Introduction To Sonography And Patient Care Pdf

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Medical ultrasound also known as diagnostic sonography or ultrasonography is a diagnostic imaging technique, or therapeutic application of ultrasound. It is used to create an image of internal body structures such as tendons , muscles , joints, blood vessels, and internal organs.

Divided into two parts, this updated text first describes the origins and evolution of diagnostic medical sonography, defines important terminology, and provides proven study techniques such as note taking, effective listening, and test-taking strategies. The second section prepares you for the clinical environment, covering topics from the sonography perspective such as taking a patient's vital signs, safety considerations, body mechanics, patient transfer, infection control, emergency procedures, and assisting patients with special needs. Patient Care Across the Specialties 3. Communication and Critical Thinking Skills 4. Sonographer Safety Issues 5.

Essentials of Sonography and Patient Care

This article reviews the use of thoracic ultrasound in the intensive care unit ICU. The focus of this article is to review the basic terminology and clinical applications of thoracic ultrasound.

The diagnostic approach to a breathless patient, the blue protocol, is presented in a simplified flow chart. The diagnostic application of thoracic ultrasound in lung parenchymal and pleural diseases, role in bedside procedures, diaphragmatic assessment, and lung recruitment are described.

Recent updates discussed in this review help support its increasingly indispensable role in the emergent and critical care setting. The introduction of lung ultrasound has revolutionized the care of patients in a modern ICU. It has also shown an impact in non-ICU settings such as in pulmonology and thoracic surgery ambulatory clinics [ 1 ]. Historically, lung ultrasonography LUS has been a neglected area given perceived notions about the utility of this modality in air-filled structures.

However, in the last two decades, significant progress has been made in using ultrasonography as a valuable tool in evaluating lung pathologies. Lung ultrasonography has many advantages that are immediately recognizable, and a few have been listed below:.

Cost: Ultrasonography is relatively inexpensive, and has almost no consumable costs. Safety: It does not utilize ionizing radiation. It can be used safely in pregnant women.

Efficiency: It efficiently gives immediate information to healthcare providers. Lung ultrasound can provide a quicker and more efficient means of providing instantaneous information at the bedside.

Adjunct to physical examination: A study by D. Lung ultrasound has been shown as a powerful adjunct to physical examination. Decreases iatrogenic complications: Rahman et al. This indicates a need to have more physicians trained in lung ultrasound. The inability to use ultrasound in performing invasive critical procedures subjects patients to preventable harm. Decreased transfer of critically ill patients: Oks et al. Ultrasound is operator dependent and the quality of images may vary depending on the technique and skill which requires a steep learning curve.

Interobserver variability makes it difficult to replicate ultrasound studies and make generalizable conclusions on its utility.

For lung ultrasound, the probe is placed in the intercostal space. This provides adequate penetration to visualize the pleura and lungs.

The ribs are radiopaque and do not provide a good medium for visualization. Linear probes may be used to provide a better definition of the pleura and to more clearly visualize some of the signs below.

Amplitude Mode A-Mode : Amplitude mode is the display of amplitude spikes on the screen with X depth and Y amplitude axis plotted as a graph. It is frequently used to study the eye and in pin-point procedures like lithotripsy [ 9 ]. Motion Mode M-Mode : A sequence of two dimensions with time on the horizontal axis and tissue depth on vertical axis follow each other and help in the detection of movement of organ boundaries as the depth from the probe changes in moving organs.

This has good applications in the emergency setting to diagnose pneumothorax, left ventricular systolic function, cardiac tamponade, and hypertrophic obstructive cardiomyopathy [ 10 ]. The hardware of ultrasound machines is constantly evolving, from older and larger bedside machines to small convenient pocket-sized machines. The resolution of an image is better at higher frequencies, but this comes at the expense of depth of penetration.

Usually, a convex 3. The A profile is when we see A lines with normal lung sliding. It is important to understand that the lung ultrasound picture may be normal A profile in the case of asthma, chronic obstructive pulmonary disease, acute exacerbation of COPD, and pulmonary embolism as described in the blue protocol below. In a breathless patient, the ultrasound probe is placed in the described points.

A detailed explanation of the various lung artifacts can be found in the respective sections of the article. These appear as vertical artifacts projecting from the pleural line to the bottom of the screen known as lung rockets or comet tails, these are referred to as B lines. The density of B lines may help in the prediction of the severity of pulmonary edema [ 8 ]. Pneumonia may be diagnosed if the consolidation is in continuity with the pleural membrane.

On placement of the ultrasound probe in the upper anterior, lower anterior, or PLAPS points, a solidified liver tissue like image usually appears on the screen. The presence of dynamic air bronchograms assists in the diagnosis of pneumonia. It is critical for the person performing the scan to identify and demarcate the liver with the help of the diaphragmatic line of separation to avoid confusion with pneumonia.

The diaphragm is highly reflective, and the liver diaphragm surface can be reflected in the air of normal lung tissue as an artifact, which may be misinterpreted as hepatization of the lower lobe of the lung.

Chest CT is the gold standard for diagnosis of pneumonia, however, it has a high radiation exposure and high cost. Chest radiographs are used most frequently in clinical practice but have a poor sensitivity of Nazerian et al.

Lung ultrasound is reliable, rapid, and conclusive to arrive at a diagnosis of pneumonia even in the emergency room [ 15 ]. The immediate changes in ultrasound are the absence of lung sliding and a still cupola with lung pulse which are signs of poor lung expansion.

As mentioned above in addition to absent lung sliding and still cupola atelectasis may appear like alveolar consolidation but with absent dynamic air bronchograms. Even if air bronchograms are present secondary to trapped air in the bronchi, they are usually static in the case of atelectasis [ 16 ].

There will also likely be signs of loss of lung volume which is indicated by the heart sign. The heart sign indicates that the heart is displaced secondary to loss of lung volume and it can be visualized anywhere in the right or left chest.

The ultrasound findings for atelectasis may be present even before radiological findings are seen [ 19 ]. A lung abscess is a thick walled collection of pus within the lung. A lung abscess appears as a hypoechoic mass with an anechoic central portion with or without septae. Ultrasound targeted therapy of administration of antibiotics inside the abscess was shown to decrease the duration of systemic antibiotics needed to cause a resolution of the abscess [ 22 ].

The diagnosis of pneumothorax requires a sequential examination and presence of signs as noted below in a defined order as in the Blue protocol. No single sign should be taken in isolation for optimal sensitivity and specificity. An A-line pattern must also be seen on B mode. This point is the location where parietal and visceral pleura part due to the appearance of air between them. This should be the last sign that should be looked for after the above two in the same sequence.

The presence of B lines indicates the absence of pneumothorax at that position, however, B lines can be absent in normal lung profiles and may not be very reliable for making a diagnosis [ 25 ]. Ultrasound may be the best method to diagnose traumatic pneumothorax and iatrogenic pneumothoraxes at bedside [ 26 ]. The results of lung ultrasound are more sensitive than supine chest radiographs for pneumothorax [ 27 - 28 ]. The distance from the mid axillary line to lung point can be useful in estimating the size of pneumothorax [ 30 ].

The visceral pleura oscillates with respiration giving rise to the sinusoid sign on the M mode [ 31 ]. The PLAPS point is one of the first points where we can pick up effusions as fluid collection is gravity driven [ 33 ].

Mean prediction error of V was We can predict the type of effusion based on echogenicity and classify it as either a transudate or exudate. Transudative pleural effusions are usually anechoic whereas exudates maybe echoic or anechoic [ 8 ].

When combined with the above, a pleural thickening of more than 1 cm, pleural nodularity, or echogenic swirling can help in suspecting a malignancy [ 35 ]. Lung ultrasound may be effective, convenient, and economical to assess the size and location of a chest wall mass and help in the biopsy of the mass lesion [ 20 ]. Neoplasms of the lung can only be seen provided they abut the pleura. Tumors of the chest wall appear as well-defined and hypoechoic masses between the soft tissue layers.

In contrast, inflammatory lesions look irregular with a heterogeneous echotexture. Bone invasion by a chest wall lesion has hyperechoic plate-like shadows within the lesion. Osteolytic bone lesions are hypoechoic with an outer ring shadow.

Malignant lymph nodes are round, hypoechoic, and single or multiple confluent and lobulated masses [ 37 ]. According to Chira et al. Ultrasound has adequate potential in identifying dangerous intercostal and percutaneous blood vessels while performing biopsies of chest wall masses [ 40 ].

The value of ultrasound has been underestimated in the evaluation of chest wall masses and tumor invasion. CT may have a higher sensitivity and specificity in detecting neoplasms overall, but ultrasonography may prove to be a useful adjunct in some settings. Further studies are needed to evaluate the role of ultrasound in chest wall masses. One of the important uses of thoracic ultrasound is in the insertion of subclavian central lines and the confirmation of their position.

This also reduces the need for a confirmatory x-ray, thus hastening the administration of drugs and reducing healthcare costs [ 41 ]. It also reduces the rate of complications like pneumothorax, hemothorax, venous tear, arterial puncture, hematoma, and nerve injury [ 42 ]. The pleural avoidance with rib trajectory PART technique has been tested as a means of reducing pneumothorax risk with central line placement [ 43 ]. Ultrasound is especially useful in locating peripheral lung lesions where bronchoscopy is not accessible [ 44 ].

Lung ultrasound may be useful in monitoring and evaluation of the resolution of pneumothorax after chest tube placement [ 45 ]. The other methods to identify diaphragmatic dysfunction are sniff test, pulmonary function tests, trans-diaphragmatic pressure Pdi , ultrasonography, and electromyography. The diaphragm will normally contract and thicken during inspiration while the chronically paralyzed diaphragm is atrophied and will be thinner.

Ultrasonography measures the thickness of the diaphragm at the zone of apposition i. Ultrasound of the diaphragm can also be used in patients to assess weaning off the ventilator. Bedside ultrasound can detect lung collapse which helps in selecting patients for recruitment maneuvers.

Moderate, severe and complete loss of lung aeration is represented on ultrasound by the presence of multiple B-line B1 lines , coalescent B-lines B2 lines and consolidation [ 49 ]. Inspiratory pressures are obtained by identifying the pressure required for the image to shift from a consolidated lung to a normal lung.

The minimum PEEP required to prevent lung collapse is the pressure recorded when there is a shift from the normal lung image to a B1-B2 pattern plus 2 cm water [ 50 ].

U.S. Food and Drug Administration

Skip to search form Skip to main content You are currently offline. Some features of the site may not work correctly. The Sonographer as Student 3. Communication and Critical Thinking Skills 4. Sonographer Safety Issues 5. Medical Techniques and Patient Care 6.


Read Introduction to Sonography and Patient Care PDF | [PDF] Introduction to Sonography and Patient Care Ebook by Steven M. Penny PDF.


Diagnostic Cardiac Sonography

This program is designed for the nurse-midwife, nurse practitioner, physician assistant or other medical professional who has limited or no formal training in diagnostic ultrasound and wishes to learn the basic concepts of limited ultrasound applications in Obstetrics. Live demonstrations and hands-on scanning sessions are utilized extensively to teach ultrasound scanning techniques and protocols. Lectures are geared toward recognition of normal anatomy and common disorders, understanding of the protocols and standards, and performing appropriate measurements and documentation of the procedure. An optional instructional hands-on scanning session is held on Saturday morning from AM to PM. During the session participants perform transabdominal and transvaginal pelvic scanning on non-pregnant models, and transabdominal limited OB scanning on third-trimester pregnant models.

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Ultrasound imaging sonography uses high-frequency sound waves to view inside the body. Because ultrasound images are captured in real-time, they can also show movement of the body's internal organs as well as blood flowing through the blood vessels. Unlike X-ray imaging, there is no ionizing radiation exposure associated with ultrasound imaging. In an ultrasound exam, a transducer probe is placed directly on the skin or inside a body opening. A thin layer of gel is applied to the skin so that the ultrasound waves are transmitted from the transducer through the gel into the body.

Application of Lung Ultrasound in Critical Care Setting: A Review

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Diagnostic Cardiac Sonography

 Шифры, - задумчиво сказал Беккер - Откуда ты знаешь, с чего начинать. То есть… как ты их вскрываешь. Сьюзан улыбнулась: - Уж ты-то мог бы это понять. Это все равно что изучать иностранный язык. Сначала текст воспринимается как полная бессмыслица, но по мере постижения законов построения его структуры начинает появляться смысл.

Следопыт показывал адрес, не имеющий никакого смысла. Взяв себя в руки, она перечитала сообщение. Это была та же информация, которую получил Стратмор, когда сам запустил Следопыта.

Сьюзан с трудом воспринимала происходящее. - Что же тогда случилось? - спросил Фонтейн.  - Я думал, это вирус. Джабба глубоко вздохнул и понизил голос. - Вирусы, - сказал он, вытирая рукой пот со лба, - имеют привычку размножаться. Клонировать самих .


Care. ISBN: # | Date: Description: PDFd34 | Introduction to Sonography and Patient Care offers today's students the training and.


Introduction and background

Взял потрепанный справочник Guia Telefonica и начал листать желтые страницы. - Ничего не выйдет, - пробормотал. В разделе Служба сопровождения в справочнике было только три строчки; впрочем, ничего иного все равно не оставалось. Беккер знал лишь, что немец был с рыжеволосой спутницей, а в Испании это само по себе большая редкость. Клушар вспомнил, что ее звали Капля Росы.

 - Какой смысл хлестать мертвую кобылу. Парень был уже мертв, когда прибыла скорая. Они пощупали пульс и увезли его, оставив меня один на один с этим идиотом-полицейским. Странно, - подумал Беккер, - интересно, откуда же взялся шрам. Но он тут же выбросил эту мысль из головы и перешел к главному.

 - Я рад, что вы живы-здоровы. Сьюзан не отрывала глаз от директора.

 Мне очень важно получить ее именно. - Это невозможно, - раздраженно ответила женщина.  - Мы очень заняты. Беккер старался говорить как можно официальнее: - Дело весьма срочное.

 Все произойдет, как булавочный укол, - заверила его Сьюзан.  - В тот момент, когда обнаружится его счет, маяк самоуничтожится. Танкадо даже не узнает, что мы побывали у него в гостях. - Спасибо, - устало кивнул коммандер.

Глаза его расширились от ужаса. - Нет! - Он схватился за голову.  - Нет.

Внезапный прилив энергии позволил ей освободиться из объятий коммандера. Шум ТРАНСТЕКСТА стал оглушающим. Огонь приближался к вершине.

Взглянув на Следопыта, она нахмурилась.

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