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Questions and Answers
What is an assumption made in ultrasound imaging?
What is a benefit of using ultrasound in the perioperative setting?
What is a characteristic of modern ultrasound equipment?
What is an example of an application of ultrasound in the perioperative setting?
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When did ultrasound equipment become more compact and portable?
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What property of tissue can generate shadows in ultrasound imaging?
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What is a major advantage of using perioperative ultrasound?
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What is a common similarity between superficial vessels and nerve blocks?
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What is a potential disadvantage of using perioperative ultrasound?
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What type of transducer is best suited for imaging shallow structures at high frequency?
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What is a benefit of using perioperative ultrasound in terms of radiation risks?
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What is the primary purpose of FOCUS in emergency situations?
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What is the primary focus of the article by Romero-González et al. (2022)?
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What is the primary benefit of using ultrasound in vascular access?
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What is the title of the journal in which the article by Via et al. (2014) was published?
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What type of transducer is best suited for imaging deeper structures in the abdomen?
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What information is obtained from a FOCUS exam?
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What is the purpose of the RUSH exam in emergency shock situations?
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What is the primary advantage of using ultrasound in lung imaging?
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What type of transducer is best suited for imaging thoracic organs?
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What is a key advantage of using ultrasound in the perioperative setting?
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What is a common similarity between superficial vessels and nerve blocks?
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According to Romero-González et al. (2022), what is the title of the journal in which the article was published?
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What is a potential disadvantage of using perioperative ultrasound?
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What is the focus of the article by Via et al. (2014)?
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What is a characteristic of modern ultrasound equipment?
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What is an advantage of using perioperative ultrasound in terms of radiation risks?
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What is the purpose of the article by Romero-González et al. (2022)?
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What is a benefit of using perioperative ultrasound in terms of image acquisition?
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What is a limitation of perioperative ultrasound?
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What happens when a strong acid or a strong base is added to water?
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What is the characteristic of acid-base reactions?
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What happens to a weak acid or a weak base when added to water?
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What is the result of an acid-base reaction?
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Which of the following is true about the reaction equilibrium in acid-base reactions?
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What is a characteristic of strong acids?
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What is a characteristic of strong bases?
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What happens when a weak acid dissolves in water?
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What is a characteristic of weak bases?
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What is a key difference between strong and weak acids?
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What is the relationship between pH and pKa of a drug?
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What determines whether a drug can cross the blood-brain barrier (BBB)?
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What is the effect of increasing the Ka of a weak acid?
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What is the role of a salt in a weak acid or weak base?
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What is the difference between a weak acid and a weak base?
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Study Notes
Objectives
- Familiarize yourself with the uses of ultrasound in the perioperative setting
- Discuss how ultrasound enhances patient care and safety
- List the uses of ultrasound in the perioperative setting
- Explain how ultrasound enhances patient care
History of Ultrasound
- Early 21st century: Ultrasound equipment became more compact and portable
- Exploration of other uses of ultrasound in perioperative setting began
- Lung
- Gastric
- Spine
- Trauma
- ICU
- Airway evaluation
Artifacts
- Speed of sound in tissues is assumed to be 1540 m/s
- Sound waves are assumed to travel in a straight line
- Tissue at different angles and echogenic properties change the angle of return
- Refractive and reflective properties of tissue generate shadows
Equipment
- Several machines and transducers are available for perioperative use
- Point-of-Care-UltraSound (POCUS) equipment provides basic images and advanced capabilities (e.g. 3D imaging, pulse doppler)
- Three basic types of transducers:
- Linear: Shallow structures, high frequency, high definition
- Phased array: Lower frequencies, better at spatial depth, good for thoracic organs
- Curvilinear: More depth of field, used for deeper structures in abdomen
Trans-Thoracic Echocardiography (TTE) and Focused Cardiac Ultrasound (FOCUS)
- FOCUS is a qualitative exam
- Used to evaluate heart, valves, and vessels
- Used in conjunction with physical exam
- Limited in scope
- Can be used to narrow down list of possible diagnoses
FOCUS Information
- Global biventricular systolic function
- Atrial and Ventricular chamber size
- Valvular abnormalities
- Pericardial effusion or tamponade
- Volume response
Emergency Use of Ultrasound
- Uses of POCUS include FOCUS for multi-organ system evaluation
- Rapid Ultrasound in Shock (RUSH) for rapid diagnosis of problems and management of intraoperative shock
Lung Ultrasound
- Uses linear transducer
- Can diagnose:
- Pneumothorax
- Pleural effusion
- Pneumonia
- Pulmonary edema
- Esophageal or endobronchial intubation
- Detection of pneumothorax is equal to or superior to CXR
Vascular Access
- Ultrasound can be used for cannulation of peripheral and central venous access
- Can also be used for intra-arterial blood pressure monitoring
- Techniques used are similar to those used for nerve blocks
Advantages and Disadvantages of Perioperative Ultrasound
- Advantages:
- Versatility
- Rapid acquisition of images
- Ability to perform repeated examinations
- Portability of ultrasound machines and probes
- Absence of ionizing radiation risks
- Disadvantages:
- Costs of initial purchase and maintenance of equipment
- Training and availability of skilled clinicians
Objectives
- Familiarize yourself with the uses of ultrasound in the perioperative setting
- Discuss how ultrasound enhances patient care and safety
- List the uses of ultrasound in the perioperative setting
- Explain how ultrasound enhances patient care
History of Ultrasound
- Early 21st century: Ultrasound equipment became more compact and portable
- Exploration of other uses of ultrasound in perioperative setting began
- Lung
- Gastric
- Spine
- Trauma
- ICU
- Airway evaluation
Artifacts
- Speed of sound in tissues is assumed to be 1540 m/s
- Sound waves are assumed to travel in a straight line
- Tissue at different angles and echogenic properties change the angle of return
- Refractive and reflective properties of tissue generate shadows
Equipment
- Several machines and transducers are available for perioperative use
- Point-of-Care-UltraSound (POCUS) equipment provides basic images and advanced capabilities (e.g. 3D imaging, pulse doppler)
- Three basic types of transducers:
- Linear: Shallow structures, high frequency, high definition
- Phased array: Lower frequencies, better at spatial depth, good for thoracic organs
- Curvilinear: More depth of field, used for deeper structures in abdomen
Trans-Thoracic Echocardiography (TTE) and Focused Cardiac Ultrasound (FOCUS)
- FOCUS is a qualitative exam
- Used to evaluate heart, valves, and vessels
- Used in conjunction with physical exam
- Limited in scope
- Can be used to narrow down list of possible diagnoses
FOCUS Information
- Global biventricular systolic function
- Atrial and Ventricular chamber size
- Valvular abnormalities
- Pericardial effusion or tamponade
- Volume response
Emergency Use of Ultrasound
- Uses of POCUS include FOCUS for multi-organ system evaluation
- Rapid Ultrasound in Shock (RUSH) for rapid diagnosis of problems and management of intraoperative shock
Lung Ultrasound
- Uses linear transducer
- Can diagnose:
- Pneumothorax
- Pleural effusion
- Pneumonia
- Pulmonary edema
- Esophageal or endobronchial intubation
- Detection of pneumothorax is equal to or superior to CXR
Vascular Access
- Ultrasound can be used for cannulation of peripheral and central venous access
- Can also be used for intra-arterial blood pressure monitoring
- Techniques used are similar to those used for nerve blocks
Advantages and Disadvantages of Perioperative Ultrasound
- Advantages:
- Versatility
- Rapid acquisition of images
- Ability to perform repeated examinations
- Portability of ultrasound machines and probes
- Absence of ionizing radiation risks
- Disadvantages:
- Costs of initial purchase and maintenance of equipment
- Training and availability of skilled clinicians
Strong Acids
- Very determined to donate protons to a base
- Essentially 100% ionized when dissolved in water
- Strong acids are relatively rare
Strong Bases
- In water, the strongest possible base is the hydroxide ion (OH−)
- A strong base ionizes essentially 100% to produce the OH− ion
- A strong base is a soluble ionic hydroxide
Weak Acids
- Able to donate hydrogen ions to bases, but are less determined to do so than strong acids
- Establish a dynamic equilibrium between the molecular form and the ionized form when dissolved in water
Weak Bases
- Able to accept hydrogen ions from acids, but are less determined to do so than strong bases
- Do not completely ionize in water to produce an equivalent concentration of the hydroxide ion
- Establish a dynamic equilibrium between the molecular form and the ionized form when dissolved in water
Acid-Base Reactions
- Involve a transfer of a hydrogen ion from the acid to the base
- To predict the products of an acid-base reaction, identify the acid and base, move an H+ ion from the acid to the base, and convert the acid into its conjugate base and the base into its conjugate acid
- Any acid-base reaction has two acids and two bases: one acid and one base on the reactant side, and the conjugate acid and conjugate base on the product side
- The base almost always has a lower (more negative) charge than the acid
- Hydrogen is almost always the first atom listed in the formula of an acid
- The reaction equilibrium always favors the formation of the weaker acid
Ionization of Weak Acids/Strong Base
- A drug with a low pKa (e.g. 3.5) is more non-ionized, while a drug with a high pKa (e.g. 8.5) is more ionized
- pH affects ionization: at pH 1.0, the drug is more acidic and non-ionized, while at pH 14, the drug is more basic and ionized
- Lipid solubility and ability to cross the blood-brain barrier (BBB) depend on ionization state
Drugs and Acids/Bases
- Most drugs are weak acids or weak bases
- Weak acids are usually paired with a positive ion (e.g. Na+, Ca+, Magnesium), while weak bases are paired with a negative ion (e.g. chloride, sulfate)
- Drug ionization affects its behavior and effects in the body
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Description
Become familiar with the uses of ultrasound in the perioperative setting, discuss its benefits, and list its uses in enhancing patient care and safety.
