POCUS from head to toe ( ultrasound icu ) DR ADRIAN WONG (UK)

Food for thought 🤠🙋‍♂️🙋‍♀️
Why only extreme values can be used for assessing Fluid Responsiveness by IVC unlike previously where 50% collapsibility was accepted, in a spontaneously breathing patient?

ANS🤷‍♂️✔
Collapsibility of IVC depends on the respiratory effort being made by the patient., this effort gets transmitted to RA and influences the venous return and hence the collapsibility. However, if the Patient is fluid loaded / hypovolemic then despite this one can still use it with extreme values of IVC
since RA pressure is accurately reflected .

TRANSCRIPT OF WEBINAR

Ultrasound Technology in Medical Practices

Dr. Wong discussed the usefulness and benefits of ultrasound technology in medical practices, particularly in critical care, anesthesia, and intensive care units. He highlighted the differences between ultrasound and radiological procedures, noting that ultrasound is more focused on clinical questions. Dr Wong presented a study comparing the accuracy of ultrasound and palpation in locating the cricoid membrane during emergency intubation procedures. Both speakers emphasized the importance of familiarizing themselves with ultrasound technology, starting with learning about the lungs, as it can help identify pathology and normalcy.

Ultrasound Imaging and Drainage Procedures

Dr Wong presented an in-depth overview of the sonographic features of ultrasound imaging, emphasizing its superiority over chest radiography for detecting complex fluid accumulations. He highlighted the importance of ultrasound guidance in minimizing complications during drainage procedures as recommended by the British Thoracic Society. He also discussed the differences between traditional radiography and a new, more dynamic imaging method, stressing its real-time capabilities and increased sensitivity and specificity.

Ultrasound's Role in Diagnosing and Resuscitation

DR Wong discussed the significant role of ultrasound in diagnosing various respiratory and cardiovascular conditions. He stressed the importance of a systematic approach to ultrasound, comparing it to examining the different lobes of the lungs or various sectors of a loan. He highlighted the superior sensitivity and specificity of ultrasound over clinical examination and chest X-ray, and its potential to predict patient outcomes and guide decisions in intensive care. He also introduced the RUSH and BLUE protocols, which aim to provide a more comprehensive assessment of a patient's condition, and emphasized the importance of using ultrasound to guide fluid management throughout the phases of resuscitation.

Venus Access Ultrasound Score Discussion

Dr Wong discussed the Venus access ultrasound score, a tool developed to assess venous flow and congestion in a more structured manner. He also touched on the function and appearance of the kidneys, highlighting the use of a contrast agent for imaging and the role of vascular nature in patient health status.

Handheld Ultrasound Devices and IVC Markers

Dr Wong discussed the increasing use of handheld ultrasound devices in medical settings, particularly in intensive care units. He emphasized the potential benefits of these devices, such as real-time feedback and diagnosis, and encouraged the team to learn more about how to use them effectively. He also highlighted the importance of developing specialized skill sets, such as in neural ultrasound, to enhance patient care. In response to questions about the use of the IVC as a marker of fluid responsiveness, Adrian advised against relying on it alone and instead recommended measuring the IVC in combination with other vital signs.

Ultrasound in Nephrology and Intensive Care

Dr.Wong discussed the use of ultrasound in nephrology, with a focus on renal ultrasound and Vexus. He emphasized the importance of Vexus in diagnosing conditions such as acute kidney injury and hydro nephrosis, and pointed out the challenges in obtaining a stable image of the kidney. They also highlighted the significance of integrating clinical knowledge and ultrasound skills in intensive care, and agreed on the need for young healthcare professionals to understand the basics of ultrasound.

FUTURE DIRECTIONS

Intensivists and anesthesiologists to learn and incorporate ultrasound skills for whole body assessment of patients, including airway, breathing, circulation, and other organ systems.

00:00:00 intro
00:03:30 overview
00:07:18 ABCDE of US
00:07:54 Airway
00:11:22 Lungs
00:18:20 BLUE PROTOCOL
00:19:20 Comparing US to other methods
00:19:40 Diaphragm
00:20:10 Heart
00:20:40 Brain
00:26:00 DAYS
00:28:44 RUSH PROTOCOL
00:30:05 Fluids, VTI
00:33:25 VEXUS
00:37:20 Microcirculation
00:38:10 Handheld
00:39:36 Reco for skill competency by ESICM, resources
00:43:30 Discussion