Reanimationsultraschall

SonoABCD

Dies ist das Gesamtkonzept des ALS-konformen "Resuscitation Ultrasound" = der zentralen Methoden des Reanimationsultraschalls nach den ERC Reanimations-Leitlinien von 2015.
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Eine Übersetzung auf Deutsch erfolgt nach und nach.

ALS-conformed

Resuscitation

Ultrasound

A concept with images and video clips of exam styles

by

Raoul Breitkreutz, MD (Frankfurt a.M. / Bad Rappenau)

Domagoj Damjanovic, MD (Freiburg i. Brsg.)

Tobias C. Schröder, MD (Frankfurt a.M.)

Markus Geuting, MD (Bad Rappenau)

A free online publication of the

The Scientific Network SonoABCD with SonoSchool

and SonoABCD Publishing Company

D-64405 Fischbachtal, Germany

ISBN - 978-3-96228-078-9

Available at yumpu.com/en/SonoABCD


ABCD


Sonoscopy of trachea in emergencies

Tracheal and Esophageal tube placement

- Simple pattern recognition -

Normal: Single (airway) tract

Double (airway) tract sign*

Edited by Raoul Breitkreutz (2020)

Scientific Network SonoABCD

The fine art of Sonoscopy.

No ventilation required.

Observe: both lateral regions of airway tract

*Zechner P, Breitkreutz R Resuscitation 2011

Chou et al. Resuscitation 2011


Airway Ultrasound Exam

Main Questions

In emergency always use post-intubation check of trachea only.

Edited by Raoul Breitkreutz (2020)

#Q1. Esophageal misplacement? Yes or No?

Only if ruled out - goto 2.

#Q2. Main stem intubation? Yes or No?

If ruled in - slightly withdraw and re-check.

Scientific Network SonoABCD

The fine art of Sonoscopy.

Available at www.yumpu.com/en/SonoABCD


Distinct clinical emergency scenarios define

two widely different tracheal ultrasound exam methods

Exam style #1: Post-intubation check

(e.g. CPR at point-of-care or on arrival at shock room)

- immediate, urgent action -

Edited by Raoul Breitkreutz (2020)

On-off evaluation

Scientific Network SonoABCD

The fine art of Sonoscopy.


Team H.K. Stanis, M.D., M. Negele, Bad Rappenau, Germany (2019)

Airway Ultrasound Exam

#Q1 - Esophageal misplacement? Yes or No?

Scientific Network SonoABCD

The fine art of Sonoscopy.

Edited by Raoul Breitkreutz (2020)

In emergency always use post-intubation check of trachea only.


Team H.K. Stanis, M.D., M. Negele, Bad Rappenau, Germany (2019)

Airway Ultrasound Exam

#Q1 - Esophageal misplacement? Yes or No?

Finding 1a: No, normal!

Scientific Network SonoABCD

The fine art of Sonoscopy.

No ventilation required.

Edited by Raoul Breitkreutz (2020)


Sonoscopy of trachea post-intubation

Check tracheal tube placement

Exam style #1 - Simple pattern recognition

Edited by Raoul Breitkreutz (2020)

Single (airway) tract

Scientific Network SonoABCD

The fine art of Sonoscopy.

Observe: both lateral regions of airway tract

No ventilation required.


Team H.K. Stanis, M.D., M. Negele, Bad Rappenau, Germany (2019)

Airway Ultrasound Exam

#Q1 - Esophageal misplacement? Yes or No?

Finding 1b: Yes! Immediate correction!

Scientific Network SonoABCD

The fine art of Sonoscopy.

No ventilation required.

Edited by Raoul Breitkreutz (2020)


Sonoscopy of trachea post-intubation

Tracheal and Esophageal tube placement

Exam style #1 - Simple pattern recognition

Normal: Single (airway) tract

Double (airway) tract sign*

Edited by Raoul Breitkreutz (2020)

Scientific Network SonoABCD

The fine art of Sonoscopy.

No ventilation required.

Observe: both lateral regions of airway tract

*Zechner P, Breitkreutz R Resuscitation 2011

Chou et al. Resuscitation 2011


Distinct clinical emergency scenarios define

two widely different tracheal ultrasound exam methods

Exam style #2: Visualization

during entire intubation process

(e.g. RSI, teaching) - planned action -

Continuous evaluation

Edited by Raoul Breitkreutz (2020)

Scientific Network SonoABCD

The fine art of Sonoscopy.


Distinct clinical emergency scenarios define

two widely different tracheal ultrasound exam methods

Exam style #2: Visualization

during entire intubation process

(e.g. RSI, teaching) - planned action -

Continuous evaluation

Scientific Network SonoABCD

The fine art of Sonoscopy.

Edited by Raoul Breitkreutz (2020)

Nota bene:

1st trial —> esophagus.

Upon instruction of clinician supervisor,

observing by sonography,

—> uninterrupted 2nd trial.

With support of M. Nickel, MD and M. Geuting, MD, Bad Rappenau


Sonoscopy of trachea during intubation

Tracheal and Esophageal tube placement

Exam style #2 - Simple pattern recognition

Normal: Single (airway) tract

- unspectacular observation -

Double (airway) tract sign*

prominent monitoring observation

(2 attempts and withdrawals)

Edited by Raoul Breitkreutz (2020)

Scientific Network SonoABCD

The fine art of Sonoscopy.

No ventilation required.

Observe: both lateral regions of airway tract

*Zechner P, Breitkreutz R Resuscitation 2011

Chou et al. Resuscitation 2011


Comparison of

Clinician sonographer

Probe movement

at frontal neck

Supervision

Immediate correction?

Action of sonographer?

Exam styles

#1 #2

post-intubation

active,

exploration of region

yes, onto and away

dynamic

no add role

or not necessary

no,

check only

during entire

intubation process

passive

no, still /static

waiting for action

active option for role,

e.g. in teaching

yes,

option to correction

while indwelling ETT

Image as is can change markedly

Time (secs)


Team K. Stanis, M.D., M. Negele, Bad Rappenau, Germany (2019)

Airway Ultrasound Exam

#Q2 - Main stem intubation?

Exam style: Extension of Trachea Check with Evaluation of Lung movements

Scientific Network SonoABCD

The fine art of Sonoscopy.

In emergency, after tracheal check, start lung sliding evaluation

at left hemithorax. In this video was no emergency.

Edited by Raoul Breitkreutz (2020)


Team K. Stanis, M.D., M. Negele, Bad Rappenau, Germany (2019)

Airway Ultrasound Exam

#Q2 - Main stem intubation?

Finding 2a: No, normal!

Scientific Network SonoABCD

The fine art of Sonoscopy.

Edited by Raoul Breitkreutz (2020)

In emergency, after tracheal check, start lung sliding evaluation at left hemithorax.


Sonoscopy of lung post-intubation

Check for lung pulse / lung sliding

Simple pattern recognition

Edited by Raoul Breitkreutz (2020)

Scientific Network SonoABCD

The fine art of Sonoscopy.

Observe:

Lung Sliding. No full ventilation cycle required.


Sonoscopy of lung post-intubation

Check for lung pulse / lung sliding

Simple pattern recognition

Edited by Raoul Breitkreutz (2020)

Scientific Network SonoABCD

The fine art of Sonoscopy.

Observe: Lung Sliding. No full ventilation cycle required.


Team Markus Geuting, M.D., M. Negele, Bad Rappenau, Germany (2019)

Airway Ultrasound Exam

#Q2 - Main stem intubation?

Exam style #1

Scientific Network SonoABCD

The fine art of Sonoscopy.

Edited by Raoul Breitkreutz (2020)

In emergency, after tracheal check, start lung sliding evaluation at left hemithorax.


Team Markus Geuting, M.D., M. Negele, Bad Rappenau, Germany (2019)

Airway Ultrasound Exam

#Q2 - Main stem intubation?

Finding 2b: Yes, correction required!

Scientific Network SonoABCD

The fine art of Sonoscopy.

Edited by Raoul Breitkreutz (2020)

In emergency, after tracheal check, start lung sliding evaluation at left hemithorax.


Team Markus Geuting, M.D., M. Negele, Bad Rappenau, Germany (2019)

Sonoscopy of lung post-intubation

Check for lung pulse / lung sliding

Simple pattern recognition

Scientific Network SonoABCD

The fine art of Sonoscopy.

Observe: Lung pulse.

Action: SlIghtly withdraw tube and re-check. No full ventilation cycle required.

Edited by Raoul Breitkreutz (2020)


Team Markus Geuting, M.D., M. Negele, Bad Rappenau, Germany (2019)

Sonoscopy of lung post-intubation

Check for lung pulse / lung sliding

Simple pattern recognition

Scientific Network SonoABCD

The fine art of Sonoscopy.

Observe: Lung pulse or lung sliding.

Action: Slightly withdraw tube and re-check. No full ventilation cycle required.

Edited by Raoul Breitkreutz (2020)


Airway Ultrasound Exam

Limitations of the check for main stem intubation

Interprete sonographic signs per hemithorax

In presence of (known or unknown) pneumothorax

Trachea ultrasound is applicable to check for normal or esophageal intubation.

Lung ultrasound: Mainstem intubation cannot be diagnosed. The air in the pleural

space, resulting in sonographic signs of pneumothorax (no lung sliding, no lung

pulse, no B-lines) overlay signs of one-sided intubation. Pneumothorax still could

be ruled in.

Edited by Raoul Breitkreutz (2020)

In presence of (known or unknown) cardiac standstill

Trachea ultrasound is applicable to check for normal or esophageal intubation.

Lung ultrasound: A firm statement regarding mainstem intubation is not possible

for the finding will be similar to sonographic findings as in pneumothorax (such as

no lung sliding and no lung pulse). Pneumothorax still could be ruled out (if lung

sliding or B-lines are present).

In presence of both pneumothorax and cardiac standstill

Trachea ultrasound is applicable to check for normal or esophageal intubation.

Lung ultrasound: Neither mainstem intubation nor pneumothorax can be firmly

diagnosed.

Scientific Network SonoABCD

The fine art of Sonoscopy.


Airway Ultrasound Exam

Finding 3: no lung sliding, no lung pulse

Edited by Raoul Breitkreutz (2020)

Scientific Network SonoABCD

The fine art of Sonoscopy.

Consider pneumothorax, but only when heart beats!


Sonoscopy of lung post-intubation

Check for lung pulse / lung sliding

Simple pattern recognition

Edited by Raoul Breitkreutz (2020)

Scientific Network SonoABCD

The fine art of Sonoscopy.

Observe: Lung movements during ventilation.

Think: If none, consider pneumothorax, but only if cardiac motion has been confirmed.

Action: Decide side, consider or perform immediate needle puncture.


Additional information

Esophageal misplacement?

Comparing methods

Ultrasound and Capnometry

Scientific Network SonoABCD

The fine art of Sonoscopy.

3 2

Use B-Mode

Regarding the question

of esophageal misplacement, in

post-intubation check of trachea,

ultrasound is faster and

does not require ventilation trials.

Capnometry is slower and

insecure for this purpose

because of slow drop, requirement of ventilation trials and not providing zero line results

Zechner PM, Breitkreutz R

Resuscitation (2011)


Additional information

Airway Ultrasound Exam

Main questions

Edited by Raoul Breitkreutz (2020)

#Q1. Esophageal

misplacement? Yes or No?

Esophageal misplacement?

Re-Check after re-intubation

Immediate action?

Yes

No, if

normal

Expected frequency

ruling in

ruling out

#Q2. Main stem

Main stem intubation?

intubation? Yes or No?

Re-Check after withdrawal

Yes

No, if

normal

Scientific Network SonoABCD

The fine art of Sonoscopy.

Available at yumpu.com/en/SonoABCD


Additional information

Airway Ultrasound Exam 1,2

Method

Edited by Raoul Breitkreutz (2020)

Method: Sonoscopy

Sonoscopy is the art of stethoscope-like use

of ultrasound.

Regarding Airway and Lung Ultrasound as part

of „Resuscitation Ultrasound“ in the clinical

context of Peri-Resuscitation: Check for trachea

post-intubation, and, in case of tracheal

placement, for lung sliding and -pulse.

Scientific Network SonoABCD

The fine art of Sonoscopy.


Additional information

Types of airway ultrasound exams within a defined clinical context

Types of airway ultrasound exams

within a defined clinical context

Action / ultrasound

exam type

Aim, emphasis on

Approx. time for

exam (seconds)

Time pressure?

/ remark

Pre-check, e.g. for

prep of dLT, difficult

laryngoscopy,

identify cricoid

membrane

planned evaluation

of upper airway

related

sonoanatomy

> 60

no time pressure

applicable, because of

measurements

Trachea exam only

after any emergency

intubation, double

tract or single tract

before ventilation

< 10, when

evaluating postintubation

only

yes, integration into a

(fast driving) process,

similar to one by one item

in a RSI

Airway Ultrasound

Exam

Airway Ultrasound as

part of Resuscitation

Ultrasound

routine check for

trachea plus lung

sliding or lung pulse

or diaphragm or

parts of it

check of treatable

conditions

< 120 no, variety of indications*

A;


Airway Ultrasound Exam 1,2

References

Slovis TL, Poland RL. Radiology. 1986; 160:262–3.

Endotracheal tubes in neonates: (Its) sonographic positioning.

Raphael DT, Conard FU. Ultrasound confirmation of endotracheal tube placement.

J Clin Ultrasound. 1987; 15:459–62.

Ma G et al. J Emerg Med 1999 (SAEM meeting Abstract 515), Acad Emerg Med. 1999; 6:515. full paper

published in 2007 (Trachea, while and post-intubation, principle, cadavers)

Drescher MJ et al.. Acad Emerg Med 2000;7:722–5.

(First detailed description of sonograms in esophageal intubation, while and post-intubation, principle,

cadavers)

Weaver B et al. Acad Emerg Med. 2006;13(3):239-44

(Lung sliding to confirm trachea placement, post-intubation, principle, cadavers)

Ma G et al. J Emerg Med 2007;32:405 (Trachea, while and post-intubation, principle, cadavers)

Werner SL et al. Ann Em Med 2007;49:75–80 (Trachea, while intubation, principle)

Chou HC et al Resuscitation 2011;82:1279–84 (Trachea, while intubation, double tract sign)

1Zechner P, Breitkreutz R Resuscitation 82 (2011) 1259–61 (First description of the

„Airway ultrasound protocol“, combining ALS-conformed trachea and lung evaluation)

2Breitkreutz R et al. Resuscitation 83 (2012) 273–274 (add of Lung sliding, Lung pulse)

Edited by Raoul Breitkreutz (2020)

Adi O et al. Crit Ultrasound J 2013; 5:7 (Trachea, Post-intubation)

Abbasi et al. Eur J Emerg Med 2015;22(1):10–6 (Trachea, Post-intubation)

Soar J et al. Resuscitation 95 (2015) 100-142 (ERC guideline 2015)

Chou EH et al. / Resuscitation 90 (2015) 97–103 (Metaanalysis)

Scientific Network SonoABCD

The fine art of Sonoscopy.


Additional exam styles

Sonoscopy of lung post-intervention

Ruling out pneumothorax

Simple pattern recognition

Scientific Network SonoABCD

The fine art of Sonoscopy.

Edited by Raoul Breitkreutz (2020)

Observe: Lung movements during ventilation.

Think: If lung sliding or lung pulse are present, you can rule out pneumothorax.

Action: Perform planned repeated exam two-staged in clinical time course.


Additional exam styles

Sonoscopy of lung: Ruling out pleural effusion

Simple pattern recognition

Edited by Raoul Breitkreutz (2020)

Scientific Network SonoABCD

The fine art of Sonoscopy.

Observe: Lung sliding, diaphragm

Think: separation of diaphragm and lung?

Action: evaluate clinical symptoms for puncture decision and if urgent


Additional exam styles

Sonoscopy tests of double lumen intubation

Simple pattern recognition

Edited by Raoul Breitkreutz (2020)

by Tobias C. Schröder, Frankfurt a.M.

Scientific Network SonoABCD

The fine art of Sonoscopy.

Observe: Lung movements during ventilation.

Think: Lung sliding or lung pulse if not clamped or clamped.

Action: Visualisation, clamping, visualisation and conclusion


Additional exam styles

Sonoscopy test of congestion - B-lines

Simple pattern recognition

Edited by Raoul Breitkreutz (2020)

Scientific Network SonoABCD

The fine art of Sonoscopy.

Observe: B-lines, multiple B-lines, effusion.

Think: multiple B-lines? bilateral? white lung?

Action: reporting, oxygen, induction of therapy


Review article

nt, especially in its specificity value. Different settings, operperience,

Ultrasonography and timing of the for ultrasound confirmation can cause of a endotracheal small but was tube used placement:

in ten studies. 9,11,12,14–20 The sensitivity and spe

mon ultrasound technique to detect esophageal intubatio

nificant A influence on the diagnostic accuracy. Ultrasonogran

be a useful tool for confirmation of tracheal intubation. real-time sonographic imaging during intubation has higher

are both high in cadaveric models, ORs, and EDs. In ge

systematic review and meta-analysis

er, Eric the use H. Chou of ultrasonography a,1 , Eitan Dickmanor a , any Po-Yang method Tsouas b , Mark the sole Tessarotivity a , Yang-Ming for detection Tsai c , of esophageal Additional intubation information

than post-intu

Matthew Huei-Ming Ma d , Chien-Chang Lee c,d,∗ , John Marshall a

a Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY, USA

b College of Medicine, National Yang-Ming University, Taipei, Taiwan

c Department of Emergency Medicine, National Taiwan University Hospital Yunlin Branch, Douliou, Taiwan

d Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan

Resuscitation 90 (2015) 97–103

a r t i c l e i n f o

Article history:

Received 19 November 2014

Received in revised form 11 February 2015

Accepted 12 February 2015

Keywords:

Intubation

Airway management

Ultrasonography

Resuscitation

Meta-analysis

Critical care

a b s t r a c t

Objective: This study aimed to undertake a systematic review and meta-analysis to summarize evidence

on the diagnostic value of ultrasonography for the assessment of endotracheal tube placement in adult

patients.

Methods: The major databases, PubMed, EMBASE, and the Cochrane Library, were searched for studies

published from inception to June 2014. We selected studies that used ultrasonography to confirm endotracheal

tube placement. The search was limited to human studies, and had no publication date or country

restrictions. Exclusion criteria included case reports, comments, reviews, guidelines and animal studies.

Two reviewers extracted and verified the data independently. We summarized test performance characteristics

with the use of forest plots, hierarchical summary receiver operating characteristic (HSROC)

curves, and bivariate random effect models. Meta-regression analysis was performed to explore the

source of heterogeneity. The methodological quality of individual studies was evaluated using the Quality

Assessment of Diagnostic Accuracy Studies (QUADAS) tool.

Results: A total of 12 eligible studies involving adult patients and cadaveric models were identified

from 1488 references. For detection of esophageal intubation, the pooled sensitivity was 0.93 (95%CI:

0.86–0.96) and the specificity was 0.97 (95%CI: 0.95–0.98). The area under the summary ROC curve was

0.97 (95%CI: 0.95–0.98). The positive and negative likelihood ratios were 26.98 (95%CI: 19.32–37.66) and

0.08 (95%CI: 0.04–0.15), respectively.

Conclusions: Current evidence supports that ultrasonography has high diagnostic value for identifying

esophageal intubation. With optimal sensitivity and specificity, ultrasonography can be a valuable adjunct

in this aspect of airway assessment, especially in situations where capnography may be unreliable.

© 2015 Elsevier Ireland Ltd. All rights reserved.

1. Introduction

Tracheal intubation serves as definite airway control when

resuscitating critically ill patients. Confirmation of proper tube

placement should be completed in all patients at the time of initial

intubation. Unrecognized misplacement of the endotracheal tube

may lead to avoidable morbidity including neurological damage,

and death, with a reported incidence of 6–16%. 1,2 Thus, immediate

post-intubation airway assessment is an essential clinical skill

for every physician in emergency medicine (EM), anesthesia and

critical care medicine. There are multiple options for confirming

tracheal intubation and all methods have unique limitations. 3–5

According to the 2010 American Heart Association (AHA) guideline,


Breitkreutz R et al. (2012)

Additional

information

Scientific Network SonoABCD

The fine art of Sonoscopy.


Sonoscopy of lung post-intubation

Check for lung pulse / lung sliding

Additional information

Consider obtaining findings. Don´t try diagnoses.

Edited by Raoul Breitkreutz (2020)

Decide C-AB or A-B-C or else upon clinical context.

Don´t get distracted by insecure interpretation of a finding.

Team leaders should decide CPR process independently.

B-Mode provides overview and is fast. Avoid M-Mode for lung

evaluation in emergencies because of lesser overview and time consuming

interaction with the ultrasound machine.

Consider this method as secondary option whenever available. With

ultrasound or capnometry you cannot intubate. However, with

bronchoscopy you could.

Train tracheal quick check, lung sliding or pulse and subcostal

window. On yourself or in any health environment. These are very simple

exams

Scientific Network SonoABCD

The fine art of Sonoscopy.


ABCD


30% VF only

>60% PEA / asystole


The problem is….

High-quality CPR!

Identify treatable

conditions!

How to integrate ALS-conformed ultrasound in (existing) interruptions?


The solution is

1) With training

ALS-conformed ultrasound is feasible.

2) It has a potential to identify

- tamponade

- acute right heart pressure overload

- hypovolemia.

3) Minimize interruptions!


2015


2015


2015

„Consider“ ≙ VAS 5!


2016

1. Cardiac activity on ultrasound was most

associated with survival following cardiac

arrest.

2. Ultrasound during cardiac arrest identifies

interventions outside of the standard ACLS

algorithm.


2018


Is Resuscitation Ultrasound = „Emergency TTE“?

Main emphasis on

Findings

Probe positions

Further regions

Method of evaluation

Resuscitation Ultrasound

resume chest compressions, driving force is

ALS, identify treatable conditions, image at

a glimpse only

Pathologies (3) and „kinetic activity“

2: cardiac, cava (sweep in subcostal area)

A: airway - trachea only, post-intubation for

observing single or double tract

B: lung (sliding, pulse) main stem intubat.

Screening, „Scanning“, simple gross

pathologies, binary answer

Emergency TTE

function, acquisition of

various views

Pathologies (>10) and

functional analysis

5+: parasternal LAX,

SAX, apical, subcostal,

IVC LAX…

-

Diagnostic accuracy,

quantitative information

Duration 400 PoCUS

longer time spans

full specialized TTE

training

Concept with

DEGUM / ÖGUM / SGUM


Scientific Network SonoABCD

The fine art of Sonoscopy.


low-cost, available at

www.SonoABCD-Verlag.org


Sweep subcostal-LAX - IVC


During CPR

subcostal window

Edited by Raoul Breitkreutz (2020)

Raoul Breitkreutz, Scientific Network Scientific Network SonoABCD

The fine art of Sonoscopy.


During CPR: EMD

subcostal window

interruption

pause of chest compressions

evaluation

Edited by Raoul Breitkreutz (2020)

Scientific Network SonoABCD

The fine art of Sonoscopy.


asystole, after

cessation no flow

subcostal window

Edited by Raoul Breitkreutz (2020)

Scientific Network SonoABCD

The fine art of Sonoscopy.


True - EMD

parasternal, LAX

Courtesy of H. Steiger, Darmstadt

Scientific Network SonoABCD

The fine art of Sonoscopy.


Pseudo - EMD

parasternal, LAX

Courtesy of H. Steiger, Darmstadt

Scientific Network SonoABCD

The fine art of Sonoscopy.


Tamponade

subcostal window

Edited by Raoul Breitkreutz (2020)

Scientific Network SonoABCD

The fine art of Sonoscopy.


Tamponade

subcostal window

parasternal, SAX

same patient

by Tobias C. Schröder, Frankfurt a.M.

Field examples, pocket-sized devices

Edited by Raoul Breitkreutz (2020)

Scientific Network SonoABCD

The fine art of Sonoscopy.


Signs of acute right heart pressure overload

subcostal 4-chamber view

Edited by Raoul Breitkreutz (2020)

Scientific Network SonoABCD

The fine art of Sonoscopy.


Signs of acute right heart

pressure overload

parasternal window, SAX

Edited by Raoul Breitkreutz (2020)

Scientific Network SonoABCD

The fine art of Sonoscopy.


two patients

Field examples, pocket-sized devices

by Tobias C. Schröder, Frankfurt a.M.

Signs of acute right heart

pressure overload

parasternal window, SAX

immediately after ROSC

Edited by Raoul Breitkreutz (2020)

Scientific Network SonoABCD

The fine art of Sonoscopy.


Signs of hypovolemia

IVC, SAX, transhepatic view

Edited by Raoul Breitkreutz (2020)

Scientific Network SonoABCD

The fine art of Sonoscopy.


Field example, pocket-sized device

after ROSC

by Tobias C. Schröder, Frankfurt a.M.

Signs of congestion

IVC, SAX, transhepatic view

Edited by Raoul Breitkreutz (2020)


IVC , eye-balling, B-Mode

Edited by Raoul Breitkreutz (2020)

„eye-balling“ evaluation

✓1. diameter (end-expiratory) < 1,5 cm?

✓2. pulsation visible?

ev. 3. respiratory variability? 0-50%

- (in CPR no sniff test to assess “collapsibility”)

Scientific Network SonoABCD

The fine art of Sonoscopy.


IVC, B-Mode, LAX, “eye-balling”

Edited by Raoul Breitkreutz (2020)

Scientific Network SonoABCD

The fine art of Sonoscopy.


VCI, LAX - Pitfall false Diameter (fD)!

- n o horizontal diameter

- vertical diameter: median or not?

Edited by Raoul Breitkreutz (2020)

fD

Scientific Network SonoABCD

The fine art of Sonoscopy.

after Scheiermann P et al. Ultraschall in der A&I, Kapitel 7.2., DÄV (2007)


(very) low EF - eyeballing

sweep of IVC and

subcostal 4-chamber view

1st exam after ROSC

Edited by Raoul Breitkreutz (2020)

Scientific Network SonoABCD

The fine art of Sonoscopy.


Therapy: Puncture/Aspiration, Lysis, Volume, Catecholamines

ER / ICU / shockroom - system has to be prepared - What about yours?

Decide!

If diagnostics - prepare also for therapy!

Edited by Raoul Breitkreutz (2020)

http://leitlinien.dgk.org/

e.g.. 1:10

(100 µg/ml)

Scientific Network SonoABCD

The fine art of Sonoscopy.


Immediate

(specialist / cardiologist was informed but immediate action was required)

Emergency: First aspiration / withdrawal of fluid to unload pressure!

Edited by Raoul Breitkreutz (2020)

Scientific Network SonoABCD

The fine art of Sonoscopy.


Urgent

(specialist / cardiologist was informed but not available)

Scientific Network SonoABCD

The fine art of Sonoscopy.

Edited by Raoul Breitkreutz (2020)


Scientific Network SonoABCD

The fine art of Sonoscopy.

Emergencies: main goal if tamponade

unload pressure = puncture + aspiration/withdrawal

Catheter insertion takes time. Can be done later!

puncture / withdrawal

Edited by Raoul Breitkreutz (2020)

no primary catheter insertion


ALS-conformed

Resuscitation

Ultrasound

A concept with images and video clips of exam styles

by

Raoul Breitkreutz, MD (Frankfurt a.M. / Bad Rappenau)

Domagoj Damjanovic, MD (Freiburg i. Brsg.)

Tobias C. Schröder, MD (Frankfurt a.M.)

Markus Geuting, MD (Bad Rappenau)

A free online publication of the

The Scientific Network SonoABCD with SonoSchool

and SonoABCD Publishing Company

D-64405 Fischbachtal, Germany

ISBN - 978-3-96228-078-9

Available at yumpu.com/en/SonoABCD


Acknowledgement

This work is dedicated to WINFOCUS, a non-profit organization.

Ideas are results of mutual scientific exchange with world leading experts

in the field of focused ultrasound now more known as „point-of-care ultrasound“.

We gathered at several annual congresses and consensus conferences

and listened and learned and talked with empathy and enthusiasm.

WINFOCUS´ vision is to spread the ideas

of the new methods of sonoscopy to the one world.

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