<p begin="00:00:08.580" end="00:00:10.059" style="s2">- [Voiceover] A phased array transducer</p>
<p begin="00:00:10.059" end="00:00:12.768" style="s2">with an abdomen exam<br />type is used to evaluate</p>
<p begin="00:00:12.768" end="00:00:16.201" style="s2">the chest cavity for<br />the presence of fluid.</p>
<p begin="00:00:16.201" end="00:00:18.749" style="s2">The procedure is best<br />performed with the subject</p>
<p begin="00:00:18.749" end="00:00:21.484" style="s2">in a sitting position,<br />leaning slightly forward,</p>
<p begin="00:00:21.484" end="00:00:25.026" style="s2">to allow access to the<br />posterior chest cavity.</p>
<p begin="00:00:25.026" end="00:00:27.464" style="s2">The patient is instructed<br />to breathe normally.</p>
<p begin="00:00:27.464" end="00:00:30.645" style="s2">And the transducer is placed<br />in a long-axis orientation</p>
<p begin="00:00:30.645" end="00:00:32.742" style="s2">over the posterior chest wall</p>
<p begin="00:00:32.742" end="00:00:35.483" style="s2">at the eighth or ninth intercostal space,</p>
<p begin="00:00:35.483" end="00:00:37.932" style="s2">in the posterior axillary line.</p>
<p begin="00:00:37.932" end="00:00:41.384" style="s2">The orientation marker is<br />directed to the patient's head.</p>
<p begin="00:00:41.384" end="00:00:44.312" style="s2">The ribs are identified in<br />the near field of the image</p>
<p begin="00:00:44.312" end="00:00:47.848" style="s2">as a bright interface<br />with a posterior shadow.</p>
<p begin="00:00:47.848" end="00:00:50.107" style="s2">The pleural line is identified as a bright</p>
<p begin="00:00:50.107" end="00:00:53.002" style="s2">hyperechoic line between the rib shadows.</p>
<p begin="00:00:53.002" end="00:00:55.800" style="s2">The to and fro sliding<br />movement of the visceral pleura</p>
<p begin="00:00:55.800" end="00:00:58.175" style="s2">against the parietal<br />pleura, with breathing,</p>
<p begin="00:00:58.175" end="00:01:00.504" style="s2">generates the lung sliding sign.</p>
<p begin="00:01:00.504" end="00:01:03.640" style="s2">The transducer is moved along<br />the posterior axillary line</p>
<p begin="00:01:03.640" end="00:01:07.426" style="s2">to identify the bright,<br />hyperreflective diaphragm.</p>
<p begin="00:01:07.426" end="00:01:10.018" style="s2">Fluid will appear as a dark anechoic area</p>
<p begin="00:01:10.018" end="00:01:12.559" style="s2">in the dependent area of the chest cavity.</p>
<p begin="00:01:12.559" end="00:01:14.832" style="s2">Identify the borders<br />of the fluid collection</p>
<p begin="00:01:14.832" end="00:01:17.483" style="s2">and the normal appearing lung.</p>
<p begin="00:01:17.483" end="00:01:19.544" style="s2">A needle insertion site should be chosen</p>
<p begin="00:01:19.544" end="00:01:21.134" style="s2">in the posterior chest,</p>
<p begin="00:01:21.134" end="00:01:24.293" style="s2">in a dependent area of<br />the fluid collection.</p>
<p begin="00:01:24.293" end="00:01:28.129" style="s2">Adjust the transducer so it<br />is located between two ribs.</p>
<p begin="00:01:28.129" end="00:01:30.041" style="s2">The needle should be inserted just below</p>
<p begin="00:01:30.041" end="00:01:32.080" style="s2">the center position of the transducer</p>
<p begin="00:01:32.080" end="00:01:34.192" style="s2">to allow the needle to pass just superior</p>
<p begin="00:01:34.192" end="00:01:37.509" style="s2">to the lower rib to avoid<br />the neurovascular bundle,</p>
<p begin="00:01:37.509" end="00:01:40.600" style="s2">which lies on the inferior<br />surface of the rib.</p>
<p begin="00:01:40.600" end="00:01:42.756" style="s2">Follow the needle entry by slowly sliding</p>
<p begin="00:01:42.756" end="00:01:46.096" style="s2">the transducer in the direction<br />of needle advancement.</p>
<p begin="00:01:46.096" end="00:01:49.808" style="s2">The needle will appear as a<br />small bright hyperechoic dot.</p>
<p begin="00:01:49.808" end="00:01:51.769" style="s2">When the needle tip appears,</p>
<p begin="00:01:51.769" end="00:01:55.196" style="s2">the transducer should be advanced<br />a short distance distally</p>
<p begin="00:01:55.196" end="00:01:58.201" style="s2">to follow the tip of<br />the needle trajectory.</p>
<p begin="00:01:58.201" end="00:02:00.488" style="s2">The needle is slowly advanced under direct</p>
<p begin="00:02:00.488" end="00:02:03.408" style="s2">ultrasound visualization<br />until the tip is seen</p>
<p begin="00:02:03.408" end="00:02:07.005" style="s2">to indent and then puncture<br />the parietal pleura.</p>
<p begin="00:02:07.005" end="00:02:09.897" style="s2">The transducer should be<br />moved slightly proximally</p>
<p begin="00:02:09.897" end="00:02:12.849" style="s2">and distally to confirm<br />that the needle tip lies</p>
<p begin="00:02:12.849" end="00:02:16.516" style="s2">in the fluid collection<br />in the chest cavity.</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="00:00:07.459" end="00:00:09.119" style="s2">- [Voiceover] A phased array transducer</p>
<p begin="00:00:09.119" end="00:00:11.852" style="s2">with a cardiac exam<br />type is used to perform</p>
<p begin="00:00:11.852" end="00:00:15.084" style="s2">the parasternal short<br />axis view of the heart.</p>
<p begin="00:00:15.084" end="00:00:18.007" style="s2">If possible, place the<br />patient in a left lateral</p>
<p begin="00:00:18.007" end="00:00:21.500" style="s2">decubitus position to<br />reduce any lung artifact</p>
<p begin="00:00:21.500" end="00:00:24.866" style="s2">and to bring the heart closer<br />to the anterior chest wall.</p>
<p begin="00:00:24.866" end="00:00:27.393" style="s2">Place the transducer<br />at the third or fourth</p>
<p begin="00:00:27.393" end="00:00:31.262" style="s2">intercostal space immediately<br />left of the sternum.</p>
<p begin="00:00:31.262" end="00:00:34.455" style="s2">Move between the third and<br />fourth intercostal space</p>
<p begin="00:00:34.455" end="00:00:38.127" style="s2">and slide the transducer toward<br />and away from the sternum</p>
<p begin="00:00:38.127" end="00:00:40.961" style="s2">to identify the optimal scanning window.</p>
<p begin="00:00:40.961" end="00:00:43.757" style="s2">Assuming the short axis of<br />the heart to be positioned</p>
<p begin="00:00:43.757" end="00:00:45.991" style="s2">on a plane from the<br />patient's right shoulder</p>
<p begin="00:00:45.991" end="00:00:47.457" style="s2">to the left hip.</p>
<p begin="00:00:47.457" end="00:00:49.349" style="s2">Rotate the transducer to adjust</p>
<p begin="00:00:49.349" end="00:00:52.084" style="s2">for the body habitus of the patient.</p>
<p begin="00:00:52.084" end="00:00:54.458" style="s2">The orientation marker<br />will be at approximately</p>
<p begin="00:00:54.458" end="00:00:56.443" style="s2">the two o'clock position.</p>
<p begin="00:00:56.443" end="00:00:59.555" style="s2">As an alternative approach,<br />this exam may be performed</p>
<p begin="00:00:59.555" end="00:01:02.883" style="s2">using an abdomen exam type<br />with an orientation marker</p>
<p begin="00:01:02.883" end="00:01:05.400" style="s2">to the patient's left<br />side at approximately</p>
<p begin="00:01:05.400" end="00:01:07.650" style="s2">the eight o'clock position.</p>
<p begin="00:01:11.625" end="00:01:13.778" style="s2">The myocardium will appear gray</p>
<p begin="00:01:13.778" end="00:01:17.599" style="s2">and the blood-filled chambers<br />will appear hypoechoic.</p>
<p begin="00:01:17.599" end="00:01:20.165" style="s2">The left ventricle will<br />appear as a doughnut shape</p>
<p begin="00:01:20.165" end="00:01:21.924" style="s2">in the center of the image.</p>
<p begin="00:01:21.924" end="00:01:25.905" style="s2">The anterior, septal,<br />inferior, and posterior</p>
<p begin="00:01:25.905" end="00:01:29.304" style="s2">lateral walls of the<br />ventricle can be identified.</p>
<p begin="00:01:29.304" end="00:01:32.414" style="s2">The mitral valve will be<br />seen in cross section.</p>
<p begin="00:01:32.414" end="00:01:35.839" style="s2">From this position, the<br />transducer can be tilted upward</p>
<p begin="00:01:35.839" end="00:01:39.756" style="s2">to visualize the aortic<br />valve in cross section.</p>
<p begin="00:01:41.591" end="00:01:44.146" style="s2">End downward to visualize the myocardium</p>
<p begin="00:01:44.146" end="00:01:45.882" style="s2">of the left ventricle.</p>
<p begin="00:01:45.882" end="00:01:48.959" style="s2">Note the wall motion of<br />the myocardial segments</p>
<p begin="00:01:48.959" end="00:01:51.209" style="s2">and function of the valves.</p>

<p begin="00:00:07.106" end="00:00:08.866" style="s2">- [Voiceover] A phased array<br />transducer with a cardiac</p>
<p begin="00:00:08.866" end="00:00:12.916" style="s2">exam type, is used to<br />perform parasternal long axis</p>
<p begin="00:00:12.916" end="00:00:14.778" style="s2">view of the heart.</p>
<p begin="00:00:14.778" end="00:00:17.654" style="s2">If possible, place the<br />patient in a left lateral</p>
<p begin="00:00:17.654" end="00:00:21.151" style="s2">decubitus position to<br />reduce any lung artifact,</p>
<p begin="00:00:21.151" end="00:00:24.731" style="s2">and to bring the heart closer<br />to the anterior chest wall.</p>
<p begin="00:00:24.731" end="00:00:27.664" style="s2">Place the transducer at the<br />third, or fourth, intercostal</p>
<p begin="00:00:27.664" end="00:00:31.090" style="s2">space immediately left of the sternum.</p>
<p begin="00:00:31.090" end="00:00:33.750" style="s2">Move between the third, and<br />fourth intercostal space,</p>
<p begin="00:00:33.750" end="00:00:37.596" style="s2">and slide the transducer toward,<br />and away from the sternum</p>
<p begin="00:00:37.596" end="00:00:40.566" style="s2">to identify the optimal scanning window.</p>
<p begin="00:00:40.566" end="00:00:43.524" style="s2">Assuming the long axis of the<br />heart to be positioned on a</p>
<p begin="00:00:43.524" end="00:00:46.849" style="s2">plane from the patients right<br />shoulder to left hip, rotate</p>
<p begin="00:00:46.849" end="00:00:49.196" style="s2">the transducer to adjust for the body</p>
<p begin="00:00:49.196" end="00:00:51.410" style="s2">habitus of the patient.</p>
<p begin="00:00:51.410" end="00:00:53.859" style="s2">The orientation marker,<br />will be at approximately</p>
<p begin="00:00:53.859" end="00:00:56.177" style="s2">the 10 o'clock position.</p>
<p begin="00:00:56.177" end="00:00:59.571" style="s2">As an alternative approach,<br />this exam may be performed using</p>
<p begin="00:00:59.571" end="00:01:02.742" style="s2">an abdomen exam type, with<br />the orientation marker</p>
<p begin="00:01:02.742" end="00:01:05.027" style="s2">to the patients right<br />side at approximately</p>
<p begin="00:01:05.027" end="00:01:06.944" style="s2">the 4 o'clock position.</p>
<p begin="00:01:11.288" end="00:01:14.255" style="s2">They myocardium will appear<br />gray, and the blood filled</p>
<p begin="00:01:14.255" end="00:01:17.073" style="s2">chambers will appear hypoechoic.</p>
<p begin="00:01:17.073" end="00:01:20.146" style="s2">The descending aorta is seen<br />in cross section as a round</p>
<p begin="00:01:20.146" end="00:01:24.539" style="s2">structure posterior to the<br />atrioventricular junction.</p>
<p begin="00:01:24.539" end="00:01:27.664" style="s2">This view is used to evaluate<br />the right ventricle, left</p>
<p begin="00:01:27.664" end="00:01:31.331" style="s2">ventricle outflow tract,<br />and left ventricle.</p>
<p begin="00:01:31.331" end="00:01:33.811" style="s2">Note overall activity of the heart.</p>
<p begin="00:01:33.811" end="00:01:37.211" style="s2">Any wall motion abnormality,<br />valve abnormalities,</p>
<p begin="00:01:37.211" end="00:01:40.628" style="s2">and the presence of pericardial effusion.</p>

<p begin="00:00:07.145" end="00:00:09.034" style="s2">- [Voiceover] A phased array transducer</p>
<p begin="00:00:09.034" end="00:00:11.398" style="s2">with a cardiac exam<br />type is used to perform</p>
<p begin="00:00:11.398" end="00:00:14.044" style="s2">the apical four chamber view of the heart.</p>
<p begin="00:00:14.044" end="00:00:16.203" style="s2">If possible, place the patient</p>
<p begin="00:00:16.203" end="00:00:18.549" style="s2">in a left-lateral decubitus position</p>
<p begin="00:00:18.549" end="00:00:21.190" style="s2">to reduce any lung artifact<br />and to bring the heart</p>
<p begin="00:00:21.190" end="00:00:23.645" style="s2">closer to the anterior chest wall.</p>
<p begin="00:00:23.645" end="00:00:25.659" style="s2">Place the transducer at the apex</p>
<p begin="00:00:25.659" end="00:00:27.843" style="s2">or point of maximum impulse,</p>
<p begin="00:00:27.843" end="00:00:30.226" style="s2">with the orientation<br />marker to the patient's</p>
<p begin="00:00:30.226" end="00:00:32.892" style="s2">left side at a three o'clock position.</p>
<p begin="00:00:32.892" end="00:00:35.499" style="s2">As an alternative<br />approach, this exam may be</p>
<p begin="00:00:35.499" end="00:00:37.954" style="s2">performed using an abdomen exam type,</p>
<p begin="00:00:37.954" end="00:00:42.421" style="s2">with the orientation marker<br />to the patient's right side.</p>
<p begin="00:00:42.421" end="00:00:44.588" style="s2">Aim to the right shoulder.</p>
<p begin="00:00:47.866" end="00:00:50.113" style="s2">The apex of the heart is visualized</p>
<p begin="00:00:50.113" end="00:00:52.001" style="s2">closest to the transducer.</p>
<p begin="00:00:52.001" end="00:00:54.267" style="s2">The myocardium will appear gray,</p>
<p begin="00:00:54.267" end="00:00:57.939" style="s2">and the blood-filled chambers<br />will appear hypoechoic.</p>
<p begin="00:00:57.939" end="00:01:00.250" style="s2">The ventricles are in the near field,</p>
<p begin="00:01:00.250" end="00:01:03.429" style="s2">and the atria are in the<br />far field of the image.</p>
<p begin="00:01:03.429" end="00:01:06.094" style="s2">This view is used to compare<br />the size of the right</p>
<p begin="00:01:06.094" end="00:01:09.410" style="s2">and left ventricles and<br />evaluate contractility.</p>
<p begin="00:01:09.410" end="00:01:11.504" style="s2">The right side of the heart,</p>
<p begin="00:01:11.504" end="00:01:14.305" style="s2">which is located on the<br />left side of the screen,</p>
<p begin="00:01:14.305" end="00:01:16.631" style="s2">should be smaller than the left.</p>
<p begin="00:01:16.631" end="00:01:19.589" style="s2">Th apical, septal, and lateral walls</p>
<p begin="00:01:19.589" end="00:01:23.756" style="s2">of the left ventricle are<br />visualized in this view.</p>