<p begin="00:00:18.008" end="00:00:20.720" style="s2">- Hello, my name is Phil<br />Perera and I'm the emergency</p>
<p begin="00:00:20.720" end="00:00:23.219" style="s2">ultrasound coordinator at the<br />New York Presbyterian Hospital</p>
<p begin="00:00:23.219" end="00:00:27.918" style="s2">in New York City, and<br />welcome to SoundBytes Cases.</p>
<p begin="00:00:27.918" end="00:00:30.365" style="s2">In this module we're<br />going to focus entirely on</p>
<p begin="00:00:30.365" end="00:00:32.585" style="s2">the trauma fast exam.</p>
<p begin="00:00:32.585" end="00:00:34.852" style="s2">Specifically, we're going<br />to look further into the</p>
<p begin="00:00:34.852" end="00:00:37.038" style="s2">right upper quadrant view, also known as</p>
<p begin="00:00:37.038" end="00:00:39.032" style="s2">the hepatorenal view.</p>
<p begin="00:00:39.032" end="00:00:40.906" style="s2">Now, we're going to cover<br />the two other views of</p>
<p begin="00:00:40.906" end="00:00:44.365" style="s2">the trauma fast exam in<br />upcoming modules of SoundBytes.</p>
<p begin="00:00:44.365" end="00:00:46.697" style="s2">The left upper quadrant<br />view, also known as</p>
<p begin="00:00:46.697" end="00:00:49.387" style="s2">the splenorenal or perisplenic view,</p>
<p begin="00:00:49.387" end="00:00:53.297" style="s2">and the suprarpubic view, also<br />known as the bladder view.</p>
<p begin="00:00:53.297" end="00:00:55.717" style="s2">There's a tremendous amount<br />of information we can gain by</p>
<p begin="00:00:55.717" end="00:00:58.141" style="s2">looking closely into the<br />right upper quadrant area</p>
<p begin="00:00:58.141" end="00:00:59.548" style="s2">in our trauma patient.</p>
<p begin="00:00:59.548" end="00:01:02.289" style="s2">Traditionally it's been emphasized<br />that the hepatorenal area</p>
<p begin="00:01:02.289" end="00:01:05.283" style="s2">or Morison's pouch view, is<br />the primary target for the</p>
<p begin="00:01:05.283" end="00:01:09.001" style="s2">right upper quadrant, but it<br />can take up to 600 ccs of fluid</p>
<p begin="00:01:09.001" end="00:01:12.922" style="s2">to make a positive exam if<br />only looking into that area.</p>
<p begin="00:01:12.922" end="00:01:15.370" style="s2">So I'll show some alternative<br />views in this module that can</p>
<p begin="00:01:15.370" end="00:01:18.974" style="s2">help us to possibly<br />improve on that number.</p>
<p begin="00:01:18.974" end="00:01:21.149" style="s2">Now let's take a look at a<br />slide showing us how to perform</p>
<p begin="00:01:21.149" end="00:01:24.407" style="s2">the right upper quadrant<br />view of the trauma fast exam.</p>
<p begin="00:01:24.407" end="00:01:27.318" style="s2">We'll want to place the probe<br />at about the anterior axillary</p>
<p begin="00:01:27.318" end="00:01:30.431" style="s2">line and using the liver as<br />an acoustic window aiming</p>
<p begin="00:01:30.431" end="00:01:33.697" style="s2">the probe down towards the<br />bedside retroperitoneally to get</p>
<p begin="00:01:33.697" end="00:01:36.441" style="s2">a good view of these<br />anatomical structures.</p>
<p begin="00:01:36.441" end="00:01:38.683" style="s2">It's best to have a small<br />footprint probe that can easily</p>
<p begin="00:01:38.683" end="00:01:41.934" style="s2">sit between the ribs giving<br />a good view on to this area.</p>
<p begin="00:01:41.934" end="00:01:44.471" style="s2">Notice that this is a long<br />axis view with a probe marker</p>
<p begin="00:01:44.471" end="00:01:46.261" style="s2">position superiorly.</p>
<p begin="00:01:46.261" end="00:01:48.855" style="s2">Now our first view from this<br />right upper quadrant area</p>
<p begin="00:01:48.855" end="00:01:52.006" style="s2">will be position one as shown here in the</p>
<p begin="00:01:52.006" end="00:01:55.219" style="s2">infra-diaphragmatic space<br />just below the diaphragm</p>
<p begin="00:01:55.219" end="00:01:56.707" style="s2">and above the liver.</p>
<p begin="00:01:56.707" end="00:01:59.563" style="s2">Second, we'll move the probe<br />slightly inferiorly to look in</p>
<p begin="00:01:59.563" end="00:02:03.092" style="s2">to the traditional Morison's<br />pouch or hepatorenal interface,</p>
<p begin="00:02:03.092" end="00:02:05.958" style="s2">and the last view is the caudal<br />tip of the liver shown here</p>
<p begin="00:02:05.958" end="00:02:07.713" style="s2">in position three.</p>
<p begin="00:02:07.713" end="00:02:09.916" style="s2">It's very important to look at<br />the caudal tip of the liver,</p>
<p begin="00:02:09.916" end="00:02:12.356" style="s2">as this represents the<br />beginning of the right paracolic</p>
<p begin="00:02:12.356" end="00:02:15.214" style="s2">gutter and small amounts of<br />fluid will pool here before</p>
<p begin="00:02:15.214" end="00:02:17.832" style="s2">moving into Morison's pouch.</p>
<p begin="00:02:17.832" end="00:02:19.746" style="s2">Now that we know how to perform<br />the right upper quadrant</p>
<p begin="00:02:19.746" end="00:02:23.008" style="s2">view of the trauma fast exam,<br />let's take a look at a normal</p>
<p begin="00:02:23.008" end="00:02:24.974" style="s2">image that you might obtain.</p>
<p begin="00:02:24.974" end="00:02:26.988" style="s2">Remembering that this is a long axis view,</p>
<p begin="00:02:26.988" end="00:02:28.701" style="s2">I have the probe marker<br />here positioned towards</p>
<p begin="00:02:28.701" end="00:02:29.859" style="s2">the patient's head.</p>
<p begin="00:02:29.859" end="00:02:31.715" style="s2">So towards the left of the clip here is</p>
<p begin="00:02:31.715" end="00:02:34.075" style="s2">superior chest cavity<br />and towards the right is</p>
<p begin="00:02:34.075" end="00:02:36.349" style="s2">inferior or abdominal cavity.</p>
<p begin="00:02:36.349" end="00:02:38.918" style="s2">Notice the first large<br />structure that comes into view</p>
<p begin="00:02:38.918" end="00:02:41.651" style="s2">in the middle of the image is<br />the liver and to the right,</p>
<p begin="00:02:41.651" end="00:02:45.386" style="s2">or inferior to the liver we<br />see the football shaped kidney.</p>
<p begin="00:02:45.386" end="00:02:47.811" style="s2">Now it's that interface between<br />the liver and kidney that</p>
<p begin="00:02:47.811" end="00:02:50.821" style="s2">represents a potential space<br />known as Morison's pouch</p>
<p begin="00:02:50.821" end="00:02:54.384" style="s2">where we're be looking for dark,<br />anechoic fluid collections.</p>
<p begin="00:02:54.384" end="00:02:57.853" style="s2">Note here, we see a thin, white<br />line making up a normal exam</p>
<p begin="00:02:57.853" end="00:03:00.193" style="s2">and representing the<br />fat within the capsule</p>
<p begin="00:03:00.193" end="00:03:01.443" style="s2">around the kidney.</p>
<p begin="00:03:01.443" end="00:03:04.321" style="s2">Notice to the left of the liver<br />we see the white diaphragm</p>
<p begin="00:03:04.321" end="00:03:06.633" style="s2">that represents the<br />interface between chest</p>
<p begin="00:03:06.633" end="00:03:08.803" style="s2">and abdominal cavities.</p>
<p begin="00:03:08.803" end="00:03:10.312" style="s2">Let's take a look at another normal</p>
<p begin="00:03:10.312" end="00:03:11.979" style="s2">right upper quadrant examination.</p>
<p begin="00:03:11.979" end="00:03:14.509" style="s2">Again the probe marker is<br />towards the patient's head.</p>
<p begin="00:03:14.509" end="00:03:16.622" style="s2">This is the superior chest<br />cavity towards the left.</p>
<p begin="00:03:16.622" end="00:03:19.290" style="s2">Inferior abdominal<br />cavity towards the right.</p>
<p begin="00:03:19.290" end="00:03:21.066" style="s2">We see the liver in the<br />middle of the image,</p>
<p begin="00:03:21.066" end="00:03:24.420" style="s2">and notice the diaphragm above<br />the liver moving up and down</p>
<p begin="00:03:24.420" end="00:03:26.220" style="s2">as the patient breathes.</p>
<p begin="00:03:26.220" end="00:03:29.127" style="s2">We see the kidney inferior<br />to the liver, and notice</p>
<p begin="00:03:29.127" end="00:03:31.606" style="s2">the potential space in between<br />the liver and the kidney</p>
<p begin="00:03:31.606" end="00:03:35.565" style="s2">that makes up the hepatorenal<br />fossa or pouch of Morison.</p>
<p begin="00:03:35.565" end="00:03:38.443" style="s2">Notice in this video clip<br />all we see is a white line</p>
<p begin="00:03:38.443" end="00:03:41.675" style="s2">representing the fat within<br />the capsule around the kidney</p>
<p begin="00:03:41.675" end="00:03:43.342" style="s2">or Gerota's capsule.</p>
<p begin="00:03:44.189" end="00:03:47.119" style="s2">If there was fluid, we would<br />see a dark or anechoic fluid</p>
<p begin="00:03:47.119" end="00:03:49.361" style="s2">collection in this potential space.</p>
<p begin="00:03:49.361" end="00:03:52.630" style="s2">Let's now look at the diaphragm<br />which we see above the liver</p>
<p begin="00:03:52.630" end="00:03:54.990" style="s2">and if we look above the<br />diaphragm this is where we would</p>
<p begin="00:03:54.990" end="00:03:57.881" style="s2">look for fluid within the<br />chest cavity or hemothorax</p>
<p begin="00:03:57.881" end="00:03:59.188" style="s2">in the trauma patient.</p>
<p begin="00:03:59.188" end="00:04:01.756" style="s2">We may have to move the probe<br />several intercostal spaces</p>
<p begin="00:04:01.756" end="00:04:03.673" style="s2">on the patient's side to fully investigate</p>
<p begin="00:04:03.673" end="00:04:05.310" style="s2">the right upper quadrant for fluid.</p>
<p begin="00:04:05.310" end="00:04:07.712" style="s2">Here's a swing view where I'm<br />starting relatively superior</p>
<p begin="00:04:07.712" end="00:04:10.059" style="s2">right there looking in the<br />area between the diaphragm</p>
<p begin="00:04:10.059" end="00:04:13.222" style="s2">and the liver, going through<br />Morison's pouch, as I'll show</p>
<p begin="00:04:13.222" end="00:04:16.271" style="s2">coming up right here the<br />area between the liver</p>
<p begin="00:04:16.271" end="00:04:18.938" style="s2">and the kidney and<br />terminating at the inferior</p>
<p begin="00:04:18.938" end="00:04:20.270" style="s2">tip of the liver.</p>
<p begin="00:04:20.270" end="00:04:22.886" style="s2">Notice here we notice the caudal<br />tip of the liver extending</p>
<p begin="00:04:22.886" end="00:04:25.891" style="s2">almost all the way inferiorly<br />down past the inferior pole</p>
<p begin="00:04:25.891" end="00:04:28.408" style="s2">of the kidney, and it's<br />important to look at that caudal</p>
<p begin="00:04:28.408" end="00:04:30.370" style="s2">tip of the liver, as it<br />represents the beginning</p>
<p begin="00:04:30.370" end="00:04:32.649" style="s2">of the right paracolic gutter.</p>
<p begin="00:04:32.649" end="00:04:34.912" style="s2">So in conclusion, I'm glad I<br />could share with you part one</p>
<p begin="00:04:34.912" end="00:04:38.553" style="s2">of the right upper quadrant<br />view of the trauma fast exam.</p>
<p begin="00:04:38.553" end="00:04:41.635" style="s2">Now we know how to recognize<br />a normal examination</p>
<p begin="00:04:41.635" end="00:04:44.321" style="s2">looking all the way from<br />the area below the diaphragm</p>
<p begin="00:04:44.321" end="00:04:47.172" style="s2">through Morison's pouch and<br />terminating at a view of</p>
<p begin="00:04:47.172" end="00:04:48.666" style="s2">the caudal tip of the liver.</p>
<p begin="00:04:48.666" end="00:04:51.621" style="s2">So I hope to see you back<br />as SoundBytes continues,</p>
<p begin="00:04:51.621" end="00:04:54.619" style="s2">and we look at part two of<br />the right upper quadrant view</p>
<p begin="00:04:54.619" end="00:04:57.452" style="s2">focusing on positive examinations.</p>

<p begin="00:00:15.546" end="00:00:16.890" style="s2">- The next view I'm<br />going to take you through</p>
<p begin="00:00:16.890" end="00:00:19.221" style="s2">is a perisplenic or left<br />upper quadrant view.</p>
<p begin="00:00:19.221" end="00:00:21.219" style="s2">This view tends to be a<br />little bit more difficult</p>
<p begin="00:00:21.219" end="00:00:23.222" style="s2">because the spleen is<br />smaller and doesn't provide</p>
<p begin="00:00:23.222" end="00:00:25.156" style="s2">as large an acoustic window.</p>
<p begin="00:00:25.156" end="00:00:25.989" style="s2">We're going to start.</p>
<p begin="00:00:25.989" end="00:00:27.762" style="s2">Again, the patient's going to be supine.</p>
<p begin="00:00:27.762" end="00:00:29.700" style="s2">This is a probe marker right here.</p>
<p begin="00:00:29.700" end="00:00:31.184" style="s2">We're going to go really posterior.</p>
<p begin="00:00:31.184" end="00:00:32.939" style="s2">My hand is going to touch the gurney.</p>
<p begin="00:00:32.939" end="00:00:34.428" style="s2">You can go about four finger breadths</p>
<p begin="00:00:34.428" end="00:00:37.158" style="s2">just above the costal margin.</p>
<p begin="00:00:37.158" end="00:00:38.895" style="s2">You can identify the kidney.</p>
<p begin="00:00:38.895" end="00:00:41.275" style="s2">That's going to be a<br />pretty identifiable organ,</p>
<p begin="00:00:41.275" end="00:00:42.830" style="s2">characteristic bean shape.</p>
<p begin="00:00:42.830" end="00:00:44.445" style="s2">Then we can see it here on the screen.</p>
<p begin="00:00:44.445" end="00:00:47.184" style="s2">Just above it, we're<br />going to see the spleen.</p>
<p begin="00:00:47.184" end="00:00:50.328" style="s2">To the far left of the screen as well</p>
<p begin="00:00:50.328" end="00:00:51.609" style="s2">we see the diaphragm.</p>
<p begin="00:00:51.609" end="00:00:53.113" style="s2">Once you're in this location,</p>
<p begin="00:00:53.113" end="00:00:55.301" style="s2">you want to carefully pan through</p>
<p begin="00:00:55.301" end="00:00:56.973" style="s2">the inferior part of the spleen,</p>
<p begin="00:00:56.973" end="00:00:58.803" style="s2">and then jump over that rib,</p>
<p begin="00:00:58.803" end="00:01:01.066" style="s2">and see the superior part of the spleen,</p>
<p begin="00:01:01.066" end="00:01:04.617" style="s2">because fluid often collects<br />just above the spleen</p>
<p begin="00:01:04.617" end="00:01:06.199" style="s2">and below the diaphragm.</p>
<p begin="00:01:06.199" end="00:01:09.079" style="s2">Once you identify a good view<br />in the left upper quadrant,</p>
<p begin="00:01:09.079" end="00:01:10.808" style="s2">you'll want to do a<br />sweep through that area</p>
<p begin="00:01:10.808" end="00:01:12.416" style="s2">looking for free fluid.</p>
<p begin="00:01:12.416" end="00:01:14.762" style="s2">Again, you see the kidney,<br />you see the spleen.</p>
<p begin="00:01:14.762" end="00:01:16.427" style="s2">Find the interface between.</p>
<p begin="00:01:16.427" end="00:01:18.594" style="s2">Look for fluid between those two organs.</p>
<p begin="00:01:18.594" end="00:01:21.864" style="s2">Then particularly scan above that spleen,</p>
<p begin="00:01:21.864" end="00:01:24.144" style="s2">scanning all the way through the organ,</p>
<p begin="00:01:24.144" end="00:01:26.408" style="s2">looking for free fluid above the spleen</p>
<p begin="00:01:26.408" end="00:01:27.960" style="s2">and below the diaphragm.</p>
<p begin="00:01:27.960" end="00:01:30.249" style="s2">Again, when you're<br />scanning through this area,</p>
<p begin="00:01:30.249" end="00:01:32.431" style="s2">you want to carefully<br />look above the diaphragm</p>
<p begin="00:01:32.431" end="00:01:35.170" style="s2">for evidence of hemothorax.</p>
<p begin="00:01:35.170" end="00:01:36.260" style="s2">When you're scanning in this view,</p>
<p begin="00:01:36.260" end="00:01:38.846" style="s2">also make sure you scan the full kidney.</p>
<p begin="00:01:38.846" end="00:01:43.581" style="s2">Here we see the superior pole<br />to the left of the screen,</p>
<p begin="00:01:43.581" end="00:01:45.337" style="s2">and the inferior pole.</p>
<p begin="00:01:45.337" end="00:01:47.178" style="s2">You want to make sure<br />you get that full kidney</p>
<p begin="00:01:47.178" end="00:01:51.261" style="s2">in view when you examine<br />the left upper quadrant.</p>

<p begin="00:00:15.825" end="00:00:18.169" style="s2">- So the patient's gonna<br />arrive in a supine position,</p>
<p begin="00:00:18.169" end="00:00:20.784" style="s2">they'll often be on a backboard<br />as full spinal precaution,</p>
<p begin="00:00:20.784" end="00:00:23.903" style="s2">so motion of the patient<br />will be impossible.</p>
<p begin="00:00:23.903" end="00:00:25.651" style="s2">We're gonna choose our transducer.</p>
<p begin="00:00:25.651" end="00:00:28.435" style="s2">We have chosen the<br />phased array transducer,</p>
<p begin="00:00:28.435" end="00:00:31.935" style="s2">we're gonna put a little gel on top of it.</p>
<p begin="00:00:34.817" end="00:00:37.465" style="s2">And I like to put the probe marker</p>
<p begin="00:00:37.465" end="00:00:40.010" style="s2">toward the patient's<br />head, toward the axilla,</p>
<p begin="00:00:40.010" end="00:00:43.825" style="s2">at about the midaxillaral<br />line, 10 to 11th ribs.</p>
<p begin="00:00:43.825" end="00:00:46.410" style="s2">Another easy tip to find out the location</p>
<p begin="00:00:46.410" end="00:00:48.017" style="s2">is get to the costal margin,</p>
<p begin="00:00:48.017" end="00:00:50.137" style="s2">go about three finger-breadths above it,</p>
<p begin="00:00:50.137" end="00:00:52.570" style="s2">and you should be able to find the kidney</p>
<p begin="00:00:52.570" end="00:00:54.690" style="s2">and see the adjacent liver.</p>
<p begin="00:00:54.690" end="00:00:56.842" style="s2">I'm just adjusting my gain here.</p>
<p begin="00:00:56.842" end="00:00:59.050" style="s2">And already I can see the interface</p>
<p begin="00:00:59.050" end="00:01:02.671" style="s2">between the kidney and the<br />liver, which is Morison's pouch.</p>
<p begin="00:01:02.671" end="00:01:05.082" style="s2">So what we see here, on the bottom,</p>
<p begin="00:01:05.082" end="00:01:08.970" style="s2">this crescent shaped organ, is the kidney.</p>
<p begin="00:01:08.970" end="00:01:10.642" style="s2">Above it we see the liver,</p>
<p begin="00:01:10.642" end="00:01:12.866" style="s2">and just to the left side of the screen</p>
<p begin="00:01:12.866" end="00:01:14.602" style="s2">we see the diaphragm.</p>
<p begin="00:01:14.602" end="00:01:16.773" style="s2">So when I'm examining this area,</p>
<p begin="00:01:16.773" end="00:01:19.161" style="s2">I'm gonna carefully scan through</p>
<p begin="00:01:19.161" end="00:01:21.954" style="s2">the entire area of Morison's pouch,</p>
<p begin="00:01:21.954" end="00:01:23.903" style="s2">including at the liver tip.</p>
<p begin="00:01:23.903" end="00:01:25.866" style="s2">So we see this whole area here</p>
<p begin="00:01:25.866" end="00:01:28.178" style="s2">looking for an anechoic stripe.</p>
<p begin="00:01:28.178" end="00:01:31.730" style="s2">An anechoic stripe would be<br />indicative of free fluid.</p>
<p begin="00:01:31.730" end="00:01:33.770" style="s2">I'm also identifying the diaphragm,</p>
<p begin="00:01:33.770" end="00:01:35.680" style="s2">so when I look at the diaphragm,</p>
<p begin="00:01:35.680" end="00:01:37.577" style="s2">this is the hypoechoic or white line</p>
<p begin="00:01:37.577" end="00:01:39.321" style="s2">to the left side of the screen,</p>
<p begin="00:01:39.321" end="00:01:41.673" style="s2">and I should be able to<br />see that pretty easily</p>
<p begin="00:01:41.673" end="00:01:43.385" style="s2">and you can see what appears to be</p>
<p begin="00:01:43.385" end="00:01:45.593" style="s2">liver on both sides of the diaphragm,</p>
<p begin="00:01:45.593" end="00:01:47.849" style="s2">on the bottom far left of the screen.</p>
<p begin="00:01:47.849" end="00:01:50.921" style="s2">That is mirror artifact<br />and is a normal finding.</p>
<p begin="00:01:50.921" end="00:01:53.945" style="s2">If the patient had a pleural<br />fluid collection after trauma</p>
<p begin="00:01:53.945" end="00:01:55.457" style="s2">that would be a hemothorax,</p>
<p begin="00:01:55.457" end="00:01:59.624" style="s2">we would see an anechoic or<br />black area in this location.</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="00:00:07.200" 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>