Emergency Echo 5Es

E is for Effusion

  • Most sensitive view is subxiphoid
  • Beware pericardial/epicardial fatty tissue
  • Can be graded as
    • Small (<1cm in diastole)
    • Moderate (1-2cm)
    • Large (>2cm)
  • Tamponade
    • Clinical diagnosis: hypotension with effusion
    • See 5Es advanced

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So the first E we're going to talk about is E for effusion, and this is the most basic pathology we're looking for- it’s fluid around the heart. It should appear black, and this could be blood or could be just fluid from something like a viral pericarditis. The most sensitive view to pick up a pericardial effusion is typically the subxyphoid view. Effusions tend to go posteriorly and inferiorly. By using the liver as a window we are able to see the most inferior part of the pericardium. We can grade effusions as small which is typically less than 1 cm in diastole in max measurement, moderate 1-2 cm, and large which is greater than 2 cm. Tamponade is really a clinical diagnosis where you have cardiovascular collapse, hypotension, from pericardial effusion. There are some clues on echo that we'll talk about a little bit in this lecture, as well as the more advanced lecture on echo.

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