72 diagnostic ultrasound cardiac ultrasound suspicion

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72 Diagnostic ultrasound Cardiac ultrasound
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suspicion for pulmonary embolus is high and these findings are seen, this may help support the decision for lysis in critical patients in the right clinical setting [ 3 ]. Scanning tips Trouble with the subcostal four-chamber view Can’t see anything recognizable? ± Try increasing the depth to its maximal level to make sure the beam is reaching the part of the thoracic cavity containing the heart. ± Flatten the probe on the abdominal wall to make sure the beam is angling toward the left thoracic cavity. ± Slide the probe over to the right to use the liver as an acoustic window and to get away from the stomach, which may be scattering the sound waves. ± Have the patient bend his or her knees if possible. This helps relax the abdominal wall muscles and can sometimes make visualization easier. Trouble with the parasternal long-axis view Rib shadow in the way? ± Try angling the probe obliquely to sneak through the intercostal space. Tricuspid Valve Right Atrium Left Atrium Right Ventricle Left Ventricle Mitral Valve Figure 3.16 Cartoon of apical four-chamber view and corresponding anatomy as visualized by ultrasound. Courtesy of Dr. Manuel Colon, Hospital of the University of Puerto Rico, Carolina, PR. Diagnostic ultrasound 73 Cardiac ultrasound
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Can’t see a recognizable image? ± Try sliding the probe along the third or fourth intercostal space toward and away from the sternum. Occasionally, the long-axis view is not adjacent to the sternum but more in the middle of the thoracic cavity. ± Have the patient lie in the left lateral decubitus position to bring the heart closer to the chest wall and limit interference from the lung. Trouble with the parasternal short-axis view Can’t find the heart? ± Try sliding the probe in the intercostal space toward and away from the sternum. Try angling the probe obliquely as well. ± If the patient can sit forward or be positioned in the left lateral decubi- tus position, the heart will be brought forward in the chest and will be closer to the probe, making for easier scanning. Trouble with the apical four-chamber view Can’t find the heart? ± This can be the trickiest view to find, and sometimes sliding the probe around where you think the PMI might be will result in a recognizable image popping into view. ± If the patient can sit forward or be positioned in the left lateral decubi- tus position, the heart will be brought forward in the chest and will be closer to the probe. ± Try to start with a parasternal long-axis view, and slide the probe laterally (left) along the chest wall until the apex is centered on the screen. Then adjust the angle and direction of the transducer to create an apical window. Normal images Figure 3.17 demonstrates normal subxiphoid four-chamber views. Note the liver visible in the near field acting as a good acoustic window for this view.
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