Thread by @Wilkinsonjonny

1/13

Today’s Tweetorial for you!

We look at basic cardiac #POCUS views👍 🫀

First; the Parasternal Long Axis (PLAX)

#FOAMed #FOAMcc #echofirst

Probe position shown with marker to right shoulder, left Parasternal edge; roughly at intercostal spaces 2-3/3-4🤷‍♂️

2/13

What should you see on ultrasound, and the associated sono anatomy🤔

BTW, this is the only basic position you need for this. Dipping the tail or lifting the tail then get you inflow and outflow views. This is more advanced. #FUSIC

3/13

Next, the Parasternal short axis (PSAX) - Mitral view

If you’ve lined up the aortic and mitral valves in the centre of the image on PLAX, a simple rotation of the probe through 90 degrees gives you your view🤛👍

4/13

Here it is:

Mitral level - with associated sonoanatomy🤛 The ‘fish mouth’

Now, with the SAX views, you are required to make some probe movements. Essentially dipping or lifting the tail to fan through the heart.

5/13

PSAX aortic level - from the mitral level, dip the tail of the probe down towards the patient’s feet and here is your Classic Mercedes badge of the hopeful fro-leaflet valve. You can see the tricuspid here as well.

6/13

PSAX papillary level - Lift the tail towards the patient’s head and find the papillary muscle heads. This is the papillary level. Great for assessing crude regional wall motion abnormalities
👍 head butting paps could mean hypovolaemia. Miles away, LV failure🤷‍♂️

7/13

Apical 4 Chamber view

Marker to the bed, around the apex beat point. Or at 3 o’clock.

As @sharonmkay says, ‘window shopping’ about with crude probe movements around the area allows the view to flash up. Then make finer movements.

8/13

Here is the apical 4 chamber and sonoanatomy.

Open up the atria and ventricles by dipping the probe tail. If the view goes, it’s a rib in your way. Move up over it or under it to get the window back👍 the LV apex should not move much, if it does, you are foreshortened!

9/13

The apical 5 chamber view

Dip the probe tail to catch the LVOT and aortic valve into your view as your 5th chamber.

It’s the VTi view folks👍

10/13

The subcostal 4 chamber view

The FAST view! Land the probe like a space rocket, around the point the xiphisternum dips down, marker to the patient’s left. Then gently scoop upwards, as if to lift the heart up.

11/13

Here it is with associated sonoanatomy

Look for LV/ RV size discrepancies, crude movements and atrial enlargement. Good for pericardial effusions too👍

12/13

Rotate the probe anti-clockwise so the marker points to 12 o’clock.

This is the IVC view👍

Look for size/collapsibility/thrombi. Do not use 1 view to tell you volume status..you need trending as well as SAX view for this, with others parameters borne in mind!⚠️

13/13

What about Regional wall motion abnormalities then🤷‍♂️

Our PSAX papillary level is fairly good for crude assessment of this. Take a look at the regions shown and stare at it to convince yourself ALL parts thicken nicely. If not, there may be a coronary territory issue.

Happy probing!

You can download all of these here:

criticalcarenorthampton.com/basic-image-ac…

Also, this too👍

criticalcarenorthampton.com/pocusgrams/

To all #POCUS nutters @RubbleEM @kyliebaker888 @avkwong @NephroP @amit_pawa @bhca @POCUSClub @NixLimerick @cianmcdermott @FTeranMD @ThinkingCC @zedunow @UltrasoundMD @cardiacACCP @MJGriksaitis @aroradrn @r_wiersema @parulekar8550 @PARADicmSHIFT @iceman_ex @rosie_hogg @curromir

And a link that works!!!

#FOAMed #POCUS #FOAMcc #echofirst #medtwitter

criticalcarenorthampton.com/basic-image-ac…