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Measurements:

Heart:

  • AOFT (mid-sinuses of valsalva leading edge to leading edge): <4cm
  • Right atrium: <4cm
  • Interventricular septum: ≤12-15mm
  • Right ventricle free wall: ≤5mm
  • RV:LV should be 0.6:1
  • PC Eff:  widest stripe on diastole small <1cm, mod 1-2cm, or lg >2cm
  • Tamponade:  Plethoric IVC, incomplete RV relaxation during diastole, incomplete RA relaxation during atrial diastole, >25% change in MV inflow with respiration

Lungs:

  • Smallest pleural effusion detectable: 20cc (vs 200cc on CXR)
  • B lines: >3 bilateral anterior intercostal space suggests interstitial edema

Vasculature:

  • Inferior vena cava: <1.5cm and caval index >50% = CVP 0-5, >2 cm and caval index <50% =  CVP 15-20
  • Aortic outflow tract: <4cm (measured leading edge to leading edge)
  • Abdominal aorta (measured outside to outside): <3cm
  • Iliac artery: <1.5cm

Biliary:

  • Gallbladder wall thickness: <3-4mm
  • Common bile duct (measured inside to inside): ≤4mm (increases 1mm per decade after age 40)
  • Dimensions of gallbladder: 4 x 10 cm

Ob/Gyn:

  • Calculating gestational age: CRL – up to 12 weeks, BPD – 2nd trimester (measured leading edge to leading edge), femur length – 3rdtrimester
  • Normal FHR: 120 – 180bpm by 6-7 weeks gestation
  • Ovarian dimensions (avg): 1.5 x 1.5 x 3cm
  • Ovarian cyst: ≥2.5cm
  • Normal RI in ovarian (scrotal) ultrasound: less than 0.6

Miscellaneous:

  • Bladder volume: <200cc (post-void)
  • Appendicitis: >6mm (measure including fluid), noncompressible, no peristalsis, blind-ended
  • 1cm strip in Morison’s Pouch = 1L fluid
  • Smallest amount of free fluid detectable during FAST (in trendelenburg): 440cc
  • Liver longest dimension (diaphragm to inferior tip) should be <15cm
  • Spleen longest dimension (superior to inferior) should be <13cm

Tips:

    Heart:  

  • Views: SX, PSLA, PSSA, A4C
  • Interpretation: AOFT (exit), IVC (entrance), pc eff (effusion), squeeze—hyperdynamic, good, moderate, depressed (ejection), RV:LV (equality)

    RUQ:

  • Interpretation: GS, WT, SM, PCF  (+/- CBD diameter)

Common Landmarks:

  • Aorta: vertebral body
  • Gallbladder: portal vein, main lobar fissure (sonographic cystic pedicle)
  • Uterus: vaginal stripe and bladder
  • Ovaries: iliacs (ovaries are medial and anterior to iliacs)
  • Femoral vein:  medial to artery
  • Popliteal vein: posterior to artery
  • Appendix: iliacs (post), psoas mm (lat), and peritoneal line (ant)

Abbreviations:

CRL: crown rump length·      
BPD: biparietal diameter·      
FL:  femur length·      
FHR: fetal heart rate·      
RI: resistance index·      
SX: subxiphoid·      
PSLA: parasternal long axis·      
PSSA: parasternal short axis A4C: apical 4 chamber·      
AOFT:  aortic outflow tract·      
PCeff:  pericardial effusion·      
PLeff:  pleural effusion·      
GS: gallstones·      
WT: wall thickening·      
SM: sonographic murphy’s·      
PCF: pericholescystic fluid·      
CBD: common bile duct

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