| Clinical scenario | Potential uses of ultrasound |
|---|---|
| Newly admitted patient | Supplement physical exam by assessing cardiac function, confirming bilateral lung sliding and presence or absence of B-lines, determining the presence of ascites |
| Procedural guidance for line placements | |
| Confirm positioning of existing lines, tubes, and drains | |
| New-onset hypotension | Assess left ventricular systolic function to diagnose cardiogenic shock |
| Check for regional wall motion abnormalities to assist in diagnosing acute coronary syndrome or stress cardiomyopathy | |
| Assess right ventricular systolic function to check for hemodynamically significant pulmonary embolism | |
| Check for major valvular stenosis or regurgitation | |
| Determine presence of pericardial effusion and/or tamponade | |
| Measure LVOT VTI to diagnose hyperdynamic function, possible distributive shock | |
| Assess IVC size and collapsibility to determine hypovolemic shock | |
| New-onset hypoxemia | Confirm endotracheal tube positioning by transtracheal ultrasound |
| Assess lung sliding and check for pneumothorax | |
| Determine presence or absence of B-lines and consolidations | |
| Perform bubble study to determine presence of intracardiac or intrapulmonary shunting | |
| Check for pleural effusions | |
| Procedural guidance for drainage of large pleural effusion | |
| Titrating ventilation settings | Monitor for changes in B-lines with titration of PEEP |
| Assess cardiopulmonary interactions with changes in mechanical ventilation | |
| Monitor progression or improvement of ARDS | |
| Determining readiness for extubation | Check for resolution of B-lines, consolidations |
| Assess cardiac filling pressures to determine the need for further diuresis | |
| Measure diaphragmatic excursion during spontaneous breathing efforts | |
| Optimize patient volume status | Measure LVOT VTI before and after a fluid challenge or passive leg raise to determine fluid responsiveness |
| Measure cardiac filling pressures to help determine the need for fluid vs diuresis | |
| Measure respiratory variation in LVOT or carotid VTI | |
| Assess IVC size and collapsibility | |
| Cardiac arrest | Check for reversible etiologies such as large pericardial effusion or tension pneumothorax |
| Monitor for return of spontaneous cardiac activity | |
| Perform carotid artery pulse checks | |
| Confirm cardiac standstill upon cessation of resuscitation | |
| Evaluation of trauma patient | FAST exam to check for hemoperitoneum, pericardial effusion, and free fluid in the pelvis |
| Assess for pneumothorax | |
| Procedural guidance for pericardiocentesis | |
| Measure optic nerve sheath diameter as an indicator of intracranial pressure if head trauma is suspected | |
| Assess gastric size and emptying to determine the need for rapid sequence intubation if patient requires general anesthesia | |
| Patient with suspected DVT | Check vein compressibility to determine presence of thrombus in deep veins |
| Assess right ventricular systolic function to check for hemodynamically significant pulmonary embolism | |
| Patient requiring mechanical circulatory support | Confirm correct cannula or device positioning |
| Monitor for thrombus formation | |
| Assess cardiac function upon weaning of support |
ARDS, acute respiratory distress syndrome; DVT, deep venous thrombosis; FAST, focused assessment with sonography for trauma; IVC, inferior vena cava; LVOT, left ventricular outflow tract; PEEP, positive end-expiratory pressure; VTI, velocity time integral.