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DMST 253 Adult Echocardiography 1 > Module 8: Subcostal And Suprasteral Notch Protocol > Flashcards

Module 8: Subcostal And Suprasteral Notch Protocol Flashcards

1
Q

What position do you want to have your patient in for substernal and subcostal exams?

A

Supine

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2
Q

What is the angle we use during subcostal exams? And where should the indicator be turned?

A

We need a large angle and we need to place the marker 3-4 o’clock

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3
Q

What is the main benefit of the sub 4CH view?

A

It is the best view for assessing interatrial shunts

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4
Q

What are some tips for getting a subcostal 4CH view?

A
  1. Depth just below the heart
  2. Focus mid
  3. Patient will likely need a full or half a breath in
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5
Q

What are some tips to get Sub IAS colour window?

A
  1. Zoom slightly
  2. Colour box over IAS
  3. Lower colour scale below 40 cm/sec
  4. FR will be below 16 just for this image
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6
Q

What is the frame rate we should aim for in the subcostal TV colour view?

A

20 hz

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7
Q

What do we sweep and assess for during the subc TV colour view?

A

Sweep and assess for TR. If you saw TR in other views you should see them here

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8
Q

What is the refraction artifact?

A

Side to side duplication artifact

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9
Q

Is the subcostal short axis image a routine image? When would we use this image?

A

No, we would use it when,
1. No parasternal window is available due to disease processes, atypical anatomy, or even implants
2. When particular structures were not seen very well in other views
3. As part of the routine paediatric echo scan

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10
Q

Sub SAX views are most often used to assess what?

A
  1. IAS interatrial septum
  2. IVS interventricular septum
  3. Tricuspid valve
  4. Pulmonary valve and branches
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11
Q

How many SAX images can be seen in the subcostal view?

A

All 6 images, in addition a “sweep” can be performed base to apex

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12
Q

How do we get the subcostal IVC image?

A
  1. Rotate the probe to the 12:30 position (almost vertical with the marker towards the head)
  2. Sweep Inferiorly from the subcostal heart
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13
Q

How should we adjust the depth for Subcostal IVC images?

A

Enough to show the IVC and the RA

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14
Q

How should we position the probe for the Subcostal IVC? How should we hold the probe?

A
  1. Probe should almost be vertical (slightly tilted superiorly)
  2. Hold the probe as you would for the abdomen scan
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15
Q

What are some tips to get a good subcostal IVC and RA in SAX?

A
  1. Probe at 12:00 just under the xiphoid
  2. Take a big sniff in, then take 3 little sniffs and freeze
  3. Over or underhand depending on the patient
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16
Q

It has been shown that we can use IVC assessment to determine what?

A

Right atrial pressure

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17
Q

We can use predetermined pressures to find RAP estimates based on what?

A

IVC diameter and collapsibility

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18
Q

What RAP if IVC Diameter and IVC collapsibility is both normal?

A

3

19
Q

What would the RAP be if either IVC diameter and IVC collapsibility is abnormal?

A

8

20
Q

What would the RAP be if both IVC diameter and IVC collapsibility is abnormal?

A

15

21
Q

What is normal IVC diameter? What is normal IVC collapsibility?

A
  1. Diameter is <21 mm
  2. Collapsibility is >50%
22
Q

To get the IVC collapsibility what do we need to do?

A

Find two measurements
1. Widest, before sniff
2. Narrowest after sniff

23
Q

What are some things that the IVC/HC colour image will show?

A

Show IVC + HV fill

24
Q

What are some tips to get the IVC/HV Colour window?

A
  1. Heel/ tow the probe to increase the angle and make sure you have good colour fill
  2. May need to lower the scale
25
Q

What does the HV PW show?

A

HV flow

26
Q

What are some tips for getting the HV PW?

A
  1. Set baseline mid 1/3 from top
  2. May need to decrease reject
  3. No need to measure
27
Q

What are some tips to getting the 2D aorta image?

A
  1. Show the full length of the ABD aorta coming through the Diaphragm
  2. Probe set right under the Xyphoid
  3. Might need a big breath
28
Q

Is the ABD Ao PW doppler a common image?

A

No

29
Q

What view is this? Label the areas

A

Subc PV/PA view

30
Q

Is the Subcostal PV view a routine image?

A

No

31
Q

What are some tips to getting the SSN image?

A
  1. Place the probe in the suprasternal notch
  2. Get patient to move chin up and LT slightly
  3. Probe indicator 1-2 o’clock and angled deep into the chest
32
Q

What should the SSN 2D image show?

A
  1. ASC aorta
  2. Arch
  3. Branches
  4. Desc. Aorta
33
Q

Where should the focus be for the SSN image? And where should the depth be?

A
  1. Focus mid
  2. Depth set at ~15cm
34
Q

Is getting the ascending aorta in colour common? What are some things to remember?

A

Not common, but if we get it we need to use a higher scale to prevent aliasing

35
Q

Is the Ascending aorta PW a common image?

A

No, because the high velocity in the valve.

36
Q

What should we do for the aortic arch colour image to prevent aliasing? Is it routine and why?

A
  1. Use a high scale to prevent aliasing
  2. Not in our routine due to poor FR
37
Q

Where should we aim to have the colour scale for te descending aorta colour image?

A

100 cm/s

38
Q

What should are FR for the descending aorta image be?

A

> 20hz

39
Q

Where should we set the sample volume for the descending Aorta PW?

A

Distal to LT Subclavian A or pulse from top to bottom

40
Q

What is the normal Descending aorta velocity? How should we adjust the scale for waveform?

A

<2cm/s and adjust to the image

41
Q

What are some alternative SSN views?

A
  1. SSN short axis (trans)
  2. SSN crab view
42
Q

What view is this? Label the structures

A

SSN trans (short axis)

43
Q

What view is this? Label the structures

A

SSN crab view

DMST 253 Adult Echocardiography 1 (27 decks)

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