Technique probe selection a phased array or

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Technique Probe selection A phased-array or curvilinear 2.5–5.0 MHz probe is most commonly used for the FAST exam. The views and windows used in the exam may all be obtained with a single probe. Some sonographers prefer larger-footprint probes that provide greater resolution of deep structures, while others prefer narrower-footprint microconvex or phased-array probes to obtain images between the ribs more readily. (A) (B) Figure 2.7 ( A ) Labeled transverse suprapubic view in female. ( B ) Longitudinal suprabic view in female. B, bladder, U, uterus; X, vesiculouterine space; *, pouch of Douglas. (A) (B) Figure 2.8 The areas of greatest dependence in the supine patient. Fluid will collect in the areas marked in blue, as seen when investigating ( A ) the left side and ( B ) the right side of the peritoneal and thoracic cavities. Images used with permission from Hoffmann B (ed.). Ultrasound Guide for Emergency Physicians , , courtesy of Dr. Beatrice Hoffmann. 32 Diagnostic ultrasound Focused assessment with sonography in trauma (FAST)
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Views The FAST exam is performed using four views ( Figure 2.9 ): 1. Hepatorenal recess or Morison’s pouch (RUQ) 2. Splenorenal or perisplenic view (LUQ) 3. Pelvic view 4. Pericardial or subxiphoid view With the eFAST exam, the probe slides superiorly from the standard RUQ and LUQ views to visualize the costophrenic angle and assess for blood in the thorax pooling in the costophrenic space and for normal sliding of the lung pleura with respiration (discussed below). Morison’s pouch The starting probe position when looking for Morison’s pouch should be the anterior axillary line in the seventh to ninth intercostal space ( Figure 2.10 ). The probe marker (green dot on the probe in Figure 2.10 ) should be pointing toward the patient’s head. To get a good view of the entire recess, the probe can be moved toward the head and then back toward the feet along this plane. If rib shadows obscure the image, the probe’s orientation may be rotated from a pure sagittal plane to a slightly oblique plane parallel to the ribs (usually 10–20 degrees). Thus, the probe will sit within a rib space, and the plane of the ultrasound beam will cut across fewer ribs. Figure 2.9 The four views that comprise the FAST exam. Diagnostic ultrasound 33 Focused assessment with sonography in trauma (FAST)
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Do not forget to visualize the inferior pole! In a supine patient, the inferior pole of the kidney on both right and left upper quadrant views is the most posterior or dependent part of the peritoneal cavity ( Figure 2.11 ). It is seen by sliding the probe more inferiorly or toward the feet along the axillary line. It is also important to fan anterior and posterior with the probe at each level to make sure the entire area is interrogated. Figure 2.12 shows how it is possible to miss the more subtle stripe of free fluid between the liver and the kidney more inferiorly if you do not image the inferior pole.
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