<p begin="00:00:07.250" end="00:00:09.115" style="s2">- [Voiceover] A phased array transducer,</p>
<p begin="00:00:09.115" end="00:00:10.741" style="s2">with an abdomen exam type,</p>
<p begin="00:00:10.741" end="00:00:13.992" style="s2">is used to perform the<br />subxiphoid or subcostal view</p>
<p begin="00:00:13.992" end="00:00:17.168" style="s2">of the heart in the fast exam.</p>
<p begin="00:00:17.168" end="00:00:20.499" style="s2">Place the transducer in<br />the subxiphoid position</p>
<p begin="00:00:20.499" end="00:00:21.997" style="s2">with the orientation marker</p>
<p begin="00:00:21.997" end="00:00:26.164" style="s2">to the patient's right side<br />at a nine o'clock position.</p>
<p begin="00:00:27.550" end="00:00:30.109" style="s2">This view uses the liver<br />as an acoustic window</p>
<p begin="00:00:30.109" end="00:00:33.113" style="s2">to visualize the four<br />chambers of the heart.</p>
<p begin="00:00:33.113" end="00:00:36.080" style="s2">Aim the transducer slightly<br />toward the left shoulder</p>
<p begin="00:00:36.080" end="00:00:39.125" style="s2">at a 15 degree angle to the chest wall.</p>
<p begin="00:00:39.125" end="00:00:40.225" style="s2">In some cases,</p>
<p begin="00:00:40.225" end="00:00:43.595" style="s2">the transducer is almost<br />flat to the abdominal wall,</p>
<p begin="00:00:43.595" end="00:00:45.582" style="s2">so the ultrasound beam is directed toward</p>
<p begin="00:00:45.582" end="00:00:47.656" style="s2">the left chest cavity.</p>
<p begin="00:00:47.656" end="00:00:49.893" style="s2">A considerable amount of ultrasound gel</p>
<p begin="00:00:49.893" end="00:00:51.884" style="s2">and downward pressure may be needed</p>
<p begin="00:00:51.884" end="00:00:54.480" style="s2">to maintain contact of the transducer face</p>
<p begin="00:00:54.480" end="00:00:56.480" style="s2">with the abdominal wall.</p>
<p begin="00:00:59.524" end="00:01:00.907" style="s2">Increase scanning depth</p>
<p begin="00:01:00.907" end="00:01:03.245" style="s2">to visualize all chambers of the heart.</p>
<p begin="00:01:03.245" end="00:01:04.989" style="s2">The first structure seen closest</p>
<p begin="00:01:04.989" end="00:01:07.593" style="s2">to the transducer is the liver.</p>
<p begin="00:01:07.593" end="00:01:09.660" style="s2">The right side of the<br />heart will appear closer</p>
<p begin="00:01:09.660" end="00:01:12.137" style="s2">to the transducer than<br />the left side of the heart</p>
<p begin="00:01:12.137" end="00:01:14.123" style="s2">on the ultrasound image.</p>
<p begin="00:01:14.123" end="00:01:16.109" style="s2">The myocardium will appear grey,</p>
<p begin="00:01:16.109" end="00:01:17.651" style="s2">and the blood-filled chambers</p>
<p begin="00:01:17.651" end="00:01:19.684" style="s2">will appear hypoechoic.</p>
<p begin="00:01:19.684" end="00:01:21.996" style="s2">The bright white pericardium<br />is seen surrounding</p>
<p begin="00:01:21.996" end="00:01:25.326" style="s2">the heart adjacent to the grey myocardium.</p>
<p begin="00:01:25.326" end="00:01:27.964" style="s2">Evaluate the function of all chambers.</p>
<p begin="00:01:27.964" end="00:01:31.741" style="s2">Compare the size of the right<br />and left ventricular cavities.</p>
<p begin="00:01:31.741" end="00:01:34.300" style="s2">Note any wall motion abnormality,</p>
<p begin="00:01:34.300" end="00:01:38.467" style="s2">and the presence or absence<br />of pericardial effusion.</p>