<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="00:00:15.596" 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>