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Indications for bedside ultrasonography in the critically-ill adult patient

Authors
John T Huggins, MD
Paul Mayo, MD
Section Editor
Scott Manaker, MD, PhD
Deputy Editor
Geraldine Finlay, MD

INTRODUCTION

Portable bedside ultrasonography is being increasingly used by clinicians in patients who are critically ill [1,2]. Critical care ultrasonography (CCUS) is most commonly used in the emergency department and the intensive care unit. It can also be used in the operating room and postoperative care unit when evaluating patients who become acutely ill in the hospital. CCUS is commonly divided into four separate elements: thoracic (lung and pleural), abdominopelvic, vascular, and cardiac (basic and advanced).

This section will review the clinical utility of these four separate elements of CCUS. Details regarding bedside ultrasonography for trauma patients, thoracic ultrasonography in non-critically-ill patients, and transcranial ultrasonography in stroke patients are discussed separately. (See "Emergency ultrasound in adults with abdominal and thoracic trauma" and "Thoracic ultrasound: Indications, advantages, and technique" and "Imaging of pneumothorax" and "Imaging of pleural effusions in adults" and "Neuroimaging of acute ischemic stroke", section on 'Ultrasound methods'.)

TERMINOLOGY AND DEFINITION

Critical care ultrasonography (CCUS) refers to the use of ultrasonography in patients who are critically ill. Multiple terms are used to describe various elements of CCUS. These include terms that refer to the bedside application of ultrasonography (eg, point-of-care ultrasonography [POCUS]), and terms that refer to the organs imaged with ultrasonography including multiorgan ultrasonography, thoracic ultrasonography (TUS; lung, pleural, and/or heart), lung ultrasonography (LUS), abdominopelvic ultrasonography, vascular ultrasonography, and cardiac ultrasonography (basic and advanced critical care echocardiography [CCE]).

Protocols that describe the use of CCUS in critically-ill patients who present with shock or trauma have been described including rapid ultrasound in shock (RUSH), abdominal and cardiac evaluation with sonography in shock (ACES), focused assessment with sonography for trauma (FAST), and focused cardiac ultrasound (FOCUS). These protocols are discussed separately. (See "Emergency ultrasound in adults with abdominal and thoracic trauma", section on 'Focused Assessment with Sonography for Trauma'.)

A widely accepted definition of the elements of CCUS that are required for competence has been published and constitutes a reasonable definition of the scope of practice of CCUS [1].

                         

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Literature review current through: Nov 2016. | This topic last updated: Thu Jul 14 00:00:00 GMT+00:00 2016.
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