ICU Vivas · Haemodynamic monitoring
Imaging viva: focused echocardiography in shock
A CICM cross-table imaging viva on focused echocardiography (FoCUS) in the shocked patient — the structural question the pressure and flow numbers cannot answer. The candidate describes the ventricular size and function, the right heart, the pericardium and the inferior vena cava, and uses the pattern to separate hypovolaemic/distributive shock (small, hypercontractile) from cardiogenic (dilated, poorly contracting) and from obstructive (right-ventricular dilatation, tamponade).
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You perform a focused bedside echocardiogram on a shocked patient and describe the four-chamber and subcostal views. The findings are:
| Structure | Finding |
|---|---|
| Left ventricle | Small, hypercontractile, near-obliterating in systole (E-point septal separation reduced) |
| Right ventricle | Normal size and function |
| Inferior vena cava | Small, less than 1 cm, collapsing more than 50% with respiration |
| Pericardium | No effusion |
| Gross valves | No gross lesion |
Describe the findings, classify the shock, and state how the echo changes the management.[1]
References2ShowHide
- [1]Bersten AD, Soni N (eds) Oh's Intensive Care Manual. 8th edition, Elsevier, 2018.
- [2]Marino PL The ICU Book. 4th edition, Lippincott Williams & Wilkins, 2014.