Ultrasound GuidedVolume Assessment

Starr Knight, M.D.HIGH RISK Hawaii

Feb 14, 2014

Outline

• IVC Ultrasound Technique

• Clinical Use of IVC Ultrasound

• Clinical Cases

IVC Ultrasound Exam

• Exam Technique

• Goals of the Exam

• Pitfalls

Probe Selection

Liver

IVC

RA

RA

Liver

IVC

Hypovolemia Hypervolemia

Hypovolemia Hypervolemia

The “Sniff” Test

Hypovolemia Hypervolemia

Caval Index

Ultrasound Protocols

• RUSH

• RADiUS

• Triple Scan

1. Cardiac Ultrasound

2. Lung Ultrasound

3. IVC Ultrasound

Goals of the Exam

Assess for Pulmonary Edema

Evaluate Pump Function

Interrogate IVC

Protocol

1. Cardiac Ultrasound

2. Lung Ultrasound

3. IVC Ultrasound

Clinical Cases

Septic

Before IVFs After 2L IVFs

CHF

Pulmonary Embolism

Cardiac Tamponade

Take Home Points

• Distinguish IVC from Aorta

• Eval IVC 2cm distal to RA-IVC junction

• Use in conjunction with Cardiac and Lung ULS

• Remember Conditions with ↑R Cardiac Pressure

• Serial Exams during resuscitation

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Thank You