Sonographic recognition of pathological conditions in realtime at the bedside facilitates good patient care

Ultrasound can visualize cardiac and pleural pathology directly and in real time at the bedside

Recognition of relevant pathology is a key competency in the FATE examination

You will now learn to recognize the relevant pathology using the standard FATE examination

The liver is used as the reference point when diaphragm and pleura on the patients right side are examined

The spleen is used as the reference point when diaphragm and pleura on the patients left side are examined

Evaluation of pleural effusion should always be performed with elevated thorax,

You have now learned:

– The anatomy of the FATE position 4

– How to obtain the correct images with respect to transducer orientation and the relationship to the presentation on the screen

Review if you are not confident about how to obtain the views and identify the structures

When you feel confident move on to cardiac function and pathology

The images show PSAX views of 4 hearts with hypovolaemia

Observe the small volume of the left ventricle in systole – the ventricle is almost empty
The walls of the left ventricle touch each other
This pattern is often called “kissing walls”

The myocardial function is good, and the ejection fraction is high
Therefore, ejection fraction seen alone is of little clinical value
Identification of the real problem/s (here hypovolaemia) is the solution

Keep this image in your mind, and when you recognise it in your patient think of hypovolaemia

Eyeballing is a simple visual qualitative method to evaluate the overall function of the heart chambers

All imaging views can be used for the eyeballing and combined information from different views is recommended

The result of eyeballing is, in the 4 basic FATE views beneath, normal ventricular function of all chambers

Page 1 on the FATE card is used for this part of the FATE examination

Position 4 is indicated on the FATE torso in the lower right corner of page 1 on the FATE card

The target image is displayed in the lower left corner of page 1 on the FATE card

Study the FATE card and memorize position 4 and the target image before beginning the examination

The two pleural views are obtained on the lower left and right side of the thorax respectively

The pleural views are obtained by placing the transducer as illustrated on the torso

The orientation marker on the transducer is pointing cranially

In the following we will go through the positions in detail, focusing on how to obtain and interpret the 2D ultrasound image

Structures identified in the FATE position 4 – the pleural view

On the right side of the patient:
– liver
– diaphragm
– lung tissue

On the left side of the patient:
– spleen
– diaphragm
– lung tissue

The diaphragm is a mandatory landmark to identify and display clearly on the screen

The scanning planes of the pleural views are coronal (frontal)

The orientation marker (OM – green spot) on the transducer is directed cranially

Due to the convention of cardiac ultrasound, the orientation indicator is placed on the right side of the screen. Consequently, the lungs are displayed on the right side of the screen, and the solid organs on the left side of the screen.

The solid organs below the diaphragm are:
– the liver (the patient’s right side)
– the spleen (the patient’s left side)

Pleural effusion, if present, will appear between the diaphragm and the lung surface