Shock & POCUS Lab

Table of Contents

Approaching Shock

SHOCK mnemonic

Shock orders

Cardiopulmonary and systemic circuits

Vasopressors

Vasopressors and Inotropes

Educational Videos

POCUS 101 - US 101

POCUS 101 - The FAST Exam

Note: Start with the cardiac portion in trauma.

POCUS 101 - Basic Echocardiography

Required video prior to starting the lab.

POCUS 101 - JVP

POCUS 101 - Navigating VTI Measurements

POCUS 101 - Lung US

Normal Anatomy

The more you spend time looking at normal anatomy, the more you'll recognize abnormal anatomy.

Parasternal Long

Parasternal Short

Apical 4 Chamber

Apical 5 Chamber

Subxiphoid View

IVC View

Case 1a

Left anterior lung

Left lateral lung

Right lung

Subxiphoid cardiac window

IVC

RUQ

LUQ

Pelvic

Case 1b

Bilateral anterior lung fields

Bilateral anterior lung fields

Right lateral lung field

Subxiphoid cardiac window

IVC

RUQ

LUQ

Pelvic

Case 1c

Left anterior lung

Left lateral lung

Right lung

Apical 4

IVC

RUQ

LUQ

Pelvic

Case 2

Checking for fluid tolerance:

Bilateral anterior lung fields

Bilateral lateral lung fields

Would this patient be fluid TOLERANT?

IVC

Cardiac POCUS

PLA

Apical 4 Chamber

RUQ

LUQ

Pelvic

Case 3

Checking for fluid tolerance: 

Bilateral anterior lung fields

IVC

Would this patient be fluid TOLERANT?

Cardiac POCUS

PLA

PSA

Apical 4 Chamber

Case 4

Checking for fluid tolerance:

Cephalad apical lung fields

Lateral lung fields

IVC

Would this patient be fluid TOLERANT?

Cardiac POCUS

PLA

PSA

Apical 4 Chamber

Case 5

An 18-year-old female was the restrained passenger in an MVC T-bone to her side of the vehicle. She is complaining of right abdominal and chest pain. She has bilateral breath sounds but has tenderness over her right chest. Her initial BP is 90/65 and her HR is 134. She appears pale with cold extremities and her cap refill is about 4 seconds. 

Checking fluid tolerance (lungs and IVC):

Bilateral anterior lung fields

Bilateral anterior lung fields

Bilateral anterior lung fields

IVC

Would this patient be fluid TOLERANT?

Cardiac POCUS:

PLA

Apical 4 Chamber

FAST Exam:

RUQ

LUQ

Pelvic Saggital

Case 6a - Aerospace Case

You're evaluating an astronaut after an unplanned return due to capsule depressurization issues prior to docking with a Low Earth Orbit space station. Recovery from the water was prolonged due to an off-nominal ballistic reentry trajectory that took the crew far off the coast and resulted in a high impact velocity. Additionally, there was some concern that there was a hypergolic leak, and the crew was decontaminated prior to medical survey. She is an otherwise healthy 43-year-old woman who is stating that she is lightheaded and short of breath, but she denies chest pain or cough. The recovery craft is too loud to auscultate effectively. Initial automated blood pressure is measured at 90/60 and her HR on palpation and on the monitor is 120. Her RR is 26 and her SpO2 is 92% on 6L nasal cannula. She is also complaining of right knee pain and numbness on aspects of her right foot. While the paramedic is establishing IV access and hanging a liter of crystalloid, you perform an ultrasound assessment of the astronaut to further determine the cause of her elevated shock index. 

RUQ

LUQ

Pelvic

Subxiphoid

Left anterior lung fields

Right apical anterior lung field

Right anterior 5th intercostal space

IVC

Apical 4 chamber

Case 6b - Aerospace Case

You're evaluating an astronaut after an unplanned return due to capsule depressurization issues prior to docking with a Low Earth Orbit space station. Recovery from the water was prolonged due to an off-nominal ballistic reentry trajectory that took the crew far off the coast and resulted in a high impact velocity. Additionally, there was some concern that there was a hypergolic leak, and the crew was decontaminated prior to medical survey. She is an otherwise healthy 43-year-old woman who is stating that she is lightheaded and short of breath. She also is mildly diaphoretic, pale, and has had multiple rounds of emesis. The recovery craft is too loud to auscultate effectively. Initial automated blood pressure is measured at 90/60 and her HR on palpation and on the monitor is 120. Her RR is 18 and her SpO2 is 96% on 2L nasal cannula. She also endorses that she had some right knee pain initially during descent, but that it has improved since landing and has not recurred. She is unsure if there was any trauma. While the paramedic is establishing IV access and hanging a liter of crystalloid, you perform an ultrasound assessment of the astronaut to further determine the cause of her elevated shock index. 

RUQ

LUQ

Pelvic

Bilateral anterior lung fields m-mode

Finding in most, but not all, lung fields

Apical 4

PSL

PSS

IVC

Case 7

Under construction...