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Ultrasound Pericardial Effusion Rohit Patel, MD University of Florida Health Director, Critical Care Ultrasound Surgical ICU Center for Intensive Care Gainesville, Florida Sunday, August 14, 16

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Page 1: Ultrasound Pericardial Effusion - University of Florida...Pericardial Effusion Rohit Patel, MD University of Florida Health Director, Critical Care Ultrasound Surgical ICU Center for

UltrasoundPericardial Effusion

Rohit Patel, MDUniversity of Florida Health

Director, Critical Care Ultrasound Surgical ICUCenter for Intensive Care

Gainesville, Florida

Sunday, August 14, 16

Page 2: Ultrasound Pericardial Effusion - University of Florida...Pericardial Effusion Rohit Patel, MD University of Florida Health Director, Critical Care Ultrasound Surgical ICU Center for

Clinical CasePt presents speaking partial sentences saturations 78%, confused

What do you do?

Grai. Acta Anaesthesiology. 2001Sunday, August 14, 16

Page 3: Ultrasound Pericardial Effusion - University of Florida...Pericardial Effusion Rohit Patel, MD University of Florida Health Director, Critical Care Ultrasound Surgical ICU Center for

Golden hour

Problem

OrderTech Reader

Back to you

Treatment

Grai. Acta Anaesthesiology. 2001Sunday, August 14, 16

Page 4: Ultrasound Pericardial Effusion - University of Florida...Pericardial Effusion Rohit Patel, MD University of Florida Health Director, Critical Care Ultrasound Surgical ICU Center for

Golden hour

Problem

OrderTech Reader

Back to you

Treatment

Point of care

Grai. Acta Anaesthesiology. 2001Sunday, August 14, 16

Page 5: Ultrasound Pericardial Effusion - University of Florida...Pericardial Effusion Rohit Patel, MD University of Florida Health Director, Critical Care Ultrasound Surgical ICU Center for

Sunday, August 14, 16

Page 6: Ultrasound Pericardial Effusion - University of Florida...Pericardial Effusion Rohit Patel, MD University of Florida Health Director, Critical Care Ultrasound Surgical ICU Center for

Sunday, August 14, 16

Page 7: Ultrasound Pericardial Effusion - University of Florida...Pericardial Effusion Rohit Patel, MD University of Florida Health Director, Critical Care Ultrasound Surgical ICU Center for

Sunday, August 14, 16

Page 8: Ultrasound Pericardial Effusion - University of Florida...Pericardial Effusion Rohit Patel, MD University of Florida Health Director, Critical Care Ultrasound Surgical ICU Center for

The PumpPericardial effusion?

Global contractility of left ventricle?

Relative size of right ventricle to left ventricle?

Joseph M, et al. Transthoracic echocardiography to identify or exclude cardiac cause of shock. Chest 2004Bealieu Y, et al. Specific skill set and gaols of focused echocardiography for critical care physicians. Crit Care Med 2007Sunday, August 14, 16

Page 9: Ultrasound Pericardial Effusion - University of Florida...Pericardial Effusion Rohit Patel, MD University of Florida Health Director, Critical Care Ultrasound Surgical ICU Center for

Back to the pump

Sunday, August 14, 16

Page 10: Ultrasound Pericardial Effusion - University of Florida...Pericardial Effusion Rohit Patel, MD University of Florida Health Director, Critical Care Ultrasound Surgical ICU Center for

Back to the pump

Sunday, August 14, 16

Page 11: Ultrasound Pericardial Effusion - University of Florida...Pericardial Effusion Rohit Patel, MD University of Florida Health Director, Critical Care Ultrasound Surgical ICU Center for

Effusion around the pump

Sunday, August 14, 16

Page 12: Ultrasound Pericardial Effusion - University of Florida...Pericardial Effusion Rohit Patel, MD University of Florida Health Director, Critical Care Ultrasound Surgical ICU Center for

Video

Perera P. "http://www.sound-bytes.tv"

Sunday, August 14, 16

http://www.sound-bytes.tv
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Page 13: Ultrasound Pericardial Effusion - University of Florida...Pericardial Effusion Rohit Patel, MD University of Florida Health Director, Critical Care Ultrasound Surgical ICU Center for

Video

Perera P. "http://www.sound-bytes.tv"

Sunday, August 14, 16

http://www.sound-bytes.tv
http://www.sound-bytes.tv
http://www.sound-bytes.tv
http://www.sound-bytes.tv
Page 14: Ultrasound Pericardial Effusion - University of Florida...Pericardial Effusion Rohit Patel, MD University of Florida Health Director, Critical Care Ultrasound Surgical ICU Center for

Effusion around the pump

Grades

Small less than 10 mm

Moderate 10-15 mm

Large greater than 15 mm

Sunday, August 14, 16

Page 15: Ultrasound Pericardial Effusion - University of Florida...Pericardial Effusion Rohit Patel, MD University of Florida Health Director, Critical Care Ultrasound Surgical ICU Center for

Video

Perera P. "http://www.sound-bytes.tv"

Descending Aorta

Sunday, August 14, 16

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http://www.sound-bytes.tv
http://www.sound-bytes.tv
http://www.sound-bytes.tv
Page 16: Ultrasound Pericardial Effusion - University of Florida...Pericardial Effusion Rohit Patel, MD University of Florida Health Director, Critical Care Ultrasound Surgical ICU Center for

Video

Perera P. "http://www.sound-bytes.tv"

Descending Aorta

Sunday, August 14, 16

http://www.sound-bytes.tv
http://www.sound-bytes.tv
http://www.sound-bytes.tv
http://www.sound-bytes.tv
Page 17: Ultrasound Pericardial Effusion - University of Florida...Pericardial Effusion Rohit Patel, MD University of Florida Health Director, Critical Care Ultrasound Surgical ICU Center for

Video

Perera P. "http://www.sound-bytes.tv"

Descending Aorta

Sunday, August 14, 16

http://www.sound-bytes.tv
http://www.sound-bytes.tv
http://www.sound-bytes.tv
http://www.sound-bytes.tv
Page 18: Ultrasound Pericardial Effusion - University of Florida...Pericardial Effusion Rohit Patel, MD University of Florida Health Director, Critical Care Ultrasound Surgical ICU Center for

Video

Perera P. "http://www.sound-bytes.tv"

Descending Aorta

Sunday, August 14, 16

http://www.sound-bytes.tv
http://www.sound-bytes.tv
http://www.sound-bytes.tv
http://www.sound-bytes.tv
Page 19: Ultrasound Pericardial Effusion - University of Florida...Pericardial Effusion Rohit Patel, MD University of Florida Health Director, Critical Care Ultrasound Surgical ICU Center for

Video

Perera P. "http://www.sound-bytes.tv"

Sunday, August 14, 16

http://www.sound-bytes.tv
http://www.sound-bytes.tv
http://www.sound-bytes.tv
http://www.sound-bytes.tv
Page 20: Ultrasound Pericardial Effusion - University of Florida...Pericardial Effusion Rohit Patel, MD University of Florida Health Director, Critical Care Ultrasound Surgical ICU Center for

Video

Perera P. "http://www.sound-bytes.tv"

Sunday, August 14, 16

http://www.sound-bytes.tv
http://www.sound-bytes.tv
http://www.sound-bytes.tv
http://www.sound-bytes.tv
Page 21: Ultrasound Pericardial Effusion - University of Florida...Pericardial Effusion Rohit Patel, MD University of Florida Health Director, Critical Care Ultrasound Surgical ICU Center for

Video

Perera P. "http://www.sound-bytes.tv"

Sunday, August 14, 16

http://www.sound-bytes.tv
http://www.sound-bytes.tv
http://www.sound-bytes.tv
http://www.sound-bytes.tv
Page 22: Ultrasound Pericardial Effusion - University of Florida...Pericardial Effusion Rohit Patel, MD University of Florida Health Director, Critical Care Ultrasound Surgical ICU Center for

Video

Perera P. "http://www.sound-bytes.tv"

Sunday, August 14, 16

http://www.sound-bytes.tv
http://www.sound-bytes.tv
http://www.sound-bytes.tv
http://www.sound-bytes.tv
Page 23: Ultrasound Pericardial Effusion - University of Florida...Pericardial Effusion Rohit Patel, MD University of Florida Health Director, Critical Care Ultrasound Surgical ICU Center for

Effusion around the pumpTamponade or not?

Hallmark: RV free wall inversion, best recognized during diastole

Right atrial inversion during systole (more common and early finding)

Increased respiratory variation of mitral or aortic inflow velocities (greater than 25%)

Dilated inferior vena cava with decreased inspiratory collapse

ASE Committee Recomendations. Am Soc Echocardiography. 2005Sunday, August 14, 16

Page 24: Ultrasound Pericardial Effusion - University of Florida...Pericardial Effusion Rohit Patel, MD University of Florida Health Director, Critical Care Ultrasound Surgical ICU Center for

Effusion around the pump - tamponade

Sunday, August 14, 16

Page 25: Ultrasound Pericardial Effusion - University of Florida...Pericardial Effusion Rohit Patel, MD University of Florida Health Director, Critical Care Ultrasound Surgical ICU Center for

Video

Perera P. "http://www.sound-bytes.tv"

Sunday, August 14, 16

http://www.sound-bytes.tv
http://www.sound-bytes.tv
http://www.sound-bytes.tv
http://www.sound-bytes.tv
Page 26: Ultrasound Pericardial Effusion - University of Florida...Pericardial Effusion Rohit Patel, MD University of Florida Health Director, Critical Care Ultrasound Surgical ICU Center for

Video

Perera P. "http://www.sound-bytes.tv"

Sunday, August 14, 16

http://www.sound-bytes.tv
http://www.sound-bytes.tv
http://www.sound-bytes.tv
http://www.sound-bytes.tv
Page 27: Ultrasound Pericardial Effusion - University of Florida...Pericardial Effusion Rohit Patel, MD University of Florida Health Director, Critical Care Ultrasound Surgical ICU Center for

Video

Perera P. "http://www.sound-bytes.tv"

Sunday, August 14, 16

http://www.sound-bytes.tv
http://www.sound-bytes.tv
http://www.sound-bytes.tv
http://www.sound-bytes.tv
Page 28: Ultrasound Pericardial Effusion - University of Florida...Pericardial Effusion Rohit Patel, MD University of Florida Health Director, Critical Care Ultrasound Surgical ICU Center for

Video

Perera P. "http://www.sound-bytes.tv"

Sunday, August 14, 16

http://www.sound-bytes.tv
http://www.sound-bytes.tv
http://www.sound-bytes.tv
http://www.sound-bytes.tv
Page 29: Ultrasound Pericardial Effusion - University of Florida...Pericardial Effusion Rohit Patel, MD University of Florida Health Director, Critical Care Ultrasound Surgical ICU Center for

Sunday, August 14, 16

Page 30: Ultrasound Pericardial Effusion - University of Florida...Pericardial Effusion Rohit Patel, MD University of Florida Health Director, Critical Care Ultrasound Surgical ICU Center for

Sunday, August 14, 16

Page 31: Ultrasound Pericardial Effusion - University of Florida...Pericardial Effusion Rohit Patel, MD University of Florida Health Director, Critical Care Ultrasound Surgical ICU Center for

Sunday, August 14, 16

Page 32: Ultrasound Pericardial Effusion - University of Florida...Pericardial Effusion Rohit Patel, MD University of Florida Health Director, Critical Care Ultrasound Surgical ICU Center for

Sunday, August 14, 16

Page 33: Ultrasound Pericardial Effusion - University of Florida...Pericardial Effusion Rohit Patel, MD University of Florida Health Director, Critical Care Ultrasound Surgical ICU Center for

Effusion around the pumpTamponade or not?

Hallmark: RV free wall inversion, best recognized during diastole

Right atrial inversion during systole (more common and early finding)

Increased respiratory variation of mitral or aortic inflow velocities (greater than 25%)

Dilated inferior vena cava with decreased inspiratory collapse

ASE Committee Recomendations. Am Soc Echocardiography. 2005Sunday, August 14, 16


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HAPTER 1 FAST/EFAST - Ultrasound Training · A normal pericardium should consist of a single hyperechoic (white) line surrounding the heart. (Movie 1.3) A pericardial effusion is

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Mediastinitis and pericardial effusion in a patient with ...illustrates a very unusual clinical presentation of DMAC disease with mediastinal, pericardial, and chest wall involvement

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Pericardial Diseases · 2020. 7. 20. · 1. Acute pericarditis • Chronic pericarditis 2. Pericardial effusion • Pericardial Tamponade 3. Constrictive pericarditis • Restrictive

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Research Article Posterior Pericardial Effusion ... · Annals of Cardiovascular Diseases. Cite this article: Macrina F, Lombardo P, Totaro M, Miraldi F (2016) Posterior Pericardial

Effusive-Constrictive Pericarditis After Pericardiocentesis · pericardial effusion (16.1%), and malignancy (11.7%) were the most common causes of pericardial effusion requiring pericardiocentesis

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