College Answer

Roles include –

Cardiac echo – be it transthoracic or transoesophageal looking at structure, function, relationships between the two ventricles and pericardial effusions. Doppler cardiac output monitoring – oesophageal, transthoracic

Vascular – specifically thoracic aorta – but also abdominal aorta. Other vascular include any accessible artery (eg radial, brachial, femoral, carotid etc), grafts for flow assessment, stenosis, patency. Also veins – for thrombosis/patency

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

Other –pleural, diaphragm etc

Diagnostic ultrasound, esp abdomen – identify bladder (urinary retention), biliary anatomy, including gallbladder important to mention acalculous cholecystitis, atelectasis, pneumothorax

Ultrasound assisted interventions (drainage of collections)

Vessel identification for line insertion

Discussion

A nice article about the use of ultrasound in the ICU can be found in Continuing Education in Anaesthesia, Critical Care & Pain (Wilson and Mackay, 2012).

This question can be approached systematically; the answer presented below has been modelled on Table 1 from this article, and is organised by body area being examined:

• Head:
  • Transcranial doppler in SAH-associated vasospasm and in confirmation of brain death
• Neck
  • Central line insertion
• Thoracic
  • Identification of pneumothorax
  • Localisation and ultrasound-guided aspiration of pleural effusions
• Cardiac
  • Echocardiography (structure and function)
  • Ultrasound-guided pericardiocentesis
• Abdominal
  • FAST
  • Solid organ pathology (eg. hydronephrosis, splenomegaly, cirrhosis)
  • Renal vascular flow
  • Gall bladder pathology
  • Portal vein pathology
  • Aortic pathology
• Peripheral
  • Peripheral venous access
  • Peripheral arterial flow assessment
  • Assessment of DVTs