Emergency Echo 5Es

E is for Entrance

  • Inferior vena cava (IVC)
  • Assessment of fluid status
  • Best seen in sagittal/ longitudinal
  • Normal IVC <2cm
  • Normal IVC collapses with respiration
    • Measurements can be done
      • overall diameter
      • % of collapse
    • Recommend qualitative assessment:
      • Very flat/ collapsed
      • Normal with some collapsibility
      • Distended and non-collapsible


sensor position


So the fifth and last E we are going to talk about is the E for entrance and that is really where the inferior vena cava enters the heart and it is very helpful for the assessment of fluid status or preload. It is best going to be seen if you do a sagittal view of the IVC so we rotate the probe so the indicator is towards the head put it in the subxyphoid or subcostal region and watch the IVC. So a normal IVC, you can measure it, but I really suggest you get used to doing it qualitatively; should be under 2 cm at its maximal diameter and it should collapse some with spontaneous inspiration or if you do what is called the sniff where you have the person sniff in through their nose they create negative intrathoracic pressure and blood runs into the chest and collapses the IVC and that is consistent with a normal preload or hydration status.

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