3-step protocol
pump : pericardiac sac, LV, RV
tank : IVC & jugular veins, lung, FAST
pipes : thoracic & abdominal aortas, femoral & popliteal veins
A. PLX, PSX, AP4C, AP5C view
1. Lt heart
(1) Systolic function (visual, M-mode)
(2) LV kissing sign
(3) RWMA
(4) Valvular dysfunction (by color doppler)
(5) Pericardial effusion
(6) LVOT diameter (at AV annulus)
(7) Hyperdynamic LV
2. Rt Heart
(1) RV size
(2) RV function - TAPSE
(3) Paradoxical IVS
(4) PTE sign
β’
RV/LV ratio, RVEDD
β’
McConell sign
β’
60/60 sign
β’
TAPSE
β’
Myocardial perfomance index
β’
Early Systolic Notching (PSX view, PW doppler at PV)
β’
Mid Ventricular strain
β’
RVOT excursion
3. LOVT VTI
Extended RUSH protocol : SV μΈ‘μ μΆκ° - μΉλ£μ λ°μμ λ³΄κ³ μΆκ° μ‘°μΉλ₯Ό κ²°μ νλ νλ‘ν μ½
DO2 = CO x (
SV = LVOT area x Stroke distance
Integration of stroke distance in systolic phase : LVOT VTI
μ μ 18~22 cm
μ¬κ²μ¬μμ LVOT VIT κ° 15~20% μ¦κ°? - νμ¬ μ²μΉκ° μ μ .
κ·Έ μ΄ν - λ°μμ΄ μλ κ². μΌν¬ λΆλ₯κ° μλͺ»λμκ±°λ μ²μΉκ° μ μ νμ§ μμλ€λ κ².
LV functionμ΄ μλ λ¨μ΄μ Έ μμλ€λ©΄, μ νλ μνμμλ SV μ΄ μ μ μ¬λΌκ° μ μλ€.
νκ³ :
LVOT dynamic obstructionμ΄ μλ κ²½μ°
Symmetric LV septal hypertrophy
Severe hypovolemia
Moderate to severe AR
LVOT VTIμ λ리μ§ν - descending aorta dopplerκ±Έμ΄μ VTI μΈ‘μ
μ μ 12 cm μ λ
B. IVC view
: CVP μμΉ (RA pressure μμΉ) μλ Volume overload μ IVC dilation λλ€.
: μ μ μνμμλ inspiration μ ICVκ° 50% μ΄μ κ°μνλ€ (no plethora)
(1) spontaneous breathing μ
β’
IVC μ§λ¦ <1 cm + ν‘κΈ° μ 50% μ΄μ collapse β normovolemia
β’
IVC μ§λ¦ 1.5~2.5 cm + ν‘κΈ° μ 50% μ΄λ΄ collapse β μ μ or νκ΄νμ₯(-)
β’
IVC μ§λ¦ 2.5cm μ΄μ + νΈν‘μ collapse μ μ λ¨ β RV failure, Tamponade, Fluid overload(-)
(2) mechanical ventilation μ
β’
IVC μ§λ¦ 1~1.5 cm + insp.distension > 20% β hypovolemia μμ¬
