Tamponade

A previously healthy male in his late 50s presented to the ED with burning chest discomfort, body aches, and mild DOE x1 week. Hx of “lung mass” 6 mos ago that was biopsied and found to be benign. BPs 90s/70s, tachy to 110s but otherwise stable. CXR with enlarged cardiac silhouette. Bedside echo attached. Patient admitted to CCU for pericardiocentesis.

IMG_5970 IMG_5971 IMG_5972 IMG_5973

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Spectral Doppler for Fetal Heart Rate – A Sono No-No

Measuring fetal heartrate using spectral Doppler violates the ALARA (as low as reasonably achievable) principle of imaging, which is the concept that we should try to minimize harm (use low energy) whenever possible. While ultrasound is generally believed to be harmless, Spectral Doppler increases the amount of energy being delivered to the tissue which could be transferred to heat energy. M-mode can obtain the same information at a much lower thermal index.

mmode - good

Appropriate Measurement Using M-Mode

spectral - bad

Inappropriate measurement using Spectral Doppler

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