Anaes Vivas · Physiology, physics and equipment
Echocardiography and POCUS for the anaesthetist — Viva
Viva on FoCUS views, LVOT VTI, and the scope/limits of anaesthetist-performed PoCUS.
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Prompt
A 72-year-old with preoperative dyspnoea has an LVOT diameter of 2.0 cm with a VTI of 18 cm at induction; HR 80.
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Viva Stems
- List the five standard FoCUS views and the haemodynamic question each answers: PLAX, PSAX, apical four-chamber, subcostal four-chamber and subcostal IVC.[1][2]
- Using LVOT VTI, how do you calculate cardiac output (SV = area × VTI ≈ 56 mL here; CO ≈ 4.5 L/min)? Because LVOT area is effectively constant, serial VTI tracks change — why is it a trend rather than an absolute number?[4]
- Your scan suggests RV strain (RV dilated, D-shaped septum). What are the possible causes including massive PE, and what is your next step?[2]
- When is a FoCUS examination inadequate — suspected valve disease, ambiguous findings, non-responding shock — what must be escalated to comprehensive echo?[1]
- What does the ASA 2022 expert panel say about anaesthetist-performed diagnostic PoCUS — scope for trained operators, training minima, safe and ethical use?[1]
References3ShowHide
- [1]Bronshteyn YS, Anderson TA, Badakhsh O, et al. Diagnostic point-of-care ultrasound: recommendations from an expert panel. J Cardiothorac Vasc Anesth, 2022.PMID 34059438
- [2]Haskings EM, Eissa M, Allard RV, et al. Point-of-care ultrasound use in emergencies: what every anaesthetist should know. Anaesthesia, 2023.PMID 36449358
- [4]Blanco P. Rationale for using the velocity-time integral and the minute distance for assessing the stroke volume and cardiac output in point-of-care settings. Ultrasound J, 2020.PMID 32318842