<p begin="00:00:15.596" end="00:00:17.684" style="s2">- We're going to go ahead<br />and do the suprapubic view</p>
<p begin="00:00:17.684" end="00:00:19.123" style="s2">of the FAST exam.</p>
<p begin="00:00:19.123" end="00:00:22.650" style="s2">We're going to put a little<br />gel on this transducer</p>
<p begin="00:00:22.650" end="00:00:25.395" style="s2">and we're going to go just<br />above the symphysis pubis</p>
<p begin="00:00:25.395" end="00:00:27.855" style="s2">and we're going to start<br />initially sagittally</p>
<p begin="00:00:27.855" end="00:00:30.312" style="s2">and then we're going to scan transversely.</p>
<p begin="00:00:30.312" end="00:00:32.689" style="s2">We have our marker right here.</p>
<p begin="00:00:32.689" end="00:00:35.183" style="s2">That's going to be aiming<br />toward the patient's head</p>
<p begin="00:00:35.183" end="00:00:36.739" style="s2">and we're going to put this transducer</p>
<p begin="00:00:36.739" end="00:00:38.298" style="s2">just above the symphysis pubis</p>
<p begin="00:00:38.298" end="00:00:39.775" style="s2">and we're going to see the bladder.</p>
<p begin="00:00:39.775" end="00:00:41.416" style="s2">We can see a pretty large bladder here.</p>
<p begin="00:00:41.416" end="00:00:43.463" style="s2">The first thing I'll take a<br />look at when I see the image</p>
<p begin="00:00:43.463" end="00:00:45.353" style="s2">is that we need to adjust our depth,</p>
<p begin="00:00:45.353" end="00:00:46.950" style="s2">so I'm changing the depth here</p>
<p begin="00:00:46.950" end="00:00:49.164" style="s2">to make this bladder into a better size</p>
<p begin="00:00:49.164" end="00:00:51.411" style="s2">that is going to fit<br />better within the image.</p>
<p begin="00:00:51.411" end="00:00:53.469" style="s2">The next thing I notice<br />that I do need to adjust</p>
<p begin="00:00:53.469" end="00:00:54.414" style="s2">is the gain.</p>
<p begin="00:00:54.414" end="00:00:58.027" style="s2">This is a very important<br />knob to be adjusting</p>
<p begin="00:00:58.027" end="00:01:00.316" style="s2">because in this view particularly</p>
<p begin="00:01:00.316" end="00:01:02.243" style="s2">you can have a lot of acoustic enhancement</p>
<p begin="00:01:02.243" end="00:01:03.634" style="s2">posterior to the bladder</p>
<p begin="00:01:03.634" end="00:01:06.338" style="s2">and we don't want to miss<br />small amounts of fluid.</p>
<p begin="00:01:06.338" end="00:01:09.210" style="s2">The far gain, which is this knob here,</p>
<p begin="00:01:09.210" end="00:01:11.960" style="s2">may need to be adjusted additionally.</p>
<p begin="00:01:11.960" end="00:01:14.215" style="s2">Once you identify the bladder,</p>
<p begin="00:01:14.215" end="00:01:16.633" style="s2">which we see as an anechoic structure</p>
<p begin="00:01:16.633" end="00:01:19.869" style="s2">with nice circumscribed walls,</p>
<p begin="00:01:19.869" end="00:01:22.452" style="s2">you want to then scan from left</p>
<p begin="00:01:23.385" end="00:01:24.218" style="s2">to right,</p>
<p begin="00:01:27.338" end="00:01:30.578" style="s2">looking particularly for evidence of fluid</p>
<p begin="00:01:30.578" end="00:01:33.322" style="s2">outside of that circumscribed bladder.</p>
<p begin="00:01:33.322" end="00:01:37.013" style="s2">We're looking for free<br />fluid within the pelvis.</p>
<p begin="00:01:37.013" end="00:01:39.720" style="s2">Once we're satisfied that<br />we can see the full bladder</p>
<p begin="00:01:39.720" end="00:01:41.647" style="s2">in a sagittal fashion,</p>
<p begin="00:01:41.647" end="00:01:45.008" style="s2">we're then going to turn<br />the transducer marker here</p>
<p begin="00:01:45.008" end="00:01:47.016" style="s2">toward the patient's right,</p>
<p begin="00:01:47.016" end="00:01:48.317" style="s2">and we're going to scan again.</p>
<p begin="00:01:48.317" end="00:01:50.003" style="s2">Now we're in a transverse view</p>
<p begin="00:01:50.003" end="00:01:53.898" style="s2">and were scanning from very inferiorly</p>
<p begin="00:01:53.898" end="00:01:55.444" style="s2">to superiorly,</p>
<p begin="00:01:55.444" end="00:01:59.611" style="s2">again looking for free fluid<br />outside of the bladder.</p>
<p begin="00:02:01.110" end="00:02:02.759" style="s2">As you're scanning through the bladder,</p>
<p begin="00:02:02.759" end="00:02:04.565" style="s2">again you're looking for free fluid,</p>
<p begin="00:02:04.565" end="00:02:08.168" style="s2">remember free fluid is anechoic<br />or black on ultrasounds</p>
<p begin="00:02:08.168" end="00:02:09.773" style="s2">so that's what you're<br />going to be looking for</p>
<p begin="00:02:09.773" end="00:02:11.690" style="s2">outside of the bladder.</p>