You have now learned:

– The anatomy of the FATE position 4 – the pleural view on the patient’s right and left side

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

Review this lesson if you are not confident about how to obtain the view and identify the structures

When you feel confident move on to the next lesson concerning cardiac function

Before you start scanning, ask yourself:

1. Which position – 1, 2, 3 or 4?
2. How should I hold the probe?
3. Where should the orientation marker (OM) be pointing to?
4. What should appear on the screen?

Holding the probe in your right hand:

1. Apply gel without touching the footprint of the probe with the gel dispenser
2. Place the transducer on the chest wall where you expect to get the desired image
3. Circle with your hand until you recognise any anatomical structures on the screen
4. Then optimise the image in only one plane at a time by rotating / tilting / sliding

Anatomy

Evaluation of cardiac function is one of the key elements of FATE

It should be emphasised that all four cardiac chambers contribute to the overall cardiac function

The focused approach to cardiac function concentrates on the ventricles

The performance of the ventricles can be differentiated into systolic and diastolic function

The FATE card shows important reference values that you can make use of

You can download the FATE card from: usabcd.org/FATE-card

Evaluation of the systolic cardiac function with ultrasound is performed by assessing:

– Endocardial (and/or myocardial) movement, during systole

– Myocardial thickening during systole

The video shows a PSAX view of a heart with normal LV function

Notice symmetrical endocardial movement towards the center of the LV and equivalent global and systolic myocardial thickening

This lesson will give an overview of the simplest assessment of the right and left ventricular function based on greyscale imaging (2D and M-mode)

First the systolic and diastolic ventricular function is covered

Next we will look at the ventricles individually

The following terms will be explained:
– Ejection fraction (EF)
– Eyeballing
– Fractional shortening (FS)
– Mitral septal separation (MSS)
– MAPSE = Mitral Annular Plane Systolic Excursion (LV)
– TAPSE = Tricuspid Annular Plane Systolic Excursion (RV)
– Myocardial and cardiac chamber dimensions

Structures identified in the FATE position 4 – the pleural view

On the left side of the patient:
– Spleen
– Diaphragm
– Lung tissue

On the right side of the patient:
– Liver
– 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 and the hand is rested on the bed

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

Echocardiographic convention applies to the FATE examination of the pleura
– i.e. the orientation indicator is on the right side of the screen

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

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

Evaluation of pleural effusion should always be performed with the thorax in the semierect position

The diaphragm is a mandatory landmark – never insert a needle unless you have identified the diaphragm

– Optimal patient position: supine and always with elevated thorax

– Hold the transducer as you prefer

– Place the transducer on the lateral part of the thorax at the edge of the lower rib

– OM should be directed cranially

– Adjust the transducer position with small incremental tilt and rotational movements

– Have the desired image clear in your mind and watch the screen until you achieve it

– The diaphragm is a mandatory landmark

– Depth: 14-18 cm