<p begin="00:00:07.862" end="00:00:09.374" style="s2">- [Voiceover] A curved array transducer</p>
<p begin="00:00:09.374" end="00:00:10.901" style="s2">with an abdomen exam type</p>
<p begin="00:00:10.901" end="00:00:14.038" style="s2">is used to perform an<br />ultrasound guided paracentesis.</p>
<p begin="00:00:14.038" end="00:00:16.119" style="s2">It is easier to perform this exam</p>
<p begin="00:00:16.119" end="00:00:18.248" style="s2">when the bladder is not filled.</p>
<p begin="00:00:18.248" end="00:00:20.735" style="s2">The patient is placed<br />in a supine position.</p>
<p begin="00:00:20.735" end="00:00:24.165" style="s2">The abdominal cavity is<br />evaluated in two planes.</p>
<p begin="00:00:24.165" end="00:00:27.188" style="s2">Place the transducer in<br />a transverse position</p>
<p begin="00:00:27.188" end="00:00:30.032" style="s2">with the orientation marker to the right.</p>
<p begin="00:00:30.032" end="00:00:32.876" style="s2">The transducer is placed<br />at the lateral border</p>
<p begin="00:00:32.876" end="00:00:35.719" style="s2">of the rectus sheath at<br />the level of the umbilicus.</p>
<p begin="00:00:35.719" end="00:00:38.433" style="s2">To evaluate the abdominal<br />cavity for free fluid,</p>
<p begin="00:00:38.433" end="00:00:42.920" style="s2">sweep the transducer from an<br />inferior to superior position.</p>
<p begin="00:00:42.920" end="00:00:45.829" style="s2">Fluid will appear hypoechoic or anechoic</p>
<p begin="00:00:45.829" end="00:00:47.828" style="s2">and accumulate in the lateral gutter</p>
<p begin="00:00:47.828" end="00:00:49.827" style="s2">and between loops of bowel.</p>
<p begin="00:00:49.827" end="00:00:51.762" style="s2">To obtain a long axis view,</p>
<p begin="00:00:51.762" end="00:00:55.516" style="s2">rotate the transducer 90 degrees<br />with the orientation marker</p>
<p begin="00:00:55.516" end="00:00:58.036" style="s2">directed to the point of needle entry.</p>
<p begin="00:00:58.036" end="00:01:00.831" style="s2">Sweep the transducer<br />across the abdominal cavity</p>
<p begin="00:01:00.831" end="00:01:04.651" style="s2">from left to right to evaluate<br />the abdomen for free fluid.</p>
<p begin="00:01:04.651" end="00:01:07.170" style="s2">A needle insertion site should be chosen</p>
<p begin="00:01:07.170" end="00:01:08.991" style="s2">in the lateral abdominal area</p>
<p begin="00:01:08.991" end="00:01:11.364" style="s2">in a dependent area of<br />the fluid collection</p>
<p begin="00:01:11.364" end="00:01:13.867" style="s2">which is clear from loops of bowel.</p>
<p begin="00:01:13.867" end="00:01:16.825" style="s2">The needle should be inserted<br />lateral to the rectus sheath</p>
<p begin="00:01:16.825" end="00:01:20.499" style="s2">in a transverse fashion to<br />avoid the epigastric artery.</p>
<p begin="00:01:20.499" end="00:01:23.571" style="s2">Follow the needle entry by<br />slowly sliding the transducer</p>
<p begin="00:01:23.571" end="00:01:26.204" style="s2">in the direction of needle advancement.</p>
<p begin="00:01:26.204" end="00:01:30.040" style="s2">The needle will appear as a<br />small, bright hypoechoic dot.</p>
<p begin="00:01:30.040" end="00:01:31.828" style="s2">When the needle tip appears,</p>
<p begin="00:01:31.828" end="00:01:35.241" style="s2">the transducer should be advanced<br />a short distance distally</p>
<p begin="00:01:35.241" end="00:01:38.150" style="s2">to follow the tip of<br />the needle trajectory.</p>
<p begin="00:01:38.150" end="00:01:39.792" style="s2">The needle is slowly advanced</p>
<p begin="00:01:39.792" end="00:01:42.035" style="s2">under direct ultrasound visualization</p>
<p begin="00:01:42.035" end="00:01:44.034" style="s2">until the tip is seen to indent</p>
<p begin="00:01:44.034" end="00:01:46.830" style="s2">and then puncture the parietal peritoneum.</p>
<p begin="00:01:46.830" end="00:01:49.758" style="s2">The transducer should be<br />moved slightly proximally</p>
<p begin="00:01:49.758" end="00:01:53.925" style="s2">and distally to confirm<br />location of the needle tip.</p>

<p begin="00:00:07.318" end="00:00:09.711" style="s2">- [Voiceover] A curved, or<br />phased array transducer,</p>
<p begin="00:00:09.711" end="00:00:11.431" style="s2">with a pelvis exam type,</p>
<p begin="00:00:11.431" end="00:00:14.568" style="s2">is used to perform the<br />pelvis ultrasound exam.</p>
<p begin="00:00:14.568" end="00:00:16.987" style="s2">A full bladder is used<br />as an acoustic window</p>
<p begin="00:00:16.987" end="00:00:18.989" style="s2">to view the pelvic organs.</p>
<p begin="00:00:18.989" end="00:00:22.579" style="s2">The pelvis is evaluated in two plains.</p>
<p begin="00:00:22.579" end="00:00:25.534" style="s2">Place the transducer<br />in a long axis position</p>
<p begin="00:00:25.534" end="00:00:28.254" style="s2">with the orientation marker<br />to the patient's head,</p>
<p begin="00:00:28.254" end="00:00:31.254" style="s2">at the level of the symphysis pubis.</p>
<p begin="00:00:32.384" end="00:00:36.384" style="s2">Angle the transducer<br />inferiorly into the pelvis.</p>
<p begin="00:00:38.036" end="00:00:40.705" style="s2">The bladder appears in the<br />near-field of the image,</p>
<p begin="00:00:40.705" end="00:00:43.616" style="s2">as a hypoechoic triangular structure.</p>
<p begin="00:00:43.616" end="00:00:45.800" style="s2">The uterus is gray in appearance</p>
<p begin="00:00:45.800" end="00:00:48.233" style="s2">and located either directly posterior</p>
<p begin="00:00:48.233" end="00:00:50.087" style="s2">or superior to the bladder.</p>
<p begin="00:00:50.087" end="00:00:52.139" style="s2">The endometrial stripe will appear as</p>
<p begin="00:00:52.139" end="00:00:55.945" style="s2">a bright echogenic line from<br />the fundus to the cervix.</p>
<p begin="00:00:55.945" end="00:00:58.877" style="s2">The uterus does not always<br />lay directly in the midline</p>
<p begin="00:00:58.877" end="00:01:02.209" style="s2">so it may be necessary to<br />slightly rotate the transducer</p>
<p begin="00:01:02.209" end="00:01:04.732" style="s2">to view the entire length of the uterus.</p>
<p begin="00:01:04.732" end="00:01:07.015" style="s2">Sweep the transducer from side to side</p>
<p begin="00:01:07.015" end="00:01:09.219" style="s2">to see the entire uterus.</p>
<p begin="00:01:09.219" end="00:01:12.192" style="s2">The ovaries may be seen<br />by sweeping the transducer</p>
<p begin="00:01:12.192" end="00:01:14.615" style="s2">to the lateral aspects of the pelvis.</p>
<p begin="00:01:14.615" end="00:01:18.536" style="s2">They are almond-shaped and<br />slightly hypoechoic structures.</p>
<p begin="00:01:18.536" end="00:01:20.605" style="s2">Follicles may appear as multiple</p>
<p begin="00:01:20.605" end="00:01:24.688" style="s2">hypoechoic, cystic structures<br />within the ovaries.</p>
<p begin="00:01:27.166" end="00:01:29.314" style="s2">Some follicles may be quite prominent,</p>
<p begin="00:01:29.314" end="00:01:31.981" style="s2">depending upon the luteal stage.</p>
<p begin="00:01:34.855" end="00:01:37.375" style="s2">To obtain a transverse view of the uterus,</p>
<p begin="00:01:37.375" end="00:01:39.869" style="s2">rotate the transducer 90 degrees,</p>
<p begin="00:01:39.869" end="00:01:42.788" style="s2">so the orientation marker<br />is to the patient's right.</p>
<p begin="00:01:42.788" end="00:01:46.581" style="s2">The bladder appears more<br />rectangular in shape in this view.</p>
<p begin="00:01:46.581" end="00:01:48.775" style="s2">Sweep the transducer superiorly</p>
<p begin="00:01:48.775" end="00:01:51.181" style="s2">from the level of the cervix to the fundus</p>
<p begin="00:01:51.181" end="00:01:53.284" style="s2">to see the entire uterus.</p>
<p begin="00:01:53.284" end="00:01:56.324" style="s2">The ovaries will be seen on<br />either side of the uterus</p>
<p begin="00:01:56.324" end="00:01:57.941" style="s2">and can vary in location,</p>
<p begin="00:01:57.941" end="00:02:01.024" style="s2">from a superior to inferior position.</p>

<p begin="00:00:08.000" end="00:00:09.607" style="s2">- [Voiceover] A phased array transducer</p>
<p begin="00:00:09.607" end="00:00:12.167" style="s2">with an abdomen exam<br />type is used to perform</p>
<p begin="00:00:12.167" end="00:00:15.543" style="s2">the right upper quadrant<br />view of the FAST exam.</p>
<p begin="00:00:15.543" end="00:00:17.461" style="s2">The orientation marker is directed</p>
<p begin="00:00:17.461" end="00:00:19.301" style="s2">towards the patients head.</p>
<p begin="00:00:19.301" end="00:00:23.018" style="s2">The transducer is placed<br />in a long axis orientation</p>
<p begin="00:00:23.018" end="00:00:25.466" style="s2">along the right mid-auxiliary line between</p>
<p begin="00:00:25.466" end="00:00:28.380" style="s2">the 7th to 9th inter-costal space.</p>
<p begin="00:00:28.380" end="00:00:31.659" style="s2">Rotation and oblique<br />positioning of the transducer</p>
<p begin="00:00:31.659" end="00:00:34.326" style="s2">will help eliminate rib shadows.</p>
<p begin="00:00:35.740" end="00:00:39.277" style="s2">To evaluate the entire area<br />of the hepatorenal recess</p>
<p begin="00:00:39.277" end="00:00:41.860" style="s2">for free fluid sweep the transducer</p>
<p begin="00:00:41.860" end="00:00:45.188" style="s2">from an anterior to posterior position.</p>
<p begin="00:00:45.188" end="00:00:47.958" style="s2">If present, fluid will appear as a dark</p>
<p begin="00:00:47.958" end="00:00:51.605" style="s2">or aniconic strip between<br />the kidney and the liver.</p>
<p begin="00:00:51.605" end="00:00:55.078" style="s2">If it is difficult to visualize<br />the hepatorenal recess.</p>
<p begin="00:00:55.078" end="00:00:57.402" style="s2">A deep inspiration will move the diaphragm</p>
<p begin="00:00:57.402" end="00:00:59.322" style="s2">and other structures in this area</p>
<p begin="00:00:59.322" end="00:01:02.882" style="s2">down and below the ribs for easier access.</p>
<p begin="00:01:02.882" end="00:01:05.357" style="s2">Sliding the transducer<br />upward will visualize</p>
<p begin="00:01:05.357" end="00:01:08.194" style="s2">the diaphragm and plural interface.</p>
<p begin="00:01:08.194" end="00:01:11.155" style="s2">Sliding the transducer<br />downward will visualize</p>
<p begin="00:01:11.155" end="00:01:14.405" style="s2">the inferior pole of the right kidney.</p>

<p begin="00:00:07.326" end="00:00:08.966" style="s2">- [Voiceover] A phased array transducer</p>
<p begin="00:00:08.966" end="00:00:10.768" style="s2">with an abdomen exam type</p>
<p begin="00:00:10.768" end="00:00:14.463" style="s2">is used to perform the<br />pelvis view of the fast exam.</p>
<p begin="00:00:14.463" end="00:00:17.238" style="s2">Place the transducer in<br />a transverse position</p>
<p begin="00:00:17.238" end="00:00:19.326" style="s2">with the orientation marker to the right</p>
<p begin="00:00:19.326" end="00:00:22.046" style="s2">at the level of the symphysis pubis.</p>
<p begin="00:00:22.046" end="00:00:25.136" style="s2">The pelvis is evaluated in two planes.</p>
<p begin="00:00:25.136" end="00:00:26.975" style="s2">It is easier to perform this exam</p>
<p begin="00:00:26.975" end="00:00:28.840" style="s2">when the bladder is filled.</p>
<p begin="00:00:28.840" end="00:00:30.951" style="s2">The bladder is used as an acoustic window</p>
<p begin="00:00:30.951" end="00:00:32.302" style="s2">to view the cul de sac</p>
<p begin="00:00:32.302" end="00:00:35.478" style="s2">or retrovesicular space for free fluid.</p>
<p begin="00:00:35.478" end="00:00:37.113" style="s2">To visualize the bladder,</p>
<p begin="00:00:37.113" end="00:00:40.830" style="s2">angle the transducer<br />inferiorly into the pelvis.</p>
<p begin="00:00:40.830" end="00:00:42.879" style="s2">If it is difficult to<br />visualize the bladder,</p>
<p begin="00:00:42.879" end="00:00:46.456" style="s2">slide to the left or right<br />of the symphysis pubis</p>
<p begin="00:00:46.456" end="00:00:48.646" style="s2">to bring the bladder into view.</p>
<p begin="00:00:48.646" end="00:00:51.313" style="s2">To evaluate the pelvis for free fluid,</p>
<p begin="00:00:51.313" end="00:00:55.480" style="s2">sweep the transducer from an<br />inferior to superior position.</p>
<p begin="00:00:56.314" end="00:00:59.499" style="s2">Fluid will appear hyperechoic or anechoic</p>
<p begin="00:00:59.499" end="00:01:01.994" style="s2">and accumulate posterior to the bladder,</p>
<p begin="00:01:01.994" end="00:01:05.569" style="s2">posterior to the uterus,<br />and between loops of bowel.</p>
<p begin="00:01:05.569" end="00:01:07.508" style="s2">To obtain a long access view,</p>
<p begin="00:01:07.508" end="00:01:09.952" style="s2">rotate the transducer 90 degrees</p>
<p begin="00:01:09.952" end="00:01:11.440" style="s2">with the orientation marker</p>
<p begin="00:01:11.440" end="00:01:14.273" style="s2">pointed toward the patient's head.</p>
<p begin="00:01:11.440" end="00:01:22.000" style="s2">Sweep the transducer across the pelvis from left to right</p>
<p begin="00:01:22.000" end="00:01:26.000" style="s2">to evaluate the pelvis for free fluid.</p>

<p begin="00:00:07.200" end="00:00:09.566" style="s2">- [Voiceover] A phased array transducer</p>
<p begin="00:00:09.566" end="00:00:11.913" style="s2">with an abdomen exam<br />type is used to perform</p>
<p begin="00:00:11.913" end="00:00:14.758" style="s2">the left upper quadrant<br />view of the FAST Exam.</p>
<p begin="00:00:14.758" end="00:00:16.868" style="s2">The orientation marker is directed</p>
<p begin="00:00:16.868" end="00:00:18.771" style="s2">toward the patient's head.</p>
<p begin="00:00:18.771" end="00:00:22.071" style="s2">the transducer is placed in<br />a long-access orientation</p>
<p begin="00:00:22.071" end="00:00:24.725" style="s2">along the left-posterior axillary line</p>
<p begin="00:00:24.725" end="00:00:28.372" style="s2">between the fifth to<br />seventh intercostal spaces.</p>
<p begin="00:00:28.372" end="00:00:30.923" style="s2">The sonographer's hand<br />will touch the gurney</p>
<p begin="00:00:30.923" end="00:00:33.344" style="s2">with the proper transducer position.</p>
<p begin="00:00:33.344" end="00:00:36.425" style="s2">Rotation and oblique<br />positioning of the transducer</p>
<p begin="00:00:36.425" end="00:00:39.092" style="s2">will help eliminate rib shadows.</p>
<p begin="00:00:43.087" end="00:00:46.518" style="s2">To evaluate the entire area<br />of the spleenorenal recess</p>
<p begin="00:00:46.518" end="00:00:49.173" style="s2">for free fluid, sweep the transducer</p>
<p begin="00:00:49.173" end="00:00:52.423" style="s2">from an anterior to posterior position.</p>
<p begin="00:00:53.723" end="00:00:56.699" style="s2">Carefully examine the spleenorenal recess</p>
<p begin="00:00:56.699" end="00:00:58.567" style="s2">and subphrenic space.</p>
<p begin="00:00:58.567" end="00:01:01.479" style="s2">Fluid will appear dark or anechoic.</p>
<p begin="00:01:01.479" end="00:01:04.925" style="s2">If it is difficult to visualize<br />the spreenorenal recess,</p>
<p begin="00:01:04.925" end="00:01:07.562" style="s2">a deep inspiration will move the diaphragm</p>
<p begin="00:01:07.562" end="00:01:09.580" style="s2">and other structures in this area</p>
<p begin="00:01:09.580" end="00:01:12.581" style="s2">down and below the ribs for easier access.</p>
<p begin="00:01:12.581" end="00:01:15.311" style="s2">Sliding the transducer<br />in an upward direction</p>
<p begin="00:01:15.311" end="00:01:19.478" style="s2">will visualize the diaphragm<br />and plural interface.</p>