<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="00:00:07.856" end="00:00:09.495" style="s2">- [Voiceover] A phased array transducer</p>
<p begin="00:00:09.495" end="00:00:13.577" style="s2">with a long exam type is used<br />to evaluate lung sliding.</p>
<p begin="00:00:13.577" end="00:00:17.220" style="s2">The anterior, lateral, and<br />posterior zones of the chest wall</p>
<p begin="00:00:17.220" end="00:00:19.143" style="s2">should be evaluated.</p>
<p begin="00:00:19.143" end="00:00:22.729" style="s2">The transducer is placed<br />in a long-axis orientation</p>
<p begin="00:00:22.729" end="00:00:25.845" style="s2">over the anterior chest<br />wall at the third or fourth</p>
<p begin="00:00:25.845" end="00:00:29.869" style="s2">intercostal space in the<br />anterior axillary line.</p>
<p begin="00:00:29.869" end="00:00:33.773" style="s2">The orientation marker is<br />directed to the patient's head.</p>
<p begin="00:00:33.773" end="00:00:36.642" style="s2">A shallow scanning depth is used.</p>
<p begin="00:00:36.642" end="00:00:39.653" style="s2">The ribs are identified in<br />the near field of the image</p>
<p begin="00:00:39.653" end="00:00:43.907" style="s2">as a bright interface<br />with a posterior shadow.</p>
<p begin="00:00:43.907" end="00:00:46.167" style="s2">The pleural line is<br />identified as a bright,</p>
<p begin="00:00:46.167" end="00:00:49.207" style="s2">hyperechoic line between the rib shadows.</p>
<p begin="00:00:49.207" end="00:00:52.263" style="s2">The to and fro sliding movement<br />of the visceral pleural</p>
<p begin="00:00:52.263" end="00:00:54.675" style="s2">against the parietal<br />pleural with breathing</p>
<p begin="00:00:54.675" end="00:00:57.189" style="s2">generates the lung sliding sign.</p>
<p begin="00:00:57.189" end="00:01:00.659" style="s2">Evaluate the pleural movement<br />for A line and B line</p>
<p begin="00:01:00.659" end="00:01:02.888" style="s2">reverberation artifacts.</p>
<p begin="00:01:02.888" end="00:01:05.925" style="s2">To evaluate the posterior pleural space,</p>
<p begin="00:01:05.925" end="00:01:08.318" style="s2">move the transducer distally to the level</p>
<p begin="00:01:08.318" end="00:01:10.972" style="s2">of the seventh intercostal space.</p>
<p begin="00:01:10.972" end="00:01:15.334" style="s2">Slide the transducer posteriorly<br />to the midaxillary line.</p>
<p begin="00:01:15.334" end="00:01:17.995" style="s2">Increase the scanning<br />depth to view the interface</p>
<p begin="00:01:17.995" end="00:01:20.934" style="s2">between the pleural space and diaphragm.</p>
<p begin="00:01:20.934" end="00:01:23.751" style="s2">In a normal patient, a<br />mirror image artifact</p>
<p begin="00:01:23.751" end="00:01:27.834" style="s2">of the liver or spleen<br />will appear the diaphragm.</p>

<p begin="00:00:07.232" end="00:00:09.517" style="s2">- [Voiceover] A curved or<br />phased array transducer</p>
<p begin="00:00:09.517" end="00:00:12.058" style="s2">with an abdominal exam<br />type is used to perform</p>
<p begin="00:00:12.058" end="00:00:14.645" style="s2">a gallbladder ultrasound exam.</p>
<p begin="00:00:14.645" end="00:00:18.041" style="s2">The gallbladder should be<br />evaluated in two planes.</p>
<p begin="00:00:18.041" end="00:00:19.988" style="s2">The gallbladder is not a fixed organ,</p>
<p begin="00:00:19.988" end="00:00:22.552" style="s2">so the position can vary.</p>
<p begin="00:00:22.552" end="00:00:25.055" style="s2">To begin the exam, place the transducer</p>
<p begin="00:00:25.055" end="00:00:26.914" style="s2">in a long access position</p>
<p begin="00:00:26.914" end="00:00:29.534" style="s2">with the orientation marker<br />to the patient's head</p>
<p begin="00:00:29.534" end="00:00:31.837" style="s2">at the right costal margin.</p>
<p begin="00:00:31.837" end="00:00:34.105" style="s2">If it is difficult to<br />visualize the gallbladder,</p>
<p begin="00:00:34.105" end="00:00:37.644" style="s2">a deep inspiration will move<br />the gallbladder below the ribs</p>
<p begin="00:00:37.644" end="00:00:39.620" style="s2">for easier access.</p>
<p begin="00:00:39.620" end="00:00:41.636" style="s2">It may also be useful to turn the patient</p>
<p begin="00:00:41.636" end="00:00:44.191" style="s2">into a left lateral decubitus position,</p>
<p begin="00:00:44.191" end="00:00:47.359" style="s2">so the gallbladder moves<br />away from the ribs.</p>
<p begin="00:00:47.359" end="00:00:48.815" style="s2">The gallbladder will appear</p>
<p begin="00:00:48.815" end="00:00:51.849" style="s2">as an anechoic or hyperechoic structure</p>
<p begin="00:00:51.849" end="00:00:56.024" style="s2">and may appear oval or in the<br />shape of an exclamation point.</p>
<p begin="00:00:56.024" end="00:00:58.912" style="s2">To obtain a true longitudinal<br />view of the gallbladder,</p>
<p begin="00:00:58.912" end="00:01:02.829" style="s2">rotate the transducer to<br />see the entire length.</p>
<p begin="00:01:06.626" end="00:01:09.693" style="s2">Identify the gallbladder,<br />main lobar fissure,</p>
<p begin="00:01:09.693" end="00:01:11.365" style="s2">and the right portal vein.</p>
<p begin="00:01:11.365" end="00:01:12.824" style="s2">Sweep from side to side</p>
<p begin="00:01:12.824" end="00:01:15.786" style="s2">to evaluate the<br />gallbladder wall and lumen.</p>
<p begin="00:01:15.786" end="00:01:18.053" style="s2">Rotate the transducer 90 degrees</p>
<p begin="00:01:18.053" end="00:01:21.454" style="s2">with the orientation marker<br />to the patient's right.</p>
<p begin="00:01:21.454" end="00:01:23.667" style="s2">Sweep the transducer inferiorly</p>
<p begin="00:01:23.667" end="00:01:25.864" style="s2">from the gallbladder to fundus</p>
<p begin="00:01:25.864" end="00:01:28.781" style="s2">to evaluate the entire gallbladder.</p>

<p begin="00:00:07.377" end="00:00:10.057" style="s2">- [Voiceover] A linear array<br />transducer with an ophthalmic</p>
<p begin="00:00:10.057" end="00:00:14.570" style="s2">exam type is used to perform<br />an ocular ultrasound exam.</p>
<p begin="00:00:14.570" end="00:00:17.496" style="s2">The eye is evaluated in two planes.</p>
<p begin="00:00:17.496" end="00:00:21.801" style="s2">Apply a copious amount of<br />ultrasound gel to the closed eye.</p>
<p begin="00:00:21.801" end="00:00:25.144" style="s2">Gently place the transducer<br />in the transverse position</p>
<p begin="00:00:25.144" end="00:00:29.311" style="s2">with the orientation maker<br />to the patient's right.</p>
<p begin="00:00:31.207" end="00:00:33.852" style="s2">The globe of the eye is seen as a round,</p>
<p begin="00:00:33.852" end="00:00:35.967" style="s2">dark fluid filled structure.</p>
<p begin="00:00:35.967" end="00:00:39.419" style="s2">Several structures are<br />identified in the globe.</p>
<p begin="00:00:39.419" end="00:00:43.241" style="s2">The cornea is a thin layer<br />parallel to the eyelid.</p>
<p begin="00:00:43.241" end="00:00:46.940" style="s2">The anterior chamber and<br />the lens are anechoic,</p>
<p begin="00:00:46.940" end="00:00:50.516" style="s2">separated by the thin, echogenic iris.</p>
<p begin="00:00:50.516" end="00:00:53.977" style="s2">The choroid and retina form<br />a thin, light grey layer</p>
<p begin="00:00:53.977" end="00:00:56.985" style="s2">at the posterior aspect of the globe.</p>
<p begin="00:00:56.985" end="00:01:01.090" style="s2">The optic nerve sheath is<br />hypoechoic, or dark grey,</p>
<p begin="00:01:01.090" end="00:01:03.208" style="s2">moving away from the globe.</p>
<p begin="00:01:03.208" end="00:01:06.464" style="s2">Angle the transducer from<br />the superior to inferior</p>
<p begin="00:01:06.464" end="00:01:10.208" style="s2">aspect of the globe to<br />visualize each structure.</p>
<p begin="00:01:10.208" end="00:01:13.503" style="s2">From the transverse position,<br />rotate the transducer</p>
<p begin="00:01:13.503" end="00:01:17.364" style="s2">90 degrees so the transducer<br />orientation marker</p>
<p begin="00:01:17.364" end="00:01:20.905" style="s2">is directed towards the<br />top of the patient's head.</p>
<p begin="00:01:20.905" end="00:01:24.520" style="s2">Angle the transducer from<br />side to side to visualize</p>
<p begin="00:01:24.520" end="00:01:28.020" style="s2">the lens, retina, and optic nerve sheath.</p>

<p begin="00:00:07.258" end="00:00:09.265" style="s2">- [Voiceover] A phased<br />array transducer is used</p>
<p begin="00:00:09.265" end="00:00:13.394" style="s2">to evaluate lung sliding as<br />an extension of the FAST exam.</p>
<p begin="00:00:13.394" end="00:00:15.215" style="s2">The orientation marker is positioned</p>
<p begin="00:00:15.215" end="00:00:17.480" style="s2">in the direction of the patient's head.</p>
<p begin="00:00:17.480" end="00:00:20.745" style="s2">The transducer is placed<br />in a long-axis orientation</p>
<p begin="00:00:20.745" end="00:00:23.212" style="s2">over the anterior chest wall at the third</p>
<p begin="00:00:23.212" end="00:00:25.251" style="s2">or fourth intercostal space</p>
<p begin="00:00:25.251" end="00:00:29.168" style="s2">in the anterior axillary<br />or midclavicular line.</p>
<p begin="00:00:31.277" end="00:00:34.318" style="s2">A superficial scanning depth is used.</p>
<p begin="00:00:34.318" end="00:00:37.356" style="s2">The ribs are identified in<br />the near field of the image</p>
<p begin="00:00:37.356" end="00:00:40.798" style="s2">as a bright interface<br />with a posterior shadow.</p>
<p begin="00:00:40.798" end="00:00:42.395" style="s2">The pleural line is identified</p>
<p begin="00:00:42.395" end="00:00:46.390" style="s2">as a bright hyperechoic line<br />between the rib shadows.</p>
<p begin="00:00:46.390" end="00:00:48.465" style="s2">The normal to and fro sliding movement</p>
<p begin="00:00:48.465" end="00:00:51.177" style="s2">of the visceral pleural<br />against the parietal pleural</p>
<p begin="00:00:51.177" end="00:00:54.543" style="s2">with breathing generates<br />the lung sliding sign.</p>
<p begin="00:00:54.543" end="00:00:57.892" style="s2">If desired, the delineation<br />of the lung sliding interface</p>
<p begin="00:00:57.892" end="00:01:02.059" style="s2">may be enhanced by changing<br />to a linear array transducer.</p>

<p begin="00:00:07.442" end="00:00:09.589" style="s2">- [Voiceover] A linear<br />array transducer is used</p>
<p begin="00:00:09.589" end="00:00:13.774" style="s2">to evaluate lung sliding as<br />an extension of the FAST exam.</p>
<p begin="00:00:13.774" end="00:00:16.420" style="s2">The orientation marker is<br />positioned in the direction</p>
<p begin="00:00:16.420" end="00:00:18.065" style="s2">of the patient's head.</p>
<p begin="00:00:18.065" end="00:00:21.277" style="s2">The transducer is placed in<br />a long access orientation</p>
<p begin="00:00:21.277" end="00:00:23.204" style="s2">over the anterior chest wall</p>
<p begin="00:00:23.204" end="00:00:25.921" style="s2">at the third or fourth intercostal space</p>
<p begin="00:00:25.921" end="00:00:29.921" style="s2">in the interior axillary<br />to mid-clavicular line.</p>
<p begin="00:00:34.764" end="00:00:37.763" style="s2">The ribs are identified in<br />the near field of the image</p>
<p begin="00:00:37.763" end="00:00:41.324" style="s2">as bright interface<br />with a posterior shadow.</p>
<p begin="00:00:41.324" end="00:00:42.910" style="s2">The plural line is identified</p>
<p begin="00:00:42.910" end="00:00:47.099" style="s2">as a bright hyperechoic line<br />between the rib shadows.</p>
<p begin="00:00:47.099" end="00:00:50.068" style="s2">The to and fro sliding<br />movement of the visceral plural</p>
<p begin="00:00:50.068" end="00:00:52.233" style="s2">against the parietal plural with breathing</p>
<p begin="00:00:52.233" end="00:00:54.900" style="s2">generates the lung sliding sign.</p>