Fluid

How to: Focused Echo: Apical View

Read more about How to: Focused Echo: Apical View

/sites/default/files/14_Focused_Echo_Apical_View_Scanning_Technique.jpg

Learn to examine the heart using the apical window and four chamber plane.

Applications

Cardiology

Media Library Type

How To Videos

Subtitles

- The other view that you wanna do
as part of the focused echo examination
is the apical four chamber view,
and the orientation marker for this view
is gonna be to the patent's left.
So it actually matches the orientation marker on the screen.
To identify where you need to go, palpate for the PMI,
and then place the transducer at this point.
This is the apical four chamber view.
On this view, we have an overall assessment of the heart.
We can see all chambers of the heart in one view.
On the left side of the screen,
we're gonna see the right side of the heart.
So this is gonna be the right atrium, tricuspid valve,
right ventricle, intraventricular septum,
left ventricle, mitral valve, and left atrium.
And what we're really looking for here is a comparison
of right to left side, size of the left ventricle
to the right ventricle, left atrium to the right atrium.
If you've determined that you need
to do a pericardiocentesis, this is a good view to evaluate
if you can get good access from this point,
because if you can get access from this point,
instead of going through the subxiphoid approach,
you avoid the liver altogether,
and at this point, you're very close to the heart
and can quickly identify where the fluid is
and draw it out.

Brightcove ID

5752153080001

https://youtube.com/watch?v=Ze0s5XRv2gQ

How to: Focused Echo: Parasternal View

Read more about How to: Focused Echo: Parasternal View

/sites/default/files/13_Focused_Echo_Parasternal_View_Scanning_Technique.jpg

Learn to examine the heart using the parasternal window and the long axis plane.

Applications

Cardiology

Media Library Type

How To Videos

Subtitles

- Okay, I'm going to walk you through the steps of
doing a focused echo exam.
And, there's a couple of different views that you do
as part of the focused echo exam.
I'm going to concentrate first on the parasternal
long axis, and then we'll walk you through the
apical four-chamber view as well.
The parasternal long axis, you can also use as part
of your FAST examination if you're having trouble
doing the subcostal or subxiphoid view.
The parasternal long axis is a great alternative to
get an overall estimation of function of the left ventricle,
as part of the FAST exam, and also
evaluate for pericardial effusion.
Okay, so the first thing you're going to do with this,
if you can, is have the patient
turn over to their left side.
The reason we like to do this is as you have the patient
turned to their left, the heart's going to fall forward in
the chest cavity and bring it a little bit closer to the
window that you're trying to access, through the ribs.
So in this case, if we're doing a cardiac examination, with
a cardiac exam type, we want the orientation marker facing
up to the patient's right shoulder.
So once we have the orientation figured out, we're going to
put a little bit of gel on the transducer.
And we're going to find where the sternum is, and just move,
just a little bit left of the sternum, looking for the
fourth to sixth intercostal space.
And that should put you at least in the ballpark area for
where you're going to find the parasternal long axis
view of the heart.
So remembering that the heart sits in the body
at a slight angle, this is going to be the
long axis view of the heart itself.
Not long axis of the body, but we'll look at the long
axis of the heart.
When we look at the ultrasound image, we should quickly
be able to identify the left ventricle, which we see here.
And what we're evaluating for is a squeeze
of this left ventricle.
So on this image, we have the right ventricle,
left ventricle, left atrium, and the aorta.
Mitral valve, and aortic valve.
Typically, we are doing this examination to
evaluate for pericardial effusion.
So we want to identify the pericardium.
This is going to be this bright, white line
around the heart.
What's important in this view is that
you have it deep enough so that you can identify
where the descending aorta is.
The descending aorta is going to appear posterior
to the left atrium.
And we're going to see it as a round circle.
If the fluid is in the pericardium,
it's going to be above this descending aorta.
If it's a plural effusion, it's going to be
behind the descending aorta.
So this is a very important landmark that you need to
identify, so you can clearly establish
where the fluid is present.
Another important area you have to identify to determine
exactly where the pericardial effusion is, is the
anterior aspect of the heart.
You have to be careful when you evaluate this area,
because there could be a fat pad in this area
that appears hypoechoic.
So for it to be a true pericardial effusion, we want to
see the fluid wrapping all the way around the heart,
to the posterior aspect.
If it's just here, in the anterior aspect,
it's probably just a fat pad.

Brightcove ID

5752164354001

https://youtube.com/watch?v=ZzizANi2bJQ

How To: Female Pelvis: Transabdominal View

Read more about How To: Female Pelvis: Transabdominal View

/sites/default/files/09_Female_Pelvis_Transabdominal_Scanning_Technique.jpg

Learn the basics of female transabdominal pelvic scanning.

Clinical Specialties

Media Library Type

Media Library Tag

Subtitles

- [Voiceover] A curved, or phased array transducer,
with a pelvis exam type,
is used to perform the pelvis ultrasound exam.
A full bladder is used as an acoustic window
to view the pelvic organs.
The pelvis is evaluated in two plains.
Place the transducer in a long axis position
with the orientation marker to the patient's head,
at the level of the symphysis pubis.
Angle the transducer inferiorly into the pelvis.
The bladder appears in the near-field of the image,
as a hypoechoic triangular structure.
The uterus is gray in appearance
and located either directly posterior
or superior to the bladder.
The endometrial stripe will appear as
a bright echogenic line from the fundus to the cervix.
The uterus does not always lay directly in the midline
so it may be necessary to slightly rotate the transducer
to view the entire length of the uterus.
Sweep the transducer from side to side
to see the entire uterus.
The ovaries may be seen by sweeping the transducer
to the lateral aspects of the pelvis.
They are almond-shaped and slightly hypoechoic structures.
Follicles may appear as multiple
hypoechoic, cystic structures within the ovaries.
Some follicles may be quite prominent,
depending upon the luteal stage.
To obtain a transverse view of the uterus,
rotate the transducer 90 degrees,
so the orientation marker is to the patient's right.
The bladder appears more rectangular in shape in this view.
Sweep the transducer superiorly
from the level of the cervix to the fundus
to see the entire uterus.
The ovaries will be seen on either side of the uterus
and can vary in location,
from a superior to inferior position.

Brightcove ID

5750473717001

https://youtube.com/watch?v=ebpcUlQVmLE

How To: FAST Exam: Female Pelvis

Read more about How To: FAST Exam: Female Pelvis

/sites/default/files/08_FAST_Exam_Female_Pelvic_View_Scanning_Technique.jpg

Learn to examine the female pelvis for free fluid.

Media Library Type

Media Library Tag

Subtitles

- We're gonna do the FAST exam,
the pelvic view in a female now.
Again we have the phase array transducer,
here's our probe marker right here,
I'm gonna start off with a sagittal view.
And ideally, the (slurred) bladder is full.
So you go just above the symphysis pubis,
so we're scanning down here sagittaly,
and some of the anatomic landmarks
that we're looking at,
at the very top of the screen is the bladder,
which is an anechoic structure,
fluid filled, obviously with urine,
it's got nice walls around it.
Just below that is the uterus,
which is a pear-shaped organ.
You can see it well visualized
because the bladder is full.
And just below that
is a potential space, the Cul de Sac,
where we can look for, very carefully,
small amounts of free fluid.
When we scan this patient,
in this view, in the sagittal view,
from the patient's left to the patient's right.
And we're slowly slowly scanning to see
if there's any evidence of free fluid.
Once we finish the sagittal view,
we want to go ahead and do a transverse view.
What we're gonna do now
is point the transducer marker toward the patient's right.
So we're gonna rotate that transducer,
toward the patient's right.
Again, we see the bladder in the center of the screen.
We're now gonna scan from inferior,
just below the symphysis, to more superior,
and in between we're also gonna identify the uterus.
So we're going right to the very top of the bladder,
to about mid-bladder,
we can see the uterus here in the center.
A very small amount of free fluid here,
which can be physiological as well.
So we're scanning all the way inferiorly,
to more superiorly, we see the uterus,
we actually see part of the ovary there,
and then we're gonna go all the way more superiorly.

Brightcove ID

5508120185001

https://youtube.com/watch?v=HxQE2gYH3Sk

How to: FAST Exam: LUQ

Read more about How to: FAST Exam: LUQ

/sites/default/files/06_FAST_Exam_LUQ_View_Scanning_Technique.jpg

Learn to scan the splenorenal recess for fluid collections.

Media Library Type

Media Library Tag

Subtitles

- The next view I'm going to take you through
is a perisplenic or left upper quadrant view.
This view tends to be a little bit more difficult
because the spleen is smaller and doesn't provide
as large an acoustic window.
We're going to start.
Again, the patient's going to be supine.
This is a probe marker right here.
We're going to go really posterior.
My hand is going to touch the gurney.
You can go about four finger breadths
just above the costal margin.
You can identify the kidney.
That's going to be a pretty identifiable organ,
characteristic bean shape.
Then we can see it here on the screen.
Just above it, we're going to see the spleen.
To the far left of the screen as well
we see the diaphragm.
Once you're in this location,
you want to carefully pan through
the inferior part of the spleen,
and then jump over that rib,
and see the superior part of the spleen,
because fluid often collects just above the spleen
and below the diaphragm.
Once you identify a good view in the left upper quadrant,
you'll want to do a sweep through that area
looking for free fluid.
Again, you see the kidney, you see the spleen.
Find the interface between.
Look for fluid between those two organs.
Then particularly scan above that spleen,
scanning all the way through the organ,
looking for free fluid above the spleen
and below the diaphragm.
Again, when you're scanning through this area,
you want to carefully look above the diaphragm
for evidence of hemothorax.
When you're scanning in this view,
also make sure you scan the full kidney.
Here we see the superior pole to the left of the screen,
and the inferior pole.
You want to make sure you get that full kidney
in view when you examine the left upper quadrant.

Brightcove ID

5508114757001

https://youtube.com/watch?v=IuRklL3cWJU

How to: FAST Exam: RUQ

Read more about How to: FAST Exam: RUQ

/sites/default/files/05_FAST_Exam_RUQ_Scanning_Technique.jpg

Learn to examine Morison's pouch in the right upper quadrant for fluid collections.

Media Library Type

Media Library Tag

Subtitles

- So the patient's gonna arrive in a supine position,
they'll often be on a backboard as full spinal precaution,
so motion of the patient will be impossible.
We're gonna choose our transducer.
We have chosen the phased array transducer,
we're gonna put a little gel on top of it.
And I like to put the probe marker
toward the patient's head, toward the axilla,
at about the midaxillaral line, 10 to 11th ribs.
Another easy tip to find out the location
is get to the costal margin,
go about three finger-breadths above it,
and you should be able to find the kidney
and see the adjacent liver.
I'm just adjusting my gain here.
And already I can see the interface
between the kidney and the liver, which is Morison's pouch.
So what we see here, on the bottom,
this crescent shaped organ, is the kidney.
Above it we see the liver,
and just to the left side of the screen
we see the diaphragm.
So when I'm examining this area,
I'm gonna carefully scan through
the entire area of Morison's pouch,
including at the liver tip.
So we see this whole area here
looking for an anechoic stripe.
An anechoic stripe would be indicative of free fluid.
I'm also identifying the diaphragm,
so when I look at the diaphragm,
this is the hypoechoic or white line
to the left side of the screen,
and I should be able to see that pretty easily
and you can see what appears to be
liver on both sides of the diaphragm,
on the bottom far left of the screen.
That is mirror artifact and is a normal finding.
If the patient had a pleural fluid collection after trauma
that would be a hemothorax,
we would see an anechoic or black area in this location.

Brightcove ID

5508114130001

https://youtube.com/watch?v=0VTRm_DNW8s

How to: FAST Exam: Male Pelvis

Read more about How to: FAST Exam: Male Pelvis

/sites/default/files/03_FAST_Exam_Male_Pelvic_View_Scanning_Technique.jpg

Learn the suprapubic view of the trauma FAST exam in males.

Media Library Type

Media Library Tag

Subtitles

- We're going to go ahead and do the suprapubic view
of the FAST exam.
We're going to put a little gel on this transducer
and we're going to go just above the symphysis pubis
and we're going to start initially sagittally
and then we're going to scan transversely.
We have our marker right here.
That's going to be aiming toward the patient's head
and we're going to put this transducer
just above the symphysis pubis
and we're going to see the bladder.
We can see a pretty large bladder here.
The first thing I'll take a look at when I see the image
is that we need to adjust our depth,
so I'm changing the depth here
to make this bladder into a better size
that is going to fit better within the image.
The next thing I notice that I do need to adjust
is the gain.
This is a very important knob to be adjusting
because in this view particularly
you can have a lot of acoustic enhancement
posterior to the bladder
and we don't want to miss small amounts of fluid.
The far gain, which is this knob here,
may need to be adjusted additionally.
Once you identify the bladder,
which we see as an anechoic structure
with nice circumscribed walls,
you want to then scan from left
to right,
looking particularly for evidence of fluid
outside of that circumscribed bladder.
We're looking for free fluid within the pelvis.
Once we're satisfied that we can see the full bladder
in a sagittal fashion,
we're then going to turn the transducer marker here
toward the patient's right,
and we're going to scan again.
Now we're in a transverse view
and were scanning from very inferiorly
to superiorly,
again looking for free fluid outside of the bladder.
As you're scanning through the bladder,
again you're looking for free fluid,
remember free fluid is anechoic or black on ultrasounds
so that's what you're going to be looking for
outside of the bladder.

Brightcove ID

5508104675001

https://youtube.com/watch?v=6Srf0briZSU