<p begin="00:00:15.335" end="00:00:17.408" style="s2">- Okay, I'm gonna take you<br />through the gallbladder exam.</p>
<p begin="00:00:17.408" end="00:00:19.520" style="s2">So in the emergency<br />department you may have</p>
<p begin="00:00:19.520" end="00:00:20.804" style="s2">a patient with abdominal pain.</p>
<p begin="00:00:20.804" end="00:00:23.268" style="s2">The question is, who are you<br />gonna do a gallbladder exam on?</p>
<p begin="00:00:23.268" end="00:00:24.703" style="s2">The patients that you suspect</p>
<p begin="00:00:24.703" end="00:00:26.397" style="s2">cholecystitis or biliary colic</p>
<p begin="00:00:26.397" end="00:00:27.783" style="s2">are the ones that we're gonna primarily be</p>
<p begin="00:00:27.783" end="00:00:29.282" style="s2">doing this exam on.</p>
<p begin="00:00:29.282" end="00:00:31.064" style="s2">The exam setup is very straightforward,</p>
<p begin="00:00:31.064" end="00:00:32.912" style="s2">let me take you through it.</p>
<p begin="00:00:32.912" end="00:00:34.695" style="s2">We have our M-Turbo system here,</p>
<p begin="00:00:34.695" end="00:00:36.405" style="s2">it's already powered up and on.</p>
<p begin="00:00:36.405" end="00:00:39.179" style="s2">We have a selection of<br />two different transducers.</p>
<p begin="00:00:39.179" end="00:00:41.564" style="s2">Most of you may already<br />have this transducer,</p>
<p begin="00:00:41.564" end="00:00:43.583" style="s2">this is a phased array transducer,</p>
<p begin="00:00:43.583" end="00:00:45.085" style="s2">this is the same<br />transducer you're gonna use</p>
<p begin="00:00:45.085" end="00:00:47.709" style="s2">for the FAST exam and echocardiography.</p>
<p begin="00:00:47.709" end="00:00:49.741" style="s2">The other transducer<br />that you may also have</p>
<p begin="00:00:49.741" end="00:00:51.790" style="s2">is a curvilinear transducer.</p>
<p begin="00:00:51.790" end="00:00:53.073" style="s2">This is an excellent transducer,</p>
<p begin="00:00:53.073" end="00:00:55.687" style="s2">though you'll sometimes have<br />problems with rib shadows.</p>
<p begin="00:00:55.687" end="00:00:57.005" style="s2">So you can use either one,</p>
<p begin="00:00:57.005" end="00:00:58.495" style="s2">but for today's demonstration</p>
<p begin="00:00:58.495" end="00:01:01.423" style="s2">I'm gonna take you<br />through the phased array.</p>
<p begin="00:01:01.423" end="00:01:03.519" style="s2">So once you've chosen the transducer,</p>
<p begin="00:01:03.519" end="00:01:06.536" style="s2">the next step is to choose<br />the exam type on the machine.</p>
<p begin="00:01:06.536" end="00:01:08.498" style="s2">To choose the examination configuration,</p>
<p begin="00:01:08.498" end="00:01:10.043" style="s2">it's very straightforward.</p>
<p begin="00:01:10.043" end="00:01:12.028" style="s2">We hit the Exam key right here,</p>
<p begin="00:01:12.028" end="00:01:14.052" style="s2">and with the selected transducer right now</p>
<p begin="00:01:14.052" end="00:01:17.957" style="s2">we can choose between<br />abdominal, OB, and cardiac.</p>
<p begin="00:01:17.957" end="00:01:20.124" style="s2">And for this exam we're<br />gonna choose abdomen,</p>
<p begin="00:01:20.124" end="00:01:21.536" style="s2">so I'm gonna hit Select,</p>
<p begin="00:01:21.536" end="00:01:23.966" style="s2">and we're gonna be<br />ready to start scanning.</p>
<p begin="00:01:23.966" end="00:01:25.025" style="s2">So I had the patient turn to</p>
<p begin="00:01:25.025" end="00:01:26.761" style="s2">the left lateral decubitus position,</p>
<p begin="00:01:26.761" end="00:01:29.442" style="s2">and I like to have their elbow up as well.</p>
<p begin="00:01:29.442" end="00:01:32.015" style="s2">The next thing I do is<br />I draw an imaginary line</p>
<p begin="00:01:32.015" end="00:01:33.682" style="s2">along the costal margin,</p>
<p begin="00:01:33.682" end="00:01:37.035" style="s2">and we have an imaginary<br />perpendicular line</p>
<p begin="00:01:37.035" end="00:01:39.370" style="s2">along the line of the shoulder.</p>
<p begin="00:01:39.370" end="00:01:40.682" style="s2">So then I'm gonna put my transducer</p>
<p begin="00:01:40.682" end="00:01:42.040" style="s2">right about in this area,</p>
<p begin="00:01:42.040" end="00:01:45.184" style="s2">and I should have a very<br />long axis of the gallbladder.</p>
<p begin="00:01:45.184" end="00:01:47.975" style="s2">So here's our transducer<br />marker right here.</p>
<p begin="00:01:47.975" end="00:01:50.097" style="s2">Again, I'm at the costal margin</p>
<p begin="00:01:50.097" end="00:01:51.847" style="s2">pointing toward the shoulder,</p>
<p begin="00:01:51.847" end="00:01:53.721" style="s2">and I'll try to find the gallbladder.</p>
<p begin="00:01:53.721" end="00:01:55.271" style="s2">So when you're scanning<br />the right upper quadrant,</p>
<p begin="00:01:55.271" end="00:01:56.299" style="s2">sometimes you'll have to have</p>
<p begin="00:01:56.299" end="00:01:58.996" style="s2">the patient take a deep breath.</p>
<p begin="00:01:58.996" end="00:02:01.675" style="s2">And what'll happen is the<br />liver will be pushed down</p>
<p begin="00:02:01.675" end="00:02:04.048" style="s2">and the gallbladder will<br />come easier into view.</p>
<p begin="00:02:04.048" end="00:02:05.695" style="s2">So that's a little trick that you can use</p>
<p begin="00:02:05.695" end="00:02:07.914" style="s2">to see organs in the upper quadrant</p>
<p begin="00:02:07.914" end="00:02:11.154" style="s2">that you may not be<br />able to identify easily.</p>
<p begin="00:02:11.154" end="00:02:14.062" style="s2">And what we see here on the screen</p>
<p begin="00:02:14.062" end="00:02:16.664" style="s2">is what we term the exclamation sign.</p>
<p begin="00:02:16.664" end="00:02:18.644" style="s2">The exclamation sign is</p>
<p begin="00:02:18.644" end="00:02:22.002" style="s2">the long part of the<br />gallbladder here, and a dot.</p>
<p begin="00:02:22.002" end="00:02:24.028" style="s2">And that dot is the portal vein.</p>
<p begin="00:02:24.028" end="00:02:27.049" style="s2">They're together, that is<br />a very important landmark.</p>
<p begin="00:02:27.049" end="00:02:29.139" style="s2">I'll be scanning through<br />the entire gallbladder</p>
<p begin="00:02:29.139" end="00:02:31.189" style="s2">in a long axis fashion,</p>
<p begin="00:02:31.189" end="00:02:32.445" style="s2">and then I'll turn the transducer</p>
<p begin="00:02:32.445" end="00:02:35.415" style="s2">just a little bit to the right,</p>
<p begin="00:02:35.415" end="00:02:39.582" style="s2">and I'll start scanning up to<br />down in a short axis plane.</p>
<p begin="00:02:40.756" end="00:02:43.058" style="s2">Things that you can do<br />to optimize that image,</p>
<p begin="00:02:43.058" end="00:02:44.723" style="s2">first thing you can do<br />is change your depth.</p>
<p begin="00:02:44.723" end="00:02:48.992" style="s2">So in this gentleman I may<br />decrease the depth just slightly</p>
<p begin="00:02:48.992" end="00:02:50.927" style="s2">to just sort of bring the gallbladder</p>
<p begin="00:02:50.927" end="00:02:53.320" style="s2">better into mod-center field of view.</p>
<p begin="00:02:53.320" end="00:02:54.833" style="s2">The other things that I can do</p>
<p begin="00:02:54.833" end="00:02:56.570" style="s2">is adjust the gain slightly.</p>
<p begin="00:02:56.570" end="00:02:59.609" style="s2">So I can try playing with<br />my gain slightly higher,</p>
<p begin="00:02:59.609" end="00:03:01.179" style="s2">and you can see the image gets brighter,</p>
<p begin="00:03:01.179" end="00:03:02.603" style="s2">or slightly lower.</p>
<p begin="00:03:02.603" end="00:03:04.626" style="s2">You want to optimize these settings</p>
<p begin="00:03:04.626" end="00:03:08.811" style="s2">so you have good contrast of<br />the fluid-filled structure,</p>
<p begin="00:03:08.811" end="00:03:10.635" style="s2">which is the gallbladder in the center,</p>
<p begin="00:03:10.635" end="00:03:13.802" style="s2">and you can also notice any artifacts.</p>
<p begin="00:03:15.179" end="00:03:16.987" style="s2">So once you've identified the gallbladder,</p>
<p begin="00:03:16.987" end="00:03:18.370" style="s2">and you're happy that you can see</p>
<p begin="00:03:18.370" end="00:03:20.333" style="s2">the gallbladder in a nice long view,</p>
<p begin="00:03:20.333" end="00:03:23.240" style="s2">you have to carefully look<br />for signs of a gallstone.</p>
<p begin="00:03:23.240" end="00:03:24.436" style="s2">Once you see the gallstone,</p>
<p begin="00:03:24.436" end="00:03:27.894" style="s2">you're gonna then press gently<br />into the right upper quadrant</p>
<p begin="00:03:27.894" end="00:03:31.175" style="s2">and see if they have signs<br />of a sonographic Murphy.</p>
<p begin="00:03:31.175" end="00:03:33.046" style="s2">Now, we're all familiar, as physicians,</p>
<p begin="00:03:33.046" end="00:03:34.272" style="s2">with what a Murphy sign is,</p>
<p begin="00:03:34.272" end="00:03:36.366" style="s2">and that's palpation of<br />the right upper quadrant,</p>
<p begin="00:03:36.366" end="00:03:38.152" style="s2">and looking for gallbladder tenderness.</p>
<p begin="00:03:38.152" end="00:03:40.961" style="s2">A sonographic Murphy<br />is much more specific,</p>
<p begin="00:03:40.961" end="00:03:43.591" style="s2">so we're gonna press on<br />the transducer gently,</p>
<p begin="00:03:43.591" end="00:03:45.392" style="s2">and to see if that elicits pain.</p>
<p begin="00:03:45.392" end="00:03:46.728" style="s2">The next things you're gonna look for</p>
<p begin="00:03:46.728" end="00:03:49.121" style="s2">are signs of inflammation<br />of the gallbladder,</p>
<p begin="00:03:49.121" end="00:03:51.000" style="s2">such as fluid around the gallbladder,</p>
<p begin="00:03:51.000" end="00:03:53.717" style="s2">that's being pericholecystic fluid,</p>
<p begin="00:03:53.717" end="00:03:55.661" style="s2">and also gallbladder wall thickening.</p>
<p begin="00:03:55.661" end="00:03:56.964" style="s2">So we're gonna look particularly</p>
<p begin="00:03:56.964" end="00:03:58.910" style="s2">at the anterior wall of the gallbladder</p>
<p begin="00:03:58.910" end="00:04:00.641" style="s2">and see that this is enlarged.</p>
<p begin="00:04:00.641" end="00:04:02.598" style="s2">And anything above four millimeters or so</p>
<p begin="00:04:02.598" end="00:04:05.939" style="s2">would be a sign of<br />gallbladder inflammation.</p>
<p begin="00:04:05.939" end="00:04:06.873" style="s2">So when you're scanning,</p>
<p begin="00:04:06.873" end="00:04:09.639" style="s2">you're gonna be carefully<br />looking for signs of a gallstone.</p>
<p begin="00:04:09.639" end="00:04:12.266" style="s2">A gallstone will have a<br />hyper-echoic appearance,</p>
<p begin="00:04:12.266" end="00:04:14.189" style="s2">meaning it's gonna be brighter in nature,</p>
<p begin="00:04:14.189" end="00:04:15.640" style="s2">and it's gonna cast a shadow.</p>
<p begin="00:04:15.640" end="00:04:17.090" style="s2">A key point here is make sure</p>
<p begin="00:04:17.090" end="00:04:19.148" style="s2">that the hyper-echoic<br />area that you're noticing</p>
<p begin="00:04:19.148" end="00:04:21.427" style="s2">actually lies within the gallbladder.</p>
<p begin="00:04:21.427" end="00:04:24.267" style="s2">A common mistake would<br />be to identify an area</p>
<p begin="00:04:24.267" end="00:04:25.395" style="s2">outside the gallbladder</p>
<p begin="00:04:25.395" end="00:04:27.042" style="s2">that would look just like a gallstone,</p>
<p begin="00:04:27.042" end="00:04:29.792" style="s2">and that would be a bowel shadow.</p>

<p begin="00:00:07.492" end="00:00:08.958" style="s2">- [Voiceover] A phased array transducer</p>
<p begin="00:00:08.958" end="00:00:10.583" style="s2">with a cardiac exam type,</p>
<p begin="00:00:10.583" end="00:00:12.586" style="s2">is used to perform an ultrasound guided</p>
<p begin="00:00:12.586" end="00:00:16.071" style="s2">trans-thoracic pericardiocentesis.</p>
<p begin="00:00:16.071" end="00:00:17.612" style="s2">The patient is placed in a</p>
<p begin="00:00:17.612" end="00:00:20.505" style="s2">left lateral decubitus<br />position, if possible.</p>
<p begin="00:00:20.505" end="00:00:22.921" style="s2">Place the transducer at the apex or point</p>
<p begin="00:00:22.921" end="00:00:26.163" style="s2">of maximum impulse, with<br />the orientation marker</p>
<p begin="00:00:26.163" end="00:00:30.330" style="s2">to the patients left side,<br />at a three o'clock position.</p>
<p begin="00:00:32.392" end="00:00:34.726" style="s2">The apex of the heart<br />is visualized closest</p>
<p begin="00:00:34.726" end="00:00:36.576" style="s2">to the transducer.</p>
<p begin="00:00:36.576" end="00:00:38.757" style="s2">Move between the apical and parasternal</p>
<p begin="00:00:38.757" end="00:00:41.165" style="s2">long axis views of the<br />heart, to determine the</p>
<p begin="00:00:41.165" end="00:00:44.298" style="s2">most superficial and<br />largest pocket of fluid.</p>
<p begin="00:00:44.298" end="00:00:46.292" style="s2">The myocardium will appear grey,</p>
<p begin="00:00:46.292" end="00:00:49.478" style="s2">and the blood filled chambers<br />will appear hypoechoic.</p>
<p begin="00:00:49.478" end="00:00:51.426" style="s2">The ventricles are in the near field,</p>
<p begin="00:00:51.426" end="00:00:54.539" style="s2">and the atria are in the<br />far field of the image.</p>
<p begin="00:00:54.539" end="00:00:57.285" style="s2">A pericardial effusion will appear as</p>
<p begin="00:00:57.285" end="00:01:00.654" style="s2">a dark anechoic fluid collection<br />surrounding the heart.</p>
<p begin="00:01:00.654" end="00:01:03.974" style="s2">For direct needle guidance,<br />using an in plane technique,</p>
<p begin="00:01:03.974" end="00:01:07.644" style="s2">the transducer is rotated<br />90 degrees counterclockwise.</p>
<p begin="00:01:07.644" end="00:01:11.539" style="s2">So the orientation marker is<br />at the 12 o'clock position.</p>
<p begin="00:01:11.539" end="00:01:13.104" style="s2">This will create a view of the heart</p>
<p begin="00:01:13.104" end="00:01:15.268" style="s2">that is between the apical fore chamber</p>
<p begin="00:01:15.268" end="00:01:17.872" style="s2">and parasternal long axis views.</p>
<p begin="00:01:17.872" end="00:01:19.872" style="s2">Note the absence of the lung,</p>
<p begin="00:01:19.872" end="00:01:22.583" style="s2">to ensure it is not in the needle path.</p>
<p begin="00:01:22.583" end="00:01:24.415" style="s2">The needle is inserted in the skin,</p>
<p begin="00:01:24.415" end="00:01:26.621" style="s2">just proximal to the transducer,</p>
<p begin="00:01:26.621" end="00:01:29.565" style="s2">opposite to the side of<br />the orientation marker.</p>
<p begin="00:01:29.565" end="00:01:31.126" style="s2">The needle is slowly advanced,</p>
<p begin="00:01:31.126" end="00:01:35.123" style="s2">and is seen as a bright<br />hypoechoic linear structure.</p>
<p begin="00:01:35.123" end="00:01:36.799" style="s2">The needle is slowly advanced,</p>
<p begin="00:01:36.799" end="00:01:39.092" style="s2">under direct ultrasound visualization,</p>
<p begin="00:01:39.092" end="00:01:40.941" style="s2">until the tip is seen to puncture the</p>
<p begin="00:01:40.941" end="00:01:42.963" style="s2">pericardial fluid collection.</p>
<p begin="00:01:42.963" end="00:01:45.358" style="s2">The needle should be<br />advanced until the needle tip</p>
<p begin="00:01:45.358" end="00:01:47.122" style="s2">lies within the fluid collection,</p>
<p begin="00:01:47.122" end="00:01:49.171" style="s2">which can then be aspirated.</p>
<p begin="00:01:49.171" end="00:01:51.175" style="s2">Vascular structures to be avoided</p>
<p begin="00:01:51.175" end="00:01:53.344" style="s2">include the internal mammary,</p>
<p begin="00:01:53.344" end="00:01:55.844" style="s2">and the intercostal arteries.</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="00:00:07.527" end="00:00:09.159" style="s2">- [Voiceover] A phased-array transducer</p>
<p begin="00:00:09.159" end="00:00:12.039" style="s2">with a cardiac exam<br />type is used to perform</p>
<p begin="00:00:12.039" end="00:00:15.543" style="s2">the subxiphoid, or<br />subcostal view of the heart.</p>
<p begin="00:00:15.543" end="00:00:18.575" style="s2">Place the transducer in<br />the subxiphoid position,</p>
<p begin="00:00:18.575" end="00:00:20.781" style="s2">with the transducer orientation marker</p>
<p begin="00:00:20.781" end="00:00:24.301" style="s2">to the patient's left side<br />at a three o'clock position.</p>
<p begin="00:00:24.301" end="00:00:26.077" style="s2">As an alternative approach,</p>
<p begin="00:00:26.077" end="00:00:29.477" style="s2">this exam may be performed<br />using an abdomen exam type,</p>
<p begin="00:00:29.477" end="00:00:32.365" style="s2">with the orientation marker<br />to the patient's right side,</p>
<p begin="00:00:32.365" end="00:00:34.485" style="s2">at the nine o'clock position.</p>
<p begin="00:00:34.485" end="00:00:37.293" style="s2">This view uses the liver<br />as an acoustic window</p>
<p begin="00:00:37.293" end="00:00:39.949" style="s2">to visualize the four<br />chambers of the heart.</p>
<p begin="00:00:39.949" end="00:00:43.398" style="s2">Aim the transducer slightly<br />toward the left shoulder,</p>
<p begin="00:00:43.398" end="00:00:47.572" style="s2">with approximately a 15-degree<br />angle to the chest wall.</p>
<p begin="00:00:47.572" end="00:00:50.692" style="s2">In some cases, the<br />transducer is almost flat</p>
<p begin="00:00:50.692" end="00:00:53.532" style="s2">to the abdominal wall,<br />so the ultrasound beam</p>
<p begin="00:00:53.532" end="00:00:56.820" style="s2">is directed toward the left chest cavity.</p>
<p begin="00:00:56.820" end="00:00:59.364" style="s2">A considerable amount of ultrasound gel</p>
<p begin="00:00:59.364" end="00:01:01.580" style="s2">and downward pressure may be required</p>
<p begin="00:01:01.580" end="00:01:04.340" style="s2">to maintain contact of the transducer face</p>
<p begin="00:01:04.340" end="00:01:06.132" style="s2">with the abdominal wall.</p>
<p begin="00:01:06.132" end="00:01:07.884" style="s2">Having the patient bend their knees</p>
<p begin="00:01:07.884" end="00:01:10.108" style="s2">helps relax the abdominal wall muscles</p>
<p begin="00:01:10.108" end="00:01:12.541" style="s2">for better transducer positioning.</p>
<p begin="00:01:12.541" end="00:01:15.348" style="s2">The first structure seen<br />closest to the transducer</p>
<p begin="00:01:15.348" end="00:01:16.558" style="s2">is the liver.</p>
<p begin="00:01:16.558" end="00:01:18.684" style="s2">The right side of the<br />heart will appear closer</p>
<p begin="00:01:18.684" end="00:01:21.076" style="s2">to the transducer than<br />the left side of the heart</p>
<p begin="00:01:21.076" end="00:01:23.034" style="s2">on the ultrasound image.</p>
<p begin="00:01:23.034" end="00:01:25.118" style="s2">The myocardium will appear grey,</p>
<p begin="00:01:25.118" end="00:01:28.638" style="s2">and the blood filled chambers<br />will appear hypoechoic.</p>
<p begin="00:01:28.638" end="00:01:30.286" style="s2">The bright white pericardium</p>
<p begin="00:01:30.286" end="00:01:32.217" style="s2">is seen surrounding the heart adjacent</p>
<p begin="00:01:32.217" end="00:01:34.598" style="s2">to the grey myocardium.</p>
<p begin="00:01:34.598" end="00:01:37.614" style="s2">Evaluate the function of all chambers.</p>
<p begin="00:01:37.614" end="00:01:38.766" style="s2">Compare the size of the</p>
<p begin="00:01:38.766" end="00:01:41.479" style="s2">right and left ventricular cavities.</p>
<p begin="00:01:41.479" end="00:01:43.983" style="s2">Note any wall motion abnormality,</p>
<p begin="00:01:43.983" end="00:01:48.150" style="s2">and the presence or absence<br />of pericardial effusion.</p>