 2.5cm mid-ureteral calculus. Aaron Inouye, PA-C, North Canyon Medical Center @PAintheED https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1666299702408-BCS28J0F204SXCPFPLL0/alerhand%2Bsevere%2Bhydro.gif Renal - Severe Hydronephrosis + Massive Hydroureter Patient with urinary obstruction with severe hydronephrosis and absolutely massive hydroureter (CT confirmed). Dr. Stephen Alerhand - US Fellow - Mt Sinai Hospital, NYC https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1666299770321-B7NACBI3GH5JQHX90F93/ezgif.com-optimize.gif Renal - Severe Hydronephrosis In this patient with severe hydronephrosis, there is gross dilation of both the renal pelvis and calyces, which are ballooned. The cortex of the kidney has atrophied and is very thin. This is severe, or grade 4. Dr. Justin Bowra et al. (Dr. Browne and Dr. Knights) https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1667663902535-YJ38TRR16FOD5T4BL5AZ/left+renal+abscess+1.gif Renal - Renal Abscess 28 y/o Female. Background of sickle cell disease, & splenectomy. Attends ED with a 2-day history of malaise, generalised pain in limbs and significant LUQ pain. No vomiting, no nausea. Denies urinary symptoms. Initial assessment included POCUS within 10 minutes of hospital arrival. The clip shows a 2.5x2.5cm thick walled collection in the upper pole of the left kidney. Analgesia, fluids & IV ABX started. Blood results revealed 23000WBC and CRP 110. Urine compatible with infection (leucocytes, blood and nitrites. Negative BHCG). CT confirmed the suspicion of a renal abscess. The patient remained stable and was admitted for continued antibiotic treatment and eventual IR drain. Dr Felipe Urriola P. | Resuscitation Fellow - Emergency Medicine | The Royal London Hospital, London, UK. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1666299955250-6GL08P6T9WTRSDPNU5O2/image-asset+%282%29.gif Renal - Perinephric Abscess Patient was admitted to ICU for DKA + pyelonephritis + E. Coli bacteremia. She was treated in the ICU and downgraded to the medicine floors, after tx for septic shock, but had persistent leukocytosis and intermittent LUQ px. Repeat CT showed 2.2 x 3.5 x 3.9 cm perinephric abscess, with the following images taken after identification on CT. 8cc of purulent drainage was subsequently drained via IR. Shane Solger, MD King's County/SUNY Downstate https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1666300055209-QAAQKH8IJO883N545HVV/image-asset+%281%29.gif Renal - Xanthogranulomatous Pyelonephritis A female presented to the ED with right flank pain, fever, leukocytosis, soft vitals, and dirty urine. Urine culture grew Proteus mirabilis. Bedside ultrasound revealed a bear claw sign with perinephric abscess indicative of xanthogranulomatous pyelonephritis. Image courtesy of Robert Jones DO, FACEP @RJonesSonoEM Director, Emergency Ultrasound; MetroHealth Medical Center; Professor, Case Western Reserve Medical School, Cleveland, OH https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1665690207459-XI6EXHZKUFHVP47B411F/Renal+Cyst+woHUN.gif Renal - Renal Cyst 87 y/o male with bilateral lower back pain and diminished urinary output. US scan of left kidney shows a cortical cyst. Finding was confirmed by CT, which reports: NO evidence of urinary calculi within the kidneys, ureters or bladder. There are multiple cortical cysts noted within the kidneys bilaterally. The renal pelvises are prominent bilaterally, but there is no upstream calyceal dilation, and the ureters have a normal calibre. No hydronephrosis or hydroureter. Dr. Felipe Urriola P. | The Royal London Hospital ED | London https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1666125734949-VQF7MPWFK25OYWMYNLTL/simple+cyst.gif Renal https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1666125737931-8XG4TY64HRCD0W3FI0US/PKD.gif Renal https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1666300463869-RX9T0S6HTM6BKM1RGAOS/image-asset+%283%29.gif Renal - Renal Cell Carcinoma Renal parenchyma showed a dysmorphic appearance with the presence of mild ascites in this patient with flank pain and hematuria. Patient was later diagnosed with renal cell carcinoma. Image courtesy of Robert Jones DO, FACEP @RJonesSonoEM Director, Emergency Ultrasound; MetroHealth Medical Center; Professor, Case Western Reserve Medical School, Cleveland, OH https://images.squarespace-cdn.com/content/v1/5ec321c2af33de48734cc929/1618497259178-6XJGK9GR6YAVBQL5L519/20140301_Trade-151_012-2.jpg Renal https://images.squarespace-cdn.com/content/v1/5ec321c2af33de48734cc929/1607694583486-2PQT0LQ193RL7MCB6DX4/20140228_Trade+151_0046.jpg Renal https://images.squarespace-cdn.com/content/v1/5ec321c2af33de48734cc929/1607694644871-IC85FNH781UNZSZEGHDR/Aro+Ha_0428.jpg Renal https://images.squarespace-cdn.com/content/v1/5ec321c2af33de48734cc929/1589847767761-J2M1HI20BXRQ9XCR0HUD/Large+JPG-Aro+Ha_0387.jpg Renal https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/b526e21b-a481-4bc0-ae64-678379c2bf46/Kidneys%26Bladder.jpg Renal https://ultra-sono.com/aorta daily 0.75 2023-12-11 https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1665687680416-ROHB4DQ67XPSW6SPO2HH/Abdominal+Aorta.jpg Aorta The coeliac trunk (common hepatic artery & splenic artery) and the superior mesenteric artery emerge from the proximal portion of the abdominal aorta. The aorta narrows down as it descends, originating the inferior mesenteric artery, and bifurcates into the iliac arteries. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1665687741679-FFLETYDF0BC7DIDR9VP0/Aorta+post.jpg Aorta https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669935818497-JPRLF2TD8F4FYFCTT76Y/anatomia_RBAI072_0117.jpg Aorta https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669935823122-A2NBLGARWF6BJL759X7K/anatomia_RBAI057_0018.jpg Aorta https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1663933728728-6J8UF49M6390Q9JH6DA5/1%3A3Transverse.gif Aorta - Proximal Aorta - Transverse At the bottom of the screen, notice the hyperechoic edge of a vertebral body. The aorta lies anteriorly and is seen as an anechoic, round, contractile structure. The IVC can be seen to the left of the image, presenting thinner walls and transmitted pulsation from the RA. The larger, isoechoic structure in the proximal field of the screen is the liver. This clip is taken over the subxiphoid region, transverse to the body’s axis, and with the probe marker oriented to the patient’s right. Dr. Felipe Urriola P. | EM Doctor, Resuscitation Fellow | The Royal London Hospital https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1663933780867-BMNASO9GX3VL404KQKSW/1%3A3%262%3A3TransverseSlide.gif Aorta - Abdominal Aorta Slide of the probe in transversal view. Notice the collapsible IVC to the left of the screen and the pulsatile Abdominal Aorta to the right of the screen. Dr. Felipe Urriola P. | EM Doctor, Resuscitation Fellow | The Royal London Hospital https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1702255802015-XN0EE97WRGCXXEBRKS13/Normal%2BIVC%2Bto%2BAA%2Bdrag%2B-%2BLongitudinal%2BView.gif Aorta - Longitudinal View In the longitudinal plane, sliding the probe from the patient’s right towards the left will show the IVC and the adjacent abdominal Aorta. Don’t get confused! https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1663933833565-BCB1L6JYRTPLU33Q6H76/1%3A3Longi.gif Aorta - Longitudinal View - Coeliac Trunk &amp; SMA At the centre of the screen, the proximal aorta can be identified by the emergence of the coeliac trunk and the superior mesenteric artery. This clip is taken at the subxiphoid level, longitudinal to the body’s axis, and with the probe marker oriented towards the head. Dr. Felipe Urriola P. | EM Doctor, Resuscitation Fellow | The Royal London Hospital https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1663933741671-WBQHRKY49DID7BJGAZ0A/1%3A3Transverse%7CSeagull.gif Aorta - Seagull Sign Normal proximal Aorta in transverse view. Hepatic & Splenic arteries conforming the seagull sign. Dr. Felipe Urriola P. | EM Doctor, Resuscitation Fellow | The Royal London Hospital https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1663933817361-LH1WO1XJZ62Y9ELX95RL/ProximatoDistal+Slide.gif Aorta - Distal Aorta Slide - Transverse View Dr. Felipe Urriola P. | EM Doctor, Resuscitation Fellow | The Royal London Hospital https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1663935431711-S7TZYKQK9NW117SSFQIL/01+AAA.gif Aorta - AAA (Copy) This image was taken from a pocket wireless device in the mesogastric region. We can see the aorta in short-axis aorta with an increased diameter (notice how the diameter is larger than that of the vertebral body), and the neighbouring anatomical references such as the dorsal spine and inferior vena cava laterally. Image courtesy of Dr. Renato Tambelli. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1663935439055-H2B35LGGVSMNQXRSUZNK/02+AAA+2.gif Aorta - AAA Rupture (Copy) A 61-year-old male was brought in via EMS after a syncopal episode. He was diaphoretic and hypotensive, complaining of severe right flank pain. While IV access was being obtained a bedside ultrasound was performed demonstrating a large abdominal aortic aneurysm with significant heterogeneous intraluminal clot. There is also appreciable focal hypoechoic disruption of the wall of the aneurysm consistent with rupture. The patient was resuscitated in the ED and taken emergently to the OR to surgical repair. Michael Macias, MD. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1663935441860-QXY6WX2CBB7ACMPPM9E4/03+AAA+3.gif Aorta - AAA with Thrombus (Copy) Approximately 6 cm abdominal aortic aneurysm with intramural thrombus. Frances Russell, MD, RDMS Assistant Professor of Emergency Medicine Division Chief, Ultrasound Fellowship Director, Ultrasound https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1663935444463-C2S2J7TV5SGEU9S9BY7W/04+AAA+4+-+Long.gif Aorta - Large AAA - Longitudinal View (Copy) Long axis view of large abdominal aortic aneurysm containing intramural thrombus without evidence of the iliac arteries involvement. Image courtesy of Giovanni Battista Fonsi https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1663935448033-50EOEU7P9DTOSIFQBOVF/05+aorta+posterior+rupture.gif Aorta - Aorta Posterior Wall Rupture (Copy) 63-year-old male with witnessed collapsed. Arrived without ital signs in a PEA rhythm. A fast look abdominal aorta POCUS showed a large abdominal aortic aneurysm with internal thrombus and rupture through the posterior wall. Note the AAA is measured from echogenic outer wall to outer wall, not the hypoechoic internal lumen that is seen pulsating. The patient was aggressively resuscitated with blood and initially survived operative repair. Unfortunately, he died in the ICU several days later from multiorgan failure. Dr. Joey Newbigging https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1663935668833-11K7URJDMROF2PN1M1GL/01+aortic%2Bdissection%2B.gif Aorta - Aortic Dissection 50 y/o male with a history of HTN presents with sudden onset upper back pain. POCUS found dissection flap in the descending aorta in both the parasternal long view and the abdominal aorta. The diagnosis of aortic dissection was quickly confirmed by CT. Given the importance of timely diagnosis with aortic dissection, POCUS allowed rapid and non-invasive diagnosis of a potentially tricky diagnosis, and facilitated expedited treatment and transfer to a cardiothoracic surgery center. Dr. Robert Allen - Kings County Emergency Medicine. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1663935670734-GRW3E2VOF7HYKPJAQLBY/02+image-asset.gif Aorta - Dissection Flap in Abdominal Aorta An elderly male with hypertension and DM presents with C/O chest pain. Bedside ultrasound performed demonstrating a dissection flap in the lumen of the abdominal aorta. A subsequent parasternal long axis show extension into descending thoracic aorta as well. Image courtesy of Robert Jones DO, FACEP. Director, Emergency Ultrasound; MetroHealth Medical Center; Professor, Case Western Reserve Medical School, Cleveland, OH. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1663935672832-6NWMBJCVHEIBVXHFVHIL/03+image-asset%2B%281%29.gif Aorta - Abdominal Aortic Dissection Flap Patient with abrupt onset chest pain radiating to back. Normal ECG and Troponin. POCUS revealed a dissection flap within the abdominal aorta. Nishant Cherian Emergency Medicine Registrar. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1663935674776-I5P7OKCFKA7GWBON4UBI/04+ezgif.com-optimize%2B%2835%29.gif Aorta - Aortic Dissection Flap Elderly fellow who had a headache while bike riding, with some leg weakness. No chest or back pain. Stable for hours then came to the hospital, suddenly hypotensive and drowsy in the ER. POCUS RUSH Exam performed lead to rapid diagnosis of Aortic Dissection with tamponade. A dissection flap can clearly be visualized. Claire Heslop - Pediatric Emergency Medicine - University of Toronto Hospital for Sick Children. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1663935677916-PPHH08CIYQXDEQ5PIF9R/05+ezgif.com-optimize%2B%287%29.gif Aorta - Extensive Type-B Aortic Dissection A 60-year-old man was transferred to a trauma facility after presumed mechanical ground-level fall. He was only able to answer yes/no questions, vital signs were normal and stable upon arrival. He denied abdominal or back pain. Upon arrival to receiving facility, POC ultrasound revealed intimal flap within the abdominal aorta extending from the subxiphoid region to the common iliac arteries. Bedside echo revealed no aortic root dilatation, pericardial effusion, or evidence of tamponade. CT scan confirmed thoracic and abdominal aortic dissection. Cardiothoracic surgery was notified immediately. POCUS can play a critical part in allowing for rapid diagnosis and can expedite patient care, particularly in patients with altered mental status who cannot provide a more robust history. Quinn Fujii, DO Desert Regional Medical Center, Emergency Medicine. https://images.squarespace-cdn.com/content/v1/5ec321c2af33de48734cc929/1618497259178-6XJGK9GR6YAVBQL5L519/20140301_Trade-151_012-2.jpg Aorta https://images.squarespace-cdn.com/content/v1/5ec321c2af33de48734cc929/1607694583486-2PQT0LQ193RL7MCB6DX4/20140228_Trade+151_0046.jpg Aorta https://images.squarespace-cdn.com/content/v1/5ec321c2af33de48734cc929/1607694644871-IC85FNH781UNZSZEGHDR/Aro+Ha_0428.jpg Aorta https://images.squarespace-cdn.com/content/v1/5ec321c2af33de48734cc929/1589847767761-J2M1HI20BXRQ9XCR0HUD/Large+JPG-Aro+Ha_0387.jpg Aorta https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1d0571d3-d5a7-414c-a67c-be3e72daa246/anatomia_RBAI077_0304.jpg Aorta https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/0adc0fb3-85ae-4294-a43c-131ce6376779/AAA%2BHaematoma_15mb.gif Aorta https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/915d1e86-000e-4865-b6d9-1b7aea18bc46/US_AAA%2BHaematoma+-+Trans+1.gif Aorta https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/76eb2897-6a26-49ed-9d54-e29a4b97297f/US_AAA%2BHaematoma+-+Long.gif Aorta https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/5e910551-eec8-460a-a0db-019cc75f15ef/Image007.jpg Aorta https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/8b6339d5-d4d3-43c3-b281-f5446a665c02/Image009.jpg Aorta https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/75aaf783-3ee5-457a-bffd-d91cf889586d/AAA+Trans1.gif Aorta https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/d77f4254-be55-41f8-b65d-50137fcaeb3c/AAA+4.2cm.gif Aorta https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/ab2ae466-be45-4cc2-bdc9-f2ca0637396a/Image001.jpg Aorta https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/682603f3-ec64-4d3c-bdfa-74f6618f00f7/AAALongitudinal.gif Aorta https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/33203dfc-751b-4446-bed5-0ef49f0c20ea/Image008.jpg Aorta https://ultra-sono.com/biliary daily 0.75 2022-12-02 https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1665679520066-VN5LZGB93TVVPLNSVTGN/BIliary+Anatomy.jpg Biliary https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1665679551208-2F89XMFS2AQULCIM1MO0/under+liver.jpg Biliary https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1665679563277-DVASCUVI4X2DVYAS4Q9H/inferior+liver.jpg Biliary https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1665679573039-0HXXOOUHFKK3NISJVOXV/inf+liver+veins.jpg Biliary https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1666199585631-ZIUA15B5Y4YUZAML9CD3/Anatomy+transversal.gif Biliary https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1666201506262-FWMHEJMFZIJRITZUJX9E/Long+Captioned.png Biliary - Map of Structures https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1666201543920-0UZUHG7IDPLRH3HYD2C9/GB+Long+%2B+Vessels.gif Biliary - Longitudinal View The same as before but in a dynamic clip. Sliding along and playing with the angle of the probe reveals the IVC in a longitudinal view. The emergence of the portal vein, together with the portal triad, lies at the neck of the gallbladder. Lastly, the thicker, pulsatile aorta lies on top of the vertebral bodies. Dr. Felipe Urriola P. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1666202192532-35I00CS0BLRA46G43WIG/Exclamation+Sign+Urriola.gif Biliary - Exclamation Sign! A closer look (10 cm) in a different patient. A normal gallbladder narrows down towards the neck, where it encounters the portal vein and portal triad. The hypoechoic structure lying deeper is the IVC. Dr. Felipe Urriola P. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1666204261852-7V9ALTKVJTMISAUZBP74/contractedGB.gif Biliary - Contracted Gallbladder In this clip, the gallbladder (centre right of the screen) appears collapsed, and the wall looks thickened. This is the normal appearance of a postprandial gallbladder which is contracted because it has just released its bile content into the duodenum for the digestion of a meal. Hannah Kopinksi and Dr. Lindsay Davis - NYU Emergency Medicine https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1666205405667-5BQZOIY9AAVGZXWAS2RJ/Rotation+Long+to+Trans.gif Biliary - 90º Rotation A 90º degree rotation to the right will show the GB in transverse view. Fan or slide the probe to assess from fundus to neck and back. Be sure to scan as much of the GB as possible to avoid missing stones or localized pathology. In this view, notice the resemblance of the GB to the IVC. Also, notice how part of the fundus is adhered to the liver, giving the appearance of a septum when fanning to cephalic. Dr. Felipe Urriola P. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1666205690632-FCU2B3IW5SM4TOVOWBYF/Transversal+and+Vessels.gif Biliary - Transverse View A normal gallbladder in transverse view. Notice both the IVC and Aorta lying on top of a vertebral body. All these structures may look similar. Always think about the anatomy and take a second to recognise the structures. Dr. Felipe Urriola P. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1666207210667-53NLPFP8F9XCB6S91VOD/RUQduodenum.gif Biliary - Duodenum In this clip, the probe is positioned over the RUQ. The liver is on the left side of the screen, and in the center of the screen we see a portion of the duodenum in cross-section. Often mistaken for a gallbladder full of gallstones by novices sonographers, it can be identified by its peristaltic waves with visible motion of the bowel contents within. Hannah Kopinksi and Dr. Lindsay Davis - NYU Emergency Medicine https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1667239929210-3VH6K7U3SWSWWOEGE00I/mygif.gif Biliary - Gallstone Compare this to the image on the left. This is not the duodenum, but a GB filled with gallstone. There is no peristalsis, and the stones cast a shadow. Dr Felipe Urriola P. | Resuscitation Fellow - Emergency Medicine | The Royal London Hospital, London. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1667235444838-D3SPYMDZDMF01T3P2JKU/05+WES+bowra.gif Biliary - Wall Echo Shadow Gallstones can be seen on the right side of the image with a hyperechoic front edge and posterior shadowing. Justin Bowra MBBS, FACEM, CCPU Emergency Physician, RNSH et al. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1667235230807-WCP7LBR8YTJVISMO6370/mygif.gif Biliary - Wall Echo Shadow Dr Felipe Urriola P. | Resuscitation Fellow - Emergency Medicine | The Royal London Hospital, London. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1667235246784-9C9VPPKC7DR7ZY32URO5/mygif.gif Biliary - WES Dr Felipe Urriola P. | Resuscitation Fellow - Emergency Medicine | The Royal London Hospital, London. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1667235459431-8A4YQL63NQJVUAHY1X7C/07+wes+2.gif Biliary - WES https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1667228464915-1FQKBYFWPXMNBQPO5ZP7/Cholelithiasis.gif Biliary - Cholelithiasis 46 yo Female. Background of obesity and frequent RUQ pain in the context of fatty meals. Attends ED with acute, intense RUQ pain. POCUS confirms a non-obstructive large stone in the GB. Dr Felipe Urriola P. | Emergency Department - Puerto Aysen Hospital, Patagonia, Chile. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1667228532232-UJBTJJNWLO1ME818KRHZ/Cholelithiasis+Long.gif Biliary - Cholelithiasis - Longitudinal 29 y/o Female. 4 hours with intense RUQ pain and vomiting. No fever. Evidence of cholelithiasis Don’t be confused by the inverted image and orientation of the image. Dr Felipe Urriola P. | Emergency Department - Puerto Aysen Hospital, Patagonia, Chile. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1667228697380-C2V1ONB9VVLKDECCBDLX/Cholelithiasis+Trans.gif Biliary - Cholelithiasis - Transversal 29 y/o Female. 4 hours with intense RUQ pain and vomiting. No fever. Evidence of cholelithiasis Don’t be confused by the inverted image and orientation of the image. Dr Felipe Urriola P. | Emergency Department - Puerto Aysen Hospital, Patagonia, Chile. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1667228940211-J79C76NQ7HOZU8ZNYVFE/Sludge+%26+Stone.gif Biliary - Sludge &amp; Stone 39 y/o Female. Attends ED after 6 hours of RUQ pain radiating to the back. No vomiting or fever. The pain started after eating a fatty meal last night. Reports multiple previous similar episodes, but no formal diagnosis or images performed until this consult. POCUS shows biliary sludge and a stone close to lying towards the GB neck. Dr Felipe Urriola P. | Emergency Department - Puerto Aysen Hospital, Patagonia, Chile. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1667229268073-0MJ32GHA6JYHUXP1MJ1X/Microlithiasis+Longitudinal.gif Biliary - Multiple Microlithiasis - Longitudinal 51 y/o Female. Attends ED with intense abdominal pain and vomiting. POCUS shows multiple small stones grouped in the GB body, casting a large posterior shadowing. Don’t be confused by the inverted image and orientation of the image. Dr Felipe Urriola P. | Emergency Department - Puerto Aysen Hospital, Patagonia, Chile. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1667229289299-A214PKA4ITMVLIJYM8AM/Microlithiasis++Transversal.gif Biliary - Multiple Microlithiasis - Transverse 51 y/o Female. Attends ED with intense abdominal pain and vomiting. POCUS shows multiple small stones grouped in the GB body, casting a large posterior shadowing. Don’t be confused by the inverted image and orientation of the image. Dr Felipe Urriola P. | Emergency Department - Puerto Aysen Hospital, Patagonia, Chile. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1667229573622-JJFP0IPCDE6LP2SFDK0T/Large+Stone+Long.gif Biliary - Cholelithiasis - Longitudinal 49 y/o Female. One week of intense RUQ abdominal pain. LFTs show raised Bilirrubin & GGT. POCUS shows a large hyperechoic structure within the GB, casting posterior shadows. The patient was admitted for management and formal US to assess CBD. Dr Felipe Urriola P. | Emergency Department - Puerto Aysen Hospital, Patagonia, Chile. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1667229586538-SY2FQ4SW9233WEF5W43I/Large+Stone+Trans.gif Biliary - Cholelithiasis - Transversal 49 y/o Female. One week of intense RUQ abdominal pain. LFTs show raised Bilirrubin & GGT. POCUS shows a large hyperechoic structure within the GB, casting posterior shadows. The patient was admitted for management and formal US to assess CBD. Dr Felipe Urriola P. | Emergency Department - Puerto Aysen Hospital, Patagonia, Chile. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1667233215271-3KX7YVNXTOFG62RMRRFF/Single+Stone+Long.gif Biliary - Longitudinal 32 y/o Female. RUQ Pain. Dr Felipe Urriola P. | Emergency Department - Puerto Aysen Hospital, Patagonia, Chile. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1667233241393-ZHJFGKZ8XL0Y6GFEUDP6/Single+Stone+Trans.gif Biliary - Transversal 32 y/o Female. RUQ Pain. Dr Felipe Urriola P. | Emergency Department - Puerto Aysen Hospital, Patagonia, Chile. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1667233679248-EKZAXW9FPGJCKQEWY07C/TransversoLongitudinal.gif Biliary - Multiple Small Stones Dr Felipe Urriola P. | Emergency Department - Puerto Aysen Hospital, Patagonia, Chile. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1667233734093-82TRLRD2P3EQH17C773N/mygif.gif Biliary - Microlithiasis Dr Felipe Urriola P. | Emergency Department - Puerto Aysen Hospital, Patagonia, Chile. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1667233816781-Y6F417Q6ON9A5JP8UESG/mygif.gif Biliary - Cholelithiasis 86 y/o female. RUQ pain Dr Felipe Urriola P. | Resuscitation Fellow - Emergency Medicine | The Royal London Hospital, London. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1667233941529-1GL17ODPFT3YA0JX4TE3/mygif.gif Biliary - Cholelithiasis 52 y/o Female. RUQ pain. Dr Felipe Urriola P. | Resuscitation Fellow - Emergency Medicine | The Royal London Hospital, London. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1667233965703-3FSAOM4B3JM0ESIQJBWY/Longitudinal.gif Biliary - Microlithiasis - Longitudinal 59 y/o female. 3 months history of RUQ pain, which is worse after eating. LFTs with obstructive jaundice pattern. POCUS shows multiple microlithiasis in both longitudinal and transverse views. Unable to assess CBD. Dr Felipe Urriola P. | Resuscitation Fellow - Emergency Medicine | The Royal London Hospital, London. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1667233978630-JWLJ7TVCC4NAMVFMDER9/Transversal.gif Biliary - Microlithiasis - Transverse 59 y/o female. 3 months history of RUQ pain, which is worse after eating. LFTs with obstructive jaundice pattern. POCUS shows multiple microlithiasis in both longitudinal and transverse views. Unable to assess CBD. Dr Felipe Urriola P. | Resuscitation Fellow - Emergency Medicine | The Royal London Hospital, London. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1667236672916-HVWQKG6XT462LAT30EHN/ezgif.com-optimize.gif Biliary - Cholecystitis with Obstructing Stone This clearly demonstrates a stone in the gallbladder neck as a hyperechoic structure with posterior shadowing. The neck is not always clearly visualized at first glance, so it is important to scan through the gallbladder in two planes to exclude stones in the neck. Other signs of acute cholecystitis include pericholecystic fluid, gallbladder wall thickening (>3mm), common bile duct dilatation, and positive sonographic Murphy's sign. Justin Bowra MBBS, FACEM, CCPU Emergency Physician, RNSH et al. (Mo) https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1667235650024-S3SPE0WPYAPFOYM0D5NT/03+pericholecystic+fluid.gif Biliary - Pericholecystic Fluid Free fluid can be appreciated around this gallbladder. This is called pericholecystic fluid. However, there are no stones, nor gallbladder wall thickening, and the sonographic Murphy's is negative. This free fluid is unlikely to be caused by cholecystitis. In this case, the free fluid came from a different source. Justin Bowra MBBS, FACEM, CCPU Emergency Physician, RNSH et al. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1667233529089-Z2LL3K2C144LGO16ENAA/mygif.gif Biliary - Impacted Stone 34 y/o Female. 1-day RUQ pain with vomiting and fever. POCUS shows an impacted stone at the GB’s neck, not mobilising with positional changes. Dr Felipe Urriola P. | Emergency Department - Puerto Aysen Hospital, Patagonia, Chile. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1667235679476-LG116W297Y0TU0H9AU53/04+angry+GB.gif Biliary - Angry GB A patient presented to the ED with altered mental status and anorexia; clinical findings were consistent with sepsis. POCUS revealed one angry gallbladder! You can appreciate gallbladder wall thickening (measuring 6mm), trace pericholecystic fluid, and shadowing from gallbladder sludge. Garrett Ghent, Resuscitationst and diagnostician; Norfolk, VA https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1667236415718-CS8LHGGX0CJ9W2DRR6RK/perifluid+trans.gif Biliary - Pericholecystic Fluid - Transverse Middle-aged Female with intense RUQ pain. POCUS show a noticeable amount of pericholecystic fluid. The GB walls appear thickened; however, the GB appears empty and acalculous. In this case, the patient was suffering from acute pancreatitis and did not have cholecystitis. Dr Felipe Urriola P. | Resuscitation Fellow - Emergency Medicine | The Royal London Hospital, London. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1667236595317-HC7VEEQ7FAB0HK0O6D7V/perifluid+long.gif Biliary - Pericholecystic Fluid - Longitudinal Middle-aged Female with intense RUQ pain. POCUS show a noticeable amount of pericholecystic fluid. The GB walls appear thickened; however, the GB appears empty and acalculous. In this case, the patient was suffering from acute pancreatitis and did not have cholecystitis. Dr Felipe Urriola P. | Resuscitation Fellow - Emergency Medicine | The Royal London Hospital, London. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1667236618155-EL4DBZSX1JNT9EZZ1BCI/image-asset.gif Biliary https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1667238563713-Z6D1P2UQJM4O6YAILL90/EmptyGB.gif Biliary - Charcot's Triad Middle-aged Female. One week history of progressive RUQ pain, vomiting and fever. Appears jaundiced on physical examination. POCUS shows a gallbladder without evidence of stones. Despite the walls being thick, the GB itself is small and non-distended (empty). Also, to the left of the GB, notice the common bile duct, adjacent to the portal vein and hepatic artery. Dr Felipe Urriola P. | Resuscitation Fellow - Emergency Medicine | The Royal London Hospital, London. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1667238581834-6PEC51AEBRAWVRMQNNRG/Dilated+CBD.gif Biliary - Dilated CBD Middle-aged Female. One week history of progressive RUQ pain, vomiting and fever. Appears jaundiced on physical examination. The Common bile duct becomes more evident under colour doppler inspection, as it has no colour flow. Notice how it appears dilated (almost 1 cm). There is no evidence of stones. Dr Felipe Urriola P. | Resuscitation Fellow - Emergency Medicine | The Royal London Hospital, London. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1667238659900-RYPHF2RHUNZYPWKRNU50/measurededit.png Biliary - Dilated CBD Middle-aged Female. One week history of progressive RUQ pain, vomiting and fever. Appears jaundiced on physical examination. The Common bile duct becomes more evident under colour doppler inspection, as it has no colour flow. At its widest point, it measures 8.2mm from inner to inner wall. The patient was admitted for IV antibiotics and further imaging study. Dr Felipe Urriola P. | Resuscitation Fellow - Emergency Medicine | The Royal London Hospital, London. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1667653365098-NA60QTVOTRW3JPY8J8M9/F_ABDOMEN_20221103_105057.jpeg Biliary - MR Colangio-Pancreatography The common bile duct is dilated, measuring 13 mm at the porta hepatis with upstream intrahepatic biliary duct dilatation. The CBD tapers smoothly towards the ampulla. No intraductal calculus or CBD stricture was seen. No sign of cholangiopathy. No periampullary mass was seen. There is no pancreatic duct dilatation. The findings are most in keeping with a choledochal cyst type 1a. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1667230206225-1SKWSDPUE7LH2VXS15P5/GB+stone.gif Biliary - Longitudinal 65-year-old Female with no medical background. Presents to ED with 6-hour RUQ pain, yet no associated vomiting or fever. POCUS reveals a hyperechoic structure within the gallbladder, casting posterior shadowing. Findings are compatible with a gallstone. Dr Felipe Urriola P. | Emergency Department - Puerto Aysen Hospital, Patagonia, Chile. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1667230241885-BQHXSA2IWMMOM4APW7C3/Dilated+CBD+%26+Stone+short.gif Biliary - Choledocolithiasis 65-year-old Female with no medical background. Presents to ED with 6-hour RUQ pain, yet no associated vomiting or fever. Upon further scanning, it is evident that both the Cystic and Common Bile Ducts are massively dilated. Also, there is a large stone within the CBD, causing dilation larger than 1 cm (centre of the screen) Dr Felipe Urriola P. | Emergency Department - Puerto Aysen Hospital, Patagonia, Chile. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1667230232197-ESP70X7ODG2XU7RAMMPR/2+stones.gif Biliary - Choledocolithiasis 65-year-old Female with no medical background. Presents to ED with 6-hour RUQ pain, yet no associated vomiting or fever. After repositioning the patient, it is possible to see a stone within the GB and at least one within the CBD, which is evidently dilated. Dr Felipe Urriola P. | Emergency Department - Puerto Aysen Hospital, Patagonia, Chile. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1667230484341-EUK4YRAGMFHYDAN3QPKK/anonym.png Biliary - Choledocolithiasis - CT scout 65-year-old Female with no medical background. Presents to ED with 6-hour RUQ pain, yet no associated vomiting or fever. The patient was referred to surgeons at the regional centre. This scout image from a contrasted CT shows the massively dilated common bile duct with four stones lined up inside. Remarkably the patient had only pain and didn’t develop jaundice or fever. Dr Felipe Urriola P. | Emergency Department - Puerto Aysen Hospital, Patagonia, Chile. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1667246904563-H9AOLTPB6GRFB1VA5Q8Q/GB%2BCBD.gif Biliary - Gallbladder and CBD In this clip, we see the liver on the left, and the IVC inferior to the liver with a hepatic vein draining into it. The ovoid anechoic gallbladder is in a long axis at the centre of the screen. To the left of the gallbladder, we see the portal vein in cross-section. Running just superior to the portal vein, in long axis, is the narrow common bile duct. Hannah Kopinksi and Dr. Lindsay Davis - NYU Emergency Medicine https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1667246738857-H235XPWUPMYLWXXA2WMG/CBD+Felipe.gif Biliary - Portal Triad Normal Anatomy – The large, “pulsatile” inferior vena cava lies at the bottom of the screen. Anterior to it and from left to right of the screen, we see the large portal vein and the small, round hepatic artery. Just above the hepatic artery lies another tubular structure with hyperechoic walls and an anechoic lumen; this is the common bile duct. Dr Felipe Urriola P. | Resuscitation Fellow - Emergency Medicine | The Royal London Hospital, London. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1667246749396-NHVUQL0VKQ5OGZ2I28T7/CBD+Doppler+Felipe.gif Biliary - Portal Triad - Doppler Normal Anatomy – The same image. Colour-doppler helps in discerning blood vessels from other anatomical structures. Anterior to the IVC and from left to right of the screen, portal vein (blue) and hepatic artery (red) with colour flow. Once again, just above the hepatic artery lies another tubular structure that presents hyperechoic walls and an anechoic lumen; this is the common bile duct. Dr Felipe Urriola P. | Resuscitation Fellow - Emergency Medicine | The Royal London Hospital, London. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1667246776547-U2NE8UQ4XKR46FDU8BWP/Full+CBD+Doppler.gif Biliary - Common Bile Duct Normal Anatomy – Often, a left lateral position delivers a clear image of the common bile duct (CBD), as is the case in this clip. Notice the normally hyperechoic walls and narrow diameter. The CBD inner wall diameter should be < 6 mm in healthy adults, although it can be enlarged in post-cholecystectomy patients. Dr Felipe Urriola P. | Resuscitation Fellow - Emergency Medicine | The Royal London Hospital, London. https://images.squarespace-cdn.com/content/v1/5ec321c2af33de48734cc929/1618497259178-6XJGK9GR6YAVBQL5L519/20140301_Trade-151_012-2.jpg Biliary https://images.squarespace-cdn.com/content/v1/5ec321c2af33de48734cc929/1607694583486-2PQT0LQ193RL7MCB6DX4/20140228_Trade+151_0046.jpg Biliary https://images.squarespace-cdn.com/content/v1/5ec321c2af33de48734cc929/1607694644871-IC85FNH781UNZSZEGHDR/Aro+Ha_0428.jpg Biliary https://images.squarespace-cdn.com/content/v1/5ec321c2af33de48734cc929/1589847767761-J2M1HI20BXRQ9XCR0HUD/Large+JPG-Aro+Ha_0387.jpg Biliary https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/6ae9bfd1-43c4-4034-bb2b-df358edf4161/Biliary+Banner.jpg Biliary https://ultra-sono.com/tim-harris daily 0.75 2022-10-19 https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/d207d353-295f-424a-bf1e-6c091b79ee80/TimHarris.png https://ultra-sono.com/lung daily 0.75 2024-03-18 https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/afb13d92-0e3a-4a56-9259-eb07a5a48730/Figure1-A-lines+2Dec2022.jpg Lung - Make it stand out Sound waves are cast by the transducer and traverse the skin, subcutaneous tissue and intercostal muscles, finally arriving at the pleura. Upon reaching the pleural line, the waves are reflected and bounce between the transducer and the visceral pleura, which is known as reverberation. The reverberation is interpreted on the screen as A-lines. Illustration by Nelly Pecheva. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669410285945-AO553ZAJO21JIMX1O97Z/Lung+Sliding+2.gif Lung - Lung Sliding https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669410281200-4V9687C5VFT6QA5TXC72/Lung+Sliding.gif Lung - Lung Sliding &amp; A-Lines https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669410318880-AXWEDS5B9U7P15ZXASVZ/Rt+Lung+Mid+Clav.gif Lung - A-Lines Normal lung sliding and A-lines across different intercostal spaces. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669574775189-H6FKSJSQPD4M1DOOZY0P/Lung+Curtain.gif Lung - Lung Curtain &amp; Diaphragm During inspiration, the expanding lung covers displace and obscure the view of the liver. Observe the lung sliding at the top of the screen and the curved hyperechoic diaphragm. Also, notice the hyperechoic vertebral bodies at the bottom of the image and how the spine is interrupted by the diaphragm. This is a normal and reassuring finding. Dr Felipe Urriola P. | Resuscitation Fellow - Emergency Medicine SpR | The Royal London Hospital, London. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669413009931-ZYP4URK3O4AEU4KBCXVU/%3E3+B-lines+in+3+Fields.gif Lung - B - Lines https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669413036144-5V7Y6IZWXG2TDT39DYQQ/%3E3+B-lines+in+Every+Field.gif Lung - Pathologic B-Lines Diffuse B-Lines in multiple adjacent fields. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669413125342-RPUVD2ARCYBZECAA0XY1/Lt+Lateral+Chest.gif Lung - Pathologic B-Lines Multiple B-Lines in two adjacent fields. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669413112049-L52UJX994W0M3YRQ61QI/Lt+Anterior+Chest.gif Lung - Pathologic B-lines Multiple apical B-lines in the left anterior chest wall. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/6b1df5a6-c383-4df7-98b3-0409ae24d7c4/Figure2-B-lines+2Dec2022.jpg Lung - Make it stand out B-lines are vertical, hyperechoic reverberation artefacts. They start at the pleural line and reach the bottom of the screen, moving with respiration. The presence of B-lines is due to air/water interfaces in the interlobular septa. Illustration by Nelly Pecheva. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669414434818-FA1YM6SQGDV1PMY68TRE/small+subpleural+consolidation.gif Lung - Trace Consolidation Small < 1cm consolidation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669413747950-OR4DR4LTCLUBU02VPV26/Small+Subpleural+consolidation.gif Lung - Small Consolidation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669825226394-JHIGJITHF5DCGOSHM2QM/small+anterior+consolidation.gif Lung - Small Consolidation 56 y/o female with clinical features compatible with CAP. Small consolidation on the anterior chest wall. Confirmed by CXR. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669413783384-HRIL4IL4RZWBD960KSAO/Small+Consolidation+Left+PLAPS.gif Lung - Consolidation Small Consolidation at the left lung base with focal B-lines https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669413879819-Z6COG0E9R9P06CXF1DSE/9cm+1.gif Lung - Shred Sign Consolidation with Air Bronchograms https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669414095301-XRS8Y92ACBGUHUDL1A4H/6cms.+Undefined+Lung+Shadow.gif Lung - Consolidation Small consolidation with air bronchograms https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669413845605-TMV1Y8J14P5NY2JB7Z7U/6cms.+Shred.gif Lung - Shred Sign Small consolidation with air bronchograms https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669413996782-FXWZUTFL0TAIKJP851A0/LT+base.gif Lung - Consolidation Left lung base consolidation. There is small pleural effusion and focal B-lines. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1680521208541-N0TWHG9X11QVNSGQ21SC/Rt+Base+Consolidation+01.gif Lung - Right Base Consolidation 40 y/o Female admitted to ICU with brittle asthma. After a lack of clinical progress with standard asthma therapy, a bedside echo revealed a slightly hyperdynamic LV and a medium-sized right lung base consolidation. The patient improved with antibiotic therapy and was subsequently discharged. Dr Felipe Urriola P. | Resuscitation Fellow | Barts Health NHS & QMUL. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669414584003-MHFKT5OPMMLP4T4HWC4V/Classic%2Bfindings%2Bpneumonia.gif Lung - Classic Findings in Pneumonia Pictured here are classic ultrasound findings for pneumonia including a shred sign, lung consolidation with dynamic air bronchograms and a small associated parapneumonic effusion. Note also adjacent B-lines. A shred sign represents the distinction between the consolidated lung and the aerated lung and is seen in this clip as the irregular “shredded” border just posterior to the consolidation. Aaron Inouye, PA-C, North Canyon Medical Center https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669414669663-TDVWEI9WDQPLN527EP0T/dynamic%2Bair%2Bbronchograms.gif Lung - Dynamic Air Bronchogram This patient actually had no cough, no crackles and only subtle changes on CXR but in seconds we had diagnosed pneumonia! Dynamic air bronchograms represent air bubbles moving up and down airways surrounded by alveolar consolidation. Lichtenstein et al compared this finding to static air bronchograms in a 2009 study of 68 ICU patients and found dynamic air bronchograms to be present in 32/52 cases of pneumonia but in only 1/16 cases of atelectasis - a specificity of 94%. Dr. Trauer https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669414632474-72BCC80EXN1416VIDBHY/dynamic%2Bair%2Bbronchogram.gif Lung - Dynamic Air Bronchogram This patient actually had no cough, no crackles and only subtle changes on CXR but in seconds we had diagnosed pneumonia! Dynamic air bronchograms represent air bubbles moving up and down airways surrounded by alveolar consolidation. Lichtenstein et al compared this finding to static air bronchograms in a 2009 study of 68 ICU patients and found dynamic air bronchograms to be present in 32/52 cases of pneumonia but in only 1/16 cases of atelectasis - a specificity of 94%. Dr. Trauer https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669414693780-Z1HGWP1O4IO9JLQ9C9C2/neumonia%2B%2B%2Bderrame.gif Lung - &lt;pneumonia This is a lung ultrasound image in PLAPS view in which we appreciate a consolidation pattern including dynamic air bronchograms as well as a small pleural effusion. The PLAPS view with these findings is a highly sensitivity and specific for the diagnosis of pneumonia. Renato Tambelli, Emergency Physician Hospital das Clínicas de Marília. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669416371640-O5L3YQCTS9UNCCM67GTJ/Left+Lung+Base.gif Lung - Large Effusion Male patient with CKD. Notice the diaphragm and a large effusion at the left lung base https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669416389457-5KB5W2YAPR0I42OMGF9G/Consolidated+Lung+with+Bronchograms.gif Lung - Large Effusion Male patient with CKD. Notice the diaphragm and a large effusion at the left lung base https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669416398914-01XBRNXF3Z6CM8QXBKAU/Jellyfish.gif Lung - Jellyfish Sign Collapsed lung with static air bronchograms floating in pleural fluid https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669416626780-OCN0RJDB2YGPHEG6GY2K/LUQ%2B.gif Lung - Pleural Effusion https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669416821145-BEITQHKC4U4L850DDUWV/EmpyemaM_CHEST_20220718_171244.jpeg Lung - Diagnosis? 62 y/o Male patient. One-week history of high fever, dry cough, general arthralgia and SOB. Chest and back pain while coughing or walking. O2Sat 92% on room air at presentation. The CXR shows a large opacity over the left lung, erasing the costophrenic angle. WBC 19.2, Neutrophils 17 and CRP 450. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669416705575-JMPTNK5D5QCOKMHGOE0O/LUQ%2B.gif Lung - Pleural Effusion Spleen, diaphragms and left-sided effusion with with consolidated lung https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669416995284-Q9XWJJZLKM6UPS77VUR0/LT+Chest+%7C+%3E2%3A3+Effusion+%7C+Back+Vertical+SlideUp+20mb..gif Lung - Diagnosis? https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669417031664-CBCE1RIHRCPR9E964D28/LT+Chest+%7C+%3E2%3A3+Effusion+%7C+Back+Vertical+SlideDown+18mb.gif Lung - Empyema The POCUS scan showed a moderate to large left pleural effusion (2/3) featuring abundant debris and loculation. The remanent lung is consolidated and collapsed. A pleural tap confirmed the suspected diagnosis of Empyema. A seldinger chest drain was placed by the respiratory team, and the patient recovered well within a week of IV ATB. Dr Felipe Urriola P. | Resuscitation Fellow - Emergency Medicine SpR | The Royal London Hospital, London. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669417242576-TPL4VFH2QCOSO9X5E99U/pericardial%2Bvs%2Bpleural.jpeg Lung https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669417292516-EGF0EFGX3TDICMHT6S1O/14.%2Bmcdermott%2Bpleural%2Beffusion.gif Lung - Pleural Effusion Don't forget to look behind the heart.... Use a survey sweep to look behind the heart for a multi-organ POCUS exam. In this PLAX view, there is a pleural effusion visible behind the posterior myocardium in the left lobe of the lung. This patient had lung consolidation with a parapneumonic effusion and rapid atrial fibrillation. Dr. Cian McDermott - Mater University Hospital, Dublin, Ireland https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669417368243-VAH94UCXDRZHTYUPQ01B/jellyfish%2B3.gif Lung - Unexpected Pleural Effusion Seen here is an unexpected finding while acquiring an apical 4 chamber view with a phased array probe. The four chambers of the heart are difficult to bring into view due to the presence of large left pleural effusion with ipsilateral collapsed lung floating within the pleural fluid. This visual of atelectatic lung swimming within a pleural effusion is referred to as “jellyfish sign”. Renato Tambelli, Emergency Physician Hospital das Clínicas de Marília, Brazil. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669574675556-UQ6K34S1ES6NMRBTA9E5/Lung+Curtain.gif Lung - Lung Curtain &amp; Diaphragm During inspiration, the expanding lung covers displace and obscure the view of the liver. Observe the lung sliding at the top of the screen and the curved hyperechoic diaphragm. Also, notice the hyperechoic vertebral bodies at the bottom of the image and how the spine is interrupted by the diaphragm. This is a normal and reassuring finding. Dr Felipe Urriola P. | Resuscitation Fellow - Emergency Medicine SpR | The Royal London Hospital, London. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669416023934-GXQ2ZLQGHGXSBH30OM6X/Right%2BLung%2BBase.gif Lung - Spine Sign Compare this to the previous image. The free fluid at the right lung base allows good visualisation of the spine cephalic to the diaphragm. This is known as the “spine sign” and indicates pleural effusion. Dr Felipe Urriola P. | Resuscitation Fellow - Emergency Medicine SpR | The Royal London Hospital, London. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669416074119-CQVCBD0VCAV4BXOVDF9F/Effusion%2B%26%2BSpine%2BSign.gif Lung - Spine Sign A 68 y/o Female with a background of CHF, resident of a rural, isolated community in Patagonia, presents to the local hospital with SoB and suspected pleural effusion. Symptoms of acute heart failure are refractory to initial treatment, requiring Air Rescue and transfer to the regional centre. POCUS performed on-flight shows a bilateral pleural effusion. This image shows a collapsed lung floating in fluid and the continuation of the spine cephalic to the diaphragm, or “spine sign”. Although using O2 support, the patient remained stable during the flight and was handed over for admission and management. Dr Felipe Urriola P. | Air Retrieval Service TASR | Aysen, Chilean Patagonia. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669416044495-OSSRU7QEH3PZ23WS8IJH/RUQ%2B.gif Lung - Pleural Fluid https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669418777883-1PBSTEQK407QP1X57ZKN/RTLungSlide.gif Lung - Lung Sliding 9 y/o Male patient. Asthmatic Attends ED feeling breathless and complaining of one week SOB, greater on exertion, feels the inhalers are not working. Also states pain in the left hemithorax. There is no background of trauma. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669418800875-W6OABFL15C7G8NRFIWSV/RTChestSlide.gif Lung - Right Chest Wall Is important to scan along the wall to confirm the presence of lung sliding in adjacent intercostal spaces. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669418835082-7O3F48I22XV496LWG1S5/LTAbsentLungSlide.gif Lung - Absent Lung Sliding This clip shows static A-lines, there is no movement or sliding. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669418842340-I9R3SPSPUNMMANL5JGOA/LTChestSlide.gif Lung - Left Chest Wall Absent lung sliding over the whole left chest wall, suggestive of a large pneumothorax. Comparing this clip with the normal right side makes the absence of lung sliding more evident. Dr Felipe Urriola P. | Resuscitation Fellow - Emergency Medicine SpR | The Royal London Hospital, London. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669418843700-JYAKCVX3CV1S44OH5LAU/PneumothoraxM_CHEST_20220711_120854%5B16564%5D.jpg Lung - CXR A Chest XR confirms the diagnosis. The patient was stable, and a Seldinger left chest drain was successfully placed. The patient was admitted for observation. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669428206952-6FG6W9UH301RZW2TBP0V/05.%2BLung%2Bpoint%2B2.gif Lung https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669428209856-JJUEB1BF3ZV633Y066L0/06.%2BDouble%2Blung%2Bpoint.gif Lung https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669428214199-J3WORXMGI04BOJSI4OD3/08.%2BLung%2Bpoint%2B4.gif Lung https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669428217427-PQC7P1MTXG2DKT67QMLK/07.%2BLung%2Bpoint%2B3.gif Lung https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669480635505-JCXSE3MCGWDPKV9AKHCQ/Punto+Pulmonar+ModoM+EN.jpg Lung https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669580168373-4E4EKKRQP0VBNFO8H0IQ/Figure3-lung-point2%2B11Nov2022.jpg Lung - Lung Point Illustration by Nelly Pecheva. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669996038342-VM4YMXN5ABRZDI2LLSGS/Figure4-lung-point+2Dec2022.jpg Lung - Lung Point Illustration by Nelly Pecheva. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/87e63b29-9bff-4757-a85a-ee9aa1b4d7b1/BLUE+Protocol+adapted+by+Urriola+%28white%29.jpeg Lung - Make it stand out This is a modification from Lichtenstein's original algorithm. The BLUE-protocol decision tree illustrates a diagnostic approach for the main causes of undifferentiated dyspnoea / acute respiratory failure. Notice that it includes a venous ultrasound scan. The PLAPS point is an addition to the diagram, as it represents the most sensitive point for finding effusion and consolidation regardless of the presence of lung sliding. Effusion is often found accompanying other disease processes. In this way, both Lung Sliding (anterior and lateral chest wall) and PLAPS point are entry doors to the diagram leading to or suggesting a diagnosis. Asthma/COPD is possible after having considered the other causes. Adapted by Felipe Urriola from ‘Lung Ultrasound in the Critically Ill’ (11). https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/582189ac-aef4-4ebb-98e5-ac7dc1d893cf/PLAPS%2BPoint.png Lung - Make it stand out Taken from ‘Lung Ultrasound in the Critically Ill’ (11). Areas of investigation and the BLUE-points. Two hands placed this way (size equivalent to the patient’s hands, upper hand touching the clavicle, thumbs excluded) correspond to the location of the lung, and allow three standardized points to be defined. The upperBLUE-point is at the middle of the upper hand. The lower-BLUE-point is at the middle of the lower palm. The PLAPS-point is defined by the intersection of: a horizontal line at the level of the lower BLUE-point; a vertical line at the posterior axillary line. Small probes, such as this Japanese microconvex one (1992), allow positioning posterior to this line as far as possible in supine patients, providing more sensitive detection of posterolateral alveolar or pleural syndromes (PLAPS). The diaphragm is usually at the lower end of the lower hand (11). https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/df8f202a-18fe-4c48-a50d-63c5049028d7/Rt+Lung+Mid+Clav.gif Lung https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/c89daf2d-f861-4d38-ba6a-41b699a80903/_3%2BB-lines%2Bin%2BEvery%2BField.gif Lung https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1a8e2605-d290-4a0d-918e-69f6951bd531/9cm+1.gif Lung https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/17134eae-cd52-4a7a-bfee-3a801d75a9a4/LT+Chest+%7C+%3E2%3A3+Effusion+%7C+Back+Vertical+SlideUp+20mb..gif Lung https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/d5743ecf-b568-4089-bd06-783d4c0bfee1/LTAbsentLungSlide.gif Lung https://ultra-sono.com/fast daily 0.75 2022-12-02 https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/2b264060-b855-4563-85e8-99249292dc51/5+Windows+Mono+English.jpg FAST - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669023098584-SB5FCN5NDM3HE6SZFUBI/bladdertrans.gif FAST - Normal 35 y/o female involved in an RTC. FAST scan negative for free fluid. Inferior to the bladder, notice the acoustic enhancement artefact and the uterus in a transversal cut. Dr Felipe Urriola P. | Resuscitation Fellow - Emergency Medicine SpR | The Royal London Hospital, London. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669023613931-V6B4BGND4VD2D98UTSMY/transmale.gif FAST - Normal Male trauma patient with negative FAST scan. Notice the prostate posterior to the bladder. Dr Felipe Urriola P. | Resuscitation Fellow - Emergency Medicine SpR | The Royal London Hospital, London. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669022264349-T456QCTBRI9FD2WT5UL1/SPTrans.gif FAST - Normal https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669022459747-KCQIEBR7CWTGQHGGZ4V0/Bladder+Trans.gif FAST - Normal https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669024996802-FNZR7L1WRDW571RMJFT7/PelvisTrans%2B.gif FAST - Positive Positive FAST scan in a male patient with CKD & PD. There is an abundant amount of free fluid superior and posterior to the bladder. Dr Felipe Urriola P. | Resuscitation Fellow - Emergency Medicine SpR | The Royal London Hospital, London. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669025008088-KHXY8YC4IBPR8UT8P7CR/PelvisLong%2B.gif FAST - Positive Positive FAST scan in a male patient with CKD & PD. There is an abundant amount of free fluid superior and posterior to the bladder. Dr Felipe Urriola P. | Resuscitation Fellow - Emergency Medicine SpR | The Royal London Hospital, London. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669025140024-GCJ1TSQGIOP3CAENENW2/SP%2BLong.gif FAST - Positive 25 y/o female with ruptured ovarian cyst. There is a small amount of free fluid superior and posterior to the bladder. Dr Felipe Urriola P. | Resuscitation Fellow - Emergency Medicine SpR | The Royal London Hospital, London. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669025120706-SU2TR08N4HA95M93PHHM/SP%2BInfravesical.gif FAST - Positive 25 y/o female with ruptured ovarian cyst. There is a small amount of free fluid superior and posterior to the bladder. Dr Felipe Urriola P. | Resuscitation Fellow - Emergency Medicine SpR | The Royal London Hospital, London. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669023021187-L7QEE52KO4VXNN67TR0X/bladderlong.gif FAST - Normal 35 y/o female involved in an RTC. FAST scan negative for free fluid. Posterior to the bladder, notice the vaginal canal and uterus, which then accommodates superior to the bladder in anteversion Dr Felipe Urriola P. | Resuscitation Fellow - Emergency Medicine SpR | The Royal London Hospital, London. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669023675666-MEJXT4EU51AZ103JNL83/longmale.gif FAST - Normal Male trauma patient with negative FAST scan. Compare this to the previous image and notice the prostate posterior to the bladder. The dark image superior to the bladder roof is a shadow cast by the bowel, not free fluid. Dr Felipe Urriola P. | Resuscitation Fellow - Emergency Medicine SpR | The Royal London Hospital, London. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669022506618-BOWQSDPQE8P3XMPE8Q2P/SPLong.gif FAST - Normal Notice the bowel peristalsis superior to the bladder, this is a normal finding https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669022491459-MJKUDM6HOZ5UTEQ9ERJL/Bladder+Long.gif FAST - Normal https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669032000475-NOCQ7ORKQQW5G6V29SY0/RUQ.gif FAST - Negative https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669032006596-Z9BD7ROMT5Q1HOZ9EM3I/RUQ.gif FAST - Negative https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669032250743-2TXVC4Q4U687RX21W0E6/RUQ.gif FAST - Negative https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669032271922-INZUQXL43BB4DVU652Y8/RUQ.gif FAST - Negative Normal FAST scan, negative for free fluid. Notice how the expanding lung generates the so-called “lung curtain” during inspiration, obscuring the visualisation of the liver and putting the pleural line in evidence at the top of the screen. This is a normal and reassuring finding. Dr Felipe Urriola P. | Resuscitation Fellow - Emergency Medicine SpR | The Royal London Hospital, London. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669032382547-WBMMQGV8909MGOM9JAU3/RUQ.gif FAST - Negative Normal FAST scan, negative for free fluid. Notice the hyperechoic vertebral bodies at the bottom of the image and how the spine is interrupted by the diaphragm. This is a normal and reassuring finding. Dr Felipe Urriola P. | Resuscitation Fellow - Emergency Medicine SpR | The Royal London Hospital, London. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669032061745-ZAIRSPHE2PCN2HIP6ROF/RUQ%2BMorison.gif FAST - Positive 25 y/o female with ruptured ovarian cyst. There is a small, linear amount of free fluid in the Morison’s pouch. Dr Felipe Urriola P. | Resuscitation Fellow - Emergency Medicine SpR | The Royal London Hospital, London. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669032091042-4HHEV5YU0CL63M652A1P/RUQ%2BLiverTip.gif FAST - Positive 25 y/o female with ruptured ovarian cyst. Small amount of free fluid in the Morison’s pouch with a noticeably larger collection around the liver tip. This highlight the importance of a complete scan Dr Felipe Urriola P. | Resuscitation Fellow - Emergency Medicine SpR | The Royal London Hospital, London. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669032052382-EBXMXKJGH8H4VR0O5N9Z/RUQ%2B.gif FAST - Positive Positive FAST scan in a male patient with CKD & PD. There is an abundant amount of free fluid around the liver capsule and tip Dr Felipe Urriola P. | Resuscitation Fellow - Emergency Medicine SpR | The Royal London Hospital, London. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669574875177-0QNHB4QQJJ93KVE832AC/Lung+Curtain.gif FAST - Lung Curtain &amp; Diaphragm During inspiration, the expanding lung covers displace and obscure the view of the liver. Observe the lung sliding at the top of the screen and the curved hyperechoic diaphragm. Also, notice the hyperechoic vertebral bodies at the bottom of the image and how the spine is interrupted by the diaphragm. This is a normal and reassuring finding. Dr Felipe Urriola P. | Resuscitation Fellow - Emergency Medicine SpR | The Royal London Hospital, London. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669033188870-XVPOZ58KIKRC78ZBWF8Y/Right+Lung+Base.gif FAST - Spine Sign Compare this to the previous image. The free fluid at the right lung base allows good visualisation of the spine cephalic to the diaphragm. This is known as the “spine sign” and indicates pleural effusion. Dr Felipe Urriola P. | Resuscitation Fellow - Emergency Medicine SpR | The Royal London Hospital, London. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669033268378-6RARVCC4ITNWSTSVVI8F/Effusion+%26+Spine+Sign.gif FAST - Spine Sign A 68 y/o Female with a background of CHF, resident of a rural, isolated community in Patagonia, presents to the local hospital with SoB and suspected pleural effusion. Symptoms of acute heart failure are refractory to initial treatment, requiring Air Rescue and transfer to the regional centre. POCUS performed on-flight shows a bilateral pleural effusion. This image shows a collapsed lung floating in fluid and the continuation of the spine cephalic to the diaphragm, or “spine sign”. Although using O2 support, the patient remained stable during the flight and was handed over for admission and management. Dr Felipe Urriola P. | Air Retrieval Service TASR | Aysen, Chilean Patagonia. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669033220362-PW5QF7WBAY66051D2HNI/RUQ%2B.gif FAST - Positive https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669034950887-P6MJKGD0U6GQP6G5ZAEV/LUQ.gif FAST - Negative https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669034458632-XKLC8GOHK8NTIWV5RDPI/LUQ%2BFibrine.gif FAST - Haemoperitoneum 25 y/o Female patient with 12 hours of intense pelvic/abdominal pain. The pain is worse when lying down, radiating to the right shoulder, so bad that it prevents the patient from lying down for more than a few seconds. Associates nausea and vomiting. Raised inflammatory markers. Negative BHCG. Urinalysis normal. There is a significant amount of free fluid around the spleen. Notice the fibrine strings in between the spleen and the bowel, pointing towards the diagnosis of hemoperitoneum, which was later confirmed by a CT scan. Dr Felipe Urriola P. | Resuscitation Fellow - Emergency Medicine SpR | The Royal London Hospital, London. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669034492732-9TQTEVWTWG35FJ3FRWSQ/LUQ%2BFibrine%26Bowel.gif FAST - Haemoperitoneum There is a significant amount of free fluid around the spleen. Notice the fibrine strings in between the spleen and the bowel, pointing towards the diagnosis of hemoperitoneum, which was later confirmed by a CT scan. Dr Felipe Urriola P. | Resuscitation Fellow - Emergency Medicine SpR | The Royal London Hospital, London. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669034411444-8VRS7Z8MB1RNCI5IMIQD/LUQ%2B.gif FAST - Positive Positive FAST scan in a male patient with CKD & PD. There is a small amount of free fluid around the spleen. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669037451746-LLWUUW8UWX67TJ524GZX/05.+sub-xiphoid-heart-10GIF.gif FAST https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669037459061-9EI4OCXETI0E441GBA3J/06.+pericardialeffusion-pericardial-cardiology-tamponade-radiology-original.gif FAST https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669037484283-EF55SWZ5REP5O3CLBS9M/07.+RV+collapse.gif FAST https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669037489559-UFVM7RIRYRFCMQMIWUPN/08.+pericardial_tamponade_-_RV_collapse-GIF.gif FAST https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669035662042-COC90KE30M5IF6MOV549/01.+subxiphoid+view.gif FAST https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669035478967-LTBAG4OXIURLMXI929UR/SX.gif FAST - Negative https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669035570802-5YWFTT39EFGEDUG7S5KF/SX.gif FAST - Negative https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669036884007-MF6ZWO4RWGSW4K9GJTBI/SubXi.gif FAST - Negative https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669038115767-KRX585BC6B7DNC1QLD3Z/SX-.gif FAST https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669035870764-W23OBIDKAIG4XMZWK5JY/SX.gif FAST - Negative https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669037029555-JQXNWBB82PCAPBVB2DRG/SX.gif FAST - Negative https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669037002193-S7TLE9HG47EINTTGVUVT/SX%2BIVC.gif FAST - Negative https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669040038634-ZEJ4ONQ4AO24NKR7X76Z/05.+Lung+point+2.gif FAST https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669040039742-1HBW6ZAZ67VK73GSYSL5/06.+Double+lung+point.gif FAST https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669040042689-8HEUWZZR8R30W4HBF1EN/08.+Lung+point+4.gif FAST https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669040041755-SD52E9QAKW5VCAS2OUAI/07.+Lung%2Bpoint%2B3.gif FAST https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669040038274-1B302N1DH53D1VD4H4XH/04.+Lung+M+mode.gif FAST https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669037843592-V0D3I16MNZYRXF3HQO7Y/Lung+Sliding.gif FAST - Lung Sliding https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669037851601-9XV3H6D3K3ID4Y4LDMDA/Lung+Sliding+2.gif FAST - Lung Sliding https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669038705890-EVQ2370K155HUY8ZCMMO/Rt+Lung+Mid+Clav.gif FAST - Anterior Chest Wall (Right) https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669037891475-0HSPZES3HW8BR1ALG841/Lt+Lung+Mid+Clav.gif FAST - Anterior Chest Wall (Left) https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669039758898-RD8EG16WZ62S22MY9CAN/%3E3+B-lines+in+Every+Field.gif FAST - B-lines B-lines artefact, secondary to interstitial oedema. The presence of B lines rules-out pneumothorax, as the artefact cannot be seen if there is trapped air between the pleural layers. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669038259775-8RIPEPTETRD2KYKE0J3I/RTLungSlide.gif FAST - Right Side 49 y/o Male patient. Asthmatic Attends ED feeling breathless and complaining of one week SOB, greater on exertion, feels the inhalers are not working. Also states pain in the left hemithorax. There is no background of trauma. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669038273595-U8Q0PFHEKYRZM2Z5XY7U/RTChestSlide.gif FAST - Right Chest Wall Is important to scan along the wall to confirm the presence of lung sliding in adjacent intercostal spaces. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669038303917-HCX6SB6S66RBGHAL90OL/LTAbsentLungSlide.gif FAST - Absent Lung Sliding This clip shows static A-lines, there is no movement or sliding. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669038313387-CQB3FYEXO2PD9KE0Y9QO/LTChestSlide.gif FAST - Left Chest wall Absent lung sliding over the whole left chest wall, suggestive of a large pneumothorax. Comparing this clip with the normal right side makes the absence of lung sliding more evident. Dr Felipe Urriola P. | Resuscitation Fellow - Emergency Medicine SpR | The Royal London Hospital, London. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669039580194-8RWKBI42UTH7YNOABBQR/PneumothoraxM_CHEST_20220711_120854%5B16564%5D.jpg FAST - CXR A Chest XR confirms the diagnosis. The patient was stable, and a Seldinger left chest drain was successfully placed. The patient was admitted for observation. https://images.squarespace-cdn.com/content/v1/5ec321c2af33de48734cc929/1618497259178-6XJGK9GR6YAVBQL5L519/20140301_Trade-151_012-2.jpg FAST https://images.squarespace-cdn.com/content/v1/5ec321c2af33de48734cc929/1607694644871-IC85FNH781UNZSZEGHDR/Aro+Ha_0428.jpg FAST https://images.squarespace-cdn.com/content/v1/5ec321c2af33de48734cc929/1589847767761-J2M1HI20BXRQ9XCR0HUD/Large+JPG-Aro+Ha_0387.jpg FAST https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/679990e8-71c7-4a42-95bd-6434951561c2/anatomia_RBAI078_0026.jpg FAST https://ultra-sono.com/heart-interpretation daily 0.75 2024-05-26 https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/a6640c29-d702-49f6-9fdd-dc06a6636c65/EPSS.png Heart: Interpretation - Make it stand out Depiction of E-point septal separation: M-mode is used to measure the distance between the open mitral valve and the ventricular septum. Measurements greater than 7 mm are suggestive of depressed systolic ejection. (1. RV free wall, 2. Interventricular septum, 3. Mitral valve, 4. LV free wall). From: The "5Es" of emergency physician-performed focused cardiac ultrasound (11). https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669585300107-F13NVR3V49BWNCP2KNCE/A4C+atrial+thrombus.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669585314728-VUCNAHEA6ECOFX9ZGD5W/actue%2Bcor%2Bpulmonale.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669585349613-AZ9XLSC3JTTSYNRWR3F1/PLAX+RV+and+RA+strain.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669585323041-I0V7RREVPUZCTL92T0DD/cor+pulmonale.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669585327666-U61L7WWYAHH29E3K2LXV/dsign%2B2.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669585346783-ISRZMTDU0DVXP7FARLEK/butterfly+D+sign.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669584827611-UHHJ4SD7K7RX8V9SNV2W/pericardial+vs+pleural+1.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669584833511-1U3WQGBK31KFEV1P0H6Y/pericardial+vs+pleural+2.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669584835228-TQ6H51XZ09E8Y47XYEHC/pericardial+vs+pleural+4.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669584882803-SZV3P9AXAAFB7D4WT2DP/apical+cardiac+tamponade.gif Heart: Interpretation - Cardiac Tamponade in Apical View Apical view demonstrating rocking heart with diastolic collapse of RV free wall. Justin Bowra MBBS, FACEM, CCPU Emergency Physician, RNSH et al. (Dr. Orr) ThePOCUSAtlas https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669584896921-1PCBAEN3IIN1QN5TD38C/pericardial%2Bhematoma.gif Heart: Interpretation - Pericardial Effusion with Hematoma This is a subcostal view of a patient presenting after a motor vehicle collision. The image demonstrates a pericardial effusion containing a large hypoechoic mobile structure concerning for hematoma. Image courtesy of IUEM Ultrasound & ThePOCUSAtlas https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669584885742-8ADDHHU8DYOP4GWHW39R/Hemorrhagic%2BCardiac%2BTamponade.gif Heart: Interpretation - Acute Traumatic Cardiac Tamponade WCUME 2017 Submission for "Best POCUS" Massive hemopericardium with coagulating blood and tamponade in a pediatric trauma patient. The patient went straight to the OR based on this image! Dr. Sarah Medeiros - Sacramento, CA ThePOCUSAtlas https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669584897228-SJRZO0N1F7D3NCP2RNA8/tamponade+plax.gif Heart: Interpretation - Cardiac Tamponade 60 y/o M with metastatic lymphoma presented with SOB over 3 days. POCUS revealed a pericardial effusion that, along with his vital signs and clinical picture, altogether suggested pericardial tamponade. Notice the diastolic collapse of the right ventricle (as the mitral valve opens, the right ventricle free wall collapses). Mitral and tricuspid inflow velocities were also used as a surrogate for pulsus paradoxus. Dr. Stephen Alerhand - Mt Sinai Hospital, NYC ThePOCUSAtlas https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669584903716-S33K38OSZ6SXYBDOIL0I/tamponade%2Bparasternal%2Blong.gif Heart: Interpretation - Cardiac Tamponade Parasternal Long 41 yo M with history of stage 4 lung cancer presents with AMS and dyspnea, normotensive and tachycardic to 140s. Parasternal long view showed moderate pericardial effusion with RV collapse. With M mode we are able to see the RV wall collapse (top line) corresponds with the mitral valve opening i.e. it occurs during diastole. Even though the patient was normotensive he was taken to the OR for a pericardial window within the hour given this evidence of echocardiographic tamponade. Nathan Kabariti MS4, Dr. Charles Murchison, Dr. John Riggins, Dr. Donald Doukas - Kings County Emergency Medicine ThePOCUSAtlas https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669584908767-5MZPTJCYKQHXGPQLJKPX/tamponade%2Bparasternal%2Bshort.gif Heart: Interpretation - Cardiac Tamponade Parasternal Short 41 yo M with history of stage 4 lung cancer presents with AMS and dyspnea, normotensive and tachycardic to 140s. Parasternal long view showed moderate pericardial effusion with RV collapse. With M mode we are able to see the RV wall collapse (top line) corresponds with the mitral valve opening i.e. it occurs during diastole. Even though the patient was normotensive he was taken to the OR for a pericardial window within the hour given this evidence of echocardiographic tamponade. Nathan Kabariti MS4, Dr. Charles Murchison, Dr. John Riggins, Dr. Donald Doukas - Kings County Emergency Medicine ThePOCUSAtlas https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/e441ad04-5a54-44a6-8aa1-19dafcbddba2/M-Mode+Tamponade.png Heart: Interpretation - Make it stand out M-mode is used to demonstrate RV collapse (arrow) occurring right after mitral valve opening during diastole. (star = pericardial effusion, 1. RV free wall, 2. Interventricular septum, 3. mitral valve, 4. LV free wall). From: The "5Es" of emergency physician-performed focused cardiac ultrasound (11). https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669584276327-4NR8P0L8XXPWBPM344MO/suprasternal+notch+flap.gif Heart: Interpretation - Type B Thoracic Aortic Dissection Flap on Suprasternal View This is a suprasternal notch view demonstrating an aortic flap in a patient with a Stanford Type B thoracic aortic dissection. This 40ish year old was a truck driver with untreated hypertension with sudden onset interscapular pain that migrated to his lumbar area. He stopped, lost strength in his right leg and was transported to our ED. The POCUS allowed the CV surgeon to prepare while the confirmatory CTA and standard treatment were performed. Suprasternal notch imaging with the linear or fine parts probe in a patient with suspicious signs/symptoms allows for a more rapid diagnosis of thoracic aortic dissection. John E. Hipskind, MD, FACEP Clerkship Director Kaweah Delta Hospital ThePOCUSAtlas https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1702059569109-HQO2XRZKISBJLKC3Y28Z/image-asset.gif Heart: Interpretation - Aortic Dissection Flap in Arch of Aorta A 65-year-old male presents with shortness of breath (no chest pain) and was found to have a dilated aortic root on CT pulmonary angiogram. POCUS (supra sternal view) showed a dissection flap in the arch of aorta; a finding subsequently confirmed on CT aortagram. Patient was sent for emergency surgical intervention. Dr.Rajasutharsan Kathirgamanathan, Emergency Physician The Northern Hospital, Melbourne, Australia ThePOCUSAtlas https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1702059738792-F5KXWMZCR9SH3K8YVOTG/image-asset+%282%29.gif Heart: Interpretation - Suprasternal View of Type A Dissection Suprasternal notch view shows a mobile intimal dissection flap in the aortic arch. Michael Cover, MD ThePOCUSAtlas https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669584260547-7R44QH8VRCTYM6E07EL7/dissection+B+with+flap.gif Heart: Interpretation - Descending Thoracic Aortic Dissection This is a parasternal long axis view of an elderly male with PMH of hypertension and DM presenting with a dissection of the descending aorta (aka type B aortic dissection). Image courtesy of Robert Jones, DO, FACEP @RJonesSonoEM Director, Emergency Ultrasound; MetroHealth Medical Center; Professor, Case Western Reserve Medical School, Cleveland, OH ThePOCUSAtlas https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669584273066-82PHV62F05Q5F32X8L3G/riscinti%2Bdissection%2Btamponade.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669584265585-168BRNMITHUIPGSW4BGW/dissection+with+flap.gif Heart: Interpretation - Aortic Dissection Flap Visualized in Proximal Aorta with Root Dilation This is a parasternal long axis view demonstrating significant enlargement of the aortic root with an identified dissection flap located in the proximal ascending aorta. (Notice the orientation in this PLAX view is inverted – LV Apex is at the right of the screen) Frances Russell, MD, RDMS Assistant Professor of Emergency Medicine Division Chief, Ultrasound Fellowship Director, Ultrasound ThePOCUSAtlas https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/17cd6905-acb1-4af7-bb17-0c6f5b0f33af/IVC+%2B+sniff.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/09766455-8c15-4d98-9836-2d8d62aacbe9/Normal%2BIVC%2Bto%2BAA%2Bdrag%2B-%2BLongitudinal%2BView.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/ac24c61d-3784-4e12-a673-8621729ecd41/Normal%2Baorta%2B%26%2BIVC%2B-%2BTransverse.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/acb94957-940d-4afc-854c-6f5c3a8ff083/IVC.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/547e5f45-c637-4679-8127-a38cf4475c6d/Normal+IVC+Label.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/79e8387e-cb57-4c3f-a02f-a2d71381df1a/small+ivc.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/ce0a3d7f-d571-432e-808c-9d2a3a4cb21f/2cm+ivc.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/8c2dc697-6546-47a0-9d11-de1c3284d999/PLAX2.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/eefe966b-d516-4d4f-91b3-8ff2a16796f6/PSAX.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/47d42727-73f7-44a6-8dbe-748b2fbfe5af/A4C.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/83d63401-9c47-4bc0-b418-b773ba8c70a2/PLAX.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/649928e2-70d8-48ce-8b35-e7ad5583c24f/PSAX+Papillary.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/7672bf7b-6781-459e-b06f-c2143293bbfa/SX.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/6b23a6d8-760b-4d3a-aa5f-258b864f2f0f/A4C.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/9a11fa22-4020-4c92-8050-d16c81995578/PLAX+15cm.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/f241e460-2f36-48d5-9b76-a1dbdaba3ec6/PSAX.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/6cdc3adb-36dd-4c85-b1e5-54df06715a98/A4C.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/f5734fae-750f-45e5-bae8-fc07cba09599/SX.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/34d7247c-85e0-4c6f-8a83-5745652f3ca8/IVC.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/a0f1d0d4-16b8-4073-9ad1-172ac07f8d70/PLAX.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/8fcb9fee-adfe-4996-b5e1-c8c83c01ef6a/PSAX.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/537ce1a3-af5f-4970-a48b-6a647623f3c4/A4C.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/ccae6134-689b-4503-bf42-7e95dc18060b/SX.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/54fc325a-8765-4c85-9817-4b5cd78ac3a7/IVC.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/c8c85162-d11d-4ebb-a69a-d2dcdeac8c65/PLAX.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/f529e2c4-34a9-4fc7-9999-40b4df15049d/PSAX.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/5bd52e8d-f69a-4ca4-8044-0cad9df9472c/A4C+%2802%29.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/7c4431f6-790c-46ca-b738-bf6063e20679/PLAX.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/b6056d8c-4fd2-496b-b574-f13fcb60b3e9/PSAX.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/db36d205-a38c-411b-8f01-aeed5166e69e/IVC.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/34e3ada2-2a2f-4d82-a982-dc67570adae4/SX.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/9a31e814-28ba-4351-be44-a2c26bdc79f2/IVC.gif Heart: Interpretation 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https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/33bbdbf1-550d-48e6-acb9-9338771e0066/A4C.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/2fcca3f4-1d65-4382-a66c-eacb1f96a1c2/SX.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/3ab93d24-a86b-44fa-8632-cefdc3e2f7f8/IVC.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/f82d87b0-8c95-4ef6-bb27-5f487e37acbe/lt+anterior+lung.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/2d430c7b-e043-4c55-8eaa-4b5494df3e37/rt+anterior+lung.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/cf2f763d-0682-4dc9-8da6-607ade86ace2/PLAX.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/4b98bab1-c876-41e6-9d52-2a14a6f64b09/PSAX+Papillary.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/01ca78c6-5d20-4498-889d-e2c417c9134b/A4C+%28rt+chambers%29.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/6b5868c2-a67e-4e2e-8374-43472c45503f/A4C.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/45b3ac4f-acbb-4529-b63e-d252a596adfd/SX.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/d516634c-bf14-4e09-9532-4a72220f27f0/IVC.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/c771e396-e472-472a-847c-aa18a02197be/PLAX.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/98d2d0bb-ab4b-4ab7-9b43-50fb02206909/PSAX+Mitral.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/c9200626-8ddf-4f26-b118-88d0daeb8c53/A4C.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1c0cbd7b-8d79-4520-b490-912596f33083/SX.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/3b7016ad-b0c2-404e-bf46-c0c98b86f85e/PLAX.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/15dea18b-c25c-4fdb-9bf6-459d4ddf12d9/D-Sign.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/7bc53125-b5a4-4355-8da0-c434143f7039/A4Ca.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/09054504-23db-4e10-b21a-c7513f9d8a03/SX.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/9787c9ef-1130-4579-9ea5-e6ed27c5846d/IVC.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/ccc35661-2061-4363-a630-754841abb71e/A4C.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/b3770bc4-6d0e-438c-98f0-dfd1c581c138/PLAX.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/aa9e12c4-a6de-4b63-8646-d686b33eaa2e/PSAX.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/7c73c186-e742-4ef0-8716-7e1a359ae8b3/SX.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/2f10106c-60e1-4c17-8caf-1ac15bdea714/PLAX.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/91ddbf37-0d89-4b7e-b717-586d220af890/PSAX.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/fb6d2e82-d204-495f-b37c-7cf9290d3e40/A4C+Swing.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/db3ec175-b821-466e-81e7-bf8eb064b720/SX.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/8933df05-6eb4-4616-a953-689214666195/PLAX%2802%29.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/53fed18e-8c32-4feb-a969-a2c60d8c81ea/PSAX+Mitral.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/677ff0a1-4e26-4189-b7fd-c4e40095c19f/A4C.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/63013f7f-d634-46ae-815f-84fdd7c46b10/SX.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/41d66acf-74bb-473b-90a5-2ee66c3ea9e1/IVC.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/3aca9ef6-3472-4316-be16-dabae17f1c2c/SX.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/4b4e5886-6fb8-4d74-a4b0-e7732c21f45b/A4C.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/b1ab6344-1558-4844-9c4e-8c4d5575580a/PLAX+19cm.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/9d5d32ea-3ff9-427e-8ffa-0877e2848870/PLAX+pleural+effusion.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/50babe8c-3b6d-48e5-941c-acd7279b7ef1/PLAX.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/34686e6b-8484-42d8-ae82-0e47e4efd40b/A4C.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/b82a87fe-1b29-410e-8ac2-21266eccd22f/Lt+Lung+Base.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/be9c2951-52a8-46d6-931d-d7e75a96021c/Rt+Lung+Base.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/c08235f0-76d7-4f7f-8227-4b0f77a9d108/RUQ.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/46d75f4f-e4b0-48c2-a066-948812f0521e/PLAX1.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/f80d3585-fce2-4174-bf84-d1773bd345aa/PSAX.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/779186ed-81fe-4c28-adc6-c5790305f08f/SX+Pleural+effusion.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/0b39200e-7813-40d9-8816-cf289e3b4eb9/A4C.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/d0be2aef-ce60-47cc-8ada-d565519eba45/PLAX+AoRoot.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/d9b1c9b0-7195-4ff2-98b9-4b9859712e33/PLAX-Normal-Labels.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/5f3f7eb2-48fb-496c-a721-23c53ef4c0b6/PSAX-Normal-Labels.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/e53af653-6dd2-4f6e-8e7f-49dda13d7de9/A4C-Normal-Labels.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/10964284-1eed-457f-b24d-5113bc4baad7/SX-Normal-Labels.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/ebe36fdd-d021-45c7-a77b-7bc6218e12a6/1to1to1.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/17895670-27fd-488c-be3f-54e6a7597b8a/mygif.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/3c4511d0-10cc-4dc1-9f22-48ef31cb919e/Image003.png Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/bbeb59fb-4bf0-4569-bae0-516a91a3d430/undefined.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/bbffd0bc-c64d-406a-acd0-c0b4565258c5/Aneurysmatic+arch.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/4e2e28a1-ff8a-48a7-9459-13d3098145ff/further+aortic+arch.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/15cfdbd4-41cd-4a06-ae10-949d437939e0/IVC.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/0650e5c2-8b14-4a6d-bb58-84a046ba68e9/PSAX+Mitral.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/2bf66727-8d60-4a7e-8b9c-58dd0d29c3dc/PLAX.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/d5c94de7-9c87-4a80-94b8-fb77055f7c1e/A4C.gif Heart: Interpretation https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/d643441b-62c4-4078-9be1-ad7725f2c619/Aneurysmatic+arch.gif Heart: Interpretation https://ultra-sono.com/heart-basics daily 0.75 2023-07-09 https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/306041af-022a-44ba-9149-cdc2fe89d1bd/Heart+and+Lungs+wo+numbers.jpg https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/153c2a19-30b7-45c2-80f0-fafddecd6fe1/PLAX.gif Echocardiography: Basics - Make it stand out Parasternal Long Axis View: The right ventricle is anterior and appears on the screen closest to the probe. The left ventricle is seen deeper to the right ventricle. Marking dot on the right. The apex of the heart points to the left of the screen. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/9b143b93-415a-4032-83ed-f45713b0575e/heart+axis+white+plane.jpg Echocardiography: Basics - Make it stand out In echocardiography, the heart is viewed in its long and short axis (parasternal views), as much as in a coronal plane going horizontally (white colour) in the long axis (apical and subcostal views). https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669489761223-E9VPB4WQVZ1ESXY3PKYY/Heart_lpla_echocardiography_diagram.jpg Echocardiography: Basics https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669489759229-EGE5LN3JHXFTM475CPJD/PLAX+View+drawing%3Eecho.jpg Echocardiography: Basics https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669489760395-SW1O6VRWHJTVQO76LGF8/PLAX+View+echo%3Edrawing.jpg Echocardiography: Basics https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669492348580-L9XI7JK81EGDFF3PD5LH/PSAX+View+drawing%3Eecho.jpg Echocardiography: Basics https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669492348580-P7Y3I5MSM7K98D3HTVYU/PSAX+View+echo%3Edrawing.jpg Echocardiography: Basics https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669492770580-F7K4TXNW572EDXRHKMZN/A4C+View+drawing%3Eecho.jpg Echocardiography: Basics https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1669492770331-9AVUBGZ0X2R5FNOHBNIX/A4C+View+echo%3Edrawing.jpg Echocardiography: Basics https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/a193d1ce-6777-4462-8357-04fe4e8f1e92/Normal%2BSubxiphoid%2B4.gif Echocardiography: Basics - Make it stand out Whatever it is, the way you tell your story online can make all the difference. https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/22d2baba-63d0-4c84-b102-261b52aee758/PLAX.gif Echocardiography: Basics https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/6addb34e-e408-4db6-8a80-4c27e2f8a748/PSAX.gif Echocardiography: Basics https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/4a72986b-1473-4b2d-8375-c664808ae196/A4C.gif Echocardiography: Basics https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/ccb63d8c-9bf2-41bc-92ba-4a58b9f44e53/IVC.gif Echocardiography: Basics https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/4dd2be19-f10f-409b-a8b8-8f133ae70fdf/SX.gif Echocardiography: Basics https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/c9ee2d37-b715-4646-8ee8-6ed37deafae8/PLAX.gif Echocardiography: Basics https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/f59c089b-cf6c-4e6a-8e2f-feb9d5c94828/PLAX+labeles.gif Echocardiography: Basics https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/b5256982-caf4-4d01-a872-586fbae8a265/PLAX.gif Echocardiography: Basics https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/4ccc6bb2-d43a-4da9-97c7-75faa0eacb59/PLAX.gif Echocardiography: Basics https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/9271472d-d28f-45b2-905d-b5d8a7f88a9b/PSAX.gif Echocardiography: Basics https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/d0803e7d-6024-4808-b739-73d3a42e98bd/PSAX+labeled.gif Echocardiography: Basics https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1991c796-537a-4730-b10c-9359ef61040a/A4C+labeled.gif Echocardiography: Basics https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/5b1dc8ee-ab55-4316-a11e-2d4a5b8b630d/A4C.gif Echocardiography: Basics https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/3e49ff26-88b3-4e7d-a77c-7b841fcf99e0/A4C.gif Echocardiography: Basics https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/049d0ec5-21ff-44b2-bcbc-571a02b2e272/SX.gif Echocardiography: Basics https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/63d228e6-7c50-4f1b-8302-bd57dee2b284/SX+labeled.gif Echocardiography: Basics https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/9310b5ed-3a2c-46af-8e85-f7544bebeaf8/SX+%282%29.gif Echocardiography: Basics https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/bfed36f2-60c9-4c38-8c00-aca3ee1996fd/IVC.gif Echocardiography: Basics https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/aad16bc8-5af6-468a-8b66-db84f02c1242/IVC+labeled.gif Echocardiography: Basics https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/c4f0472c-1638-43c8-b3c7-79782903621f/IVC+%2B+sniff.gif Echocardiography: Basics https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/ace1d3f4-b36c-43a0-8f32-8cd917f4b142/PLAX.gif Echocardiography: Basics https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/bc4913c5-852b-4db8-b3ef-438c777ef00a/PSAX.gif Echocardiography: Basics https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/56da8e52-4f9a-4884-b9f0-087d755425ef/A4C.gif Echocardiography: Basics https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/6141da1b-46ab-4f39-bd95-bd3374249f58/SX.gif Echocardiography: Basics https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/6f63a71a-3b97-4d6f-a017-e7523d84f881/IVC.gif Echocardiography: Basics https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/d2c748be-7b09-48b0-a9d0-3cb0df33a315/PLAX.gif Echocardiography: Basics https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/cba7992a-67be-4eaf-9b9c-f0161bc9894f/PSAX.gif Echocardiography: Basics https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/85e62b68-1c87-417c-81b0-f17fa0288182/A4C.gif Echocardiography: Basics https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/d00852c3-b418-4657-9023-0915dca0d15e/SX.gif Echocardiography: Basics https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/1deb8bcc-2972-4ac2-99d8-3fe138b9fac3/Normal%2Baorta%2B%26%2BIVC%2B-%2BTransverse.gif Echocardiography: Basics https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/f407e596-f9c9-40f9-bc89-76ee9c04a828/Normal%2BIVC%2Bto%2BAA%2Bdrag%2B-%2BLongitudinal%2BView.gif Echocardiography: Basics https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/67aff8f5-2e88-4a6d-ba6d-867145ddb02c/PSAX+Papillary+%26+Mitral.gif Echocardiography: Basics https://ultra-sono.com/ruth-sneep daily 0.75 2022-12-02 https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/19f33776-7554-4cec-862c-1e925ff71c2e/IMG-0149.jpg Ruth Sneep - Ruth Sneep Ruth is a consultant in Emergency Medicine from the Netherlands. Born and raised in Amsterdam, she obtained her MSc in Medicine in 2011. She started her medical career in a vibrant city hospital in the city of The Hague, where she worked in Intensive Care and Emergency Medicine. After this she decided to broaden her horizons quite literally and go for an adventure. She worked a year in a small hospital on an island in the Caribbean, where her love for ultrasound was sparked. In an area without the luxury of 24/7 radiology cover, it seemed an ideal tool for an Emergency doctor. When she moved back to do Specialty Training in Emergency Medicine in the renowned Leiden University Medical Centre, ultrasound became a serious part of her daily practice. With ultrasound enthusiast consultants present 24/7 in both the Emergency Department as Intensive Care to support her development, she followed multiple courses and gained more skills on the bedside. Especially the latter she found invaluable. In 2018 she finished Specialty training and decided to move to London for a year. NHS clearly did something to her, since she's still here. She worked at King’s College Hospital and in Wales in the Emergency Department and pre-hospital with the EMRTS team. By that time she was acquainted with the RCEM courses and got her sign off here as well. Her love of teaching could finally be combined when she joined an ultrasound course provider where she taught doctors of diverse specialty’s the old Level 1 and Level 2 courses. She also worked for the departmental Ultrasound-groups in the different hospitals and continued teaching on the shop floor. When she joined Royal London Hospital it made sense she would carry the flame of the US-fellowship and here we are: adding another nationality to our team! https://ultra-sono.com/blocks-serratus-anterior daily 0.75 2023-09-25 https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/49f1d03f-58b8-4a6e-91b7-c0c3b333c6df/Serratus%2BAnterior%2BArea%2BPosterior.jpg https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/01d9f4b1-790e-4508-b49b-15a09dcbe1c8/Serratus%2BAnterior%2BArea%2BAnterior.jpg https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/e49c56b2-74bd-4245-8c1d-83dbd76c0adb/serratus.jpg https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/8c61b271-a8b4-4158-aeff-54481c840509/nerve+anatomy.jpg https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/eb326420-8df2-4825-aa6e-dbb7e4200825/IMG_2593.jpg https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/c4286556-852b-4f25-9c9e-91329c17811e/SAB.gif https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/0f541b32-04fd-4a89-b544-342a3d99d169/SAB+drawing.png https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/2cbeb3a3-f194-4fd9-a9cd-f4b4fe6cc3dd/SAB+corrected.png https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/df42865d-ee4c-4f20-aa14-d59a169607a0/Brevik%2BSerratus%2BAnterior.gif https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/a8e5aad1-2f82-4256-8464-6d19e2ac67b3/image-asset.gif https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/8a03200a-afac-445c-bc4d-f61d9cc39315/image-asset+%281%29.gif https://images.squarespace-cdn.com/content/v1/5ec321c2af33de48734cc929/1607694583486-2PQT0LQ193RL7MCB6DX4/20140228_Trade+151_0046.jpg Blocks: Serratus Anterior https://images.squarespace-cdn.com/content/v1/5ec321c2af33de48734cc929/1618497259178-6XJGK9GR6YAVBQL5L519/20140301_Trade-151_012-2.jpg Blocks: Serratus Anterior https://images.squarespace-cdn.com/content/v1/5ec321c2af33de48734cc929/1607694644871-IC85FNH781UNZSZEGHDR/Aro+Ha_0428.jpg Blocks: Serratus Anterior https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/38ca1867-858f-45c1-bd91-48a3544b3fc8/serratus.jpg Blocks: Serratus Anterior https://ultra-sono.com/fusic daily 0.75 2023-12-08 https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/e17fabf9-1a8a-476b-897d-ee66dd264119/anatomia_RBAI077_0276.jpg FUSIC https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/7c79212c-f907-4048-bee9-e01b555f5095/anatomia_RBAI077_0281.jpg FUSIC https://ultra-sono.com/pablo-extremera daily 0.75 2023-12-08 https://images.squarespace-cdn.com/content/v1/6298fd0adc52d760ccf65305/d48079df-bea7-479c-abd5-3b4892d9931a/Pablo+Extremera.jpg