Figure 217 probe positioning for subxiphoid view

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Figure 2.17 Probe positioning for subxiphoid view. Liver Pericardium Figure 2.18 Normal subxiphoid view. 38 Diagnostic ultrasound Focused assessment with sonography in trauma (FAST)
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± Try sliding the probe on the same coronal plane toward the head or toward the feet to see if something familiar pops into view. Trouble with the LUQ view Rib shadow in the way ? ± Try the same techniques as listed previously. ± Sometimes, because the spleen is so much smaller than the liver, it is actually easier to visualize the splenorenal recess from a more anterior plane. Slide the probe over the spleen anteriorly and angle the probe through the spleen to the kidney from anterior to posterior. Trouble with the pelvic view Can’t find the bladder ? ± This is most often because the probe is too cephalad. Bring the probe almost on top of the symphysis pubis, angling toward the feet. ± The bladder is sometimes off midline. Position the probe transverse (marker to the patient’s right) and slide from right to left. ± Has the Foley catheter already been placed or the bladder decom- pressed? Try again after some fluid is given. Trouble with the cardiac view Can’t find the heart ? ± This is most often because the angle of the probe is too steep when looking subcostally. Position the probe almost flat on the abdomen in the subxiphoid position. ± The second most common problem is that the depth on the machine is set too shallow. Bring the depth out as deep as the machine allows and look for the moving organ. The depth can be readjusted to a more shallow view once the heart is found. ± Often, because a trauma patient has swallowed a lot of air, the stomach is distended. When looking subcostally, the beam is trying to reach the heart through an air-filled stomach. Slide the probe more to the right, and try looking for the heart through the liver, not the stomach. Occa- sionally this just won’t work, and a second cardiac view should be tried (see Chapter 3 ). Normal images Figures 2.19 –2.25 are examples of normal FAST ultrasound scans. Diagnostic ultrasound 39 Focused assessment with sonography in trauma (FAST)
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Figure 2.19 Normal RUQ. K, kidney; L, liver. Figure 2.21 Normal LUQ. Figure 2.20 Negative view of RUQ with no fluid in Morison’s pouch. K, kidney; L, liver. 40 Diagnostic ultrasound Focused assessment with sonography in trauma (FAST)
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Figure 2.24 Normal subxiphoid view. LV, left ventricle; RV, right ventricle. Figure 2.23 Normal ( A ) transverse and ( B ) longitudinal views of the male pelvis. Figure 2.22 Normal female suprapubic view. This is a longitudinal view, because you see the uterus in its longitudinal orientation and the probe marker is toward the patient’s head. Diagnostic ultrasound 41 Focused assessment with sonography in trauma (FAST)
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Abnormal images Figures 2.26 –2.39 are examples of abnormal FAST ultrasound scans.
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