Similarly, as a surgeon does not slash at a layer of fascia without regard to potentially important structures underneath, but patiently dissects through each layer, learn to be deliberate about each of the four main probe movements.2 First, each probe has two broad sides and two narrow sides. Fanning or tilting is the side-to-side movement along the broad side, while angling or rocking is the side-to-side movement along the narrow side. (Fig. 1, 2) Movement around the axis formed by the head of the probe to the handle is called rotation. (Fig. 3) Recognize that the movement of the probe leads to an opposite scan plane. For example, by tilting the probe handle inferiorly, the scan plane is actually directed superiorly, and vice versa. The last movement is actually translating or sliding the probe to a different position on the chest wall. (Fig. 4)
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If placing the probe on the 3rd or 4th intercostal space with the indicator pointed to the right shoulder (or left elbow, depending on the convention) consistently yielded an adequate parasternal long axis window, then echo would truly be easy for all novices. However, there is significant variation between the position of the heart and the surface anatomy. For example, patients with ascites or elevated left hemi-diaphragms have hearts situated more superiorly, with a leftwardly displaced apex. Patients with obstructive lung disease or long thoraces, tend to have more inferiorly displaced hearts with apexes that are more rightward.
Echocardiography is a POCUS skill that requires the sonographer to understand the cross-sectional cardiac anatomy, and to be able to predict changes based on deliberate probe movements. Developing a technique to acquire basic parasternal windows, using isolated probe movements, will help you to master echo troubleshooting, and apply when your echo skills will matter most--on your next sick patient! 2ff7e9595c
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