Learning how to acquire the four basic echo views when performing point-of-care ultrasound (POCUS)

Getting clear views of the heart using echocardiography can be quite challenging if you don't know what you're doing! In this video from our Point-of-Care Ultrasound Essentials course, Associate Professor Viveta Lobo (Director of POCUS in the Department of Emergency Medicine at Stanford University) shows you how to position your ultrasound probe to get the clearest views, and points out the important landmarks you should be looking for to be sure you're in the right place.

In this course, you’ll learn how to use point-of-care ultrasound (POCUS) to diagnose the most important problems seen in the acute care setting. This course is ideal for anyone who’s just starting to use POCUS, whether you're working in an emergency department, a general ward, the ICU, or a private clinic. Learn how to use POCUS to increase your success rate and decrease complications when performing common procedures.

[00:00:00] Let's begin to review how to acquire the four basic echo views of point-of-care ultrasound. The first, we are going to talk about is your parasternal long-axis view. Using your phased array probe, with your indicator to your patient's left hip. Place the probe between the 3rd and 4th intercostal space, just left lateral to the sternum. This is the image orientation you want to get. You should have your right ventricle on the top

[00:00:30] of the image, your left ventricle adjacent to it, the left atria, the mitral valve in between, and the aortic valve here. This is what it looks like on ultrasound. Again, your right ventricle on the top of your screen, left ventricle, mitral valve, left atrium, and your aortic valve. Here's the video. Again, your right ventricle on the top, your left ventricle, your left atrium, your mitral valve

[00:01:00] with the anterior and posterior leaflets of your valve, and your aortic valve. Don't forget that a bright white pericardium will be surrounding your heart. Once you obtain your parasternal long-axis view, it's very easy to obtain your parasternal short-axis view. All you have to do is rotate your probe 90 degrees clockwise, to now have your indicator towards your patient's right hip. This should be your image orientation. You should have your right ventricle

[00:01:30] on the top of your screen and the left ventricle just adjacent to it. You will only see the two ventricles on this view. Here's what it looks like on ultrasound. Again, the right ventricle, here, with the left ventricle next to it. Notice your bright white septum in between the two ventricles. Here's what a video will look like. Right ventricle on the top with left ventricle, here and your white septum in between. The next view we're going to review is the subxiphoid

[00:02:00] view. Here, you're going to bring your phased array probe underneath your patient's xiphoid process. You want the indicator to your patient's right. Tuck the probe underneath the xiphoid process. It will actually help to place your index finger on the top of the probe and using your palm, flatten out the probe, push it up towards the xiphoid process, looking into the chest cavity. You should be able to identify your heart. This is the orientation you will see. Right ventricle,

[00:02:30] left ventricle, mitral valve, left atria, right atria, and your tricuspid valve. Here's what it would look like on ultrasound. Again, right and left ventricles on the top, mitral valve, your left atria, your right atria, and your tricuspid valve. Here’s a video. Again, to orient. The right and left ventricles, the right atrium, left atrium, your mitral valve, and your

[00:03:00] tricuspid valve. Don't forget that your bright white hyperechoic line will surround your heart and that will be your pericardium. The last of your four views is your apical view. This is often the most challenging view to obtain. To acquire this view, place your phased array probe underneath your patient's left nipple. Indicate it towards your patient's right. Tuck the probe between that rib space and aim up towards the chest cavity. There are a couple of

[00:03:30] tips I want to provide. First, when performing your parasternal long-, short- or your apical view, when possible, move your patient into the left lateral decubitus position. This will bring your probe closer to your heart, making it easier for you to obtain your view. Another trick when performing these views is have your patient raise their left arm above their head. This will give you more access to obtain your views and often

[00:04:00] produce better images. Your images should have an orientation, like this. The right and the left ventricle on the top, the mitral valve, and your left atrium, your right atrium, and your tricuspid valve. Here, is your ultrasound image. Again, right ventricle and your left ventricle, your mitral valve, your left atria, your right atria, and your tricuspid valve. Here's a video. Again, to orient, you have your right

[00:04:30] and left ventricles on the top, your left atrium and your right atrium, here, and your mitral and tricuspid valves in between your chambers. So, to review, we went over how to obtain your parasternal long-axis view, your parasternal short-axis view, your subxiphoid view, and your apical view.