Ultrasound in Perioperative Setting
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Questions and Answers

What is an assumption made in ultrasound imaging?

  • The speed of sound in tissues is 1500 m/s.
  • The speed of sound in tissues is 1540 m/s. (correct)
  • Sound waves travel in a curved line.
  • Tissue at different angles does not change the angle of return.

    • What is a benefit of using ultrasound in the perioperative setting?

  • It is only used in trauma cases.
  • It enhances patient care and safety. (correct)
  • It only provides 2D imaging.
  • It is only used for airway evaluation.

    • What is a characteristic of modern ultrasound equipment?

  • It is only used in the ICU.
  • It has advanced capabilities such as 3D imaging. (correct)
  • It is bulky and non-portable.
  • It is only used for lung imaging.

    • What is an example of an application of ultrasound in the perioperative setting?

    <p>Gastric ultrasound. (D)</p> Signup and view all the answers

    When did ultrasound equipment become more compact and portable?

    <p>In the early part of the 21st century. (C)</p> Signup and view all the answers

    What property of tissue can generate shadows in ultrasound imaging?

    <p>All of the above. (D)</p> Signup and view all the answers

    What is a major advantage of using perioperative ultrasound?

    <p>Portability of ultrasound machines and probes (D)</p> Signup and view all the answers

    What is a common similarity between superficial vessels and nerve blocks?

    <p>Techniques used (A)</p> Signup and view all the answers

    What is a potential disadvantage of using perioperative ultrasound?

    <p>Costs of initial purchase and maintenance of equipment (B)</p> Signup and view all the answers

    What type of transducer is best suited for imaging shallow structures at high frequency?

    <p>Linear (C)</p> Signup and view all the answers

    What is a benefit of using perioperative ultrasound in terms of radiation risks?

    <p>Reduces ionizing radiation risks (C)</p> Signup and view all the answers

    What is the primary purpose of FOCUS in emergency situations?

    <p>To narrow down the list of possible diagnoses and guide anesthetic management (D)</p> Signup and view all the answers

    What is the primary focus of the article by Romero-González et al. (2022)?

    <p>PoCUS in Nephrology (D)</p> Signup and view all the answers

    What is the primary benefit of using ultrasound in vascular access?

    <p>To guide cannulation of peripheral and central venous access (D)</p> Signup and view all the answers

    What is the title of the journal in which the article by Via et al. (2014) was published?

    <p>Journal of the American Society of Echocardiography (D)</p> Signup and view all the answers

    What type of transducer is best suited for imaging deeper structures in the abdomen?

    <p>Curvilinear (B)</p> Signup and view all the answers

    What information is obtained from a FOCUS exam?

    <p>All of the above, plus volume response (C)</p> Signup and view all the answers

    What is the purpose of the RUSH exam in emergency shock situations?

    <p>To provide a rapid diagnosis of problems and guide management of intraoperative shock (C)</p> Signup and view all the answers

    What is the primary advantage of using ultrasound in lung imaging?

    <p>It can detect pneumothorax with equal or superior accuracy to CXR (C)</p> Signup and view all the answers

    What type of transducer is best suited for imaging thoracic organs?

    <p>Phased array (B)</p> Signup and view all the answers

    What is a key advantage of using ultrasound in the perioperative setting?

    <p>All of the above (D)</p> Signup and view all the answers

    What is a common similarity between superficial vessels and nerve blocks?

    <p>Techniques used (D)</p> Signup and view all the answers

    According to Romero-González et al. (2022), what is the title of the journal in which the article was published?

    <p>Clinical Kidney Journal (B)</p> Signup and view all the answers

    What is a potential disadvantage of using perioperative ultrasound?

    <p>Costs of initial purchase and maintenance of equipment (A)</p> Signup and view all the answers

    What is the focus of the article by Via et al. (2014)?

    <p>Focused cardiac ultrasound (C)</p> Signup and view all the answers

    What is a characteristic of modern ultrasound equipment?

    <p>Portability and high frequency (D)</p> Signup and view all the answers

    What is an advantage of using perioperative ultrasound in terms of radiation risks?

    <p>Reduced radiation risks to patients (D)</p> Signup and view all the answers

    What is the purpose of the article by Romero-González et al. (2022)?

    <p>To discuss the application of PoCUS in nephrology (D)</p> Signup and view all the answers

    What is a benefit of using perioperative ultrasound in terms of image acquisition?

    <p>Rapid acquisition of images (C)</p> Signup and view all the answers

    What is a limitation of perioperative ultrasound?

    <p>All of the above except b (D)</p> Signup and view all the answers

    What happens when a strong acid or a strong base is added to water?

    <p>It will completely ionize (B)</p> Signup and view all the answers

    What is the characteristic of acid-base reactions?

    <p>Transfer of a hydrogen ion from the acid to the base (C)</p> Signup and view all the answers

    What happens to a weak acid or a weak base when added to water?

    <p>It will partially ionize and partially remain unionized (B)</p> Signup and view all the answers

    What is the result of an acid-base reaction?

    <p>One acid and one base on the reactant side, and one acid and one base on the product side (B)</p> Signup and view all the answers

    Which of the following is true about the reaction equilibrium in acid-base reactions?

    <p>It always favors the formation of the weaker acid (D)</p> Signup and view all the answers

    What is a characteristic of strong acids?

    <p>They are essentially 100% ionized when dissolved in water (B)</p> Signup and view all the answers

    What is a characteristic of strong bases?

    <p>They are soluble ionic hydroxides and ionize essentially 100% to produce the OH− ion (A)</p> Signup and view all the answers

    What happens when a weak acid dissolves in water?

    <p>It establishes a dynamic equilibrium between the molecular form and the ionized form (D)</p> Signup and view all the answers

    What is a characteristic of weak bases?

    <p>They are able to accept hydrogen ions from acids, but are less determined to do so (A)</p> Signup and view all the answers

    What is a key difference between strong and weak acids?

    <p>Strong acids are essentially 100% ionized when dissolved in water, while weak acids are not (A)</p> Signup and view all the answers

    What is the relationship between pH and pKa of a drug?

    <p>When pH is equal to pKa, the drug is 50% ionized and 50% unionized (C)</p> Signup and view all the answers

    What determines whether a drug can cross the blood-brain barrier (BBB)?

    <p>The lipid solubility of the drug (C)</p> Signup and view all the answers

    What is the effect of increasing the Ka of a weak acid?

    <p>The reaction tends to favor the products (B)</p> Signup and view all the answers

    What is the role of a salt in a weak acid or weak base?

    <p>To provide a counterion for the drug (A)</p> Signup and view all the answers

    What is the difference between a weak acid and a weak base?

    <p>A weak acid donates H+, while a weak base accepts OH- (D)</p> Signup and view all the answers

    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.

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