Page 143 - Basic Monitoring in Canine and Feline Emergency Patients

VetBooks.ir Fig. 7.4. Modified sternal recumbency for FAST
scanning. In patients that are dyspneic or too
stressed to be in right lateral recumbency, a modified
sternal recumbency has been described to perform
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AFAST and TFAST procedures. In this recumbency,
the thorax and forelimbs are in sternal recumbency
while the hindlimbs are shifted into right lateral
recumbency. This position hopefully allows the patient
to be less stressed and allows for possible larger tidal
volumes in respiratory compromised patients.

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Fig. 7.5. VetBLUE protocol. The regions evaluated during the VetBLUE protocol are the following: (1) caudodorsal
lung lobe region; (2) perihilar lung lobe region; (3) middle lung lobe region; and (4) cranial lung lobe region. All four
regions are assessed on both the left and right hemithorax. The caudodorsal lung lobe is at the level of approximately
the TFAST CTS of the left hemithorax (directly dorsal to the xiphoid within the upper one third of the thorax at
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approximately the eighth to ninth intercostal space). The perihilar lung lobe region is a point within the central one third
of the thorax between intercostal spaces six and seven. The middle lung lobe region is a point within the lower
one-third of the thorax over the heart at the level of the fourth and fifth intercostal spaces. The cranial lung lobe
region is a point within the ventral one third of the thorax cranial to the heart at approximately intercostal spaces two
and three. Often the patient’s thoracic limb needs to be extended cranially to achieve this view. The operator should
repeat all four sites on the opposing thorax side to complete the VetBLUE protocol. For each site, the US operator
can assess for the presence of A-lines with glide sign, B-lines, shred sign, tissue sign, nodule sign, and presence of
pleural effusion. See text for more detail on these signs.

in trauma patients. Additionally, this position has recumbency or standing (Fig. 7.5). Dorsal recumbency is
not been validated for AFAST examinations in the not recommended as many patients that are in respira-
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veterinary patient at this time. tory distress are hemodynamically unstable and being
When completing the VetBLUE protocol for lung placed into dorsal recumbency may be overly stressful
ultrasound, the patient is typically placed in sternal and lead to possible decompensation of the patient.

Applications of Serial Focal Ultrasound Techniques in the Hospitalized Small Animal Patient 135