<p begin="00:00:07.000" end="00:00:09.879" style="s2">- [Voiceover] A curved or<br />phased array transducer with an</p>
<p begin="00:00:09.879" end="00:00:12.611" style="s2">abdomen exam type is used to perform a</p>
<p begin="00:00:12.611" end="00:00:14.407" style="s2">renal ultrasound exam.</p>
<p begin="00:00:14.407" end="00:00:17.740" style="s2">The kidney should be<br />evaluated in two planes.</p>
<p begin="00:00:17.740" end="00:00:21.151" style="s2">The transducer is placed in<br />a long access orientation</p>
<p begin="00:00:21.151" end="00:00:23.459" style="s2">along the right midaxillary line,</p>
<p begin="00:00:23.459" end="00:00:24.913" style="s2">at the costal margin,</p>
<p begin="00:00:24.913" end="00:00:27.233" style="s2">with the orientation<br />marker directed toward the</p>
<p begin="00:00:27.233" end="00:00:28.487" style="s2">patient's head.</p>
<p begin="00:00:28.487" end="00:00:30.913" style="s2">If it is difficult to<br />visualize the kidney,</p>
<p begin="00:00:30.913" end="00:00:33.981" style="s2">a deep inspiration will move<br />the kidney below the ribs,</p>
<p begin="00:00:33.981" end="00:00:36.044" style="s2">for easier access.</p>
<p begin="00:00:36.044" end="00:00:39.524" style="s2">It may also be necessary to<br />move the transducer proximally</p>
<p begin="00:00:39.524" end="00:00:42.725" style="s2">along the midaxillary line,<br />to visualize the kidneys,</p>
<p begin="00:00:42.725" end="00:00:44.939" style="s2">using an intercostal approach.</p>
<p begin="00:00:44.939" end="00:00:48.233" style="s2">Using this approach will<br />result in rib shadow artifacts</p>
<p begin="00:00:48.233" end="00:00:50.609" style="s2">overlying the ultrasound image.</p>
<p begin="00:00:50.609" end="00:00:53.963" style="s2">Once the kidney is identified,<br />the transducer is slightly</p>
<p begin="00:00:53.963" end="00:00:58.130" style="s2">rotated to adjust for the oblique<br />orientation of the kidney.</p>
<p begin="00:01:04.713" end="00:01:08.435" style="s2">The transducer is swept<br />from anterior to posterior</p>
<p begin="00:01:08.435" end="00:01:10.457" style="s2">to image the kidney parenchyma,</p>
<p begin="00:01:10.457" end="00:01:14.119" style="s2">which will appear hypoechoic<br />when compared to the liver.</p>
<p begin="00:01:14.119" end="00:01:16.892" style="s2">The renal pyramids are<br />triangular in shape,</p>
<p begin="00:01:16.892" end="00:01:19.550" style="s2">and darker than the renal cortex.</p>
<p begin="00:01:19.550" end="00:01:23.140" style="s2">The renal pelvis will appear<br />as bright, hyperechoic echoes</p>
<p begin="00:01:23.140" end="00:01:24.546" style="s2">within the kidney.</p>
<p begin="00:01:24.546" end="00:01:27.247" style="s2">To obtain a transverse access view,</p>
<p begin="00:01:27.247" end="00:01:29.659" style="s2">rotate the transducer 90 degrees,</p>
<p begin="00:01:29.659" end="00:01:31.652" style="s2">from the long access position.</p>
<p begin="00:01:31.652" end="00:01:34.098" style="s2">The kidney appear as a circular structure,</p>
<p begin="00:01:34.098" end="00:01:35.311" style="s2">with a horseshoe shape,</p>
<p begin="00:01:35.311" end="00:01:37.249" style="s2">at the level of the renal pelvis.</p>
<p begin="00:01:37.249" end="00:01:40.994" style="s2">The transducer is swept from<br />the superior to inferior poles,</p>
<p begin="00:01:40.994" end="00:01:43.494" style="s2">to evaluate the entire kidney.</p>

<p begin="00:00:08.000" end="00:00:09.607" style="s2">- [Voiceover] A phased array transducer</p>
<p begin="00:00:09.607" end="00:00:12.167" style="s2">with an abdomen exam<br />type is used to perform</p>
<p begin="00:00:12.167" end="00:00:15.543" style="s2">the right upper quadrant<br />view of the FAST exam.</p>
<p begin="00:00:15.543" end="00:00:17.461" style="s2">The orientation marker is directed</p>
<p begin="00:00:17.461" end="00:00:19.301" style="s2">towards the patients head.</p>
<p begin="00:00:19.301" end="00:00:23.018" style="s2">The transducer is placed<br />in a long axis orientation</p>
<p begin="00:00:23.018" end="00:00:25.466" style="s2">along the right mid-auxiliary line between</p>
<p begin="00:00:25.466" end="00:00:28.380" style="s2">the 7th to 9th inter-costal space.</p>
<p begin="00:00:28.380" end="00:00:31.659" style="s2">Rotation and oblique<br />positioning of the transducer</p>
<p begin="00:00:31.659" end="00:00:34.326" style="s2">will help eliminate rib shadows.</p>
<p begin="00:00:35.740" end="00:00:39.277" style="s2">To evaluate the entire area<br />of the hepatorenal recess</p>
<p begin="00:00:39.277" end="00:00:41.860" style="s2">for free fluid sweep the transducer</p>
<p begin="00:00:41.860" end="00:00:45.188" style="s2">from an anterior to posterior position.</p>
<p begin="00:00:45.188" end="00:00:47.958" style="s2">If present, fluid will appear as a dark</p>
<p begin="00:00:47.958" end="00:00:51.605" style="s2">or aniconic strip between<br />the kidney and the liver.</p>
<p begin="00:00:51.605" end="00:00:55.078" style="s2">If it is difficult to visualize<br />the hepatorenal recess.</p>
<p begin="00:00:55.078" end="00:00:57.402" style="s2">A deep inspiration will move the diaphragm</p>
<p begin="00:00:57.402" end="00:00:59.322" style="s2">and other structures in this area</p>
<p begin="00:00:59.322" end="00:01:02.882" style="s2">down and below the ribs for easier access.</p>
<p begin="00:01:02.882" end="00:01:05.357" style="s2">Sliding the transducer<br />upward will visualize</p>
<p begin="00:01:05.357" end="00:01:08.194" style="s2">the diaphragm and plural interface.</p>
<p begin="00:01:08.194" end="00:01:11.155" style="s2">Sliding the transducer<br />downward will visualize</p>
<p begin="00:01:11.155" end="00:01:14.405" style="s2">the inferior pole of the right kidney.</p>

<p begin="00:00:07.200" end="00:00:09.566" style="s2">- [Voiceover] A phased array transducer</p>
<p begin="00:00:09.566" end="00:00:11.913" style="s2">with an abdomen exam<br />type is used to perform</p>
<p begin="00:00:11.913" end="00:00:14.758" style="s2">the left upper quadrant<br />view of the FAST Exam.</p>
<p begin="00:00:14.758" end="00:00:16.868" style="s2">The orientation marker is directed</p>
<p begin="00:00:16.868" end="00:00:18.771" style="s2">toward the patient's head.</p>
<p begin="00:00:18.771" end="00:00:22.071" style="s2">the transducer is placed in<br />a long-access orientation</p>
<p begin="00:00:22.071" end="00:00:24.725" style="s2">along the left-posterior axillary line</p>
<p begin="00:00:24.725" end="00:00:28.372" style="s2">between the fifth to<br />seventh intercostal spaces.</p>
<p begin="00:00:28.372" end="00:00:30.923" style="s2">The sonographer's hand<br />will touch the gurney</p>
<p begin="00:00:30.923" end="00:00:33.344" style="s2">with the proper transducer position.</p>
<p begin="00:00:33.344" end="00:00:36.425" style="s2">Rotation and oblique<br />positioning of the transducer</p>
<p begin="00:00:36.425" end="00:00:39.092" style="s2">will help eliminate rib shadows.</p>
<p begin="00:00:43.087" end="00:00:46.518" style="s2">To evaluate the entire area<br />of the spleenorenal recess</p>
<p begin="00:00:46.518" end="00:00:49.173" style="s2">for free fluid, sweep the transducer</p>
<p begin="00:00:49.173" end="00:00:52.423" style="s2">from an anterior to posterior position.</p>
<p begin="00:00:53.723" end="00:00:56.699" style="s2">Carefully examine the spleenorenal recess</p>
<p begin="00:00:56.699" end="00:00:58.567" style="s2">and subphrenic space.</p>
<p begin="00:00:58.567" end="00:01:01.479" style="s2">Fluid will appear dark or anechoic.</p>
<p begin="00:01:01.479" end="00:01:04.925" style="s2">If it is difficult to visualize<br />the spreenorenal recess,</p>
<p begin="00:01:04.925" end="00:01:07.562" style="s2">a deep inspiration will move the diaphragm</p>
<p begin="00:01:07.562" end="00:01:09.580" style="s2">and other structures in this area</p>
<p begin="00:01:09.580" end="00:01:12.581" style="s2">down and below the ribs for easier access.</p>
<p begin="00:01:12.581" end="00:01:15.311" style="s2">Sliding the transducer<br />in an upward direction</p>
<p begin="00:01:15.311" end="00:01:19.478" style="s2">will visualize the diaphragm<br />and plural interface.</p>