Subxiphoid (Pericardial) View
In this view, the liver is used as a sonographic window to view the pericardium. With the probe indicator directed towards the patients right, the transducer is placed in the midepigastric line and directed cephalad, almost so that the transducer is parallel with the stretcher. Firm downward pressure may be needed to obtain this retrosternal angle, especially in larger patients. Both sagittal and transverse views should be obtained, and the potential pericardial space is visualized both inferiorly and posteriorly in a supine patient.
When held in a transverse plane and angled caudally, the IVC and hepatic veins may be visualized. This may be warranted to rapidly determine fluid status of the patient. A dilated IVC with minimal respiratory variation indicates a well or over-hydrated patient. Conversely, a narrow IVC with exaggerated respiratory variation may indicate that the patient is dry. Obviously this application may be useful in situations other than trauma incidents
Left Flank (Perisplenic) View
Here, the spleen is used as a sonographic window, as was the liver in the right flank. However, since this provides a much smaller window, it is usually necessary to begin scanning along the posterior axillary line, or even more posterior in some cases. Four potential spaces for free fluid collection are examined: the pleural space, the subphrenic space, the splenorenal space, the inferior pole of the kidney. To facilitate Sonography, the probe should be angled towards the head of the ribs, at a 45 degree clockwise angle from the longitudinal plane. This allows a better view between the ribs and utilizes the small window provided by the spleen. Because of this smaller window, it is usually necessary to move the probe within an area of 2-3 intercostal spaces to visualize the potential spaces being examined. Again, all spaces should be investigated in multiple planes to assure adequate visualization.
The Last View...
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