The FATE position 4 is called the pleural view

Two different views are obtained in the FATE position 4:
– The left side pleural view
– The right side pleural view

The position obtained in position 4 is displayed on page 1 of the FATE card

The pleural views are suitable for a quick evaluation of:
– pleural effusion
– atelectasis
– pulmonary edema

You will now be taken through the positions in detail, focusing on how to obtain and interpret the images

This view is suitable for assessment of global and regional left ventricular function as myocardium with blood supply from all three coronary arteries are represented

The image quality is often improved with expiration

The left lateral position – approx. 80 degree – is generally the optimal position

In basic FATE the PSAX view should be obtained at the mid papillary level

You have now learned:

– The anatomy of the FATE position 3, the parasternal long and short axis views
– How to obtain the correct image 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 view and identify the structures of the heart

When you feel confident move on to FATE position 4, the pleural view

The structures identified in the FATE position 3, parasternal short axis view are

– RV: Right ventricle
– LV: Left ventricle
– ALPM: Antero-lateral papillary muscle
– PMPM: Postero-medial papillary muscle
– IVS: Inter-ventricular septum
– LW: Lateral wall
– PW: Posterior wall
– Pericardium

Imagine that the probe is placed on the upper border of the monitor with the red and the blue radii diverging from the probe

The red radius of the sector displayed on the screen corresponds to the red radius of the sector of the ultrasound beam intersecting the heart in the torso

The blue radii also correspond to each other

Notice that the orientation marker of the probe (the green arrow) is pointing towards the patient’s left shoulder

The PLAX view is the only view in the basic FATE protocol where the orientation marker on the transducer is directed towards the right shoulder

It is the standard view for measuring the dimensions of the heart

The image quality is often improved with expiration

Left lateral position – approx. 70-90 degrees – is generally the optimal position for the PLAX view

The apex is generally not seen

The second FATE position 3 is the parasternal short axis (PSAX) view

The parasternal short axis view is obtained by placing the transducer in the intercostal space III-IV to the left of the sternum

The orientation marker on the transducer should be directed towards the patient’s left shoulder (90 degrees clockwise rotation from the long axis view)

Notice the location of the heart in the thoracic cavity and the orientation of the ultrasound sector beam (the scanning plane)

The following will explain the position in detail, focusing on how to obtain and interpret the 2D ultrasound image