V LANDES ad eme c um LANDES BIOSCIENCE V a d e m e c u m BIOSCIENCE V a d e m e c u m Table of contents 1. Education Credentialing 8. Insertion of the Central Ultrasound and Getting Started: Catheters With Attention to Physics 9. Transcranial Doppler and Instrumentation for Surgeons Ultrasound for Surgeons 2. FAST (Focused 10. Diagnosis and Treatment Assessment by of Fluid Collections Sonography in Trauma) and Other Pathology 3. Chest Trauma 11. Open Applications 4. Abdominal Aortic 12. Laparoscopic Applications Aneurysm Screening 13. Breast Ultrasound in the Emergent Setting 14. Vascular 5. Appendicitis 15. Rectal 6. Pediatric Applications 7. Surveillance of Deep Vein Thrombosis (DVT) The Vademecum series includes subjects generally not covered in other handbook series, especially many technology-driven topics that reflect the increasing influence of technology in clinical medicine. The name chosen for this comprehensive medical handbook series is Vademecum, a Latin word that roughly means “to carry along”. In the Middle Ages, traveling clerics carried pocket-sized books, excerpts of the carefully transcribed canons, known as Vademecum. In the 19th century a medical publisher in Germany, Samuel Karger, called a series of portable medical books Vademecum. The Landes Bioscience Vademecum books are intended to be used both in the training of physicians and the care of patients, by medical students, medical house staff and practicing physicians. We hope you will find them a valuable resource. Frankel ISBN 1-57059-597-6 Heidi L. Frankel All titles available at www.landesbioscience.com 9 781570 595974 vademecum Ultrasound for Surgeons Heidi L. Frankel, M.D., F.A.C.S. Associate Professor of Surgery Section of Trauma and Surgical Critical Care Yale University New Haven, Connecticut, U.S.A. L A N D E S B I O S C I E N C E GEORGETOWN, TEXAS U.S.A. VADEMECUM Ultrasound for Surgeons LANDES BIOSCIENCE Georgetown, Texas U.S.A. Copyright ©2005 Landes Bioscience All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without permission in writing from the publisher. Printed in the U.S.A. Please address all inquiries to the Publisher: Landes Bioscience, 810 S. Church Street, Georgetown, Texas, U.S.A. 78626 Phone: 512/ 863 7762; FAX: 512/ 863 0081 ISBN: 1-57059-597-6 Library of Congress Cataloging-in-Publication Data Frankel, Heidi L. Ultrasound for surgeons / Heidi L. Frankel. p. ; cm. -- (Vademecum) Includes index. ISBN 1-57059-597-6 1. Ultrasonics in surgery. 2. Operative ultrasonography. I. Title. II. Series. [DNLM: 1. Ultrasonography--methods--Handbooks. 2. Surgical Procedures, Operative--methods--Handbooks. WN 208 F828u 2004] RD33.7.F73 2004 617'.07543--dc22 2003025277 While the authors, editors, sponsor and publisher believe that drug selection and dosage and the specifications and usage of equipment and devices, as set forth in this book, are in accord with current recommendations and practice at the time of publication, they make no warranty, expressed or implied, with respect to material described in this book. In view of the ongoing research, equipment development, changes in governmental regulations and the rapid accumulation of information relating to the biomedical sciences, the reader is urged to carefully review and evaluate the information provided herein. Dedication Dedicated to my husband, John, and spouses like him, who allow us to practice our craft. Contents Foreword ......................................................................... 12 Acknowledgements ......................................................... 14 1. Education Credentialing and Getting Started: With Attention to Physics and Instrumentation ............... 1 Vicente H. Gracias, Heidi Frankel and Ronald I. Gross Historical Perspective .................................................................................. 1 Education in Surgeon-Performed Ultrasound: Training/Credentialing and Practice Domains ......................................................................... 1 Credentialing in Ultrasound ....................................................................... 2 A Physics Primer ......................................................................................... 6 Appendix I. CESTE Guidelines Surgeon Eligibility and Verification in Basic Ultrasonography .......................................... 7 Appendix II. Credentialing Requirements for Granting of Privileges to Surgeons to Perform the Focused Abdominal Sonogram in Reply To: Trauma (FAST) ............................................................... 9 General Principles ....................................................................................... 9 Training ...................................................................................................... 9 Maintenance of Qualifications .................................................................. 10 Use in the Emergent Setting 2. FAST (Focused Assessment by Sonography in Trauma)... 11 Ronald I. Gross History ..................................................................................................... 12 Technique: Performing the FAST Examination ......................................... 14 Advantages and Drawbacks of the FAST Examination .............................. 19 Application: Uses of FAST in the Acute Setting ........................................ 21 Future Applications of Ultrasound in the Acute Setting ............................ 24 Appendix I. Lectures for Postgraduate Course No. 23: Ultrasound for the General Surgeon .................................................................... 26 3. Chest Trauma .................................................................. 30 Frank Davis and M. Gage Ochsner Cardiac Injuries ........................................................................................ 30 Blunt Cardiac Injuries ............................................................................... 34 Traumatic Effusions (Hemothoraces) ........................................................ 35 Ultrasound Diagnosis of Pneumothorax ................................................... 37 TEE ......................................................................................................... 39 IVUS Assessment of Traumatic Injury to the Thoracic Aorta .................... 44 4. Abdominal Aortic Aneurysm Screening in the Emergent Setting .................................................. 49 David B. Pilcher Relation of Aneurysm Size to Risk of Rupture .......................................... 49 Ultrasound Equipment ............................................................................. 49 Information by Ultrasound Other Than Aneurysm Presence and Size ....... 52 Performing Aortic Aneurysm Ultrasound .................................................. 52 Comparison to CT Scan and Plain X-Rays ............................................... 52 5. Appendicitis .................................................................... 54 Shyr-Chyr Chen Historical Review ...................................................................................... 54 Graded Compression Technique ............................................................... 55 Modified Compression Method ................................................................ 57 Sonography of Normal Appendix ............................................................. 60 Sonographic Diagnosis of Appendicitis ..................................................... 61 6. Pediatric Applications ..................................................... 68 Oluyinka Olutoye, Richard Bellah and Perry Stafford Acute Appendicitis .................................................................................... 68 Hypertrophic Pyloric Stenosis (HPS) ........................................................ 70 Intussusception ......................................................................................... 72 Intestinal Malrotation ............................................................................... 73 Testicular Torsion...................................................................................... 73 Trauma ..................................................................................................... 76 Use in the ICU 7. Surveillance of Deep Vein Thrombosis (DVT) ................ 78 Rajan Gupta and Jeffrey Carpenter History and Indications ............................................................................ 78 Technique and Pitfalls ............................................................................... 80 8. Insertion of Central Catheters......................................... 84 Tarek Razek and Michael Russell Background .............................................................................................. 84 The Problem ............................................................................................. 84 Guided Techniques ................................................................................... 85 Potential Disadvantages to the Routine Use of Ultrasound Guidance........ 87 Clinical Efficacy of Ultrasound Guided Central Venous Cannulation ....... 87 9. Transcranial Doppler ...................................................... 91 George Counelis and Grant Sinson Technique ................................................................................................. 91 Clinical