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)
- IVC less than 1 cm
- 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)
- IVC does not reflect CVP
- 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)
- IVC is affected by position Bigger if standing, bigger in left lateral position
- 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)
- Look for myocardial contractility – no contractility – very poor prognosis
In the context of PEA
- Look for large RV, D shaped LV, and MConnels sign suggestive of large PE
- Look for hyperkinetic heart suggestive of significant fluid depletion or blood loss
- Look for acute valvular prolapses which may cause acute heart failure and arrest