Abdomen

Case: FAST RUQ Exam - Normal Exam

Read more about Case: FAST RUQ Exam - Normal Exam

/sites/default/files/Cases_SB_FAST_RUQ1_Thumb.jpg

This video (part 1 of 2) details how performing the right upper quadrant (RUQ) ultrasound examination on trauma patients enables clinicians to potentially identify internal injuries.

Media Library Type

Media Library Tag

Subtitles

- Hello, my name is Phil Perera and I'm the emergency
ultrasound coordinator at the New York Presbyterian Hospital
in New York City, and welcome to SoundBytes Cases.
In this module we're going to focus entirely on
the trauma fast exam.
Specifically, we're going to look further into the
right upper quadrant view, also known as
the hepatorenal view.
Now, we're going to cover the two other views of
the trauma fast exam in upcoming modules of SoundBytes.
The left upper quadrant view, also known as
the splenorenal or perisplenic view,
and the suprarpubic view, also known as the bladder view.
There's a tremendous amount of information we can gain by
looking closely into the right upper quadrant area
in our trauma patient.
Traditionally it's been emphasized that the hepatorenal area
or Morison's pouch view, is the primary target for the
right upper quadrant, but it can take up to 600 ccs of fluid
to make a positive exam if only looking into that area.
So I'll show some alternative views in this module that can
help us to possibly improve on that number.
Now let's take a look at a slide showing us how to perform
the right upper quadrant view of the trauma fast exam.
We'll want to place the probe at about the anterior axillary
line and using the liver as an acoustic window aiming
the probe down towards the bedside retroperitoneally to get
a good view of these anatomical structures.
It's best to have a small footprint probe that can easily
sit between the ribs giving a good view on to this area.
Notice that this is a long axis view with a probe marker
position superiorly.
Now our first view from this right upper quadrant area
will be position one as shown here in the
infra-diaphragmatic space just below the diaphragm
and above the liver.
Second, we'll move the probe slightly inferiorly to look in
to the traditional Morison's pouch or hepatorenal interface,
and the last view is the caudal tip of the liver shown here
in position three.
It's very important to look at the caudal tip of the liver,
as this represents the beginning of the right paracolic
gutter and small amounts of fluid will pool here before
moving into Morison's pouch.
Now that we know how to perform the right upper quadrant
view of the trauma fast exam, let's take a look at a normal
image that you might obtain.
Remembering that this is a long axis view,
I have the probe marker here positioned towards
the patient's head.
So towards the left of the clip here is
superior chest cavity and towards the right is
inferior or abdominal cavity.
Notice the first large structure that comes into view
in the middle of the image is the liver and to the right,
or inferior to the liver we see the football shaped kidney.
Now it's that interface between the liver and kidney that
represents a potential space known as Morison's pouch
where we're be looking for dark, anechoic fluid collections.
Note here, we see a thin, white line making up a normal exam
and representing the fat within the capsule
around the kidney.
Notice to the left of the liver we see the white diaphragm
that represents the interface between chest
and abdominal cavities.
Let's take a look at another normal
right upper quadrant examination.
Again the probe marker is towards the patient's head.
This is the superior chest cavity towards the left.
Inferior abdominal cavity towards the right.
We see the liver in the middle of the image,
and notice the diaphragm above the liver moving up and down
as the patient breathes.
We see the kidney inferior to the liver, and notice
the potential space in between the liver and the kidney
that makes up the hepatorenal fossa or pouch of Morison.
Notice in this video clip all we see is a white line
representing the fat within the capsule around the kidney
or Gerota's capsule.
If there was fluid, we would see a dark or anechoic fluid
collection in this potential space.
Let's now look at the diaphragm which we see above the liver
and if we look above the diaphragm this is where we would
look for fluid within the chest cavity or hemothorax
in the trauma patient.
We may have to move the probe several intercostal spaces
on the patient's side to fully investigate
the right upper quadrant for fluid.
Here's a swing view where I'm starting relatively superior
right there looking in the area between the diaphragm
and the liver, going through Morison's pouch, as I'll show
coming up right here the area between the liver
and the kidney and terminating at the inferior
tip of the liver.
Notice here we notice the caudal tip of the liver extending
almost all the way inferiorly down past the inferior pole
of the kidney, and it's important to look at that caudal
tip of the liver, as it represents the beginning
of the right paracolic gutter.
So in conclusion, I'm glad I could share with you part one
of the right upper quadrant view of the trauma fast exam.
Now we know how to recognize a normal examination
looking all the way from the area below the diaphragm
through Morison's pouch and terminating at a view of
the caudal tip of the liver.
So I hope to see you back as SoundBytes continues,
and we look at part two of the right upper quadrant view
focusing on positive examinations.

Brightcove ID

5767048880001

https://youtube.com/watch?v=lzgxZsFZhTU

Case: Aorta Ultrasound - Introduction

Read more about Case: Aorta Ultrasound - Introduction

/sites/default/files/Cases_SB_Aorta1_EDU00185.jpg

This video details how bedside ultrasound imaging can be used, as well as proper probe placement and how to interpret the ultrasound images seen during abdominal ultrasound examinations.

Media Library Type

Media Library Tag

Subtitles

- Hello, my name is Phillips Perera
and I'm the Emergency Ultrasound Coordinator
at the New York Presbyterian Hospital in New York City.
Welcome to SoundBytes Cases.
In this SoundBytes Module entitled Part 1
of Beside Ultrasound of the Aorta,
we're going to specifically look
at the Beside Detection of Abdominal Aortic Aneurysms.
Now this application of Point of Care Beside Sonography
is one of the most crucial ones for the Emergency Physician
as Detection of an Abdominal Aortic Aneurysm can be
life saving for your patient at the bedside.
Using Point of Care Sonography to make a rapid
diagnosis of a rupturing Abdominal Aortic Aneurysm
in a patient who has unstable vital signs can facilitate
timely transfer of the patient to the operating theater
without undue delay in the Emergency Department
such as waiting for a CAT Scan.
Because there's a lot of material to cover
on the topic of Bedside Ultrasound of the Aorta,
I've divided this module into Aorta Ultrasound
Parts one and two.
In this module entitled Aorta Ultrasound Part 1
we're gonna begin by reviewing the anatomy of the Aorta,
we'll then move on to learn how to perform the Ultrasound
examination of the Abdominal Aorta, all the way from the top
at the subxiphoid process as the Aorta
exits the thoracic cavity to bifurcation
at the level of the Umbilicus.
We'll then also move on to learn how to understand
the interpretation of the Ultrasound images
that you will obtain using Beside Sonography.
Let's review the position of the probe
for Sonography of the Aorta.
Generally we'll begin by placing the probe in
a short axis configuration.
Begin by placing the probe in probe position one
in the Epigastric region to visual the Aorta
as it enters the Abdominal Cavity and exits
through the Thoracic Cavity via the diaphragm.
The probe should be configured with a marker dot
over towards the patients right side.
Press down to firmly displace bowel gas
and get a glimpse of that Aorta.
Now, we should visualize the spine as our landmark
and on top of the spine we'll visualize the Aorta.
Then we should slide the probe inferiorly to probe position
two here as show in the Super Umbilical region.
This will allow us to visualize the entire part
of the Abdominal Aorta all the way down
to Bifurcation.
We should complete the examination of the Aorta
by looking at the Aorta in a long-axis plane.
We'll begin by placing the probe in probe position one
again in the Epigastric region to visualize the top part
of the Abdominal Aorta.
Have the marker dot superiorily oriented towards the
patient's head.
We can then slide the probe inferiorily
to probe position two
at the region just above the Umbilicus to visualize
the Aorta all the way down to Bifurcation into the
Periceliac.
Now if we're having problems visualizing the Aorta
due to the presence of a lot of bowel gas,
we can also get a glimpse of the Aorta from probe position
three, the Right Hepatic area.
This is going to be about the region where we're
going to look at the trauma fast Right Upper Quadrant
view, but here were going to angle the probe more interior
over the kidney to get a glimpse at the Abdominal Aorta
and long access.
Here's an image showing the Antatomy of the Aorta
that we'll need to know to perform Beside Sonography
of this structure.
Recall that the Inferior Vena Caba and Aorta form
two pair tubular structures that course through
the Abdominal compartment.
The IVC will be towards the patient's right
and the Aorta will be over towards the patient's left-side.
We see here the first major Abdominal branch
of the Aorta which is the Celiac Axis made up
predominantly of the Hepatic Artery
and the Splenic Artery.
The third branch, the left Gastric Artery is not
well seen on Bedside Sonography.
The next major branch that we can see using
Bedside Sonography is the Superior Mesenteric Artery.
This is a very important landmark as the Renal
Artery and Vein come out the Aorta at about this level.
In fact the Left Renal Vein courses right below the
Superior Mesenteric Artery.
We need to pay particular attention to the Infer-Renal
part of the Aorta as this is where the majority of
the Abdominal Aortic Aneurysms will originate.
Now we need to scan all the way down to the Bifurcation
of the Aorta into the Periceliac Arteries
and sometimes we'll catch small aneurysms
at the Distal Aspect of the Aorta that branch
into the Illiac Artery.
This is a Short-Axis configuration taken
of the Abdominal Aorta just below the subxiphoid
process of the Sternum looking through the liver.
Now, our first landmark should be the spine.
Notice that it has a hyperechoic or bright appearance
on Bedside Ultrasound.
Just above the spine we see the Inferior Vena Cava
with it's Respiratory Phasic Pulsations
towards the patient's right and the Aorta
towards the patient's left side.
We can apply Doppler sonography to further differentiate
the two structures and notice here we're doing Colorflow
Doppler and we again recognize the spine as our landmark
for recognizing the Vascular structures of the IVC
and the Aorta on top of the spine
and we see the Phasic Respitory pattern of bloodflow
within the IVC and the steady pulsations of blood
within the Aorta with each heart beat
differentiating the two structures.
Let's now take a closer look at the Celiac Axis,
the first major branch of the Abdominal Aorta
The Celiac Axis has the Ultrasound appearance of
a seagull sign and it's made up of three arteries,
the Hepatic Artery, the Splenic Artery
and the Left Gastric Artery, although the third
is usually not visualized well with Bedside Sonography.
Now, let's take a look at some Ultrasound images
of the Celiac Axis and we see a B-mode or gray scale
image to the upper right.
Notice the IVC to the right and the Aorta to the left.
We see the Celiac Axis coming off the Aorta
having the appearance of a seagull in flight.
Notice that the right wing of the seagull will
be the Hepatic Artery coursing towards the patient's
right side and the Splenic Artery will be branching
over towards the patient's left.
To the bottom we see a Colorflow Doppler image
of the Celiac Axis showing flow within both
the Hepatic and Splenic Arteries.
Here's a video clip of the Celiac Axis in action.
Again, we're in the short-axis configuration with the
probe marker over towards the patient's right side.
We identified the spine as our landmark for identification
of the IVC and Aorta Anterior to the spine
and we see here that the bright bone table
of the spine.
Notice the Inferior Vena Cava towards
the patient's right side and we see the Aorta
towards the patient's left side.
With the seagull sign made up of the Celiac Axis
coming up the Aorta.
Here we have video clip in which we'll look at
Ultrasonic appearance of the Celiac Axis using
Doppler Sonography.
We've again identified the spine by it's
hyperechoic or bright appearance and we see the IVC
over towards the patient's right and the Aorta towards
the patient's left.
As we look closely at the Aorta we see the branch
the Celiac Axis coming up anteriorly from the Aorta.
Again, having that classic appearance of the seagull sign
with the two branches, the Hapatic and Splenic Arteries.
The second major branch of the Abdominal Aorta
is Superior Mesenteric Artery also known as the SMA.
Now, the Superior Mesenteric Artery has a classic
appearance as it has a bright or hyperechoic rim
due to fat wrapped around the Artery.
Remember that it's at this level that the Renal Artery
and veins come up the IVC and Aorta and we must be very
aware of the Aorta at this area because of the presence
of Infer-Renal Aortic Aneurysms.
We see a B-mode or gray scale image over to the right
and we see the IVC and Aorta on top of the spine.
Notice the classic appearance of the Superior Mesenteric
Artery as it arches up the Aorta with it's hyperechoic
or bright rim.
Here we actually catch the Splenic Vein passing Anterior
to the Super Mesenteric Artery.
To the bottom we see a Colorflow Doppler image showing
the Superior Mesentary Artery coming off of the Aorta.
This video clip show the Proximal Abdominal Aorta
in short axis.
We identify the spine and the Aorta on top of
the spine.
There's the Celiac Axis coming up
and there's the Superior Mesenteric Artery
with the Splenic Vein over the top,
so again, Celiac and there's SMA and there's
the Splenic Vein wrapped on top.
Let's freeze down that image and again identify
the Superior Mesenteric Artery
with it's bright or hyperechoic rim
and the Splenic Vein passing anterior
to the SMA.
Here we'll apply Colorflow Doppler to further
examine the Superior Mesenteric Artery
coming up the Aorta.
We identify the Aorta on top of the spine
and we can see the Superior Mesenteric Artery
coming up anterior
from the Aorta.
Notice we can also catch the Splenic Vein wrapped
on top of the Superior Mesenteric Artery.
We'll go ahead and freeze that down.
There's Aorta towards the back of the image,
the Superior Mesenteric Artery anterior to the Aorta
and the Splenic Vein arching on top of SMA.
To complete your examination of the Aorta
it's important to look all the way to Bifurcation.
Here where I identified the spine and on top of that
the Distal Aorta and Short Axis.
As we scan more Distally, down to the level
of the Umbillicus, here we see the Bifurcation
of the Illiac Arteries.
So, we'll watch that again and there we see
Bifurcation bright at that point here.
There's the Periceliac Arteries and we can see
the right and left Illiac Arteries delineated well
on B-mode imaging.
Now we'll apply Colorflow Doppler
to look at the Birfurcation of the Aorta.
Again, we're in the Short Axis configuration
and we see the spine, the IVC to the right
and the Aorta to the left.
Let's put this into video play, now.
What we see here is the pulsations of flow within
the IVC and Aorta and we can see the Aorta
branching right there to the Periceliac Arteries.
Notice the pulsations within the both
of the Periceliac Arteries.
We'll still that down and we can see the right and the left
Illiac Arteries well delineated
with the Colorflow Doppler.
It's always important to look at body structures
in two planes, so now we're going to inspect
the Aorta in a Long Axis view.
The probe is place in the mid-sagittal orientation
with the marker towards the patient's head.
We have Superior to the left and Inferior
to the right.
We can identify the Aorta with it's pulsations and
it's thick muscular wall.
We see the branches of the Aorta, the Celiac Axis
branching more superiorly and the Superior
Mesentaric Artery
arching inferiorly into the intestine.
We can apply Colorflow Doppler
to the Aorta in Long Axis view,
and again, we can see the pulsations of the Aorta
with each heart beat.
We see the liver anteriorly in the mid-sagittal
configuration and notice the Celiac Axis arching here
superiorly and the Superior Mesentaric Artery moving
inferiorly down towards the intestine.
In conclusion, thanks for joining me
for this SoundBytes Module cover Part one
of Beside Ultrasound of the Aorta.
Using Bedside Ultrasound to detect an Abdominal
Aortic Anuerysms remains one of the most crucial
applications of Point of Care Sonography
for the Emergency Physician.
Hopefully by going through the module you now understand
the anatomy of the Abdominal Aorta, how to perform
the Ultrasound Exam of this structure and how
to interpret the images of the Aorta that you will obtain.
I hope to see you back as SoundBytes continues
and as we return in Beside Ultrasound of the Aorta
Part two when we're going to focus entirely on the
detection of Abdominal Aortic Anuerysms.

Brightcove ID

5508121223001

https://youtube.com/watch?v=uiTsFtanyzM

How to: Abdominal Aorta Measurements

Read more about How to: Abdominal Aorta Measurements

/sites/default/files/11_Abdominal_Aortic_Aneurysm_Measurement_Guidelines.jpg

Learn to measure the abdominal aorta with ultrasound.

Applications

Cardiology

Media Library Type

How To Videos

Media Library Tag

Subtitles

- Once we've done the survey,
we wanna go back and take measurements
of the aorta in a transverse view in three levels.
One level is proximal above the level of the renal arteries,
the second is just at the level of the renal arteries
and the third is at the level of the bifurcation.
We're gonna go back to the epigastric area
and look for our landmarks again.
In the middle of the screen we have the aorta pulsating
to the right of the aorta the IVC
and anterior to the aorta we have
the superior mesenteric artery.
I'm going to freeze the image here
and perform two measurements.
Measuring from the outside wall to outside wall,
so I measure the entire size of the aorta
and just the residual lumen of an aneurysm.
I will perform two measurements, anterior to posterior,
and a transverse measurement.
From there I'm gonna move a little bit more inferior
optimizing the image so I can see
the wall of the aorta clearly.
I will freeze the image.
Perform my measurements, the same two views again.
From the outside wall
to the outside wall,
that's the AP measurement and the same for the transverse.
The measurement is displayed on
the bottom left of the screen and
in this case our measurement is 1.36 centimeters
by 1.69 centimeters.
So we're looking for a value of over three centimeters
to be considered aneurysmal.
I'll keep moving down in a transverse view
towards the bifurcation.
Here we see the aorta divide.
So right before it divides, I want to
perform my measurement at that point.
So I will freeze and perform the
same two measurements again.
Anterior
and transverse.
From outside wall to outside wall.
And that is the completion of the measurements
you need to do for the abdominal aortic exam.

Brightcove ID

5745409357001

https://youtube.com/watch?v=SHhKyEaW1NM

How to: Abdominal Aorta

Read more about How to: Abdominal Aorta

/sites/default/files/10_Abdominal_Aortic_Aneurysm_Scanning_Technique.jpg

Learn to examine the abdominal aorta with ultrasound.

Media Library Type

Media Library Tag

Subtitles

- So what I'd like to do now
is walk you through the abdominal aortic exam.
We do this exam when we're looking for
abdominal aortic aneurysm.
We're gonna use a phased array transducer.
This is a good all-purpose transducer
for the emergency department,
so you can use this for fast exam or abdominal aortic exam.
We're gonna start in the transverse view.
I'm going to put some gel on the patient,
from the epigastric area to the area of the umbilicus,
in a straight line.
I'm going to orient the transducer
so the marker is to the patient's right.
And i'm gonna place it straight up and down
in the epigastric area.
The first thing that you're gonna see
on the ultrasound image
is a round, pulsating structure in the middle of the image,
and this will be the aorta.
Immediately posterior to this round, pulsating area
will be the shadow of the spine.
So we just see the anterior surface of the spine
as the white, bright line,
and then behind this, we see a shadow.
That is what we call the spine shadow,
and you can use that as your landmark
to identify the aorta all the way down the body.
So we're gonna start in the epigastric area,
assessing the size of the aorta.
The first landmarks that we want to see,
to know that we are superior enough
above the renal arteries, is the SMA.
This is going to appear as a smaller anechoic circle
just anterior to the aorta.
So just be careful you don't mistake this
actually for the aorta 'cause it is possible
there could be an aneurysm
in the superior mesenteric artery as well.
Immediately anterior to this is the pancreas,
and then, to the right of the patient,
on the left of the screen, we see the IVC
as this hypoechoic structure.
So from this point, we're gonna move down
we're looking for the left renal vein to cross over
as our landmark for the renal level,
and we're gonna continue moving inferiorly.
If you see bowel gas like this,
just wiggle the transducer a little bit
to try to push it out of the way and work around it.
And I'm gonna decrease my depth as I move inferior
because the aorta is gonna move anterior in the body.
So I can decrease my depth to get it into better view.
'Kay, and we're dealing with some bowel gas here.
I just push it away with the transducer,
and here's the aorta, pulsating,
just sitting anterior to the spine,
with the IVC to the right.
I'm going to continue down to the level of the umbilicus,
pushing away the bowel gas,
and here, I see the aorta divide
into right and left iliac arteries.
So now we see two round circles instead of one.
Once we finish the transverse sweep,
we're gonna turn the transducer so the orientation marker
is facing the patient's head.
We'll place it again starting at the epigastric level.
I'm gonna increase the depth here a little bit,
find the aorta, and, at this point,
because I'm in a sagittal view,
it should appear as a long, black tube
moving from the left to the right of the image.
We can see here in the image,
I'm in the very proximal portion of the aorta.
We see the liver anterior to the aorta.
I move up a little bit, I can see the heart beating
just above the diaphragm.
So I know I'm at the very proximal level,
and I'm just gonna start to survey down the aorta.
The branch that I'm seeing here, coming at a shallow angle,
is the superior mesenteric artery.
So I know I'm above the level of the renal arteries
when I see that landmark.
I'm gonna continue down,
following it in a longitudinal view,
and again, I see the shadow of the spine
directly posterior to the aorta.
I keep moving down, working around the bowel gas,
looking for the long, black tube
immediately anterior to the spine.
And again, I do this all the way down
to the level of the umbilicus.
And I will see a left iliac artery
and a right iliac artery.
And again, I can decrease the depth to optimize my image
because it is so anterior
by the time you get to the umbilicus.

Brightcove ID

5745320579001

https://youtube.com/watch?v=AqAHzGijNIo

How To: Female Pelvis: Transabdominal View

Read more about How To: Female Pelvis: Transabdominal View

/sites/default/files/09_Female_Pelvis_Transabdominal_Scanning_Technique.jpg

Learn the basics of female transabdominal pelvic scanning.

Clinical Specialties

Media Library Type

Media Library Tag

Subtitles

- [Voiceover] A curved, or phased array transducer,
with a pelvis exam type,
is used to perform the pelvis ultrasound exam.
A full bladder is used as an acoustic window
to view the pelvic organs.
The pelvis is evaluated in two plains.
Place the transducer in a long axis position
with the orientation marker to the patient's head,
at the level of the symphysis pubis.
Angle the transducer inferiorly into the pelvis.
The bladder appears in the near-field of the image,
as a hypoechoic triangular structure.
The uterus is gray in appearance
and located either directly posterior
or superior to the bladder.
The endometrial stripe will appear as
a bright echogenic line from the fundus to the cervix.
The uterus does not always lay directly in the midline
so it may be necessary to slightly rotate the transducer
to view the entire length of the uterus.
Sweep the transducer from side to side
to see the entire uterus.
The ovaries may be seen by sweeping the transducer
to the lateral aspects of the pelvis.
They are almond-shaped and slightly hypoechoic structures.
Follicles may appear as multiple
hypoechoic, cystic structures within the ovaries.
Some follicles may be quite prominent,
depending upon the luteal stage.
To obtain a transverse view of the uterus,
rotate the transducer 90 degrees,
so the orientation marker is to the patient's right.
The bladder appears more rectangular in shape in this view.
Sweep the transducer superiorly
from the level of the cervix to the fundus
to see the entire uterus.
The ovaries will be seen on either side of the uterus
and can vary in location,
from a superior to inferior position.

Brightcove ID

5750473717001

https://youtube.com/watch?v=ebpcUlQVmLE

How To: FAST Exam: Female Pelvis

Read more about How To: FAST Exam: Female Pelvis

/sites/default/files/08_FAST_Exam_Female_Pelvic_View_Scanning_Technique.jpg

Learn to examine the female pelvis for free fluid.

Media Library Type

Media Library Tag

Subtitles

- We're gonna do the FAST exam,
the pelvic view in a female now.
Again we have the phase array transducer,
here's our probe marker right here,
I'm gonna start off with a sagittal view.
And ideally, the (slurred) bladder is full.
So you go just above the symphysis pubis,
so we're scanning down here sagittaly,
and some of the anatomic landmarks
that we're looking at,
at the very top of the screen is the bladder,
which is an anechoic structure,
fluid filled, obviously with urine,
it's got nice walls around it.
Just below that is the uterus,
which is a pear-shaped organ.
You can see it well visualized
because the bladder is full.
And just below that
is a potential space, the Cul de Sac,
where we can look for, very carefully,
small amounts of free fluid.
When we scan this patient,
in this view, in the sagittal view,
from the patient's left to the patient's right.
And we're slowly slowly scanning to see
if there's any evidence of free fluid.
Once we finish the sagittal view,
we want to go ahead and do a transverse view.
What we're gonna do now
is point the transducer marker toward the patient's right.
So we're gonna rotate that transducer,
toward the patient's right.
Again, we see the bladder in the center of the screen.
We're now gonna scan from inferior,
just below the symphysis, to more superior,
and in between we're also gonna identify the uterus.
So we're going right to the very top of the bladder,
to about mid-bladder,
we can see the uterus here in the center.
A very small amount of free fluid here,
which can be physiological as well.
So we're scanning all the way inferiorly,
to more superiorly, we see the uterus,
we actually see part of the ovary there,
and then we're gonna go all the way more superiorly.

Brightcove ID

5508120185001

https://youtube.com/watch?v=HxQE2gYH3Sk

How to: FAST Exam: LUQ

Read more about How to: FAST Exam: LUQ

/sites/default/files/06_FAST_Exam_LUQ_View_Scanning_Technique.jpg

Learn to scan the splenorenal recess for fluid collections.

Media Library Type

Media Library Tag

Subtitles

- The next view I'm going to take you through
is a perisplenic or left upper quadrant view.
This view tends to be a little bit more difficult
because the spleen is smaller and doesn't provide
as large an acoustic window.
We're going to start.
Again, the patient's going to be supine.
This is a probe marker right here.
We're going to go really posterior.
My hand is going to touch the gurney.
You can go about four finger breadths
just above the costal margin.
You can identify the kidney.
That's going to be a pretty identifiable organ,
characteristic bean shape.
Then we can see it here on the screen.
Just above it, we're going to see the spleen.
To the far left of the screen as well
we see the diaphragm.
Once you're in this location,
you want to carefully pan through
the inferior part of the spleen,
and then jump over that rib,
and see the superior part of the spleen,
because fluid often collects just above the spleen
and below the diaphragm.
Once you identify a good view in the left upper quadrant,
you'll want to do a sweep through that area
looking for free fluid.
Again, you see the kidney, you see the spleen.
Find the interface between.
Look for fluid between those two organs.
Then particularly scan above that spleen,
scanning all the way through the organ,
looking for free fluid above the spleen
and below the diaphragm.
Again, when you're scanning through this area,
you want to carefully look above the diaphragm
for evidence of hemothorax.
When you're scanning in this view,
also make sure you scan the full kidney.
Here we see the superior pole to the left of the screen,
and the inferior pole.
You want to make sure you get that full kidney
in view when you examine the left upper quadrant.

Brightcove ID

5508114757001

https://youtube.com/watch?v=IuRklL3cWJU

How to: FAST Exam: RUQ

Read more about How to: FAST Exam: RUQ

/sites/default/files/05_FAST_Exam_RUQ_Scanning_Technique.jpg

Learn to examine Morison's pouch in the right upper quadrant for fluid collections.

Media Library Type

Media Library Tag

Subtitles

- So the patient's gonna arrive in a supine position,
they'll often be on a backboard as full spinal precaution,
so motion of the patient will be impossible.
We're gonna choose our transducer.
We have chosen the phased array transducer,
we're gonna put a little gel on top of it.
And I like to put the probe marker
toward the patient's head, toward the axilla,
at about the midaxillaral line, 10 to 11th ribs.
Another easy tip to find out the location
is get to the costal margin,
go about three finger-breadths above it,
and you should be able to find the kidney
and see the adjacent liver.
I'm just adjusting my gain here.
And already I can see the interface
between the kidney and the liver, which is Morison's pouch.
So what we see here, on the bottom,
this crescent shaped organ, is the kidney.
Above it we see the liver,
and just to the left side of the screen
we see the diaphragm.
So when I'm examining this area,
I'm gonna carefully scan through
the entire area of Morison's pouch,
including at the liver tip.
So we see this whole area here
looking for an anechoic stripe.
An anechoic stripe would be indicative of free fluid.
I'm also identifying the diaphragm,
so when I look at the diaphragm,
this is the hypoechoic or white line
to the left side of the screen,
and I should be able to see that pretty easily
and you can see what appears to be
liver on both sides of the diaphragm,
on the bottom far left of the screen.
That is mirror artifact and is a normal finding.
If the patient had a pleural fluid collection after trauma
that would be a hemothorax,
we would see an anechoic or black area in this location.

Brightcove ID

5508114130001

https://youtube.com/watch?v=0VTRm_DNW8s

How to: FAST Exam: Male Pelvis

Read more about How to: FAST Exam: Male Pelvis

/sites/default/files/03_FAST_Exam_Male_Pelvic_View_Scanning_Technique.jpg

Learn the suprapubic view of the trauma FAST exam in males.

Media Library Type

Media Library Tag

Subtitles

- We're going to go ahead and do the suprapubic view
of the FAST exam.
We're going to put a little gel on this transducer
and we're going to go just above the symphysis pubis
and we're going to start initially sagittally
and then we're going to scan transversely.
We have our marker right here.
That's going to be aiming toward the patient's head
and we're going to put this transducer
just above the symphysis pubis
and we're going to see the bladder.
We can see a pretty large bladder here.
The first thing I'll take a look at when I see the image
is that we need to adjust our depth,
so I'm changing the depth here
to make this bladder into a better size
that is going to fit better within the image.
The next thing I notice that I do need to adjust
is the gain.
This is a very important knob to be adjusting
because in this view particularly
you can have a lot of acoustic enhancement
posterior to the bladder
and we don't want to miss small amounts of fluid.
The far gain, which is this knob here,
may need to be adjusted additionally.
Once you identify the bladder,
which we see as an anechoic structure
with nice circumscribed walls,
you want to then scan from left
to right,
looking particularly for evidence of fluid
outside of that circumscribed bladder.
We're looking for free fluid within the pelvis.
Once we're satisfied that we can see the full bladder
in a sagittal fashion,
we're then going to turn the transducer marker here
toward the patient's right,
and we're going to scan again.
Now we're in a transverse view
and were scanning from very inferiorly
to superiorly,
again looking for free fluid outside of the bladder.
As you're scanning through the bladder,
again you're looking for free fluid,
remember free fluid is anechoic or black on ultrasounds
so that's what you're going to be looking for
outside of the bladder.

Brightcove ID

5508104675001

https://youtube.com/watch?v=6Srf0briZSU

How To: CBD Measurements

Read more about How To: CBD Measurements

/sites/default/files/youtube_S72PbzqihrI.jpg

Learn how to measure the common bile duct.

Media Library Type

Media Library Tag

Double Barrel Shotgun Sign

Subtitles

- The more advanced area that you may want to look at
is actually measuring the bile duct.
That's a pretty straight forward procedure.
First thing you do is again find that exclamation sign.
And again we see it here with the gallbladder in length
we see the portal vein,
and just above the portal vein lies the bile duct.
So when we carefully scan you can see an area.
Just above the portal vein which is anechoic.
I'm going to freeze this here in a moment.
And you should be able to see a very tiny duct.
If you are squinting at the screen like I am
trying to see where the duct is.
You are dealing with a patient with a normal duct.
Usually if the duct is enlarged it will be quite evident,
and it can be as large as the portal vein itself.
So I'm going to freeze this here.
So on the screen right now I have a reasonably good image
of the portal vein,
and the associated structures around it.
Right above it we see a very tiny anechoic stripe,
that is the bile duct.
In addition, we also note a very small area which is the
hepatic artery which I'll point out in a moment.
So what we are going to do now is go ahead
and do the measurement of the bile duct.
A normal bile duct measurement is about four millimeters
or less or about one millimeter per decade of life.
So I'm going to go ahead and hit caliper.
And I'm going to drag one end of this to the inter aspect
of the bile duct.
Once I have found that I'm going to hit select,
and I'm going to drag this down.
Just adjacent to it and you can see we are getting
a measurement here of .14 centimeters or 1.4 millimeters,
so well within the normal limits.
Okay I'm going to illustrate to you where
the hepatic artery is.
We can see first this is the portal vein right here.
Right above it is that little anechoic stripe,
which is very tiny and difficult to see,
because this bile duct is normal.
This is the common bile duct.
But right adjacent to here is another anechoic structure,
which is an hepatic artery.
If there is ever any confusion of what you're measuring
you can easily turn the color flow on
to differentiate the two.

Brightcove ID

5733871281001

https://youtube.com/watch?v=S72PbzqihrI

Subscribe to Abdomen

Search

Case: FAST RUQ Exam - Normal Exam

Case: FAST RUQ Exam - Normal Exam

Case: Aorta Ultrasound - Introduction

Case: Aorta Ultrasound - Introduction

How to: Abdominal Aorta Measurements

How to: Abdominal Aorta Measurements

How to: Abdominal Aorta

How to: Abdominal Aorta

How To: Female Pelvis: Transabdominal View

How To: Female Pelvis: Transabdominal View

How To: FAST Exam: Female Pelvis

How To: FAST Exam: Female Pelvis

How to: FAST Exam: LUQ

How to: FAST Exam: LUQ

How to: FAST Exam: RUQ

How to: FAST Exam: RUQ

How to: FAST Exam: Male Pelvis

How to: FAST Exam: Male Pelvis

How To: CBD Measurements

How To: CBD Measurements

Search