Point of care usg in Anaesthesia and Critical Care. For MD Anaesthesia exam with table VIVA questions
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I have comprehensive material from Miller's Anesthesia (10e) and Barash's Clinical Anesthesia (9e). Now compiling the full MD Anaesthesia exam resource:
Point-of-Care Ultrasound (POCUS) in Anaesthesia and Critical Care
MD Anaesthesia Exam - Complete Study Notes with VIVA Questions
DEFINITION AND OVERVIEW
POCUS is defined as the use of ultrasonography at the bedside by the treating clinician to rapidly answer specific, goal-oriented clinical questions, guide procedures, and monitor response to therapy in real time.
Key distinguishing features:
- Performed by the clinician, not a sonographer
- Goal-directed (answers YES/NO questions)
- Bedside, real-time, repeatable
- 2D-based (largely qualitative)
- Extension of physical examination
"POCUS allows anesthesiologists to use ultrasound at the bedside to perform rapid, goal-oriented assessments, and guide a variety of acute care procedures. The potential utility of POCUS spans the entire perioperative care spectrum." - Barash Clinical Anesthesia, 9e
POCUS vs. CONSULTATIVE ECHOCARDIOGRAPHY vs. LIMITED TTE
| Feature | POCUS / FoCUS | Limited TTE | Comprehensive Echo |
|---|---|---|---|
| Performer | Bedside clinician | Trained specialist | Expert echocardiographer |
| Scope | Specific clinical questions | Broad, includes incidental findings | Full diagnostic workup |
| Technique | 2D mainly | 2D + Doppler | 2D, 3D, all Doppler modes |
| Questions answered | Yes/No format | Normal/abnormal/pathologic | Full grading + severity |
| Training required | Short focused training | Advanced training | Comprehensive certification |
| Timing | Immediate bedside | Scheduled | Scheduled |
| Views | 4-5 standard | Fewer than comprehensive | Full 28-view TEE / TTE |
| Interpretation | Semi-quantitative | Quantitative possible | Fully quantitative |
(Barash Clinical Anesthesia, 9e; Miller's Anesthesia, 10e)
FOCUSED CARDIAC ULTRASOUND (FoCUS) - KEY VIEWS
| Window/View | Abbreviation | Structures Visualized |
|---|---|---|
| Parasternal Long Axis | PLAX | LV, RV, mitral valve, aortic valve, aortic root, LA, descending aorta |
| Parasternal Short Axis | PSAX | LV cavity (at papillary level), RV, IVS |
| Apical 4-Chamber | A4C | All 4 chambers, mitral & tricuspid valves, IVS |
| Subcostal | SC | RV, RA, LV, LA, IVC, pericardium, liver |
| Suprasternal | SS | Aortic arch, great vessels |
| Subcostal IVC view | IVC | IVC diameter, collapsibility index |
CLINICAL QUESTIONS ANSWERED BY POCUS
| Clinical Question | POCUS Answer Rate |
|---|---|
| Is the patient stable? | 98% |
| Is the patient in shock? | 95% |
| Is the patient bleeding? | 94% |
| Is the patient in respiratory distress? | 93% |
| Is the patient in pain? | 92% |
| Is the patient in atrial fibrillation? | 91% |
(Barash Clinical Anesthesia, 9e - Table 27-15)
POCUS FINDINGS IN DIFFERENT SHOCK STATES
| Shock Type | LV Function | RV Size/Function | IVC | Other |
|---|---|---|---|---|
| Cardiogenic | Severely depressed, dilated LV, poor wall thickening | May be dilated with dysfunction | Dilated, non-collapsing (>2.1 cm, <50% collapse) | Pleural effusions, B-lines |
| Distributive (Septic) | Hyperdynamic (initially), later depressed | May be normal or dilated | Small, hyperdynamic (early); later dilated | Minimal pericardial fluid |
| Obstructive (PE) | Small hyperkinetic LV, D-sign | Severely dilated RV, RV:LV ratio >0.9, poor RV wall motion, McConnell sign | Dilated, non-collapsing | Absent DVT rules out PE |
| Obstructive (Tamponade) | Small, hyperdynamic | RA collapse (systole), RV collapse (diastole) | Dilated IVC | Pericardial effusion all around |
| Hypovolemic | Small hyperdynamic LV ("kissing walls") | Small | Collapsed IVC (<1.5 cm, >50% collapse) | Reduced VTI |
(Miller's Anesthesia, 10e - Table 79.3; Barash, 9e - Table 27-15)
LUNG ULTRASOUND
Normal Lung Artifacts
| Artifact | Description | Significance |
|---|---|---|
| Pleural line | Hyperechoic line at pleura | Always present |
| A-lines | Horizontal equidistant reverberation lines below pleural line | Normal aeration |
| Lung sliding | Shimmering/glittering at pleural line ("ants marching on a twig") | Normal lung movement |
| B-lines | Vertical laser-like lines from pleura to far field ("comet tails / pleural rockets") | 1-2 = normal; ≥3 = pathological |
M-mode Signs
| Sign | Appearance | Meaning |
|---|---|---|
| "Sandy beach" / Seashore sign | Soft tissue = sky (horizontal lines); below pleura = grainy beach | Normal lung (lung sliding present) |
| "Barcode" / Stratosphere sign | All horizontal lines (no graininess below pleura) | Pneumothorax (no lung sliding) |
| Lung point | Transition between sliding and non-sliding | Pathognomonic of pneumothorax (100% specificity) |
Pathological Lung Ultrasound Findings
| Condition | Lung Sliding | A-lines | B-lines | Consolidation | Other |
|---|---|---|---|---|---|
| Normal | Present | Present | 0-2 | Absent | - |
| Pneumothorax | Absent | Predominant | Absent | Absent | Barcode sign; Lung point |
| Pulmonary edema | Present | Absent | Bilateral confluent (≥3/zone) | Absent | Pleural effusions |
| Pneumonia | Reduced | Absent | Focal | Present | Air bronchograms (hyperechoic) |
| ARDS | Reduced | Absent | Bilateral | Present | Non-homogeneous |
| Pleural effusion | Variable | Variable | Variable | "Jellyfish sign" | Anechoic/echogenic space above diaphragm |
| COPD exacerbation | Present | A-predominant | Absent/rare | Absent | Near-normal LUS |
| Atelectasis | Reduced/absent | Variable | Variable | Wedge-shaped | Homogeneous, no air bronchograms |
BLUE Protocol (Bedside Lung Ultrasound in Emergency)
- Anterior A-lines + lung sliding → COPD / asthma
- Anterior B-lines bilateral → pulmonary edema (cardiogenic)
- Anterior A-lines, no sliding, lung point → pneumothorax
- Posterior consolidation or effusion → pneumonia
- Anterior A-lines + DVT on leg → Pulmonary embolism
VASCULAR ULTRASOUND
Central Venous Access (SCCM Recommendations)
| Site | Recommendation Grade |
|---|---|
| Internal jugular vein | Grade 1A |
| Femoral vein | Grade 1A |
| Subclavian vein | Grade 1B |
| Arterial cannulation (general) | Grade 2B |
| DVT screening by intensivist | Grade 1B |
Views for Vascular Access
| View | Advantage | Disadvantage |
|---|---|---|
| Short axis (out-of-plane) | See surrounding structures; higher success rate; less training needed | Cannot see entire needle length |
| Long axis (in-plane) | Visualize full needle; prevent posterior wall puncture | Requires more skill; no view of surrounding structures |
FAST AND E-FAST (FOCUSED ASSESSMENT WITH SONOGRAPHY IN TRAUMA)
FAST Exam - Four Standard Views
| View | Location | What It Detects |
|---|---|---|
| 1. Subxiphoid / Pericardial | Subxiphoid | Hemopericardium, tamponade |
| 2. Right upper quadrant (RUQ) | Right flank - hepatorenal (Morrison's pouch) | Hemoperitoneum |
| 3. Left upper quadrant (LUQ) | Left flank - perisplenic | Hemoperitoneum |
| 4. Suprapubic / Pelvic | Suprapubic | Pelvic free fluid |
E-FAST adds: Anterior thoracic views bilaterally for pneumothorax detection.
FAST Performance Data
| Trauma Type | Sensitivity | Specificity |
|---|---|---|
| Blunt thoracoabdominal trauma | 74-82% | 96-99% |
| Penetrating trauma | As low as 28% | 94-100% |
| Pneumothorax (POCUS) vs. CXR | 91% vs. 47% | 99% vs. 100% |
Limitations of FAST: Poor detection of bowel, retroperitoneal, diaphragmatic, and pancreatic injuries. CT scan needed when FAST is negative but clinical suspicion is high.
(Barash Clinical Anesthesia, 9e)
AIRWAY ULTRASOUND
| Application | How |
|---|---|
| Pre-intubation airway assessment | Identify hyoid, thyroid cartilage, cricothyroid membrane (CTM), trachea |
| CTM identification | High-freq linear probe; 80% accurate even in obese/difficult anatomy |
| Predict difficult airway | Pre-epiglottic space distance, tongue base |
| Confirm ETT position | Tracheal vs. esophageal intubation: trachea shows single airway shadow; esophageal = "double tract" sign |
| ETT position confirmation | Diaphragm excursion (bilateral = correct placement) - especially reliable in low cardiac output where capnography unreliable |
| Front of neck access (FONA) | Real-time guidance for emergency cricothyrotomy |
GASTRIC ULTRASOUND (Perioperative POCUS)
| Assessment | Probe/View | Findings |
|---|---|---|
| Gastric content | Curvilinear probe, RLQ (right lateral decubitus) | Antrum in sagittal view between liver and aorta/IVC |
| Empty stomach | Antral area <340 mm² (sitting), <10 mm (lying) | Grade 0: no content |
| Clear liquid | Hypoechoic homogeneous | Grade 1: small volume |
| Solid content | Hyperechoic, heterogeneous with shadowing | Grade 2: high aspiration risk |
| Full stomach risk | Antral CSA >340 mm² or gruel appearance | Consider RSI or defer surgery |
IVC ULTRASOUND AND VOLUME STATUS
| IVC Parameter | Finding | Interpretation |
|---|---|---|
| IVC diameter | <1.5 cm | Hypovolemia / fluid responsive |
| IVC diameter | >2.1 cm | Hypervolemia / high RA pressure |
| Collapsibility Index (CI) | >50% collapse with inspiration (spontaneous breathing) | Fluid responsive |
| CI | <50% | Not fluid responsive |
| Distensibility Index (DI) | >18% with mechanical ventilation (12 mL/kg tidal volume) | Fluid responsive |
IVC-CI = (IVC max - IVC min) / IVC max × 100
OPTIC NERVE SHEATH DIAMETER (ONSD) - ICP MONITORING
| Parameter | Value | Significance |
|---|---|---|
| Normal ONSD | <5 mm | Normal ICP |
| Raised ICP (ONSD) | ≥5.7-6 mm | Suggests ICP >20 mmHg |
| Probe | High-frequency linear | Measured 3 mm behind globe |
| Sensitivity/Specificity | ~90% / ~85% | Good screening tool |
DIAPHRAGM ULTRASOUND (Ventilator Weaning)
| Parameter | Measurement | Significance |
|---|---|---|
| Diaphragm excursion (DE) | Normal: 1.5-2.5 cm (quiet breathing); >10 cm max | <1 cm = diaphragm paresis |
| Diaphragm thickening fraction (DTF) | DTF = (Tee-Ti)/Ti × 100 | <20% = poor respiratory effort; >36% = likely wean success |
| Zone of apposition (ZOA) | Right diaphragm between ribs 8-10 MAL | Best site for measurement |
PERIOPERATIVE POCUS APPLICATIONS
| Perioperative Phase | Application |
|---|---|
| Pre-op | Gastric volume, cardiac function assessment, airway assessment |
| Intraoperative | Hemodynamic monitoring, TEE/TTE for cardiac surgery |
| Immediate post-op | Volume assessment, cardiac function, pneumothorax after CVP insertion |
| ICU | Full POCUS protocol - shock, respiratory failure, DVT, ICP, weaning |
| Emergency | FAST, airway POCUS, resuscitation guidance |
| Cardiac arrest | Cardiac standstill, PE diagnosis, tamponade (pulse-less electrical activity - PEA causes) |
POCUS TRAINING AND CERTIFICATION
| Body | Certification |
|---|---|
| American Society of Echocardiography (ASE) | Basic perioperative TEE examination |
| National Board of Echocardiography (NBE) | PTEeXAM (Basic), Advanced PTEeXAM |
| European Association of Cardiovascular Imaging (EACVI) | European competency based programs |
| SCCM | Critical care echocardiography competency |
POCUS PROTOCOLS - SUMMARY TABLE
| Protocol | Full Name | Used For |
|---|---|---|
| FAST | Focused Assessment with Sonography for Trauma | Trauma: free fluid, hemopericardium |
| E-FAST | Extended FAST | FAST + pneumothorax |
| BLUE | Bedside Lung Ultrasound in Emergency | Acute respiratory failure differentials |
| RUSH | Rapid Ultrasound for Shock and Hypotension | Undifferentiated shock |
| FATE | Focused Assessment Transthoracic Echo | Cardiac assessment in critically ill |
| FALLS | Fluid Administration Limited by Lung Sonography | Safe fluid resuscitation end-point |
| FEEL | Focused Echocardiographic Evaluation in Life support | Cardiac arrest / CPR |
RUSH PROTOCOL (Rapid Ultrasound for Shock and Hypotension)
| Component | What to Assess | Hypovolemic | Cardiogenic | Obstructive | Distributive |
|---|---|---|---|---|---|
| Pump (Heart) | LV/RV size, function | Hyperdynamic | Dilated, poor LV | Normal/Dilated RV | Hyperdynamic |
| Tank (Vessels) | IVC, DVT | Collapsed IVC | Dilated IVC | Dilated IVC | Collapsed/Normal |
| Pipes (Aorta) | AAA, aortic dissection | Normal | Normal | Normal | Normal |
| Lungs | B-lines, PTX, effusion | A-lines | B-lines | A-lines + DVT | Variable |
POCUS IN CARDIAC ARREST (FEEL Protocol)
| Rhythm | POCUS Finding | Action |
|---|---|---|
| PEA | Cardiac standstill (true asystole) | CPR, no further intervention |
| PEA | Cardiac activity present (pseudo-PEA) | Continue aggressive resuscitation; look for cause |
| PEA | Pericardial effusion + RA/RV collapse | Pericardiocentesis |
| PEA | RV dilation, D-sign, thrombus | Thrombolysis for PE |
| PEA | Collapsed IVC, no wall motion | Hypovolemia - aggressive fluids |
| Any | Spontaneous return of cardiac motion | ROSC confirmed |
5 Hs and 5 Ts detectable by POCUS: Hypovolemia, Tamponade, Tension PTX, Thromboembolism (PE), Thrombosis (MI with wall motion abnormality)
POCUS FOR DVT SCREENING
| Technique | Sensitivity | Specificity |
|---|---|---|
| 2-point compression (femoral + popliteal) | ~86% | ~96% |
| Complete compression ultrasound | Higher | Higher |
- Method: Compress femoral vein at groin and popliteal vein behind knee
- DVT positive: Vein does not fully collapse under compression
- SCCM recommendation: Grade 1B for DVT screening by intensivist
VIVA QUESTIONS AND ANSWERS
Q1. Define POCUS. How does it differ from formal echocardiography?
A: POCUS is bedside ultrasound performed by the treating clinician to rapidly answer specific clinical questions. It differs from formal echo in that: it is performed at the bedside by the treating physician (not a dedicated sonographer), answers binary yes/no questions, uses mainly 2D imaging, requires less training, and is used for immediate clinical decision-making rather than comprehensive diagnosis.
Q2. What are the SCCM guideline recommendations for ultrasound-guided vascular access?
A: Internal jugular and femoral vein - Grade 1A; Subclavian vein - Grade 1B; Arterial cannulation - Grade 2B; DVT screening by intensivist - Grade 1B. Real-time imaging with short-axis view is specifically recommended.
Q3. What are A-lines, B-lines, and what do they indicate?
A: A-lines are horizontal reverberation artifacts equidistant from the pleural line, indicating normal air-filled lung. B-lines (comet tails/pleural rockets) are vertical laser-like artifacts from the pleura to the far field caused by thickening of interlobular septae - 1-2 per rib space can be normal; ≥3 bilateral indicate interstitial edema. Confluent bilateral B-lines suggest cardiogenic pulmonary edema.
Q4. What are the M-mode signs in lung ultrasound?
A: (1) Seashore/Sandy beach sign - normal finding; horizontal lines above pleura ("sky") and granular pattern below ("beach") from lung sliding. (2) Barcode/Stratosphere sign - horizontal lines throughout (no granular pattern) indicating absent lung sliding = pneumothorax. (3) Lung point - transitional zone between sliding and non-sliding pleura = pathognomonic for pneumothorax (100% specificity vs. CT).
Q5. What are the four views of FAST exam? What does each detect?
A: (1) Subxiphoid/pericardial - hemopericardium; (2) RUQ / Morrison's pouch (hepatorenal) - hemoperitoneum; (3) LUQ perisplenic - hemoperitoneum; (4) Suprapubic/pelvic - pelvic free fluid. E-FAST adds bilateral anterior thoracic views for pneumothorax. FAST sensitivity for blunt trauma is 74-82%, specificity 96-99%.
Q6. How do you diagnose pneumothorax on lung POCUS?
A: Loss of lung sliding artifact + absence of B-lines + predominance of A-lines = pneumothorax. On M-mode: barcode sign (stratosphere sign). Lung point (transition between sliding and non-sliding) has 100% specificity. POCUS outperforms supine CXR (sensitivity 91% vs. 47%, specificity 99% vs. 100%). Grade 1A recommendation by SCCM.
Q7. What are the echo features of cardiac tamponade?
A: Pericardial effusion (usually circumferential) + RA collapse during ventricular systole + RV collapse during diastole + dilated non-collapsing IVC + inspiratory increase in RV and decrease in LV filling (Doppler pulsus paradoxus). On POCUS: the most specific finding is RV free wall diastolic collapse.
Q8. Describe the RUSH protocol for undifferentiated shock.
A: RUSH = Rapid Ultrasound for Shock and Hypotension. Examines: (1) Pump - LV/RV size and systolic function; (2) Tank - IVC size and collapsibility, leg veins for DVT; (3) Pipes - aorta (AAA), aortic dissection; (4) Lungs - B-lines, consolidation, pneumothorax. Combines findings to differentiate cardiogenic, hypovolemic, obstructive, and distributive shock.
Q9. What is McConnell's sign and its significance?
A: McConnell's sign is RV free wall hypokinesis with sparing of the RV apex, seen in acute massive pulmonary embolism on echo. It occurs because the pulmonary embolic pressure overload impairs RV free wall function, while the apex remains tethered to and partly supported by the interventricular septum and LV. It has >70% specificity for acute PE in the setting of RV dysfunction.
Q10. How do you assess fluid responsiveness using POCUS?
A: Three main methods:
- IVC collapsibility index (spontaneously breathing patients): CI >50% = fluid responsive (IVC <1.5 cm). CI = (IVCmax - IVCmin)/IVCmax × 100.
- IVC distensibility index (mechanically ventilated, 12 mL/kg TV): DI >18% = responsive.
- VTI (velocity-time integral) of LVOT before and after passive leg raise: >10-15% increase = fluid responsive.
- Stroke volume variation (SVV) by POCUS: >13% = responsive (requires regular sinus rhythm, controlled ventilation).
Q11. What is the BLUE protocol?
A: Bedside Lung Ultrasound in Emergency (BLUE) protocol differentiates causes of acute respiratory failure: A-lines + lung sliding = COPD/asthma; Bilateral anterior B-lines = pulmonary edema; A-lines + absent sliding + lung point = pneumothorax; Posterior consolidation or effusion = pneumonia; A-lines + DVT on leg = PE.
Q12. How is POCUS useful in cardiac arrest?
A: FEEL (Focused Echocardiographic Evaluation in Life support) protocol: assess for cardiac standstill (true asystole vs. pseudo-PEA), identify reversible causes - tamponade (pericardiocentesis), massive PE (thrombolysis), tension PTX, hypovolemia, severe LV dysfunction. POCUS during 10-second pulse check minimizes interruption to CPR. Can confirm ROSC. Avoids futile resuscitation in confirmed cardiac standstill.
Q13. What are signs of severe LV systolic dysfunction on POCUS?
A: (1) LV wall thickening <30% during systole (best in PLAX and PSAX); (2) LV chamber emptying <50% in 2D views (EF <50%); (3) MAPSE (Mitral Annular Plane Systolic Excursion) <8 mm on A4C view; (4) Peripheral clues: minimal diastolic excursion of anterior mitral leaflet (Echographic B-bump), minimal aortic valve systolic opening without calcification.
Q14. What is the IVC diameter significance in different conditions?
A:
- Collapsed IVC (<1.5 cm, >50% collapsibility) = hypovolemia, fluid responsive
- Normal IVC (1.5-2.1 cm, variable collapsibility) = euvolemia
- Dilated IVC (>2.1 cm, <50% collapsibility) = elevated RA pressure (heart failure, tamponade, massive PE, tension PTX, PEEP)
Q15. What are the indications for POCUS in the perioperative period?
A:
- Pre-op: Gastric volume/aspiration risk assessment; cardiac function in high-risk patients; airway assessment (CTM identification)
- Intra-op: Hemodynamic monitoring, regional anesthesia guidance, TEE for cardiac surgery
- Post-op: Diagnosis of pneumothorax after CVC insertion, hemodynamic assessment, fluid management
- ICU: Shock evaluation, respiratory failure workup, DVT screening, weaning assessment (diaphragm), ICP monitoring (ONSD)
Q16. How does gastric ultrasound help in anaesthesia?
A: Gastric POCUS (antrum in right lateral decubitus position using curvilinear probe) assesses aspiration risk. Grade 0: empty antrum (no content). Grade 1: clear liquid (hypoechoic) visible only in sitting position. Grade 2: content in supine and sitting (solid content = high risk). Antral cross-sectional area (CSA) >340 mm² suggests full stomach. Helps decision on RSI vs. standard induction.
Q17. How is POCUS useful in airway management?
A: (1) Pre-intubation CTM identification (linear probe, 80% success even in difficult anatomy); (2) Predict difficult laryngoscopy (pre-epiglottic space, tongue base thickness); (3) Confirm ETT position - tracheal sliding sign bilaterally; esophageal intubation = "double tract sign"; (4) Emergency FONA guidance; (5) ETT displacement - diaphragm excursion asymmetry suggests endobronchial intubation; (6) Reliable in low cardiac output states when EtCO2 may be unreliable.
Q18. What is diaphragm ultrasound, and how is it used for ventilator weaning?
A: Diaphragm ultrasound uses a high-frequency probe at the zone of apposition (right side, between ribs 8-10 in midaxillary line). Diaphragm thickening fraction (DTF) = (thickness at end-inspiration - thickness at end-expiration) / thickness at end-expiration × 100. DTF >36% predicts successful weaning; <20% indicates insufficient respiratory effort. Diaphragm excursion <1 cm indicates dysfunction. Helps guide weaning decisions and identify diaphragm-sparing ventilation strategies.
Q19. What is ONSD and what is its significance in critical care?
A: Optic Nerve Sheath Diameter (ONSD) measured 3 mm behind the globe using high-frequency linear probe. Normal <5 mm. ONSD ≥5.7-6 mm suggests ICP >20 mmHg. Sensitivity ~90%, specificity ~85%. Non-invasive bedside ICP monitoring in TBI, hypertensive emergencies, post-cardiac arrest, liver failure. Does not replace formal ICP monitoring but is a rapid bedside tool.
Q20. What are the limitations of POCUS?
A: (1) Operator-dependent (skill and knowledge critical); (2) Poor image quality in obese patients, subcutaneous emphysema, bandages, wounds; (3) Cannot replace comprehensive echo for grading valvular disease or diastolic dysfunction; (4) Lung POCUS false positives (pleural adhesions, endobronchial intubation can mimic pneumothorax by causing absent sliding); (5) Cannot detect bowel, retroperitoneal, diaphragmatic injuries (FAST limitation); (6) Visual information must be interpreted with clinical context; (7) Lack of strong clinical outcomes data for some applications.
QUICK REVISION TABLE - HIGH-YIELD POCUS FACTS
| Topic | Key Point |
|---|---|
| IVC for fluids (spont. breathing) | CI >50% = fluid responsive |
| IVC for fluids (mech. vent.) | DI >18% = fluid responsive |
| DVT sensitivity (bedside) | 86% sensitivity, 96% specificity |
| PTX on POCUS vs. CXR | POCUS 91% sens vs. CXR 47% sens |
| Lung point | 100% specific for PTX |
| McConnell's sign | RV free wall akinesis + apical sparing = acute PE |
| MAPSE normal | >8 mm (A4C view) |
| ONSD for raised ICP | ≥5.7 mm suggests ICP >20 mmHg |
| FAST blunt trauma sens/spec | 74-82% / 96-99% |
| FAST penetrating trauma sens | As low as 28% |
| Sandy beach sign | Normal lung (M-mode) |
| Barcode sign | Pneumothorax (M-mode) |
| Jellyfish sign | Atelectatic lung in effusion |
| B-lines | Interstitial edema (≥3 = pathological) |
| BLUE protocol | Differentiates acute respiratory failure causes |
| RUSH | Rapid shock diagnosis: Pump-Tank-Pipes-Lungs |
| FEEL | POCUS during cardiac arrest CPR |
| ABA recognition | POCUS = core competency in anesthesia training |
| SCCM IJV guideline | Grade 1A for IJV/femoral CVC |
Sources: Miller's Anesthesia, 10e (Chapters 26, 33, 79); Barash Clinical Anesthesia, 9e (Chapters 27, 53)
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