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KEY IMAGES

IVC, transverse

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Video 09-01: Transverse view of a normal inferior vena cava

In the transverse view the IVC can be seen to collapse during the respiratory cycle in this patient with normal volume status. The hepatic veins can be seen to converge on the IVC at the beginning of the clip. The aorta can be seen to the right, running in front of the spine. Of note is the impressive pulsatility of the IVC, a reminder not to use that to distinguish it from the aorta.

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IVC, longitudinal

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Video 09-02: Longitudinal view of a normal IVC

In the longitudinal view, the IVC can be seen changing from 2 centimeters to an almost complete collapse. The collapsibility should be measured approximately 1 cm distal to the confluence of the hepatic veins, and normal respirations should be used. In this video of the author's IVC, he may have sniffed to exaggerate the effect.

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Lung ultrasound, apex—A-lines

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Video 09-03: A lines at the apex of normal lungs

At the apex of the lung in a patient without any pulmonary edema, the horizontal artifact known as A lines are easily seen repeating 3 times below the bright pleural line.

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Internal jugular vein (IJ) assessment

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Video 09-04: Longitudinal view of the internal jugular vein

In the longitudinal view, the internal jugular takes on a paintbrush (or wine bottle) appearance. The point where the walls come together corresponds to the externally measured jugular venous distension or the invasively measured central venous pressure. The movement is driven by the pressure changes during respiration.

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Cardiac ultrasound, parasternal long axis (PLAX)

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Video 09-05: Normal parasternal long axis view

This patient with pneumonia and mild tachycardia demonstrates a normally sized left atrium, left ventricle, and right ventricular outflow track. The ejection fraction can also be seen to be normal. The observant user will notice the subtle left sided pleural effusion with some atelectatic lung seen in the bottom left corner of the screen.

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Cardiac ultrasound, parasternal short axis (PSSA)

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Video 09-06: Normal parasternal short axis

This video of the heart via the parasternal short axis view at the level of the papillary muscles demonstrates normal ejection fraction anda normal left ventricular end diastolic dimensions.

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ACQUISITION TIPS

  • Indications: When history and physical exam do not provide a clear answer to the volume status of the patient. Especially useful in undifferentiated shock or ...

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