The following questions relate to targeted critical care transthoracic echocardiography (Level 1 haemodynamic assessment) performed in the ICU.
a) In a patient with suspected pericardial tamponade:
i. Which view on transthoracic echocardiography would you use to assess the heart and why? (10% marks)
ii. Describe three features of pericardial tamponade that you would expect to see in this view. (30% marks)
b) In a patient with a history of ischaemic heart disease who is cold, clammy and hypotensive, describe how you would assess left ventricular systolic function in the parasternal short axis (PSSA) view. (30% marks)
c) In a previously healthy patient with a traumatic leg amputation, describe how you would assess volume status in the subcostal view. (30% marks)
i. Subxiphoid view is the single best view, if you could only choose one view:
ii. Features of tamponade in this view:
Theoretically, one could also list "a visible pericardial effusion", and that would accurate, but would probably score no marks because of obviousness.
b) A patient with a history of ischaemic heart disease who is cold, clammy and hypotensive? Surely it could not be cardiogenic shock? It's hard to know why that extra sentence was added. Also, the parasternal short axis is specified. From Mitchell et al (2019):
Also, though they might not be assessing LV systolic function strictly speaking, the PSAX view gives you an assessment of the ventricular size and wall thickness.
c) Volume assessment on the subcostal view could be performed using:
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Luis, Sushil A., Jonathan Chan, and Patricia A. Pellikka. "Echocardiographic assessment of left ventricular systolic function: an overview of contemporary techniques, including speckle-tracking echocardiography." Mayo Clinic Proceedings. Vol. 94. No. 1. Elsevier, 2019.
Mitchell, Carol, et al. "Guidelines for performing a comprehensive transthoracic echocardiographic examination in adults: recommendations from the American Society of Echocardiography." Journal of the American Society of Echocardiography 32.1 (2019): 1-64.
Desai, N., and D. Garry. "Assessing dynamic fluid-responsiveness using transthoracic echocardiography in intensive care." Bja Education 18.7 (2018): 218.
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