Knowledge Check Waveforms

Identify the following waveform

• Coeliac Axis
  
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• Descending Thoracic Aorta
  
  Correct! Wave is above the line indicating flow moving away from the probe. It shows the forward flow during systole. The probe will be near to the appropriate depth marker. It will be the tallest brightest waveform. It will have the loudest, sharpest 'whipcrack' sound.
• Inadequate Signal
  
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Identify the following waveform

• Intracardiac Signal
  
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• Coeliac Axis
  
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• Venous Signal
  
  Correct! Wave is below the line indicating flow moving towards the probe. Although the depth and rotation may appear correct, there will not be a clear 'whipcrack' sound. This is likely to be the azygous vein.

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Identify the following waveform

• Descending Thoracic Aorta
  
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• Venous Signal
  
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• Coeliac Axis
  
  Correct! Flow is seen during systole and diastole. Diastolic flow starts high and tapers down. Arrows may be misplaced. Parameters may be extremely high and implausible. The probe is likely to be too deep.

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Identify the following waveform

Identify the following waveform

• Coeliac Axis
  
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• Pulmonary Signal
  
  Correct! Wave is below the line indicating flow moving towards the probe. There may or may not be a 'whipcrack' sound. The probe will be too far out and needs inserting further.
• Inadequate Signal
  
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Identify the following waveform

• Intracardiac Signal
  
  Correct! No clear waveform above the line. Flow is above and below the line and sounds like a galloping horse. The probe is facing the heart instead of the aorta and the depth may need to be checked.
• Descending Thoracic Aorta
  
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• Venous Signal
  
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Select ALL statements that are true for an optimal descending thoracic waveform

• Listen for the loudest sharpest whipcrack sound.
  
  The waveform should also have a black centre.
• Look for the shortest, brightest waveform.
  
  The waveform should be the tallest for that patient.
• Ensure the incisors are near to depth markers 1 and 2 for oral insertion.
  
  You should aim to be close to these markers unless the patient is exceptionally tall or small.
• Look for the tallest, brightest waveform.
  
  The waveform should be the tallest for that patient.
• Sound is not important when focussing the probe.
  
  Try closing your eyes when focussing the probe and listen for the loudest sharpest whipcrack.

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Select ALL statements that are true for the following adult waveform

• The focus appears to be good.
  
  The waveform has orange and white along the edges with a dark centre. The green line is tidy around the waveform and the white arrows are correctly placed on the triangular wave. This needs to accompany the loudest, sharpest 'whipcrack' sound.
• The focus is inadequate.
  
  The waveform has orange and white along the edges with a dark centre and could be optimal. The green line is tidy around the waveform and the white arrows are correctly placed on the triangular wave. This needs to accompany the loudest, sharpest 'whipcrack' sound.
• The signal indicates descending thoracic aortic flow.
  
  The wave represents flow in the correct vessel.
• The signal indicates a coeliac axis.
  
  The coeliac axis is characterised by a wide waveform with flow that tapers down during diastole.
• Stroke Volume is ’normal’ and nothing else needs to be considered.
  
  SV appears 'normal', but it may not be optimal for the clinical scenario. FTc is inversely related to resistance/afterload and the most common cause is hypovolaemia.
• Stroke Volume is ’normal’ yet the Flow Time corrected is low and may require further consideration.
  
  SV may not be optimal for the clinical scenario. FTc less than 330 ms is never normal.
• As long as the urine output is >30 ml/hr, the results shown on the monitor are irrelevant.
  
  Flow parameters may indicate a change long before urine output is affected.

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