<p begin="00:00:07.406" end="00:00:09.090" style="s2">- [Voiceover] A phased array transducer</p>
<p begin="00:00:09.090" end="00:00:11.818" style="s2">with a cardiac exam<br />type is used to perform</p>
<p begin="00:00:11.818" end="00:00:15.443" style="s2">an Inferior Vena Cava ultrasound exam.</p>
<p begin="00:00:15.443" end="00:00:18.065" style="s2">The Inferior Vena Cava is evaluated</p>
<p begin="00:00:18.065" end="00:00:20.928" style="s2">at the level of the liver and diaphragm.</p>
<p begin="00:00:20.928" end="00:00:23.006" style="s2">The transducer is placed to the right</p>
<p begin="00:00:23.006" end="00:00:24.914" style="s2">of the epigastric midline,</p>
<p begin="00:00:24.914" end="00:00:28.139" style="s2">with the orientation marker<br />to the patient's feet.</p>
<p begin="00:00:28.139" end="00:00:29.684" style="s2">As an alternative approach,</p>
<p begin="00:00:29.684" end="00:00:33.224" style="s2">this exam may be performed<br />using an abdomen exam type</p>
<p begin="00:00:33.224" end="00:00:36.593" style="s2">with the orientation marker<br />to the patient's head.</p>
<p begin="00:00:36.593" end="00:00:39.491" style="s2">The liver, diaphragm, right atrium,</p>
<p begin="00:00:39.491" end="00:00:43.640" style="s2">and Inferior Vena Cava are<br />identified in this view.</p>
<p begin="00:00:43.640" end="00:00:46.020" style="s2">Sweep from side-to-side to differentiate</p>
<p begin="00:00:46.020" end="00:00:49.252" style="s2">the Inferior Vena Cava from the aorta.</p>
<p begin="00:00:49.252" end="00:00:52.603" style="s2">The aorta is thicker walled and pulsatile.</p>
<p begin="00:00:52.603" end="00:00:56.534" style="s2">The superior mesenteric and<br />celiac branches of the aorta</p>
<p begin="00:00:56.534" end="00:00:58.923" style="s2">are identified at this level.</p>
<p begin="00:00:58.923" end="00:01:01.883" style="s2">The Inferior Vena Cava is thin walled</p>
<p begin="00:01:01.883" end="00:01:04.668" style="s2">and changes caliber with respiration.</p>
<p begin="00:01:04.668" end="00:01:06.928" style="s2">The diameter of the Inferior Vena Cava</p>
<p begin="00:01:06.928" end="00:01:11.095" style="s2">decreases with inspiration<br />and increases with expiration.</p>

<p begin="00:00:07.385" end="00:00:09.473" style="s2">- [Voiceover] A curved or<br />phased array transducer</p>
<p begin="00:00:09.473" end="00:00:12.170" style="s2">with an abdomen exam<br />type is used to perform</p>
<p begin="00:00:12.170" end="00:00:14.744" style="s2">an aorta ultrasound exam.</p>
<p begin="00:00:14.744" end="00:00:16.791" style="s2">The entire length of the aorta from</p>
<p begin="00:00:16.791" end="00:00:18.015" style="s2">the level of the diaphragm</p>
<p begin="00:00:18.015" end="00:00:20.748" style="s2">to the bifurcation of the iliac arteries</p>
<p begin="00:00:20.748" end="00:00:23.480" style="s2">must be evaluated in two planes.</p>
<p begin="00:00:23.480" end="00:00:26.126" style="s2">The examination begins with the transducer</p>
<p begin="00:00:26.126" end="00:00:29.631" style="s2">placed transversely in<br />the epigastric mid line,</p>
<p begin="00:00:29.631" end="00:00:33.631" style="s2">with the marker directed<br />to the patient's right.</p>
<p begin="00:00:34.682" end="00:00:37.901" style="s2">The aorta is seen as a<br />round, pulsatile structure,</p>
<p begin="00:00:37.901" end="00:00:41.184" style="s2">anterior to the bright<br />reflection of the vertebrae.</p>
<p begin="00:00:41.184" end="00:00:43.074" style="s2">The vena cava is an oval structure</p>
<p begin="00:00:43.074" end="00:00:46.359" style="s2">immediately to the left of<br />the aorta on the screen,</p>
<p begin="00:00:46.359" end="00:00:48.639" style="s2">which changes in caliber with compression</p>
<p begin="00:00:48.639" end="00:00:50.751" style="s2">or deep inspiration.</p>
<p begin="00:00:50.751" end="00:00:53.234" style="s2">The abdominal aorta will course gradually,</p>
<p begin="00:00:53.234" end="00:00:56.523" style="s2">becoming more superficial<br />as it progresses distally.</p>
<p begin="00:00:56.523" end="00:00:58.935" style="s2">The transducer is slowly moved distally</p>
<p begin="00:00:58.935" end="00:01:01.352" style="s2">to identify the celiac trunk,</p>
<p begin="00:01:02.313" end="00:01:03.563" style="s2">renal arteries,</p>
<p begin="00:01:06.503" end="00:01:08.753" style="s2">superior mesenteric artery,</p>
<p begin="00:01:12.713" end="00:01:15.718" style="s2">and bifurcation to the iliac arteries.</p>
<p begin="00:01:15.718" end="00:01:18.027" style="s2">Note the location of any change in size</p>
<p begin="00:01:18.027" end="00:01:20.307" style="s2">of the aorta or iliac arteries,</p>
<p begin="00:01:20.307" end="00:01:23.021" style="s2">and measure in long and short axis views</p>
<p begin="00:01:23.021" end="00:01:25.054" style="s2">from outer wall to outer wall</p>
<p begin="00:01:25.054" end="00:01:27.444" style="s2">to determine the true diameter.</p>
<p begin="00:01:27.444" end="00:01:30.347" style="s2">The transducer is returned<br />to the epigastric area</p>
<p begin="00:01:30.347" end="00:01:32.963" style="s2">and rotated 90 degrees clockwise,</p>
<p begin="00:01:32.963" end="00:01:36.205" style="s2">with the orientation marker<br />to the patient's head.</p>
<p begin="00:01:36.205" end="00:01:38.466" style="s2">The transducer is swept side to side</p>
<p begin="00:01:38.466" end="00:01:41.870" style="s2">to identify the maximal<br />diameter of the aorta.</p>
<p begin="00:01:41.870" end="00:01:45.463" style="s2">The abdominal aorta will have<br />proximal to distal taper.</p>
<p begin="00:01:45.463" end="00:01:47.712" style="s2">The transducer is moved distally</p>
<p begin="00:01:47.712" end="00:01:49.767" style="s2">to evaluate the walls of the aorta</p>
<p begin="00:01:49.767" end="00:01:52.767" style="s2">for any change in the shape or size.</p>
<p begin="00:01:55.622" end="00:01:57.555" style="s2">If the aorta is difficult to visualize</p>
<p begin="00:01:57.555" end="00:02:01.245" style="s2">due to overlying bowel, gentle<br />downward transducer pressure</p>
<p begin="00:02:01.245" end="00:02:04.715" style="s2">may encourage peristalsis<br />of the overlying bowel.</p>
<p begin="00:02:04.715" end="00:02:06.950" style="s2">Alternatively, consider moving the patient</p>
<p begin="00:02:06.950" end="00:02:09.314" style="s2">into a left lateral decubitus position</p>
<p begin="00:02:09.314" end="00:02:13.481" style="s2">to re-position the bowel<br />away from the field of view.</p>