[Consensus document on ultrasound training in Intensive Care Medicine. Care process, use of the technique and acquisition of professional skills]. / Documento de consenso para la formación en ecografía en Medicina Intensiva. Proceso asistencial, uso de la técnica y adquisición de competencias profesionales.

Ultrasound has become an essential tool in assisting critically ill patients. His knowledge, use and instruction requires a statement by scientific societies involved in its development and implementation. Our aim are to determine the use of the technique in intensive care medicine, clinical situations where its application is recommended, levels of knowledge, associated responsibility and learning process also implement the ultrasound technique as a common tool in all intensive care units, similar to the rest of european countries. The SEMICYUC's Working Group Cardiac Intensive Care and CPR establishes after literature review and scientific evidence, a consensus document which sets out the requirements for accreditation in ultrasound applied to the critically ill patient and how to acquire the necessary skills. Training and learning requires a structured process within the specialty. The SEMICYUC must agree to disclose this document, build relationships with other scientific societies and give legal cover through accreditation of the training units, training courses and different levels of training.

[Role of echocardiography in the hemodynamic monitorization of critical patients]. / Papel de la ecocardiografía en la monitorización hemodinámica de los pacientes críticos.

The use of echocardiography in intensive care units in shock patients allows us to measure various hemodynamic variables in an accurate and a non-invasive manner. By using echocardiography not only as a diagnostic technique but also as a tool for continuous hemodynamic monitorization, the intensivist can evaluate various aspects of shock states, such as cardiac output and fluid responsiveness, myocardial contractility, intracavitary pressures, heart-lung interaction and biventricular interdependence. However, to date there has been little guidance orienting echocardiographic hemodynamic parameters in the intensive care unit, and intensivists are usually not familiar with this tool. In this review, we describe some of the most important hemodynamic parameters that can be obtained at the patient bedside with transthoracic echocardiography in critically ill patients.

[Ultrasound in the management of the critically ill patient with SARS-CoV-2 infection (COVID-19): narrative review]. / Ecografía en el manejo del paciente crítico con infección por SARS-CoV-2 (COVID-19): una revisión narrativa.

The clinical picture of SARS-CoV-2 infection (COVID-19) is characterized in its more severe form, by an acute respiratory failure which can worsen to pneumonia and acute respiratory distress syndrome (ARDS) and get complicated with thrombotic events and heart dysfunction. Therefore, admission to the Intensive Care Unit (ICU) is common. Ultrasound, which has become an everyday tool in the ICU, can be very useful during COVID-19 pandemic, since it provides the clinician with information which can be interpreted and integrated within a global assessment during the physical examination. A description of some of the potential applications of ultrasound is depicted in this document, in order to supply the physicians taking care of these patients with an adapted guide to the intensive care setting. Some of its applications since ICU admission include verification of the correct position of the endotracheal tube, contribution to safe cannulation of lines, and identification of complications and thrombotic events. Furthermore, pleural and lung ultrasound can be an alternative diagnostic test to assess the degree of involvement of the lung parenchyma by means of the evaluation of specific ultrasound patterns, identification of pleural effusions and barotrauma. Echocardiography provides information of heart involvement, detects cor pulmonale and shock states.

[Giant intracavitary thrombi secondary to a heparin-induced thrombocytopenia-thrombosis syndrome]. / Trombos gigantes intracavitarios secundarios a un "síndrome de trombocitopenia-trombosis inducido por heparina".

The secondary thrombocytopenia to heparin is not infrequently seen; nevertheless, the heparin-induced thrombocytopenia-thrombosis is much less frequent and associated to high mortality. We show one heparin induced thrombocytopenia-thrombosis syndrome with developed thrombi in the cardiac cavities. Its physiopathologic mechanism was reviewed, the importance of clinic suspicion in the presence of: thrombi in a rather unusual place, thrombi resistant to the common anticoagulant therapy, thrombosis repetition or thrombosis in a person with anticoagulant therapy by heparin. The complexity of its treatment, as well as the transesophageal echocardiography utility in diagnostics of thrombus on cardiac cavities, and its relationship with the reaction to the treatment, is discussed.

[Embolism due to cholesterol crystals]. / Embolismo por cristales de colesterol.

We present a case of cholesterol crystal embolization confirmed histologically by skin biopsy and by the presence of a yellowish microemboli with a refringent look lodged inside a retinal arterioles. The presence of a typical clinic case history, together concurrent risk factor (coronarography, implantation of stent and anticoagulation) supported the diagnostic suspicion. Although it is a serious illness, often with a fatal evolution, the patient has followed a favourable clinic course.