Here, some of the instructors from the point of care echocardiography workshop at the SONIC Conference, share their top tips for the skills they were teaching.
Basic PLAX and PSAX views
By Dr Georgia Livesay
PLAX
Put probe anywhere just to patient’s left of sternum, then gently pull probe down onto rib below. If not optimal try rib spaces above and below
Begin with marker pointing at patient’s R shoulder, then adjust marker position slightly to elongate LV depending on individual patient variation
Heel and toe to produce horizontal view on screen
Make sure the descending aorta is in the view to distinguish between pericardial and pleural effusions
Ball parks for beginners to help you remember normal measurements:
RVOT, aortic root and LA should be roughly the same size
RV lumen should be about half the size of LV
RV wall thickness should be about 0.5cm, septum and LV free wall about 1cm
Tilt patient to their left and use expiratory pause if window difficult
PSAX
Begin by getting PLAX view with aortic valve centrally and rotate 90 degrees so marker pointing at patient’s L shoulder
Start at level of aortic valve then tilt probe to “shine torch” towards apex to move sequentially through mitral valve, papillary muscles to apex
LV should always appear circular; if septum flattened the RV pressures are raised. To decide whether acute or chronic look at thickness of RV: if normal (ie thin) more likely acute, if thickened probably chronic element.
If you have trouble finding the A4C view, can cheat by starting in PSAX and sliding down to apex then angle probe towards base
Subcostal 4 Chamber View and IVC
By Lynne Johnson
Place probe in subxiphoid position and angle toward patient's left shoulder
Place hand on top of the probe with the index finger resting on the front of the probe in order to use pressure and flatten the probe
If the heart is not evident, ask patient to bend their knees in order to relax abdominal muscles and place the probe pointing towards the patient's right shoulder to identify the right lobe of liver, then fan to the left lobe
The easiest way to obtain the subcostal view of the inferior vena cava is to start with a four-chamber view. Make sure the right atrium is in the center of the image. Then rotate the transducer counterclockwise and direct it to the right. The subcostal view shows the vena cava inferior in the long axis