Classification of Shock States:  

Classification of Shock

  • Hypovolenic
  • Cardiogenic
  • Distributive

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Goal Directed Ultrasound in Shock:


  • The Pump
  • The Tank
  • The Pipes

Cardiac Ultrasound:

Pericardial Effusion:

Left Ventricular Dysfunction:

Right Ventricular Enlargement:

Inferior Vena Cava:  Assessment of Volume Responsiveness

IVC in M-Mode

  • Measures an anatomical slice over time
  • Allows easy assessment of change in IVC size with respiration
  • AP diameter changes with respiration
  • Fixed at the diaphragm

Evaluating the Tank: Estimating CVP

IVC Diameter Respiratory Change Estimated CVP
< 1.5 cm Total Collapse <5 cmH20
1.5-2.5 cm >50% Collapse 6-10 cmH20
1.5-2.5 cm <50% Collapse 11-15 cmH20
>2.5 cm <50% Collapse 15-20 cmH20
>2.5 cm No Change >20 cmH20

Obstructive Shock:  Tension Pneumothorax

Tension Pneumothorax

  • Chest Ultrasound quickly identifies PTX
  • More accurate than supine AP chest x-ray
  • To Be continued During E-FAST evaluation

Distributive Shock:  Focused Abdominal Sonography in Trauma 

Aortic Pathology:

Aortic Root Measurement:

The Tank: FAST Exam

  • Focused Assessment with Sonography Trauma
  • Evaluation of intra abdominal Free Fluid
  • Next Lecture…

The Pipes: Aorta

  • Aortic Root Dilation
  • Abdominal Aorta Dilation
  • Abdominal Aorta Dissection

Aortic Root

  • Measure Just Beyond Tips of Valve at End Systole
  • Include Lumen Wall
  • Normal Root Diameter <3cm

Aortic Aneurysm:

Aortic Dissection:

Deep Vein Thrombosis:

Pipes: DVT

  • High Frequency Probe
  • Compression Venography Only
  • Scan From Just Below Inguinal Crease to Popliteal Fossa
  • Waypoints:
    • Common Femoral Vein
    • CFV at confluence with Saphenous Vein
    • Popliteal Vein
  • How Much Pressure?
    • Collapse veins without collapsing artery


Putting it all together:

USPSTF on screening for abdominal aortic aneurysm

Joseph Esherick, M.D., FAAFP, FHM

July 15, 2014

The USPSTF continues to recommend screening primarily in 65- to 75-year-old men who have ever smoked.

U.S. Preventive Services Task Force (USPSTF)​

Prevalence of abdominal aortic aneurysms (AAAs; defined by an aortic diameter of ≥3.0 cm) in adults older than 50 is as high as 7% in men and 1% in women. In 2005, the USPSTF recommended one-time screening by ultrasonography in 65- to 75-year-old men who had ever smoked (defined as having ever smoked ≥100 cigarettes) and recommended against routine screening in women (NEJM JW Gen Med Feb 18 2005). The USPSTF now has updated its recommendations.

Key Points
—Risk factors: Older age; positive smoking history; having a first-degree relative with AAA; and having a history of vascular aneurysms, coronary artery disease, cerebrovascular disease, hypercholesterolemia, obesity, or hypertension.
—As in 2005, the Task Force continues to recommend:
* One-time screening for AAAs with ultrasound in 65- to 75-year-old men who have ever smoked (Grade: B [recommend]).
* Selective screening for AAAs in 65- to 75-year-old men who have never smoked, if additional risk factors are present (Grade: C [recommend for selected patients]).
* No screening for women who have never smoked (Grade D: [recommend against]).

—The Task Force finds insufficient data to determine the balance of benefits and harms of screening for AAAs in 65- to 75-year-old women who have ever smoked (Grade: I [no recommendation]).
—Screening test: Abdominal duplex ultrasonography has sensitivity and specificity of 97% and 99%, respectively, and is the standard approach for AAA screening.
* Refer patients with large AAAs (≥5.5 cm) for open repair or endovascular intervention.
* For smaller AAAs (3.0–5.4 cm), manage patients conservatively (e.g., with repeat ultrasonography every 3–12 months).
—Screening in men is associated with an absolute risk reduction in AAA-related death of 1.4 per 1000 men screened.

LeFevre ML et al. Screening for abdominal aortic aneurysm: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2014 Jun 24; [e-pub ahead of print]. (http://dx.doi.org/10.7326/M14-1204)