Question 3: IVC

Question 3: 

a ) State the two (2) features of Inferior vena cava measurement by Ultrasound that supports a reduced central venous pressure measurement. (2 marks)

  1. IVC less than 1 cm
  2. Collapsibility index of > 50%

b ) State four (4) limitations to the use of inferior vena cava measurement by Ultrasound, in the Emergency Department setting, for the assessment of intravascular volume. (4 marks)

  1.  IVC does not reflect CVP
  2. IVC is affected my numerous other conditions other than intravascular volume including intrathoracic pressures(COPD, tension pneumothorax, large pericardial effusion, PE_), intracardiac pressures (cardiomyopathy, heart failure), Intrapericardial pressures (pericardial effusions), valvular pathologies (tricuspid stenosis, pulmonary valve stenosis)
  3. IVC is affected by position Bigger if standing, bigger in left lateral position
  4. IVC can be affected by other conditions which are non pathological – larger in athletes

c ) Other than Inferior vena cava measurement, list four (4) uses for Bedside ECHO in the setting of a cardiac arrest. (4 marks)

  1. Look for myocardial contractility – no contractility – very poor prognosis

In the context of PEA

  1. Look for large RV, D shaped LV, and MConnels sign suggestive of large PE
  2. Look for hyperkinetic heart suggestive of significant fluid depletion or blood loss
  3. Look for acute valvular prolapses which may cause acute heart failure and arrest

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