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 shown on page 1 of the FATE card
The pleural views are suitable for a quick evaluation of:
– Pleural effusion
– Atelectasis
– Pulmonary oedema
– Correct intubation
– Pneumothorax
This lesson will go through the positions in detail, focusing on how to obtain and interpret the images
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
You can download the FATE card from: usabcd.org/FATE-card
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
In the daily clinical practice it is important to know the blood supply of the heart
Remember the individual variations can be substantial
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
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
– To appreciate the biological variations
Review this lesson if you are not confident about how to obtain the views and identify the structures of the heart
When you feel confident move on to the next lesson on the FATE position 4, the pleural view
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
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 degrees – is generally the optimal position
In basic FATE the PSAX view should be obtained at the mid papillary level
– Optimal patient position: 80-90 degrees left lateral position; image often improves in expiration
– Place yourself on the patient’s right side
– Hold the transducer in pencil grip with your right hand
– Place the transducer in IC III-IV close to the sternum
– OM should be directed towards the patient’s left shoulder
– 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
– Depth: 12-16 cm
