Teach the eFAST exam remotely 4/4 - Subxiphoid Cardiac

In this series, Dr Peter Weimersheimer and myself teach the Royal College of Surgeons Ireland #RCSI #Sonogames team how to perform the Extended Focused Assessment with Sonography in Trauma #eFAST #POCUS exam. This episode it's the Subxiphoid Cardiac portion of the eFAST exam. Chapters 0:00 Introduction 2:16 Subxiphoid - Dr Peter Weimershimer 7:04 Subxiphoid - Dr Nicolas Lim Tips - Set depth initially to 30 cm. Hold probe with fingers on top to allow you to tilt probe tail down. Start with probe on lower edge of sternum (yes over bone) then slide down. As it drops down into epigastrium, push probe upwards - like scooping the sternum. To enable better visualisation, ask patient to bend their knees (relaxing abdominal wall) and also to take a deep breath (pushes heart down and closer to the probe) If the ventricles appear rounded, rotate the probe anti-clockwise. Free fluid / blood appears around in the pericardium. In trauma, if it is clotted, it can also appear hyperechoic The epicardial fat pad is a common false positive for pericardial effusions. In order to rule this out, tilt the probe tail up to view the posterior section of the heart. The epicardial fat pad will disappear as you tilt the probe tail up.