Full download Pocus in critical care, anesthesia and emergency medicine noreddine bouarroudj pdf doc
Visit to download the full and correct content document: https://textbookfull.com/product/pocus-in-critical-care-anesthesia-and-emergency-me dicine-noreddine-bouarroudj/
More products digital (pdf, epub, mobi) instant download maybe you interests ...
Critical Care Emergency Medicine 2nd Edition William Chiu
This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether the whole or part of the material is concerned, specifcally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microflms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specifc statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affliations.
This Springer imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
Paper in this product is recyclable.
Foreword
“Wherever the art of Medicine is loved, there is also a love of Humanity.”
—Hippocrates
Healthcare landscape is rapidly evolving. The ability to rapidly and accurately assess patients in different clinical contexts is critical to delivering optimal care and improve their outcomes. Point-of-care ultrasound (POCUS) has emerged as a powerful tool in the hands of healthcare professionals across various specialties. POCUS has revolutionized the way we diagnose, monitor, and treat patients. This transformative technology is an indispensable asset in the armamentarium of healthcare providers.
This book is a step-by-step guide to physicians and healthcare providers across the globe on the utility of POCUS in different specialties. As we embark on this educational journey, it is essential to acknowledge the authors who contributed their collective knowledge and experiences to create this invaluable resource. The chapters within this book provide an indepth examination of POCUS in diverse clinical scenarios, covering its use in cardiovascular assessment, pulmonary care, trauma management, and all ultrasound techniques in anesthesia practice (i.e., gastric ultrasound, airway ultrasound, and ultrasound-guided vascular access). Each chapter has clear explanations, detailed images, and case studies. Readers will gain invaluable insights into the practical application of POCUS in real-world medical settings.
Point-of-care ultrasound empowers clinicians to make rapid, informed decisions at the bedside. It grants us the ability to visualize the internal workings of the human body in real-time, transcending the limitations of traditional physical examinations. The pages of this book are a treasure trove of insights, protocols, and clinical wisdom, aimed at demystifying the complexities of POCUS and enabling healthcare practitioners to harness its potential for the beneft of their patients.
The applications of POCUS are vast and encompass critical care, anesthesia, and emergency medicine, making it an essential skill for professionals in these felds. From assessing the hemodynamic status of a critically ill patient to guiding invasive procedures with precision, POCUS has revolutionized our ability to provide timely, targeted care. The narratives contained within these pages demonstrate the profound impact POCUS has on patient outcomes and the satisfaction of the clinicians who wield this powerful tool.
As POCUS continues to evolve, this book acts as a beacon of knowledge, illuminating the path to mastery. Whether you are a novice eager to learn the fundamentals or an experienced practitioner seeking to refne your skills, the chapters herein cater to a wide range of expertise. The detailed illustrations, case studies, and step-by-step instructions offer a comprehensive guide to incorporating POCUS into your daily practice.
In the modern healthcare environment, where time is often of the essence, and accurate diagnosis and intervention can make the difference between life and death, POCUS is not just a technological marvel but a humanitarian imperative. This book is a testament to the dedication of healthcare providers and their unwavering commitment to improving patient care.
As you delve into the pages of this book, you embark on a journey of discovery and enlightenment. It is our hope that, through this collective effort, you will gain the knowledge and confdence to wield POCUS as a powerful instrument of healing and compassion. May this book serve as an enduring resource, enabling you to provide the best care for your patients, even in the most challenging and time-critical situations.
The practice of medicine in critical care, anesthesia, and emergency medicine demands a profound understanding of human physiology, rapid decisionmaking, and precise interventions. POCUS is a game-changer in these disciplines, providing clinicians with real-time, non-invasive, and highly informative imaging at the patient’s bedside. With its ability to assess cardiac function, detect fuid accumulation, identify pathology, guide procedures, and monitor patient response to treatment, POCUS empowers healthcare providers to deliver more effcient, safer, and patient-centered care.
This book, crafted by a team of esteemed experts, represents a comprehensive exploration of POCUS in the context of critical care, anesthesia, and emergency medicine. It delves into the principles, techniques, and clinical applications of POCUS, offering a wealth of knowledge to both novices and seasoned practitioners. It serves as a guide for those who seek to harness the full potential of this technology to enhance patient care.
Furthermore, the integration of POCUS into educational curricula is explored, underscoring its role in shaping the future of medical training and continuing education.
As we navigate the complex terrain of modern healthcare, our responsibility as healthcare providers is to continuously adapt and embrace innovative solutions that advance the well-being of our patients. POCUS is a tool that exemplifes this commitment to progress. It is a means of improving patient outcomes, enhancing safety, and increasing diagnostic accuracy. This book is an essential resource for anyone who is passionate about delivering exceptional care in critical moments.
I commend the authors for their dedication to advancing our understanding of POCUS in critical care, anesthesia, and emergency medicine. I trust that their expertise and insights will inspire readers to embrace this powerful technology, ensuring that the benefts of POCUS continue to reshape and enhance the delivery of healthcare across the globe.
In closing, I invite you to embark on a journey through the pages of this book, to explore the world of POCUS and to envision its limitless potential in the noble pursuit of saving and improving lives. It is my hope that this book will empower and inspire healthcare providers, educators, and learners alike to embrace the future of medicine, one where POCUS is an indispensable ally in the quest for better patient care.
Clinical Operations, Department of Anesthesiology Nabil Elkassabany University of Virginia Charlottesville, VA, USA
Shahridan bin Mohd Fathil, Yeoh Jie Cong, Lee Kee Choon, Lim See Choo, Sultan Haji Ahmad Shah Ahmad Suhailan Mohamed, Muhazan Mazlan, Nurul Shaliza Shamsudin, and Muhamad Rasydan Abd Ghani
2
5
Noreddine Bouarroudj and Cherif Bouzid
2.1 The Motion Mode (M Mode) .
2.2 The 2D Mode or B Mode or Brightness Mode
2.3 The Doppler Effect.
2.4 Three-Dimensional Imaging
2.4.1 Data Acquisition.
Noreddine Bouarroudj and Cherif Bouzid
3.1 Preparation
3.2 Equipment and Techniques
3.2.1
3.2.2
3.2.3
5.1
5.2 Parasternal
5.3
5.3.1
5.3.2
5.4 Apical Five-Chamber (A5C)
5.4.1
5.4.2
5.5
(Fig.
5.5.2
5.6 Apical Three-Chamber (A3C) View (Fig. 5.9)
5.6.1 Technique
5.6.2
5.7 Sub-costal Views
5.7.1 Sub-costal Four-Chamber View
5.7.2 Inferior Vena Cava (IVC) View
5.7.3 Sub-costal Short-Axis View
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
7.5 Heart Valve Disease
7.5.1 Introduction
7.5.2 The Technique of the Echocardiographic Exam
7.5.3 Pathologic Findings
7.6 Cardiomyopathies
7.6.1 Hypertrophic Cardiomyopathy
7.6.2 Dilated Cardiomyopathy
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
7.8.3 Doppler Features of Replacement Valves
7.8.4 Pathologic Findings
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
Diagnostic Approach
7.10.3 Prognostic
7.10.4 Technique
7.11 Pericardiocentesis
7.11.1 Introduction
7.11.2 Contraindications
7.11.3 Ultrasound Technique
8 Pediatric and Congenital Heart Disease
Noreddine Bouarroudj and Cherif Bouzid
8.1 Patent Foramen Ovale
8.1.1
8.1.2 Diagnosis of PFO
8.2 Atrial Septal Defects
8.2.3
8.3
8.4 Patent Ductus Arteriosus
8.5 Tetralogy of Fallot
8.6 Transposition of the Great Arteries (Complete TGA or D-TGA)
8.7 Atrioventricular Septal Defects
11
Ultrasound-Guided Vascular Access 105
Noreddine Bouarroudj and Cherif Bouzid
11.1 Introduction . . .
11.2 General Considerations 105
11.2.1 Blood Vessel Identifcation
11.2.2 Approaches for Vascular Cannulation
11.2.3 Transducer and Imaging Mode 108 11.2.4 Preparation
Lamine Abdennour Neuro-Réanimation Chirurgicale, Département d’Anesthésie-Réanimation, Groupe Hospitalier Pitié-Salpêtrière, APHPSorbonne Université, Paris, France
Divesh Arora Department of Anaesthesia and OT Services, Asian Hospital, Faridabad, Haryana, India
Muhammad Faiz Baherin Emergency and Trauma Department, Hospital Tuanku Ja’afar, Seremban, Negeri Sembilan, Malaysia
Noreddine Bouarroudj Department of Anesthesiology and Critical Care, Clinique Maissalyne, Constantine, Algeria
Department of Anaesthesia and Critical Care, Maissalyne Hospital, Constantine, Algeria
Cherif Bouzid Department of Anaesthesia and Critical Care, El Afa Hospital, Mila, Algeria
Peňafrancia C. Cano Division of Regional Anesthesia, Department of Anesthesiology, University of the Philippines-Philippine General Hospital, Manila, Philippines
Lim Teng Cheow Department of Anaesthesia and Intensive Care, Malacca General Hospital, Melaka, Malaysia
Lim See Choo Emergency and Trauma Department, Hospital Sultan Haji Ahmad Shah, Temerloh, Malaysia
Lee Kee Choon Emergency and Trauma Department, Hospital Sultan Haji Ahmad Shah, Temerloh, Malaysia
Yeoh Jie Cong Department of Anaesthesiology and Intensive Care, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
Vincent Degos Neuro-Réanimation Chirurgicale, Département d’Anesthésie-Réanimation, Groupe Hospitalier Pitié-Salpêtrière, APHPSorbonne Université, Paris, France
Shahridan bin Mohd Fathil Department of Anaesthesia, Gleneagles Medini Hospital Johor, Iskandar Puteri, Malaysia
Muhamad Rasydan Abd Ghani Department of Anaesthesiology and Intensive Care, Kulliyyah of Medicine, Bandar Indera Mahkota Campus, International Islamic University, Kuantan, Malaysia
Department of Anaesthesiology and Intensive Care, Sultan Ahmad Shah Medical Centre @ IIUM, International Islamic University, Kuantan, Malaysia
Habiba Hemamid Medical Faculty, Intensive Care Unit, Critical Care Department, University Hospital of Sadna Mohamed Abdennour, University of Elbaz, Sétif, Algeria
Alice Jacquens Neuro-Réanimation Chirurgicale, Département d’Anesthésie-Réanimation, Groupe Hospitalier Pitié-Salpêtrière, APHPSorbonne Université, Paris, France
Muhazan Mazlan Emergency and Trauma Department, Hospital Sungai Buloh, Sungai Buloh, Malaysia
Sultan Haji Ahmad Shah Ahmad Suhailan Mohamed Emergency Department, National Heart Institute, Kuala Lumpur, Malaysia
Amrita Rath Department of Anaesthesia, IMS, BHU, Varanasi, UP, India
Nurul Liana Roslan Emergency and Trauma Department, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
Nor Hanisah Mohd Said Hospital Pantai Ayer Keroh, Melaka, Malaysia
Mohd Hafs Mohamed Sakan Emergency and Trauma Department, Melaka General Hospital, Melaka, Malaysia
Nurul Shaliza Shamsudin Emergency and Trauma Department, Hospital Serdang, Kajang, Malaysia
Emergency and Trauma Department, Hospital Sultan Idris Shah, Serdang, Selangor, Malaysia
Hetal Vadera Department of Anaesthesia, Sterling Hospital, Rajkot, Gujarat, India
Mohammad Fadhly Yahya Emergency and Trauma Department, Melaka General Hospital, Melaka, Malaysia
Nur Hafza Yezid Department of Emergency Medicine, Hospital Sultanah Bahiyah, Alor Setar, Malaysia
Part I
Basic Ultrasound in Critical Care, Anesthesia and Emergency
Principle of Ultrasound
Shahridan bin Mohd Fathil, Yeoh Jie Cong, Lee Kee Choon, Lim See Choo, Sultan Haji Ahmad Shah Ahmad Suhailan Mohamed Muhazan Mazlan, Nurul Shaliza Shamsudin, and Muhamad Rasydan Abd Ghani
1.1 Introduction
1.1.1 History and Evolution of Medical Ultrasound
The discovery of ultrasound waves dates back to 1793, when Lazzaro Spallanzani, an Italian biologist, observed the echolocation ability of bats in navigation [1]. Later on, in 1915, Pierre and Jacques Curie observed the phenomenon of piezoelectric effect, which refers to the generation of electric charges by specifc crystals under mechanical pressure thereby generating pressure waves upon application of electricity. This signifcant fnding led to the development of ultra-
sound transducers capable of emitting and receiving such waves.
The medical application potential was realized by John Wild, an English-born surgeon in 1950 through his research papers that highlighted how ultrasonic imaging could effectively differentiate between normal tissue and those invaded by tumors, setting the foundation for future advancements in this feld [2].
In 1953, Inge Edler, a Swedish physician, together with Carl Hertz, a German physicist, pioneered the initial usage of echocardiography using M mode recording using a sophisticated ultrasonic refectoscope, which is a tool employed for examining the inner regions of solid compo-
S. M. Fathil (*)
Department of Anaesthesia, Gleneagles Medini
Hospital Johor, Iskandar Puteri, Malaysia
Y. J. Cong
Department of Anaesthesiology and Intensive Care, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
L. K. Choon · L. S. Choo
Emergency and Trauma Department, Hospital Sultan Haji Ahmad Shah, Temerloh, Malaysia
S. H. A. S. A. S. Mohamed
Emergency Department, National Heart Institute, Kuala Lumpur, Malaysia
e-mail: drsuhailan@ijn.com
M. Mazlan
Emergency and Trauma Department, Hospital Sungai Buloh, Sungai Buloh, Malaysia
N. S. Shamsudin
Emergency and Trauma Department, Hospital Serdang, Kajang, Malaysia
M. R. A. Ghani
Department of Anaesthesiology and Intensive Care, Kulliyyah of Medicine, Bandar Indera Mahkota Campus, International Islamic University, Kuantan, Malaysia
Department of Anaesthesiology and Intensive Care, Sultan Ahmad Shah Medical Centre @ IIUM, International Islamic University, Kuantan, Malaysia
nents to identify imperfections [3]. During the same period, medical doppler imaging was also developed by a Japanese physicist, Shigeo Satumura, to measure blood fow and velocity non-invasively. [4] Medical ultrasound technology has continued to progress in the 1990s with harmonic imaging and the advancement of imaging technology was marked by the adoption of three-dimensional (3D) and fourdimensional (4D) ultrasound, which signifcantly improved image resolution and quality. [5]
1.1.2 Evolution of POCUS in Critical Care, Anesthesiology, and Emergency Medicine
In 1993, a French intensivist, Daniel Liechtenstein, was the frst to describe the use of diagnostic and procedural guidance with ultrasound for the abdomen, lung, and major veins in the intensive care setting [6].
1.1.3 Lung Ultrasound
Lung ultrasound was initially viewed with skepticism due to its inability to assess the parenchyma of the aerated lung properly. The frst mention of thoracic ultrasound was from André Dénier, the father of medical ultrasound. However, it was Daniel Lichtenstein who improved on the concept and understanding of lung ultrasound, redefning its uses and debunking many criticisms. [7]
1.1.4 Echocardiography
As described above, in 1953, Inge Edler and Carl Hertz succeeded in capturing the initial dynamic visual depiction of cardiac movement [8]. In 1976, Leon Frazin and colleagues frst described transesophageal echocardiography using a rounded transducer that was swallowed by the patients themselves. [9] In 1980, Eugene DiMagno introduced a side-viewing gastroscope that integrated an ultrasound probe within its tip.
This innovation facilitated the examination of the upper gastrointestinal tract using endoscopy and enabled ultrasonic imaging of internal organs like the heart. [10]
1.1.5 Abdominal Ultrasound for Trauma
In 1970, American radiologists, Barry Goldberg and colleagues instilled fuid into cadavers and patients to assess the capacity of A mode ultrasound for identifying “free fuid.” [11] In 1971, JK Kristensen and colleagues from Germany published the primary case report detailing the application of ultrasound in assessing blunt abdominal trauma. [12] In 1976, Michael Asher and colleagues conducted a preliminary study on the use of ultrasound for screening purposes in a cohort of 70 patients who exhibited blunt abdominal trauma and were suspected to have sustained splenic injury. [13] In 1992, Paul Tso and colleagues compared the usefulness of ultrasound with diagnostic peritoneal lavage (DPL) and computed tomography scan on 163 blunt abdominal traumas. Overall, ultrasound had high specifcity and sensitivity. [14] The currently accepted nomenclature Focused Assessment with Sonography for Trauma (FAST) was standardized in 1996 to describe the ultrasound scanning for free fuid in abdominal trauma. [15]
1.1.6 Ultrasound Guidance for Vascular Cannulation
James Ullman and Robert Stoelting reported the use of an ultrasound doppler pencil-shaped fow probe to improve the rate of successful cannulation of the internal jugular vein [16]. A decade later, in 1986, Akitomo Yonnei and colleagues described the frst real-time ultrasound-guided cannulation of the internal jugular vein. [17] Today, ultrasound guidance is the standard of practice for central and peripheral venous and arterial cannulations across all medical disciplines. [18–21]
1.1.7 Ultrasound-Guided Regional Anesthesia
The frst ultrasound guidance for a regional block was performed by P Ting and V Sivagnanaratnam in 1989 in Singapore. The authors documented the before and after local anesthetic administration ultrasound images of the axilla for axillary brachial plexus blocks in ten patients. [22] In 1994, Stephan Kapral and colleagues from Austria, documented the frst case series of realtime ultrasound-guided supraclavicular blocks in 40 patients [23]. Since then, ultrasound-guided regional anesthesia and pain blocks has evolved into a mainstream anesthesia sub-specialty. [24–26]
1.1.8 Advancement of POCUS from the Past Decade
The implementation of point-of-care ultrasound (POCUS) guidance has resulted in improved outcomes and reduced complications for a range of medical procedures, such as central and peripheral vascular access, thoracocentesis, and regional anesthesia. It appears that acquiring profciency in using POCUS for these procedures requires less time than other techniques; however, there is currently no widely accepted method to determine competence. Clinicians who master the use of POCUS can also apply this tool to monitor clinical conditions that may escalate quickly, leading to earlier interventions with potentially favorable patient outcomes.
Point-of-care ultrasonography has emerged as an effcient and cost-effective alternative to traditional ultrasonography. It has led to reduced referrals, improved diagnosis accuracy, and effective management of various clinical conditions. However, it requires appropriate training and quality assurance since indiscriminate use may lead to unnecessary testing or interventions. Despite the potential benefts of POCUS on patient outcomes, studying its impact is challenging due to factors such as patient diversity, lack of standardization in protocols used by clinicians alongside confounding variables that include
concurrent therapeutic measures, variation in clinician skills level, as well as diffculty fnding unbiased professionals toward using POCUS techniques. [27, 28]
1.1.9 Machine Learning and Artifcial Intelligence in POCUS (AI and ML)
In today’s world, AI and ML in POCUS have garnered tremendous attention, especially in the realm of medical imaging. Point-of-care ultrasound is an area where these technologies are fnding their feet while computed tomography and radiography already bear witness to their effcacy [29]. Using AI/ML to sift through massive amounts of data and formulate algorithms can equip clinicians with invaluable support for quick decision-making, error detection tools, and techniques for image optimization [30]. Despite this progress though, it remains crucial that further research be conducted on safety concerns as well as ethical dilemmas and legal implications that may arise before we can fully rely on AI/ML in clinical applications.
1.1.10 Newer Applications in Handheld Portable Devices
Handheld portable ultrasound devices have been available for over a decade, evolving from laptop to pocket size and now wirelessly connected to tablets or smartphones. The more affordable capacitive micromachined ultrasound transducer (CMUT) can replace the piezoelectric crystal, allowing for analysis of a wide range of frequencies and enhancing portability. Longer battery life, better heat dissipation, and ergonomic probe design are attractive features for users. These smaller, durable, pocket-sized devices have also improved tele-ultrasound services, especially in remote areas where POCUS expertise is required. The utilization of technology has been signifcantly infuenced and molded by worldwide pandemics, including the recent COVID-19 pandemic. [31]
1.2 Ultrasound Physics
1. Describe ultrasound as a mechanical wave
2. Elaborate piezoelectric crystal and effect
3. Basic physics defnitions
(a) Frequency
(b) Velocity
(c) Wavelength
(d) Amplitude
(e) Intensity
(f) Power
(i) Mechanical index
(ii) Thermal index
Ultrasound is a mechanical wave that travels through the body and interacts with the tissues along the penetration. A sound wave can be a moving longitudinal or transverse waveform in the medium. The propagation of the longitudinal soundwave is parallel to the displacement of the medium. Therefore, only longitudinal soundwaves are important in medical ultrasonography. Medical ultrasound commonly ranges from 1 to 15 MHz (1 MHz = 1 million hertz). Meanwhile, normal human hearing ranges from 20 to 20,000 Hz; anything above the human hearing range is considered ultrasound [32].
1.2.1
Piezoelectric Crystal
and Efect [32, 33]
The ultrasound source is the piezoelectric (piezo is a Greek word piezein—to squeeze/ press) crystal. When electrical current is present, the piezoelectric crystals’ vibration will generate sound waves. This elastic property of the crystal is known as the piezoelectric effect. Inversely, the crystals can convert the waves to electrical energy, and the data will be processed as anatomic images. Current ultrasound transducers commonly use lead zirconate titanate (PZT) ceramics. PZT is preferred due to its ability to produce a wide range of frequencies.
1.2.2
Basic Physics Defnitions [32, 34–37]
1.2.2.1 Frequency and Wavelength
In soundwave, frequency represents the number of cycles per second (Hertz). One hertz (Hz) is equivalent to one wave per second. It is an essential property of waves as it determines their wavelength and energy. Higher frequency waves exhibit a shorter wavelength, while lower frequency waves exhibit a longer wavelength. Longwavelength sound waves can travel into deeper tissues than short wavelengths; however, they produce a lower resolution.
1.2.2.2 Velocity
Velocity is the speed at which an ultrasound wave passes through a medium. It is the product of wavelength and frequency [ v = wavelength (λ) × frequency (ƒ)]. Different mediums will produce different velocities (shown in Table 1.1). The velocities of sound waves change when passing through a different mediums. Changes in the medium cause a certain amount of energy loss. For example, the sound velocity through the water and soft tissue is 1430 m/s and 1540 m/s, respectively. Due to minor differences, no signifcant amount of energy was lost. However, when the low velocity of the sound wave passes through the air (331 m/s), it results in a signifcant loss of signal, thus making it a poor acoustic window.
Table 1.1 The reported velocity of soundwaves in human soft tissues
Media Velocity (m/s)
Air 330
Water 1480
Fat 1450
Blood 1570
Kidney 1560
Liver 1550
Muscle 1580
Bone 4080
1.2.2.3 Amplitude
Amplitude is related to the loudness or size of the wave. It refers to the maximum displacement (from baseline to top of the wave) or distance of the particles in the medium which the soundwave traveled. The amplitude of a sound wave can affect its ability to penetrate tissue. A higher voltage applied to the piezoelectric crystal will increase the vibration, thus making the image brighter.
1.2.2.4 Intensity
Intensity is defned as the energy concentration in the cross section of the soundwave. It is the product of power divided by the cross-sectional area of the sound wave [I = Power (Watts)/ Area (cm2)]. It is directly proportional to power. Theoretically, high intensity ultrasound can cause tissue damage.
1.2.2.5 Power
It is the rate of energy (joules) transferred over a certain amount of time (watts). Although power is not visible in ultrasound, the two variables are indirectly related. The frst is the mechanical index, which represents the risk of cavitation (the formation of small gas bubbles within the scanning area). The second is the thermal index (TI), which is
related to the tissue temperature increment in the region of interest. TI is calculated from the acoustic power of the source divided by the power required to raise the tissue temperature by 1 °C. Although there are no known biological effects of ultrasound, it is recommended that total exposure time and intensity be kept as low as reasonably achievable –also known as the ALARA principle.
1. Ultrasound interaction with tissues
(a) Refection
(b) Attenuation
(i) Absorption
(ii) Scattering
(iii) Refraction
1.2.3 Ultrasound Wave Interaction with Tissues [32, 34]
1.2.3.1 Refection
Ultrasound waves transmitted through tissues and different mediums are refected to the transducer and displayed as ultrasound images. The greater the refection, the brighter the images are displayed on the ultrasound machine. The intensity of the refection determines the image brightness display and the descriptions are as follows:
HyperechoicIsoechoic Hypoechoic Anechoic
1.1 Different echogenicity with the surrounding tissue
Hyperechoic: An area that generates a bright signal due to intense refection.
Isoechoic: Same echogenicity with surrounding tissue.
Hypoechoic: Darker signal at the area that does not refect as much.
Anechoic: Completely black area with no sound waves refected (Fig. 1.1).
The refection of the soundwave is determined by the acoustic impedance difference of the two mediums, the angle of incidence and the ultrasound wave frequency.
The acoustic impedance of a medium describes its ability to transmit ultrasound waves. It also measures the material’s resistance to the transmission of soundwaves. It is calculated from the density of the material and the speed of sound in the material.
Z =×ρν
Z (acoustic impedance); ρ (density of the medium); ν (velocity).
Mediums with high acoustic impedance, such as bone, offer greater resistance to the transmission of acoustic waves compared to mediums with low acoustic impedance, such as soft tissue. As the difference in acoustic impedance between two mediums increases and the mismatch grows, it leads to refection of sound waves back to the transducer, causing an artifact phenomenon known as acoustic shadowing (Table 1.2) (Fig. 1.2).
1.2.3.2 Attenuation
As the ultrasound wave propagates through different mediums, attenuation occurs in which there is a gradual reduction in the intensity of the ultra-
Table 1.2 Impedance of different mediums
Medium Acoustic Impedance (Rayls)
Air 0.00043
Fat 1.3 × 106
Water 1.48 × 106
Muscle 1.6 × 106
Liver 1.6 × 106
Blood 1.6 × 106
Kidney 1.7 × 106
Bone 6.5–8.0 × 106
Fig. 1.2 Ultrasound of aorta—the acoustic impedance (AI) difference between surrounding tissues and vertebrae bone is high, which results in acoustic shadowing of the vertebrae body
sound wave. A portion of the wave returns to the probe to be displayed as an image on the ultrasound machine results of the refection of the ultrasound wave.
However, the rest of the sound wave loses energy in three ways: absorption, scattering, and refraction.
Fig.
S. M. Fathil et
(a) Absorption—the soundwave energy is absorbed by the medium and converted to heat energy.
(b) Scattering—the ultrasound wave is redirected in different directions when it encounters small structures or irregularities within the medium.
(c) Refraction—when the ultrasound wave is transmitted through two media with different acoustic impedances (e.g., a soft tissue and a bone), the direction of the ultrasound wave is bent or altered due to a change in its velocity and direction. This process leads to some of the energy being lost in the process.
The degree of attenuation is also determined by the soundwave frequency and the density of the medium. Higher frequency sound waves attenuated more, resulting in less penetration; conversely, lower frequency sound waves have lesser attenuation, better penetration, resulting in better visualization of deep structures (Fig. 1.3).
1. Resolution
(a) Spatial
(i) Axial (ii) Lateral
(b) Temporal
1.2.4 Resolution [32, 34]
It is the ability to accurately distinguish between two subjects that are nearby at a particular distance. In addition to distance or space (Spatial), resolution can also be defned by time (Temporal) or color (Contrast). There are two types of spatial resolution. Axial and lateral resolution (Fig. 1.4).
1.2.4.1 Axial Resolution
Axial resolution is the ability to distinguish between two objects at different distances from the transducer along the axis of the ultrasound beam. A short pulse is better for distinguishing between two objects that are very close to each other. Therefore, the higher the frequency setting, the higher the resolution (Fig. 1.5).
1.2.4.2 Lateral Resolution
Lateral resolution is the ability to distinguish between two objects that are aligned to the ultrasound beam. Lateral resolution is highest in the
Fig. 1.3 Interaction of ultrasound wave with tissue
Fig. 1.4 Diagram shows the difference between axial and lateral resolution
narrowest part of the beam and decreases with distance (Fig. 1.6).
1.2.4.3 Temporal Resolution
This is the ability of an ultrasound machine to accurately detect and display changes of moving tissue over time. Higher temporal resolution allows the machine to capture images quickly, producing sharper images of dynamic structures like the heart and blood vessels. However, there are several factors such as ultrasound transducer
frequency, frame rate, and computer system processing power that affect resolution.
1. Scanning modes
(a) A-mode
(b) B-mode
(c) M-mode
(d) Doppler
(i) Defne Doppler effect/shift
(ii) Describe different types of Doppler mode
• Pulsed wave
• Continuous wave
• Color
1.2.5 Scanning Modes [32, 34, 35, 37, 38]
1.2.5.1 A-Mode
This mode represents the amplitude mode of medical ultrasound. It displays the intensity or amplitude of each returning echo and plots it on the display as a vertical line representing the depth at which the echo was received. The image produced looks like a series of peaks or spikes. Higher peaks indicate stronger echoes and deeper structures. A-mode is commonly used in ophthalmic sonography to measure the axial length of the eyeball and retina. This is important for intraocular lens implantation.
1.2.5.2 M-Mode
M mode stands for motion mode. Images displayed in M-mode represent the movement of tissue or structures (y-axis) over time (x-axis). It is advantageous as it allows for accurate measurement of size and distance, as well as providing high temporal resolution. M-mode in echocardiography has several common uses. For instance, it is used to measure left ventricular wall thickness in the parasternal short-axis view, calculate diastolic and systolic diameters to determine LV fractional shortening, and estimate LV function by measuring systolic excursion of the mitral annulus plane (Fig. 1.7). Additionally, M-mode
S. M. Fathil
Another random document with no related content on Scribd:
The Project Gutenberg eBook of One hundred & one Mexican dishes
This ebook is for the use of anyone anywhere in the United States and most other parts of the world at no cost and with almost no restrictions whatsoever. You may copy it, give it away or re-use it under the terms of the Project Gutenberg License included with this ebook or online at www.gutenberg.org. If you are not located in the United States, you will have to check the laws of the country where you are located before using this eBook.
Title: One hundred & one Mexican dishes
Compiler: May E. Southworth
Release date: June 4, 2022 [eBook #68235]
Language: English
Original publication: United States: Paul Elder and Company, 1906
Credits: deaurider, Les Galloway and the Online Distributed Proofreading Team at https://www.pgdp.net (This file was produced from images generously made available by The Internet Archive) *** START OF THE PROJECT GUTENBERG EBOOK ONE HUNDRED & ONE MEXICAN DISHES ***
Transcriber’s Notes
Obvious typographical errors have been silently corrected.
One Hundred & One MEXICAN DISHES
COMPILED BY MAY E. SOUTHWORTH
PAUL ELDER AND COMPANY PUBLISHERS, SAN FRANCISCO
Copyright, 1906 by P E C S F
Second Printing, 1914
CLASSIFICATION
SOUP
FISH
MEAT
FOWL
VEGETABLES
MEAT DUMPLINGS
DESSERTS
ENCHILADAS
TAMALES
OLLA PODRIDA
SOUP
ALMENDRA
Wash a cupful of rice and put in a double boiler with a quart of milk and cook slowly until every grain is tender. Shell and blanch a halfpound of almonds, chop fine and then pound in a mortar; add, a few drops at a time, a half-cupful of cream, forming a smooth paste. Mix with this a tablespoonful of sugar, a little ground chile and a pint of milk and put all in with the cooked rice and simmer for a half-hour. Season with salt, and if too thick add more milk.
CALDO DE PESCADO
Chop four onions and fry in four tablespoonfuls of oil; add six tomatoes peeled and cut fine, one herb bouquet, a sprig of parsley, a glassful of white wine, four tablespoonfuls of oil, one chile pepper and four tablespoonfuls of flour. When brown add three pints of water and boil a half-hour; then add six slices of fish of almost any variety. Remove the herb bouquet, add salt, and pour over crusts of dry bread.
CHILE BISQUE
Take eight large sweet chile peppers, remove seeds and veins, boil and put the pulp through a colander; to this add a cupful of boiled rice, mashed smooth. Season highly with tabasco and salt. Beat an egg with a half-cupful of cream and add to a quart of hot milk. Put the bisque in this, let boil up once and serve immediately, pouring over toasted squares of bread.
CORDERO
Cut a pound of young lamb into small chunks and fry with a sliced onion in hot lard. When nicely browned add three peeled and sliced tomatoes and three green peppers chopped fine. Cover with two quarts of water and simmer slowly; add a cupful of green peas, one of green corn cut from the cob, a half-cupful of rice, salt and chile pepper. Work into a raw egg a teaspoonful of oil and a halfteaspoonful of vinegar; put this in the bottom of the soup-tureen and pour the soup over it.
GITANO
Into three quarts of good beef stock, put one onion, four cloves of garlic and an eighth of a pound of salt pork; to this add a cupful of beans and a pound of salt codfish which has been soaked overnight. Cook slowly, and when partly done, season with chorizo (Mexican sausage) and add some potatoes peeled and cut into dice.
MEXICAN NOODLE
Use two quarts of any clear stock. For the paste, take a small cupful of grated Parmesan cheese, one of flour, and a little salt and cayenne; beat four eggs and add slowly, also a half-cupful of cream, making a rather thin batter. Have the stock boiling, and let this batter
run into it through a very small but coarse sieve. It will make long strings which must boil ten minutes.
RANCHEROS
Fry a large cupful of minced vegetables, mostly onions, in a small cupful of butter. When a light brown, mix in a small cupful of flour and set the pan in the oven for the mixture to brown through without burning. Then scrape the contents of the pan into three quarts of soup stock and add two cupfuls of dry stewed tomatoes, eight cloves, half a bay-leaf and a teaspoonful of chopped chile pepper. Cook an hour, skimming the top occasionally and season well with salt.
FISH
CANGREJUELOS
Put a teaspoonful of lard in a deep porcelain saucepan and when hot add a quarter of a pound of ham, chopped fine, an onion chopped, salt and chile powder. When these are well browned, add a pint of picked shrimps and stir until hot; then put in a half-pint of washed rice, a bay-leaf, thyme and parsley. Cover and simmer with sufficient water added to cook the rice until each grain stands out alone.
CARACOLES CON PEREJIL
Soak the snails in salt water, then wash them in two or three waters. Crack the shells and throw them in boiling water with a little salt and herbs. Cook fifteen minutes, drain from the water and pick the snails from the shells. Fry some chopped onion, garlic and parsley in olive-oil and add a bay-leaf and some thyme. Dry the snails and put in this, with a seasoning of salt and pepper, and fry twenty minutes. Thicken with a little flour and at the last moment add the juice of a lemon.
LANGOSTA À LA CATALANA
Remove the lobster meat from the shell, lay it in a bowl, so as to save all the water that comes from it, and cut in quarters. Chop four large onions and a bunch of parsley, mash four cloves of garlic, and fry all together in a half-cupful of olive-oil until nearly brown. Season with salt and cayenne; add the lobster with all the juice, a cupful of washed rice and a tablespoonful of capers. Cook until the rice is done. When serving put whole pimientos on top.
PILCHERS
Take the sardines carefully from the box, skin and bone them and lay on brown wrapping paper until ready to use. Cut strips of bread a little longer and a little wider than the sardines, removing all crusts. Fry these in olive-oil a delicate brown. Lay a sardine on each piece and put in the oven until heated through. When ready to serve sprinkle each one with grated parmesan cheese and lay a thin slice of pimiento on top.
MEAT
BUEY AHUMANDO Y HUEVOS
To a cupful of chipped beef, soaked in hot water and chopped fine, add a cupful of strained tomatoes, two hard-boiled eggs cut fine, one tablespoonful of grated cheese, one grated onion, a chile pepper chopped fine and a big lump of butter. Beat all these together, break in two raw eggs and scramble in a frying-pan.
CHILE CON CARNE
Cut a pound of fresh pork into inch chunks and parboil. Soak five chiles in hot water, take out the seeds and veins, wash them well and put in a mortar (the Mexicans use the molcajete and tejolote). Pound to a pulp, adding a little garlic, black pepper, two cloves and a cooked tomato. Fry this in hot lard; then add the meat with some of the liquid in which it was boiled and a little salt. Cover and let it cook down until rather thick.
CHONZO
Cut one pound of fresh pork and one pound of beef into small pieces. Chop two pods of garlic and add one teaspoonful of ground chile, one-third teaspoonful of ground cloves, one teaspoonful of black pepper and one of oregano. Season with salt and mix all together with a glass of port wine and fry in two teaspoonfuls of olive-oil. When ready to serve break in two whole eggs and scramble together.
CHULETAS
DE TERNERO
Trim veal cutlets and season with pepper and salt; roll them in flour and lay them in a frying-pan in which six onions chopped fine have already been placed in hot lard. Cover the pan tightly and let the cutlets fry, turning to cook the other side; add a tablespoonful of vinegar, a little thyme, a bay-leaf, a clove of garlic and some comino seed or chopped parsley. When the cutlets are well browned, cover them with boiling water and move the pan to the back of the stove and let them simmer in this spicy bath for two hours. Serve with a garnish of fresh, crisp, cold radishes.
ESTOFADO
Heat a tablespoonful of drippings in a saucepan and put into it two whole green peppers, one onion sliced, one clove of minced garlic, one tablespoonful of vinegar, two tomatoes peeled and sliced, onehalf cupful of raisins and olives mixed, and a pinch of thyme. Add two pounds of round steak cut small, cover closely and stew slowly and thoroughly. When serving, put squares of toast on the platter and pour this over.
Cut a round-steak into small pieces and put into a frying-pan with a tablespoonful of hot drippings, four tablespoonfuls of rice, a cupful of boiling water and a sliced onion. Cover closely and cook slowly until tender. Remove the seeds and veins from four Mexican peppers, cover with a half-pint of boiling water and let stand until cool; squeeze them from the water with the hand, getting out all the pulp. Add salt and a little flour to thicken. Pour this over the cooked meat, let boil for a moment and serve very hot.
JAMON CON PIMIENTOS
Cut a pound of ham into small chunks; add to this a pound of sausage meat, two onions and two tomatoes sliced, a sprig of parsley or a few comino seeds and some small bits of dried chile pepper. Fry these together in a little butter or drippings and then add a pint of boiling water Stir in a pound of soaked rice, cover and set where it will cook slowly without stirring. Salt to taste and serve hot.
LENGUA DE BUEY CONCIDA
Dissolve one-half cupful of salt in enough boiling water to cover a beef’s tongue and cook until just done. When cool remove the skin and slice thin. Take a dozen chiles anchos or large dry chiles, cut them the long way, remove all seeds, veins and the stem end; drop the skins into boiling water with one-half cupful of salt, press them under the water and keep at boiling heat two hours. Skim into a chopping-tray, chop fine and press through a sieve. Add a teaspoonful of powdered summer savory, two of finely chopped onion, salt and a half-cupful of olive-oil. Squeeze the juice of two lemons into a cup and fill it up with vinegar. Add this to the sauce by spoonfuls and a bottle of olives stoned and cut fine. Heat and pour over the tongue as it is served.
LOMA DE VACA
Take a quarter of a pound of suet, slice thin and fry until thoroughly melted. Put a sliced onion in this and fry until brown; then put in a four-pound roast of beef and brown on all sides. Take the juice of a large tomato, the pulp of a chile pepper, two whole cloves, one teaspoonful of vinegar, one of sugar, salt, and a dash of pepper, and put in the pot with the meat. Add a little water, just enough to keep from scorching, cover tightly, set on the back of the stove and cook slowly until tender. Serve with brown gravy.
PATITAS CON MANI
Scrape, singe and wash the pigs’ feet thoroughly clean. Place in a kettle with plenty of water to which a little vinegar has been added and boil until tender. Peel, quarter and parboil some potatoes and have a cupful of roasted peanuts, half of which are whole and half ground. Remove and dry the trotters and fry with the potatoes and peanuts in hot olive-oil. Season with allspice and salt. Stir constantly so as to brown on all sides, cooking about ten minutes.
PUERCO EN ESTOFADO
Sauter in a frying-pan a pound of young pork cut small; add the livers and gizzards of two chickens, an ounce of green root-ginger and three stalks of celery, all cut into small pieces. Then add, a little at a time, a mixture of four tablespoonfuls of olive-oil, one of winevinegar, one of Worcestershire sauce, a dash of powdered cloves, salt and pepper. Add a half-cupful of boiling water and cook until nearly done; then put in a cupful of bean-sprouts and one of small mushrooms.
PULCHERO GRUESO
Cut up three pounds of beef, one pig’s foot, a half-pound of ham, the giblets of a fowl and a chile pepper and simmer together for two hours; add a slice of pumpkin, free from seeds, half of a small
cabbage, a large carrot, a bunch of herbs, two large onions and some broken macaroni. Cook an hour longer, then put in six small sausages and boil until they are done. Strain, thicken the gravy and serve meat and vegetables on separate dishes.
TIA JUANA
Chop a clove of garlic very fine, peel and slice a medium-sized onion and fry both with a pound of sausage meat made into balls. When it begins to brown add a pint of tomatoes and one chile. Meantime scald a pound of tripe, scrape it with the back of a knife and cut into strips about two inches wide and five long. Roll each and tie with a thread; brown quickly in butter, dredging with a little flour. Remove to a hot platter, making a circle of the rolls of tripe. Lift the sausage balls from the sauce and heap in the center Strain the sauce, season with salt, reheat and pour over all.
TRIPE SPANISH
Boil the tripe until tender and cut into narrow strips. Brown a sliced onion, a clove of garlic and half a chile pepper chopped fine in two tablespoonfuls of olive-oil. Thicken with a little flour, season with salt and add a peeled tomato cut fine and a pinch of smoked Spanish sausage. Put the tripe in this sauce and cook fifteen minutes, adding a little water if necessary
FOWL
À LA MODA
Boil a well-cleaned fowl slowly until tender. When cold, cut from the bones in small pieces and to these add a tablespoonful of chopped parsley, an onion and a pepper chopped fine; season with salt, chile powder and a little Spanish sausage. Line a mold with cooked macaroni, pour in the chicken, cover lightly and steam for an hour. Serve with tomato sauce.
CHILE CHICKEN
Boil a chicken until tender. When cold, cut into small pieces. Wash and dry a cupful of rice, put in hot olive-oil and fry for a few moments; add a peeled tomato, an onion cut fine, salt and chile peppers or powder. Put in the chicken and some of the broth, and cook until the rice is tender
GALLINA CON GARBANZOS
Put the giblets of a chicken with a sliced onion, a little parsley and grated lemon-peel in a frying-pan with fresh lard or olive-oil, and fry slowly. Cut up a chicken, slice some ham or bacon, put these in with the giblets and fry brown. In a separate stew-pan put a little of the strained gravy, salt, chile pepper, a teaspoonful of olive-oil and one of tarragon vinegar. Add the browned fowl, also the giblets chopped fine, some chopped onion and parsley; last, put in a quart of green peas and cook until the peas are done. Serve with the peas in the center and the chicken piled about.
GANSO EN ACEITUNAS
Boil a goose until well done in water to which has been added two cloves of garlic and three chile peppers. Lift from the water, dry, and put it immediately in a pan of sizzling-hot bacon for a few minutes, turning it constantly so that every part is covered with the hot grease; add a half-pound of coarsely cut olives to the gravy before serving.
MEXICAN TURKEY
Soak fifteen chiles anchos or the broad dried peppers, without roasting, in a pint of water; then grind with two onions and the boiled giblets of the fowl; fry all in oil, adding a large pinch of oregano (wild marjoram), salt and a little vinegar. Stuff the turkey with whole onions and boil until about half cooked. Remove, wipe dry and put in a pan to roast. Add the liquor in which it was boiled to chile sauce and pour half of it over the turkey. After it has roasted for half an hour, turn, and pour over it the remaining sauce and cook until tender, basting often with the sauce in the pan.
MOLE DE GUAJOLOTE
Boil a turkey, save the broth, and cut into pieces as for serving. Remove all the seeds and veins from a pound of dry chile peppers, a pound of broad chiles and one of black chiles. Throw away the veins
but fry the seeds with peanuts, almonds, walnuts, a piece of cinnamon, a pinch of comino seed and a piece of chocolate the size of a walnut. Fry the peppers until brown and then grind with the seeds to a smooth paste; fry all together again, then mix with the turkey broth. Put the pieces of turkey in a deep pan with a small piece of lean pork, pour the dressing over and bake an hour. When dished for serving sprinkle anjonjoli seeds over the top.
POLLO GUISADO
Steam two tender spring chickens for twenty minutes and then cut into pieces as for fricassee. Strain a can of tomatoes and mix with a can of corn and add a pepper chopped fine and a little parsley. Season with paprika, salt, cayenne, celery-salt and black pepper. Put the pieces of chicken in this and thicken with cracker-crumbs. Turn into an earthen baking-dish, put big lumps of butter over the top and bake for half an hour.
POLLUELO
EN ESTOFADO
Quarter a young chicken and fry in plenty of olive-oil with half a cupful of finely chopped onion and diced raw potato mixed. Let this all fry until the fowl is white; add a little fine parsley and chopped green pepper and a little hot water. Season with salt and pepper and simmer over a slow fire until thoroughly cooked.
