Hypotension

- 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: Focused Echo: Subcostal View

Read more about How to: Focused Echo: Subcostal View

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Learn to examine the heart using the subcostal window and four chamber plane. This view is commonly taught as part of the cardiac evaluation during the trauma FAST exam.

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Cardiology

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- The next view I'm gonna take you through
in the FAST exam is the subcoastal view
of the heart in a four-chamber plane.
For this, we're gonna put our transducer
to phased array
to the subxiphoid area,
aiming towards the patient's left shoulder.
Here is the probe marker here,
which I'm going to angle towards
the patient's right.
When I do this exam, I wanna make sure this transducer is
along the frontal plane
and aiming toward the chest.
A common mistake is to go too
inferior into the abdomen,
so you want to go deep into the chest.
When you're in this location,
the other thing you're gonna need to do
is increase your depth.
I'm gonna use my depth key right here
and I'm gonna increase,
so I can see the full heart in view
and now you can see we're at 21 centimeters.
Some common landmarks that you need to identify,
the first thing you see is that we see liver
at the top of the screen.
That liver is our coustic window into the heart.
The beating thing in the center is obviously the heart
and we can identify the entire heart
and the perimeter of the heart with the pericardium.
The pericardium is the white line that I'm seeing,
you can see that's surrounding the full heart.
Then we can identify the chambers.
The chambers are relatively easy to identify
in this view.
The chambers on the right side
of the heart are over here
and the easy way to identify those,
remember the liver's on the right side of the body,
so these chambers that are adjacent to the liver would be
right-sided chambers.
The large chamber, which is adjacent to the liver
is the right ventricle,
on the other side we see the left ventricle
and we see the two atria.
Again, our focus
on this exam is to identify the pericardium
and to look for free fluid within it.
What we're gonna look for
is an anechoic area within that pericardium
which would be signs of a hemopericadium.
Now if you can't get this view,
a great alternate view is the parasternal view
of the heart in a long axis plane.
We're gonna take you through that in the
echocardiography section.

Brightcove ID

5794989675001

https://youtube.com/watch?v=Mkc6tUVRgKo

How to: FAST Exam: LUQ

Read more about How to: FAST Exam: LUQ

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Learn to scan the splenorenal recess for fluid collections.

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- 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

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

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- 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

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

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- 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