<p begin="00:00:15.492" end="00:00:16.763" style="s2">- The next view I'm gonna take you through</p>
<p begin="00:00:16.763" end="00:00:19.343" style="s2">in the FAST exam is the subcoastal view</p>
<p begin="00:00:19.343" end="00:00:21.477" style="s2">of the heart in a four-chamber plane.</p>
<p begin="00:00:21.477" end="00:00:23.708" style="s2">For this, we're gonna put our transducer</p>
<p begin="00:00:23.708" end="00:00:24.958" style="s2">to phased array</p>
<p begin="00:00:25.797" end="00:00:27.248" style="s2">to the subxiphoid area,</p>
<p begin="00:00:27.248" end="00:00:29.577" style="s2">aiming towards the<br />patient's left shoulder.</p>
<p begin="00:00:29.577" end="00:00:30.820" style="s2">Here is the probe marker here,</p>
<p begin="00:00:30.820" end="00:00:32.310" style="s2">which I'm going to angle towards</p>
<p begin="00:00:32.310" end="00:00:33.977" style="s2">the patient's right.</p>
<p begin="00:00:34.826" end="00:00:38.844" style="s2">When I do this exam, I wanna<br />make sure this transducer is</p>
<p begin="00:00:38.844" end="00:00:40.564" style="s2">along the frontal plane</p>
<p begin="00:00:40.564" end="00:00:42.678" style="s2">and aiming toward the chest.</p>
<p begin="00:00:42.678" end="00:00:45.604" style="s2">A common mistake is to go too</p>
<p begin="00:00:45.604" end="00:00:47.052" style="s2">inferior into the abdomen,</p>
<p begin="00:00:47.052" end="00:00:49.209" style="s2">so you want to go deep into the chest.</p>
<p begin="00:00:49.209" end="00:00:50.476" style="s2">When you're in this location,</p>
<p begin="00:00:50.476" end="00:00:52.066" style="s2">the other thing you're gonna need to do</p>
<p begin="00:00:52.066" end="00:00:53.609" style="s2">is increase your depth.</p>
<p begin="00:00:53.609" end="00:00:55.598" style="s2">I'm gonna use my depth key right here</p>
<p begin="00:00:55.598" end="00:00:56.957" style="s2">and I'm gonna increase,</p>
<p begin="00:00:56.957" end="00:00:59.650" style="s2">so I can see the full heart in view</p>
<p begin="00:00:59.650" end="00:01:03.130" style="s2">and now you can see<br />we're at 21 centimeters.</p>
<p begin="00:01:03.130" end="00:01:05.906" style="s2">Some common landmarks<br />that you need to identify,</p>
<p begin="00:01:05.906" end="00:01:07.530" style="s2">the first thing you see<br />is that we see liver</p>
<p begin="00:01:07.530" end="00:01:09.204" style="s2">at the top of the screen.</p>
<p begin="00:01:09.204" end="00:01:12.362" style="s2">That liver is our coustic<br />window into the heart.</p>
<p begin="00:01:12.362" end="00:01:14.562" style="s2">The beating thing in the<br />center is obviously the heart</p>
<p begin="00:01:14.562" end="00:01:16.369" style="s2">and we can identify the entire heart</p>
<p begin="00:01:16.369" end="00:01:19.474" style="s2">and the perimeter of the<br />heart with the pericardium.</p>
<p begin="00:01:19.474" end="00:01:21.725" style="s2">The pericardium is the<br />white line that I'm seeing,</p>
<p begin="00:01:21.725" end="00:01:24.114" style="s2">you can see that's<br />surrounding the full heart.</p>
<p begin="00:01:24.114" end="00:01:25.951" style="s2">Then we can identify the chambers.</p>
<p begin="00:01:25.951" end="00:01:28.377" style="s2">The chambers are<br />relatively easy to identify</p>
<p begin="00:01:28.377" end="00:01:30.019" style="s2">in this view.</p>
<p begin="00:01:30.019" end="00:01:32.203" style="s2">The chambers on the right side</p>
<p begin="00:01:32.203" end="00:01:34.286" style="s2">of the heart are over here</p>
<p begin="00:01:34.286" end="00:01:36.094" style="s2">and the easy way to identify those,</p>
<p begin="00:01:36.094" end="00:01:38.496" style="s2">remember the liver's on<br />the right side of the body,</p>
<p begin="00:01:38.496" end="00:01:41.725" style="s2">so these chambers that are<br />adjacent to the liver would be</p>
<p begin="00:01:41.725" end="00:01:43.475" style="s2">right-sided chambers.</p>
<p begin="00:01:44.344" end="00:01:47.441" style="s2">The large chamber, which<br />is adjacent to the liver</p>
<p begin="00:01:47.441" end="00:01:48.958" style="s2">is the right ventricle,</p>
<p begin="00:01:48.958" end="00:01:51.012" style="s2">on the other side we<br />see the left ventricle</p>
<p begin="00:01:51.012" end="00:01:53.258" style="s2">and we see the two atria.</p>
<p begin="00:01:53.258" end="00:01:55.106" style="s2">Again, our focus</p>
<p begin="00:01:55.106" end="00:01:58.091" style="s2">on this exam is to<br />identify the pericardium</p>
<p begin="00:01:58.091" end="00:02:00.495" style="s2">and to look for free fluid within it.</p>
<p begin="00:02:00.495" end="00:02:01.446" style="s2">What we're gonna look for</p>
<p begin="00:02:01.446" end="00:02:04.309" style="s2">is an anechoic area<br />within that pericardium</p>
<p begin="00:02:04.309" end="00:02:07.044" style="s2">which would be signs of a hemopericadium.</p>
<p begin="00:02:07.044" end="00:02:08.424" style="s2">Now if you can't get this view,</p>
<p begin="00:02:08.424" end="00:02:11.246" style="s2">a great alternate view<br />is the parasternal view</p>
<p begin="00:02:11.246" end="00:02:13.387" style="s2">of the heart in a long axis plane.</p>
<p begin="00:02:13.387" end="00:02:14.778" style="s2">We're gonna take you through that in the</p>
<p begin="00:02:14.778" end="00:02:16.861" style="s2">echocardiography section.</p>