Outline the potential roles for the use of ultrasound  in the critically ill patient.

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College Answer

The potential roles of ultrasound in critically ill patients are diverse and are increasing in number.

They include:

Cardiac echo – transthoracic/transoesophageal looking at structure, function, relationships between the two and pericardial effusions, and doppler cardiac output monitoring.

Vascular –thoracic and abdominal aorta (dissection, aneurysm etc). Other vascular roles include any accessible artery (eg radial, brachial, femoral, carotid etc), grafts for flow assessment, stenosis, patency. Also larger veins for thrombosis/patency, and vessel identification for line insertion

Cranial – monitor cerebral blood flow, hyperaemia, ischaemia, detection of vasospasm, fat and other emboli, stroke related artery reperfusion following thrombolysis.

Renal perfusion – following AAA repair, renal transplant and acute tubular necrosis.

Free fluid – peritoneal and pleural – allows diagnosis, quantitative assessment as well as marking for drainage.

Other anatomical – identify bladder (urinary retention), biliary anatomy, including gallbladder (eg. acalculous cholecystitis), atelectasis, pneumothorax.

Nineteen out of twenty-six candidates passed this question.

Discussion

This question is identical to Question 2 from the first paper of 2008.