POCUS in Critical Care, Anesthesia and Emergency Medicine

Foreword
Contents
Contributors
Part I: Basic Ultrasound in Critical Care, Anesthesia and Emergency
	1: Principle of Ultrasound
		1.1	 Introduction
			1.1.1	 History and Evolution of Medical Ultrasound
			1.1.2	 Evolution of POCUS in Critical Care, Anesthesiology, and Emergency Medicine
			1.1.3	 Lung Ultrasound
			1.1.4	 Echocardiography
			1.1.5	 Abdominal Ultrasound for Trauma
			1.1.6	 Ultrasound Guidance for Vascular Cannulation
			1.1.7	 Ultrasound-Guided Regional Anesthesia
			1.1.8	 Advancement of POCUS from the Past Decade
			1.1.9	 Machine Learning and Artificial Intelligence in POCUS (AI and ML)
			1.1.10	 Newer Applications in Handheld Portable Devices
		1.2	 Ultrasound Physics
			1.2.1	 Piezoelectric Crystal and Effect [32, 33]
			1.2.2	 Basic Physics Definitions [32, 34–37]
				1.2.2.1	 Frequency and Wavelength
				1.2.2.2	 Velocity
				1.2.2.3	 Amplitude
				1.2.2.4	 Intensity
				1.2.2.5	 Power
			1.2.3	 Ultrasound Wave Interaction with Tissues [32, 34]
				1.2.3.1	 Reflection
				1.2.3.2	 Attenuation
			1.2.4	 Resolution [32, 34]
				1.2.4.1	 Axial Resolution
				1.2.4.2	 Lateral Resolution
				1.2.4.3	 Temporal Resolution
			1.2.5	 Scanning Modes [32, 34, 35, 37, 38]
				1.2.5.1	 A-Mode
				1.2.5.2	 M-Mode
				1.2.5.3	 B-Mode
				1.2.5.4	 Doppler Mode
					Color Doppler
					Spectral Doppler
						Pulsed-Wave Doppler
						Continuous-Wave Doppler
						Tissue Doppler [38]
		1.3	 Transducers, Image Optimization, and Artifacts
			1.3.1	 Transducer
			1.3.2	 Ultrasound Image Optimization
			1.3.3	 Artifacts
				1.3.3.1	 Acoustic Shadowing Artifact
				1.3.3.2	 Edge Artifact
				1.3.3.3	 Side Lobe Artifact
				1.3.3.4	 Reverberation Artifact
				1.3.3.5	 Mirror Image Artifact
				1.3.3.6	 Acoustic Enhancement Artifact
			1.3.4	 Ergonomics in Point-of-Care Ultrasound
				1.3.4.1	 Ergonomics Definition
				1.3.4.2	 Ergonomics to Reduce WRMSD
		References
	2: Basic Transthoracic of Echocardiography
		2.1	 The Motion Mode (M Mode)
		2.2	 The 2D Mode or B Mode or Brightness Mode
		2.3	 The Doppler Effect
			2.3.1	 Flow Doppler
				2.3.1.1	 Spectral Doppler
					Pulsed Wave Doppler (PWD)
					Continuous Wave Doppler (CWD)
				2.3.1.2	 Color Flow Doppler (CFD)
			2.3.2	 Tissue Doppler Imaging (TDI)
		2.4	 Three-Dimensional Imaging
			2.4.1	 Data Acquisition
				2.4.1.1	 Real-Time or Live 3DE Imaging
				2.4.1.2	 Electrocardiographically Triggered Multiple-Beat 3D Imaging
			2.4.2	 Data Acquisition Modes
				2.4.2.1	 Simultaneous Multi-plane Mode
				2.4.2.2	 Real-Time 3D Narrow Sector
				2.4.2.3	 Focused Wide Sector ̶ Zoom
				2.4.2.4	 Full Volume-Gated Acquisition
				2.4.2.5	 Full Volume with Color Flow Doppler
			2.4.3	 3DE Display
				2.4.3.1	 Cropping
				2.4.3.2	 Post-Acquisition Display
	3: Preparation, Equipment, and Techniques
		3.1	 Preparation
		3.2	 Equipment and Techniques
			3.2.1	 2D Mode
			3.2.2	 M-Mode
			3.2.3	 Doppler Imaging
				3.2.3.1	 Color Doppler (Fig. 3.4)
				3.2.3.2	 Spectral Doppler
					PWD (Fig. 3.5)
					CWD
	4: Windows
	5: Sonoanatomy of Standard Views
		5.1	 Parasternal Long-Axis (PLAX) View
			5.1.1	 Introduction
			5.1.2	 Technique
			5.1.3	 Assessments and Measurements
				5.1.3.1	 Left Ventricular (LV) Systolic Function
		5.2	 Parasternal Short Axis (PSAX) View
			5.2.1	 Introduction
			5.2.2	 Technique
			5.2.3	 Assessments and Measurements
				5.2.3.1	 PSAX View at the Level of AOV
				5.2.3.2	 PSAX View at the Level of MV
				5.2.3.3	 PSAX View at the Level of Papillary Muscles
				5.2.3.4	 PSAX View at the Level of Apex
		5.3	 Apical Four Chamber (A4C) View
			5.3.1	 Introduction
			5.3.2	 Technique
			5.3.3	 Assessment and Measurements (Fig. 5.9)
		5.4	 Apical Five-Chamber (A5C) View
			5.4.1	 Technique
			5.4.2	 Assessment and Measurements
		5.5	 Apical Two-Chamber (A2C) View (Fig. 5.9)
			5.5.1	 Technique
			5.5.2	 Assessment and Measurements
		5.6	 Apical Three-Chamber (A3C) View (Fig. 5.9)
			5.6.1	 Technique
			5.6.2	 Assessment and Measurements
		5.7	 Sub-costal Views
			5.7.1	 Sub-costal Four-Chamber View
				5.7.1.1	 Introduction
				5.7.1.2	 Technique
				5.7.1.3	 Assessment and Measurements
			5.7.2	 Inferior Vena Cava (IVC) View
			5.7.3	 Sub-costal Short-Axis View
			5.7.4	 Supra-sternal Long Axis View
			5.7.5	 Supra-sternal Short-Axis View
	6: Aorta, Vena Cava, and Heart Chambers
		6.1	 LV Systolic Function
			6.1.1	 Introduction
			6.1.2	 Approaches to Estimate EF
				6.1.2.1	 Quantitative Approach
					Fractional Shortening Method
					Ventricular Volumes Method
					Biplane Method of Discs (Modified Simpson’s Rule) (Fig. 6.2)
				6.1.2.2	 Qualitative Approach
					Normal Left Ventricular Systolic Function
					Hyperdynamic Left Ventricular Systolic Function
					Reduced Left Ventricular Systolic Function
					Severely Reduced Left Ventricular Systolic Function
				6.1.2.3	 Other Approaches
		6.2	 LV Diastolic Function
			6.2.1	 Introduction
			6.2.2	 Pertinence of LV Diastolic Function Evaluation
			6.2.3	 Standard Cardiology Assessment of LV Diastolic Function
				6.2.3.1	 Simplified Approach to Assess LV Diastolic Function
		6.3	 Left and Right Atria
			6.3.1	 Left Atrium
				6.3.1.1	 Introduction
				6.3.1.2	 Assessing the LA Vacuity
				6.3.1.3	 Assessment of LA Size
					Simplified Approach
					LA Volume Measure (Simpson’s Approach)
			6.3.2	 Right Atrium
		6.4	 Thoracic Aorta
			6.4.1	 Introduction
			6.4.2	 Thoracic Aorta Anatomy
			6.4.3	 Technique
			6.4.4	 Pathologic Finding
				6.4.4.1	 Dilatation and Aneurysm
				6.4.4.2	 Aortic Dissection
			6.4.5	 Complications Diagnosis
		6.5	 Inferior Vena Cava
			6.5.1	 Introduction
			6.5.2	 Physiology
			6.5.3	 Technique
			6.5.4	 Clinical Applications
				6.5.4.1	 Volume Responsiveness
					Spontaneous Ventilation
					Controlled Ventilation
				6.5.4.2	 Tamponade Physiology
				6.5.4.3	 RA Pressure and CVP Assessment
		References
Part II: Adults and Pediatrics Diseases
	7: Adult Heart Diseases
		7.1	 Coronary Artery Disease
			7.1.1	 Introduction
			7.1.2	 Regional Wall Motion Abnormality
			7.1.3	 Mechanical Complications of Acute Myocardial Infarction
		7.2	 Right Heart Diseases
			7.2.1	 Introduction
			7.2.2	 Assessment of the RV in the Different Standard Views
			7.2.3	 The Interpretation of Pathological Finding
				7.2.3.1	 RV Size
				7.2.3.2	 Wall Thickness of the RV
				7.2.3.3	 IVS
				7.2.3.4	 Systolic Function of RV
					Qualitative Method
					Quantitative Method
				7.2.3.5	 Measurement of Pulmonary Artery Pressure
		7.3	 Pulmonary Hypertension(PHT)
			7.3.1	 Introduction
			7.3.2	 Pertinence of Measurement of Pulmonary Pressure
			7.3.3	 Technique of Measurement
				7.3.3.1	 Quantitative Estimation
				7.3.3.2	 Estimation Using the Tricuspid Valve Regurgitation Maximum Jet
				7.3.3.3	 Assessment of Flow Through the RVOT
				7.3.3.4	 Estimation Using the Pulmonic Regurgitant Diastolic Flow
		7.4	 Pericardial Effusion and Tamponade
			7.4.1	 Introduction
			7.4.2	 Positive Diagnosis of Pericardial Effusion
			7.4.3	 Differential Diagnosis
			7.4.4	 Pathological Finding
				7.4.4.1	 Pericardial Effusion Size
				7.4.4.2	 Cardiac Tamponade
		7.5	 Heart Valve Disease
			7.5.1	 Introduction
			7.5.2	 The Technique of the Echocardiographic Exam
			7.5.3	 Pathologic Findings
				7.5.3.1	 MR
				7.5.3.2	 Aortic Regurgitation
				7.5.3.3	 Stenotic Valvular Lesions
		7.6	 Cardiomyopathies
			7.6.1	 Hypertrophic Cardiomyopathy
				7.6.1.1	 Echographic Diagnosis of HCM
				7.6.1.2	 Echographic Finding
			7.6.2	 Dilated Cardiomyopathy
				7.6.2.1	 Echographic Finding
			7.6.3	 Restrictive Cardiomyopathy
		7.7	 Acute Fibrillation and Other Arrhythmias
			7.7.1	 Atrial Fibrillation
			7.7.2	 Other Arrhythmia
		7.8	 Prosthetic Valves
			7.8.1	 Introduction
			7.8.2	 2D and TM Features of Replacement Valves
				7.8.2.1	 Mechanical Replacement Valves
			7.8.3	 Doppler Features of Replacement Valves
			7.8.4	 Pathologic Findings
		7.9	 Endocarditis
			7.9.1	 Introduction
			7.9.2	 Vegetations
			7.9.3	 Destructive Lesions
			7.9.4	 Hemodynamic Consequences
		7.10	 Advanced Cardiac Life Support (Cardiac Arrest)
			7.10.1	 Introduction
			7.10.2	 Diagnostic Approach
				7.10.2.1	 Ventricular Fibrillation
				7.10.2.2	 Pulseless Electrical Activity and Asystole
			7.10.3	 Prognostic
			7.10.4	 Technique
		7.11	 Pericardiocentesis
			7.11.1	 Introduction
			7.11.2	 Contraindications
			7.11.3	 Ultrasound Technique
			7.11.4	 Complications
		References
	8: Pediatric and Congenital Heart Disease
		8.1	 Patent Foramen Ovale
			8.1.1	 Introduction
			8.1.2	 Diagnosis of PFO
		8.2	 Atrial Septal Defects
			8.2.1	 Introduction
			8.2.2	 Anatomic Classification
				8.2.2.1	 ASD Ostium Secundum
				8.2.2.2	 ASD Sinus Venosus
				8.2.2.3	 ASD Ostium Premium
				8.2.2.4	 ASD Coronary Sinus
			8.2.3	 Technique
			8.2.4	 Echographic Finding
				8.2.4.1	 Type of the ASD
				8.2.4.2	 Size of the Defect
				8.2.4.3	 Evaluation of the Effect of the Shunt
		8.3	 Ventricular Septal Defect
			8.3.1	 Introduction
			8.3.2	 Pathophysiology
			8.3.3	 Anatomy and Imaging
				8.3.3.1	 Membranous VSD (Gerboud Defect)
				8.3.3.2	 Perimembranous VSD (Infracristal)
				8.3.3.3	 Muscular VSD
				8.3.3.4	 Inlet VSD
				8.3.3.5	 Supracristal VSD (Sub-pulmonic, doubly-committed, Sub- and Juxta-Arterial, Outlet VSD)
			8.3.4	 Steps of Echocardiography Exam
				8.3.4.1	 Location of the VSD
				8.3.4.2	 Size of the Defect
				8.3.4.3	 Flow Direction
				8.3.4.4	 Estimation of the Size of Shunt
				8.3.4.5	 Estimation of the Effect of the VSD
		8.4	 Patent Ductus Arteriosus
			8.4.1	 Introduction
			8.4.2	 Steps of Echocardiography Exam
				8.4.2.1	 Positive Diagnosis of PDA
				8.4.2.2	 Evaluation of the Size of PDA
				8.4.2.3	 Evaluation of the Direction of the Shunt
				8.4.2.4	 Evaluation of the Effect of PDA
		8.5	 Tetralogy of Fallot
			8.5.1	 Introduction
			8.5.2	 Objective of the Echographic Exam: Fig. 8.3
			8.5.3	 Echography Imaging of the Main Lesions
				8.5.3.1	 VSD
				8.5.3.2	 Assessment of Pulmonary Tract
				8.5.3.3	 Associated Lesions
		8.6	 Transposition of the Great Arteries (Complete TGA or D-TGA)
			8.6.1	 Introduction
			8.6.2	 Pathophysiology
			8.6.3	 Objective of the Echographic Assessment
			8.6.4	 2D-Imaging Mode
				8.6.4.1	 Acquisition
				8.6.4.2	 Analysis
			8.6.5	 Doppler Imaging
				8.6.5.1	 Acquisition
		8.7	 Atrioventricular Septal Defects
			8.7.1	 Introduction
			8.7.2	 2D-Imaging Mode
				8.7.2.1	 Anatomic Finding
				8.7.2.2	 Acquisition
			8.7.3	 Doppler Finding
				8.7.3.1	 AVV Assessment
		8.8	 Other Anomalies
			8.8.1	 Pulmonary Stenosis
			8.8.2	 Coarctation of the Aorta: Fig. 8.5
			8.8.3	 Aortic Aneurysm Can Lead to Dissection or Rupture
		References
	9: Tips and Tricks
Part III: US in Different Settings
	10: Lung Ultrasound in Acute Care
		10.1	 Introduction
		10.2	 Principles
		10.3	 Technical Considerations
		10.4	 Technique of Examination
		10.5	 Sonography of Normal Lung
		10.6	 Sonography of Lung Pathologies
			10.6.1	 Interstitial Syndrome
				10.6.1.1	 Number of B-Lines
			10.6.2	 Pleural Effusion
			10.6.3	 Pneumothorax
			10.6.4	 Alveolar Syndrome
		10.7	 Conclusion
		References
	11: Ultrasound-Guided Vascular Access
		11.1	 Introduction
		11.2	 General Considerations
			11.2.1	 Blood Vessel Identification
			11.2.2	 Approaches for Vascular Cannulation
				11.2.2.1	 Out-of-Plane Approach
				11.2.2.2	 In-Plane Approach
				11.2.2.3	 Oblique Approach
			11.2.3	 Transducer and Imaging Mode
				11.2.3.1	 Transducer
				11.2.3.2	 Imaging Mode
			11.2.4	 Preparation
				11.2.4.1	 Pre-procedural Checklist
				11.2.4.2	 Equipment
				11.2.4.3	 Positioning and Ergonomy
		11.3	 Ultrasound-Guided Internal Jugular Vein Cannulation
			11.3.1	 Anatomic and Sonoanatomic Considerations
				11.3.1.1	 Anatomic Considerations
				11.3.1.2	 Sonoanatomic Considerations
			11.3.2	 Cannulation Technique
			11.3.3	 Complications
		11.4	 Ultrasound-Guided Subclavian Vein Cannulation
			11.4.1	 Anatomic and Sonoanatomic Considerations
				11.4.1.1	 Anatomic Considerations
				11.4.1.2	 Sonoanatomic Considerations
			11.4.2	 Cannulation Technique
				11.4.2.1	 The Infraclavicular Approach
				11.4.2.2	 The Supraclavicular Approach
			11.4.3	 Complications
		11.5	 Femoral Vein Cannulation
			11.5.1	 Anatomic and Sonoanatomic Considerations
				11.5.1.1	 Anatomic Considerations
				11.5.1.2	 Sonoanatomic Consideration
			11.5.2	 Cannulation Technique
		11.6	 Peripherally Inserted Central Catheter Lines
			11.6.1	 Definition
			11.6.2	 Indications
			11.6.3	 Contraindications
			11.6.4	 Technique
				11.6.4.1	 Initial Scan
				11.6.4.2	 Material and Preparation
				11.6.4.3	 Procedure (Modified Seldinger Method)
			11.6.5	 Complications
		11.7	 Ultrasound-Guided Arterial Cannulation
			11.7.1	 Technique
				11.7.1.1	 Preparation
				11.7.1.2	 Transverse Versus Longitudinal Approach
					Transverse Approach
					Longitudinal Approach
			11.7.2	 Arteries Cannulation Sites Particularities
				11.7.2.1	 Radial Artery
				11.7.2.2	 Femoral Artery
				11.7.2.3	 Dorsalis Pedis Artery
				11.7.2.4	 Posterior Tibial Artery Cannulation (Figs. 11.22 and 11.23)
		11.8	 Ultrasound-Guided Peripheral Venous Cannulation
			11.8.1	 Indications
				11.8.1.1	 Primary Indications
				11.8.1.2	 Secondary Indications
			11.8.2	 Technique
				11.8.2.1	 Initial Scan
				11.8.2.2	 Distinguish Vein from Artery
				11.8.2.3	 Choice of the Vein to be Cannulated
				11.8.2.4	 Material and Preparation
				11.8.2.5	 Transverse Versus Longitudinal Approach
					Transverse Approach
					Longitudinal Approach
			11.8.3	 Complication
		11.9	 Pediatric Considerations
			11.9.1	 Central Venous Access
			11.9.2	 Peripheral Venous Cannulation
			11.9.3	 Arterial Cannulation
		References
	12: E-FAST and Abdominal Ultrasound
		12.1	 Introduction
		12.2	 Preparation Equipment and Technique
			12.2.1	 Transducer Selection
			12.2.2	 Orientation Marker
			12.2.3	 Patient Position
			12.2.4	 E-FAST Sequence
		12.3	 Anatomy
		12.4	 Sonoanatomy E-FAST Views
			12.4.1	 Right Upper Quadrant View
			12.4.2	 Subcostal View
			12.4.3	 Left Upper Quadrant View
			12.4.4	 Pelvic View (Long and Short Axis)
			12.4.5	 Rectovesical Pouch in Males
			12.4.6	 Rectouterine Pouch in Females
			12.4.7	 E-FAST Thoracic View
		12.5	 Other Abdominal Views
			12.5.1	 Liver Ultrasound
			12.5.2	 Liver Pathology
			12.5.3	 Gall Bladder and Common Bile Duct Ultrasound
		12.6	 Gall Bladder and CBD Pathology
			12.6.1	 Cholelithiasis
			12.6.2	 Cholecystitis
			12.6.3	 Choledocholithiasis
			12.6.4	 Appendicitis
		12.7	 Pathology
			12.7.1	 Hemoperitoneum in the Hepatorenal Space
			12.7.2	 Haemothorax in the Right and Left Pleural Space
			12.7.3	 Haemoperitoneum in the Splenorenal Space
			12.7.4	 Haemoperitoneum in the Rectovesical and Rectouterine Excavation
			12.7.5	 Haemopericardium
			12.7.6	 Detecting Pneumothorax
			12.7.7	 Abdominocentesis
		12.8	 Advantages of E-FAST
		12.9	 Tips and Tricks
		12.10	 E-FAST Examination in Medical Decision-Making
		12.11	 Conclusion
		References
	13: Point-of-Care Gastric Ultrasound
		13.1	 Introduction
			13.1.1	 Gastric Ultrasound: An Emerging Technique
			13.1.2	 Gastric Ultrasound to Prevent Perioperative Pulmonary Aspiration
		13.2	 Principles
		13.3	 Assessment of Gastric Content vs. Schrödinger’s Cat Thought Experiment
			13.3.1	 Teaching Schrödinger’s Cat to Evaluate the Clinical State of Superposition?
		13.4	 Anatomy and Physiology
			13.4.1	 Applied Anatomy
			13.4.2	 Gastric Wall Histology
			13.4.3	 Gastric Motor Function Physiology and Pathophysiology
		13.5	 Indications
			13.5.1	 Confirm Gastric Emptiness in Superposition of Clinical States
			13.5.2	 Other Clinical Applications
		13.6	 Preparation, Equipment, and Techniques
			13.6.1	 Preparation
			13.6.2	 Position
				13.6.2.1	 Supine Position
				13.6.2.2	 Right Lateral Position
				13.6.2.3	 Half Sitting Position
				13.6.2.4	 Equipment
					Probes
				13.6.2.5	 Techniques
		13.7	 Sonoanatomy
			13.7.1	 Sonographic Appearance of Gastric Wall Layers
			13.7.2	 Sonographic Appearance of Gastric Content
			13.7.3	 Sonographic Appearance of Antrum
		13.8	 Ultrasonographic Measurement of Antral Area
			13.8.1	 Qualitative Assessment of Gastric Volume
			13.8.2	 Quantitative Assessment of Gastric Volume
		13.9	 Interpretation and Scores
			13.9.1	 Medical Decision-Making
		13.10	 Specific Patients
			13.10.1 Point-of-Care Gastric Ultrasound in Adults
			13.10.2 Point-of-Care Gastric Ultrasound in Pregnancy
				13.10.2.1	 Ultrasound Findings During Pregnancy
			13.10.3 Point-of-Care Gastric Ultrasound in Pediatrics
			13.10.4 Point-of-Care Gastric Ultrasound in Obese Patients
			13.10.5 Point-of-Care Gastric Ultrasound for Critically Ill Patients
		13.11	 Tips and Tricks
		References
	14: Vascular Ultrasound
		14.1	 Introduction
		14.2	 Techniques
		14.3	 Assessment of Upper Limb Vessels
			14.3.1	 Anatomy
				14.3.1.1	 Artery Anatomy of the Upper Extremity
				14.3.1.2	 Venous Anatomy of the Upper Extremity
			14.3.2	 Sonoanatomy
			14.3.3	 Pathology
		14.4	 Neck Vessels
		14.5	 Assessment of Lower Limb Vessels
			14.5.1	 Assessment of Lower Limb Artery
			14.5.2	 Assessment of Lower Limb Venous
		14.6	 Abdominal Aorta
		14.7	 Arteriovenous Fistula
		14.8	 Fistula Complication
		References
	15: Role of Ultrasound in Airway Management
		15.1	 Introduction
		15.2	 Sonoanatomy of the Airway
		15.3	 Functions of Ultrasound in the Airway
			15.3.1	 Cricothyroidotomy
			15.3.2	 Confirmation of Endotracheal Tube (ETT) Placement
			15.3.3	 Prediction of Difficult Laryngoscopy
			15.3.4	 Prediction of Endotracheal Tube Size
			15.3.5	 Prediction of Postextubation Stridor
		15.4	 Conclusion
		References
	16: Echocardiographic Evaluation of Shock
		16.1	 Introduction
			16.1.1	 Value of Echocardiography in Shock State
			16.1.2	 When and How to Use Echocardiography in Shock
		16.2	 Mechanisms of Shock
			16.2.1	 Obvious Cardiac Abnormalities
			16.2.2	 Hyperkinetic State
			16.2.3	 Hypokinetic State
			16.2.4	 Normokinetic State
		16.3	 Haemodynamic Profile of Shock
			16.3.1	 Left Ventricular Systolic Function
			16.3.2	 Cardiac Output Assessment
			16.3.3	 Fluid Requirement
			16.3.4	 Vasoplegia
			16.3.5	 Right Ventricular Function
		16.4	 Haemodynamic Monitoring Using Repeated Echocardiography
		16.5	 Management of Shock
			16.5.1	 Therapeutic Impact
			16.5.2	 Assessment of Efficacy and Tolerance Therapy
		16.6	 Limitation of Echocardiography
		16.7	 Conclusion
		References
	17: Transcranial Doppler Sonography
		17.1	 Introduction
		17.2	 The Main Acoustic Windows
			17.2.1	 Transtemporal Window (Picture 17.1)
			17.2.2	 Transforaminal Window (Picture 17.2)
			17.2.3	 Transorbital Window (Picture 17.3)
			17.2.4	 Submandibular Window (Picture 17.4)
		17.3	 Anatomical Landmarks
		17.4	 The Main Cerebral Arteries
			17.4.1	 Carotid Circulation
				17.4.1.1	 Internal Carotid Artery: (ICA)
				17.4.1.2	 Middle Cerebral Artery: MCA
				17.4.1.3	 Anterior Cerebral Artery: ACA
				17.4.1.4	 Posterior Communicating Artery: PComA
			17.4.2	 Posterior Circulation (Vertebro-basilar Circulation)
				17.4.2.1	 Posterior Cerebral Artery: PCA
				17.4.2.2	 Vertebral Artery: VA
				17.4.2.3	 Basilar Artery: BA
				17.4.2.4	 Postero-inferior Cerebellar Artery: PICA
				17.4.2.5	 Antero-inferior Cerebellar Artery: AICA
				17.4.2.6	 Superior Cerebellar Artery: SCA
			17.4.3	 The Characteristics of the Circle of Willis
		17.5	 Different Velocities Measurement and Index Calculation
			17.5.1	 Normal Velocities
			17.5.2	 Pulsatility Index (Gosling Index): PI
			17.5.3	 Resistance Index (Pourcelot Index): RI
			17.5.4	 Lindegaard or Aaslid Index (LI or AI): LI
		17.6	 Exploration of Vascular Reactivity
			17.6.1	 Vascular Reactivity to Arterial Pressure: Cerebral Pressure Autoregulation
			17.6.2	 Cerebrovascular Reactivity to Au CO2
		17.7	 Pathological Situations
			17.7.1	 Hypoperfusion Situation
			17.7.2	 Hyperaemia and Hyperaemia Syndrome
			17.7.3	 Vasospasm
			17.7.4	 Brain Death
		17.8	 Other Situations
			17.8.1	 Patent Foramen Ovale
			17.8.2	 Carotid Artery Dissection
			17.8.3	 Vertebral Artery Dissection
			17.8.4	 Carotidcavernous Fistula
			17.8.5	 Venous Sinus Thrombosis
		17.9	 Conclusions
		References
	18: Renal Ultrasound
		18.1	 Introduction
		18.2	 Sonoanatomy of the Kidney
		18.3	 Clinical Indications
		18.4	 Preparation, Equipment, and Scanning Techniques
			18.4.1	 Patient and Machine Positioning
			18.4.2	 Transducer Selection and Machine Setting
			18.4.3	 Scanning Technique
		18.5	 Normal Sonographic Findings of Kidney, Ureter, and Bladder
			18.5.1	 Renal Ultrasound Landmark Summary
				18.5.1.1	 Right Longitudinal Kidney View
				18.5.1.2	 Right Transverse Kidney View
				18.5.1.3	 Left Longitudinal Kidney View
				18.5.1.4	 Left Transverse Kidney View
				18.5.1.5	 Longitudinal Bladder View
				18.5.1.6	 Transverse Bladder View
		18.6	 Renal Ultrasound Pathology
			18.6.1	 Hydronephrosis
			18.6.2	 Direct Visualization of Kidney Stone
			18.6.3	 Hydronephrosis of Affected Kidney
			18.6.4	 Absence of Ureteral Jets
			18.6.5	 Twinkling Artifact
			18.6.6	 Renal Cysts
			18.6.7	 Renal Masses
			18.6.8	 Urinary Tract Infection
				18.6.8.1	 Acute Cystitis
				18.6.8.2	 Acute Pyelonephritis
				18.6.8.3	 Emphysematous Pyelitis and Emphysematous Pyelonephritis
				18.6.8.4	 Renal Abscess
		18.7	 Bladder Volume Calculation
			18.7.1	 Steps to Perform Urinary Bladder Ultrasound
				18.7.1.1	 Preparation of the Patient
				18.7.1.2	 Ultrasound Machine, Transducer, and Setup
				18.7.1.3	 Scanning the Bladder
		18.8	 Renal Hemodynamics
			18.8.1	 Renal Venous Congestion
			18.8.2	 Renal Resistive Index (RI)
		References
	19: Obstetric and Gynaecological Ultrasound
		19.1	 Introduction
		19.2	 Principles
		19.3	 Normal Anatomy
			19.3.1	 Pelvic Cavity
			19.3.2	 Anterior Cul-de-Sac
			19.3.3	 Posterior Cul-de-Sac
			19.3.4	 Uterine Anatomy
				19.3.4.1	 Description
				19.3.4.2	 Size
			19.3.5	 Relations and Position
			19.3.6	 Ovarian Anatomy
		19.4	 Preparation, Equipment and Techniques
			19.4.1	 Preparation
			19.4.2	 Equipment
			19.4.3	 Technique
				19.4.3.1	 Sagittal Plane
				19.4.3.2	 Transverse Plane
		19.5	 Sonoanatomy
			19.5.1	 Transabdominal Sagittal Plane (Fig. 19.7)
			19.5.2	 Transabdominal Transverse Plane (Figs. 19.8, 19.9, and 19.10)
		19.6	 POCUS in First Trimester Pregnancy Sonography of Important Pathology
			19.6.1	 Ectopic Pregnancy
			19.6.2	 Molar Pregnancy
			19.6.3	 Missed/Incomplete Abortion
				19.6.3.1	 Incomplete Abortion
		19.7	 POCUS in Antenatal (Second and Third Trimester Pregnancy) Sonography of Important Pathology
			19.7.1	 Placental Abruption (Abruptio Placentae)
			19.7.2	 Placenta Previa
			19.7.3	 Uterine Rupture
			19.7.4	 Fetal Demise
			19.7.5	 Retained Placenta
		19.8	 POCUS in the Non-Pregnant with Lower Abdominal Pain Sonography of Important Pathology
			19.8.1	 Ovarian Cysts Accident (Ruptured, Twisted, Haemorrhage)
			19.8.2	 Tubo-Ovarian Abscess
			19.8.3	 Pelvic Inflammatory Disease
		References