POCUS and critical care echo

Obtain parasternal long and short axis, apical four-chamber and subcostal views. Grade LV function visually (normal, mildly, severely reduced, hyperdynamic) and look for pericardial effusion, gross valve failure and LV size.

Compare RV and LV size in the apical four-chamber view, look for septal flattening, measure TAPSE, and interpret signs of acute (thin-walled, McConnell sign) vs chronic (hypertrophied) RV overload.

The IVC estimates right atrial pressure in spontaneously breathing patients but predicts fluid responsiveness poorly, especially on the ventilator. A plethoric IVC with abnormal hepatic, portal and intrarenal Doppler (VExUS grade 2-3) signals venous congestion: stop fluids and consider decongestion.

Lung sliding, A-lines, B-lines, consolidation and effusion answer most bedside questions: pneumothorax, pulmonary oedema vs COPD/asthma, pneumonia, PE and pleural effusion.

RUSH checks the pump (LV, RV, pericardium), the tank (IVC, lungs, peritoneum, pleura) and the pipes (aorta, leg veins) to classify shock in minutes. eFAST looks for free fluid and pneumothorax in trauma.

Compress the common femoral vein (and saphenofemoral junction) and the popliteal vein with a linear probe. A non-compressible vein means DVT. A negative 2-point scan in a high-probability patient needs repeat at 1 week or a whole-leg scan.