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Cardiac US

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The Views

HOW TO SCAN THE HEART

Just for echo, the probe marker is on the right hand side of the screen. For every other ultrasound modality, the probe marker is on the left side of the screen. Due to this, echo imaging can be extremely confusing when you start. The best way to deal with this is to divorce your brain from your hand movements. Don't look at your hand when you try and get a better image. Look at the screen and try to optimise the image to get as close as possible to the ideal by making small hand movements this way or that. As you do more scans, your hand will automatically do the movements necessary to get more on axis images. 

When you're scanning, be aware how you hold the transducer. Always hold it as close to the face as possible with the distal phalanges of you thumb and first two fingers, The other two fingers should always rest on the patient to anchor your position.  When you hold the transducer using the small muscles of the hand, rather than your forearm muscles, you will be able to make finer, more graded movements, which is essential in echo. But it can be frustrating initially when your thenar muscles ache from the unusual activity.

Note how the transducer is held close to its face and how the other fingers are resting on the patient
Note how the transducer is held close to its face and how the other fingers are resting on the patient

At the start of the examination, do big sliding movements around the chest to try and find the best window to the heart. Don't settle for the first view you get. Move around until you are sure you are in the best window and then do tiny movement to adjust the image. 

It's often difficult to remember where the probe marker should be when you start doing echo. The easiest eay to remember is to always start with PLAx which has the probe marker to the patient's right shoulder. From here, each view is 90 degrees clockwise: PSAx: patient's right shoulder, A4C: 3 o clock, IVC 6 o'clock etc

Be aware that the probe marker position is just a guide. Each person's heart is in a unique position so keep sliding, rotating, fanning and rocking until you get the most on axis image. 

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PLAx