Emergency Medicine Book

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Right Intercostal Oblique Ultrasound View

Aka: Right Intercostal Oblique Ultrasound View, Right Coronal Ultrasound View
  1. See Also
    1. FAST Exam
    2. Subcostal Echocardiogram View (Subxiphoid Echocardiogram View)
    3. Right Intercostal Oblique Ultrasound View
    4. Right Coronal Ultrasound View
    5. Left Intercostal Oblique Ultrasound View
    6. Left Coronal Ultrasound View
    7. Suprapubic Ultrasound View (Long Axis or Longitudinal View)
    8. Lung Ultrasound for Pneumothorax (Sliding Lung Sign, Lung Point)
    9. Emergency Echocardiography
    10. Ultrasound
  2. Indications
    1. FAST Exam
  3. Approach: Right Intercostal Oblique View (Right lower chest to RUQ)
    1. Transducer positioning
      1. Placement: Right lateral lower chest and upper Abdomen
      2. Axis: Long Access with indicator at 12:00
        1. May rotate indicator to oblique 10-11:00 to reduce rib shadowing
      3. Direction: Energy perpendicular to lateral chest towards Spleen
    2. Landmarks
      1. Diaphragm
      2. Liver
      3. Right Kidney may be visible in this view
    3. Conditions
      1. Right Hemothorax
        1. Posterior lateral wall bright attenuation artifact extends above diaphragm
        2. Black anechoic fluid (may have internal echoes if clotted blood)
        3. Lung tissue may be seen within black fluid, free floating
    4. Images
      1. ultrasoundProbePositionLungFASTruq.jpg
      2. ultrasoundCartoon_fastRuq.jpg
      3. ultrasoundBMP_abdFastRUQ.jpg
  4. Approach: Right Coronal View (RUQ to RLQ, pericolic and inferior renal pole)
    1. Obtain view by tilting transducer inferiorly from right intercostal view (or dropping down 1-2 rib spaces)
    2. Transducer positioning
      1. Placement: Right lateral Abdomen
      2. Axis: Long axis with indicator at 12:00
      3. Direction: Energy perpendicular to lateral Abdomen
        1. Pan transducer inferiorly to scan the inferior pole of Kidney
        2. Tilt transducer, sweeping from anterior to posterior Kidney
    3. Landmarks
      1. Liver
      2. Right Kidney
      3. Right Psoas Muscle
    4. Conditions
      1. Blood in Morrison's Pouch (between right Kidney and liver)
        1. Fat may appear similar to blood
          1. However fat has a homogeneous speckled appearance without change in size
        2. Blood Clot in Morrison's Pouch is a sign of catastrophic Hemorrhage (>1 Liter of blood in Abdomen)
        3. Fluid in Morrison's Pouch in the absence of Trauma
          1. Ascites may also appear as fluid in pouch, but will be diffuse
          2. In association with Acute Abdomen, suggests intraabdominal catastrophe
      2. Blood in Paracolic Gutter (anterior or superficial to right Kidney)
        1. In supine patients, paracolic gutter is lowest point in peritoneal cavity above pelvic brim
        2. Small blood accumulations may appear here first (prior to Morrison's pouch)
      3. Blood in Right Retroperitoneum
        1. Blood accumulates between Kidney and psoas muscle
        2. Most blood in Retroperitoneum will be indistinguishable from muscle
    5. Images
      1. ultrasoundProbePositionLungFASTrtPeriColic.jpg
      2. ultrasoundBMP_abdFastRUQpericolic.jpg
  5. Resources
    1. FAST Exam RUQ (Dr. Mandavia, Sonosite)
      1. http://www.youtube.com/watch?v=0VTRm_DNW8s
    2. FAST Exam RUQ -Normal (Dr. Mandavia, Sonosite)
      1. http://www.youtube.com/watch?v=lzgxZsFZhTU
    3. FAST Exam RUQ - Hemorrhage (Dr. Mandavia, SonoSite)
      1. http://www.youtube.com/watch?v=Gj5IioG7SyM
  6. References
    1. Reardon (2016) FAST Scan, Online Video Stabroom.com, accessed 4/1/2016
    2. Reardon (2013) Emergency Ultrasound Course, 3rd Rock Ultrasound, Minneapolis, MN
    3. Alameda County Trauma Service FAST Exam
      1. http://eastbay.surgery.ucsf.edu/eastbaytrauma/Protocols/ER%20protocol%20pages/FAST-files/FAST.htm
    4. Mateer (2012) Introduction to Trauma Ultrasound Video, GulfCoast Ultrasound, VL-95-T
      1. https://www.gcus.com/products/about.asp?product=338/Introduction-to-Trauma-Ultrasound
    5. HCMC FAST Exam
      1. http://vimeo.com/1044031

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