Ultrasound
                                ==========

        Trauma Ultrasound       <T-US.TXT>
        OB Ultrasound           <OB-US.TXT>

þ Pericardial Effusion
 - Mild: < 1 (or 0.5) cm
 - Moderate: 1 (or 0.5 cm)-2 cm
 - Severe: > 2 cm
 - up to 40% of pregnant patients will have an effusion
 - ESRD, AIDS, CHF, nephrosis, low albumin will all cause 
 
 
þ IVC filling
 < 1.5 cm, inspiratory collapse: 0-5 cm CVP
 1.5-2.5 cm:                     5-15 cm CVP (>50% collapse: 5-10, <50% 
                                              collapse: 10-15)
 > 2.5 cm:                       >15 cm CVP  (<50% collapse: 15-20, no collapse, 
                                             > 20 cm)

þ Gallbladder
 - Normal wall is <=3mm
 - Thickened wall, pericystic fluid, sludge/stones, + sonographic Murphy sign
   along with WBC or fever or air in biliary tree means infection.
 - Acute cholecystitis: average 9 mm (chronic: 5 mm)
 - CBD < 6-7 mm, but if prior surgery, passed gallstone, older: may be bigger
 

þ Focus in ultrasound
 - can have many focuses on most machines
 - but the more focuses, the slower the refresh rate
 - for EM, recommend only a single focus

þ ED docs in France are better than radiologists for reading selected types of
  ultrasounds.
  Date sent:                Wed, 3 Jul 1996 13:56:09 +0200
  Send reply to:    Simon Nicolas <asimon@CLUB-INTERNET.FR>
  From:             Simon Nicolas <asimon@CLUB-INTERNET.FR>
  Subject:               Ultrasound in the ED
  To:               Multiple recipients of list EMED-L <EMED-L@itssrv1.ucsf.EDU>
  [snip]
  We made a study in our ED that showed a sensitivity of 93% and a specificity
  of 87% for US by Emergency doctors compared with radiologists on the same
  patient. So just get familiar with the new technology, get some training
  with your radiologists, take the probe and explore your patients. Just in
  case anyone wondered: we do not charge anything for the US scans we do in
  the ED. Nicolas Simon DAU CHI Poissy France