Chapter 11 Intensive Care Unit

264

SECTION 1 • Techniques and Methods in Critical Care

knowledge of acoustic windows and structural imag- ing correlations is quickly becoming an essential skill for the intensivist (Fig. 11-20A and B). Large pericar- dial effusions and gross deficiencies or asymmetries of ventricular filling, for example, are readily detect- able through one or more acoustic windows, as are the noncompressible femoral veins of a fresh lower extremity clot. Pericardial effusions or blood clots

within the pericardium do not move with the heart, whereas the epicardial fat pads do. Descriptive tech- nical details of how to perform such studies are read- ily available from comprehensive published review articles and educational online videos and will not be attempted here. Increasingly, US imaging has become integrated into everyday practice. ACUS provides considerable

Apical 4-Chamber View of Cardiac Ultrasound

Apex of heart

Septum

Papillary muscles

AV

MV

TV

Mitral valve

Tricuspid valve

Right atrium

Left atrium

Interatrial septum

A

Longitudinal Axis Cardiac Ultrasound

RV

Ao

Ao V

LV

MV

PW

LA

Desc Ao

B FIGURE 11-20. A: Apical 4-chamber view obtained with 2D cardiac ultrasound. B: Longitudinal axis view of left heart and aorta by cardiac echo.