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Peritoneal Fluid

Video Author: A. Y. Denault
Published on: 09.01.2021
Associated with: September 2021, Volume 133, Issue 3; Anesthesia & Analgesia. 133(3):630-647, September 2021

Mild amount of peritoneal fluid in unstable patients.

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Creator: Anesthesia & Analgesia Editorial Board
Duration: 3:04
Video summary covering three featured articles in the September 2022 issue of Anesthesia & Analgesia.
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Creator: Anesthesia & Analgesia Editorial Board
Duration: 2:15
Video summary covering three featured articles in the August 2022 issue of Anesthesia & Analgesia.
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Creator: Anesthesia & Analgesia Editorial Board
Duration: 3:26
Video summary covering three featured articles in the July 2022 issue of Anesthesia & Analgesia.
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Creator: Chris W. Fields & Jon G. Dean
Duration: 6:30
The video in left panel shows behavioral arousal after bilateral electrical stimulation of basal forebrain (200 Hz, 30 s ON, 30 s OFF, 60 – 100 µA) in a female Sprague Dawley rat (session 1). Note that the behavioral arousal after electrical stimulation occurred under continuous sevoflurane exposure; the rat was breathing 1.7% sevoflurane before, during, and after recovery of the righting reflex. The right panel shows the effect of bilateral electrical stimulation in the same rat (session 2;~1 week later) after inactivation of prefrontal cortex with bilateral infusion of 156 µM tetrodotoxin. The inactivation of prefrontal cortex attenuated the arousal-promoting effects of basal forebrain stimulation. The traces on top of the video show the electroencephalographic activation induced by electrical stimulation. The lightning bolt in the upper right-hand corner indicates when the electrical stimuli were being delivered.
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Creator: Jon Dean & Chris W. Fields
Duration: 2:35
Chemogenetic stimulation of basal forebrain cholinergic neurons, via local dialysis delivery of 0.5 mM Compound 21, in sevoflurane-anesthetized female ChAT-Cre rat produced behavioral arousal. Note that the rat is continuously inhaling sevoflurane before, during, and after recovery of the righting reflex. The traces on top of the video show the electroencephalographic activation induced by Compound 21.
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Creator: Hongye Zhang
Duration: 00:43
The subparaneural upper trunk block is performed in the supraclavicular fossa, at the site where the upper trunk has trifurcated into anterior and posterior divisions and the suprascapular nerve. Local anesthetic is injected inside the paraneural sheath between either anterior and posterior divisions or posterior division and the suprascapular nerve.
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Creator: Anesthesia & Analgesia Editorial Board
Duration: 3:07
Video summary covering three featured articles in the June 2022 issue of Anesthesia & Analgesia.
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Creator: Daniel Mount and Jeanette Esau
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Video summary covering three featured articles in the May 2022 issue of Anesthesia & Analgesia.
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Creator: Daniel Mount and Jeanette Esau
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Video summary covering three featured articles in the March 2022 issue of Anesthesia & Analgesia.
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Creator: Daniel Mount and Jeanette Esau
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Video summary covering three featured articles in the February 2022 issue of Anesthesia & Analgesia.
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Creator: Daniel Mount and Jeanette Esau
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Video summary covering three featured articles in the January 2022 issue of Anesthesia & Analgesia.
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This video provides an overview of the anatomical and functional features of a novel pediatric airway model using a combination of additive manufacturing and casting techniqiues
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Video summary covering three featured articles in the November 2021 issue of Anesthesia & Analgesia.
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Creator: A. Y. Denault
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Renal sinus cyst.
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Creator: A. Y. Denault
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Renal tumor with color Doppler.
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Creator: A. Y. Denault
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Renal artery air embolism upon unclamping at the end of cardiopulmonary bypass.
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Creator: A. Y. Denault
Duration: 0:04
Renal artery air embolism and simultaneous transcranial Doppler upon unclamping at the end of cardiopulmonary bypass. A total of 3590 high-intensity transient signals occurred during the procedure.
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Creator: Anesthesia & Analgesia Editorial Board
Duration: 3:04
Video summary covering three featured articles in the September 2022 issue of Anesthesia & Analgesia.
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Creator: Anesthesia & Analgesia Editorial Board
Duration: 2:15
Video summary covering three featured articles in the August 2022 issue of Anesthesia & Analgesia.
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Creator: Anesthesia & Analgesia Editorial Board
Duration: 3:26
Video summary covering three featured articles in the July 2022 issue of Anesthesia & Analgesia.
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Creator: Jon Dean & Chris W. Fields
Duration: 2:35
Chemogenetic stimulation of basal forebrain cholinergic neurons, via local dialysis delivery of 0.5 mM Compound 21, in sevoflurane-anesthetized female ChAT-Cre rat produced behavioral arousal. Note that the rat is continuously inhaling sevoflurane before, during, and after recovery of the righting reflex. The traces on top of the video show the electroencephalographic activation induced by Compound 21.
Play
Creator: Hongye Zhang
Duration: 00:43
The subparaneural upper trunk block is performed in the supraclavicular fossa, at the site where the upper trunk has trifurcated into anterior and posterior divisions and the suprascapular nerve. Local anesthetic is injected inside the paraneural sheath between either anterior and posterior divisions or posterior division and the suprascapular nerve.
Play
Creator: A. Y. Denault
Duration: 0:24
Renal artery air embolism upon unclamping at the end of cardiopulmonary bypass.
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Creator: A. Y. Denault
Duration: 1:31
Transgastric abdominal ultrasonography view of the pancreas using a longitudinal view. Note the position of the splenic vein under the pancreas.
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Creator: A. Y. Denault
Duration: 0:01
Transgastric abdominal ultrasonography view at 0o with color Doppler (Nyquist 8 cm/s) of the splenic vein shows alternative to and fro splenic venous flow.
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Creator: A. Y. Denault
Duration: 0:01
This abnormality was associated with only mild tricuspid regurgitation as seen from a mid-esophageal modified right ventricular inflow view.
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Creator: A. Y. Denault
Duration: 0:01
Spontaneous contrast in a 55-year-old man before pericardectomy. The right atrial pressure was 20 mmHg.
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Creator: A. Y. Denault
Duration: 0:01
Transgastric abdominal ultrasonographic view of the spleen.
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Creator: A. Y. Denault
Duration: 0:01
Transgastric abdominal ultrasonography images of the stomach at various transducer angles showing a full stomach.
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Creator: A. Y. Denault
Duration: 0:01
Transgastric abdominal ultrasonography images of the stomach at various transducer angles show a full stomach.
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Creator: A. Y. Denault
Duration: 0:02
Transgastric abdominal ultrasonography view of the stomach at 0o.
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Creator: A. Y. Denault
Duration: 0:01
Transgastric abdominal ultrasonography view of the stomach at 90o.
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Creator: A. Y. Denault
Duration: 0:03
Free peritoneal fluid in an unstable patient after cardic arrest. Transgastric view at 0o showing free fluid between the stomach, the left lobe of the liver and the heart.
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Creator: A. Y. Denault
Duration: 0:01
Transgastric abdominal ultrasonography images of the stomach at various transducer angles showing a normal stomach.
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Creator: Daniel Mount and Jeanette Esau
Duration: 3:35
Video summary covering three featured articles in the September 2021 issue of Anesthesia & Analgesia.
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Creator: Daniel Mount and Jeanette Esau
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Video summary covering four featured articles in the July 2021 issue of Anesthesia & Analgesia.
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Creator: Richard D. Urman
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This video discusses how to conduct goals of care discussions, topics that need to be covered with the patient, and how to assess whether you have conducted a successful discussion that is most beneficial for the patient.
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Creator: Richard D. Urman
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This video discusses how to manage DNR orders for patients undergoing invasive procedures. It also advocates for patient autonomy and full disclosure of risks and benefits.
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Creator: Richard D. Urman
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This video provides useful tips about what topics should be included in the goals of care discussion, and how to best approach them with the patient. Useful tips are provided for the clinician.
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Creator: Richard D. Urman
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This video demonstrates how to approach the topic of DNR/DNI and goals of care with the patient, and the topics such a conversation should contain
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Creator: Richard D. Urman
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Creator: Gerald Matchett
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Creator: Marta Kelava
Duration: 0:39
SAP block can be performed in supine or lateral position. Using a 12-15 MHz linear ultrasound probe, scanning starts from the midclavicular line just below the clavicle. The ribs are counted with caudal and lateral probe movement until the 4th and 5th ribs are identified in the midaxillary line. The in-plane needle approach and injection is usually performed in an anteroposterior or craniocaudal direction in the midaxillary line at the level of the 4-5th ribs with LA deposition above (superficial SAP) or below (deep SAP) the serratus anterior muscle
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Creator: Marta Kelava
Duration: 0:41
The PIF block is performed under ultrasound guidance, with either cranio-caudal or latero-medial needle advancement. The latter has been proposed to avoid inadvertent puncture of the perforating branch of the internal thoracic artery or the anterior perforating veins joining the internal thoracic vein, with the goal to deposit LA between the pectoralis major and intercostal muscles. The craniocaudal in-plane needle approach and injection is usually performed 1 cm lateral to the sternum at the midsternal level with LA deposition between the pectoralis major and intercostal muscles.
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Creator: Marta Kelava
Duration: 1:16
A 12-15 MHz linear ultrasound probe is placed at a midclavicular line below the clavicle. The probe is moved inferolaterally to the level of the 3rd rib. With a slight medial tilt, the three layers of muscles are identified: pectoralis major, pectoralis minor and serratus anterior. When performing both blocks simultaneously, single puncture site can be used to preserve near-field imaging with deposition of the LA between the layers of the serratus anterior and pectoralis minor (PECS II), followed by needle withdrawal and injection between the pectoralis minor and pectoralis major (PECS I)
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Creator: Marta Kelava
Duration: 0:36
The ESP block is performed in a sitting, prone or lateral decubitus position under ultrasound guidance. A high frequency (12-15 MHz) linear array transducer is placed in a parasagittal plane and moved from a lateral to medial direction until the ribs are no longer visualized and transverse processes of T3-5 are identified. An in-plane needle is inserted in the craniocaudal direction and advanced below the erector spine muscle with the tip contacting the T5 transverse process. LA is injected and lifting of the erector spine muscle off the transverse process with craniocaudal spread of the LA is confirmed.
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Creator: Sean Ermer
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This video demonstrates what the Poincare plot looks like as ataxic breathing severity progresses
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This is a patient encounter whereby video glasses worn by a clinician managing the airway could relay the scene via audio and video imaging to a consulting expert in real-time. Images of the airway via the videolaryngoscope monitor as well as the vital signs and scene dynamics are relayed using a wearable video camera so the on-scene clinician is not restricted by handheld video devices.
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Creator: Adam C. Adler, MS, MD, FAAP, FASE
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Demonstration of ultrasound use for real-time confirmation of caudal block placement.
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The performance of spinal anesthesia using preprocedural ultrasound skin marking, via paramedian approach.
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Video summary of featured articles in Anesthesia & Analgesia for November 2019.
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Creator: Barry Smit, Craig Kilroe, Dale Hunt, Dr Jessica Purcell-Jones, Dr Rowan Duys.
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The video follows the journey of a Xhosa women having spinal anesthesia for her cesarean section. The procedure and its risks and benefits are described in a Xhosa narrative. Additionally, the patient described her personal experience for part of the video.
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Creator: Lee Goeddel
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In prebypass imaging the midesophageal 5 chamber view with color Doppler demonstrated a bullet in the aortic root and absence of aortic valve regurgitation. With simultaneous orthogonal imaging the bullet was localized to the non-coronary sinus of Valsalva within the aortic valve. An eccentric mitral regurgitation jet was found in the anterior leaflet of the mitral valve in the midesophageal long axis view. RCC= Right coronary cusp of the aortic valve. LCC= Left coronary cusp of the aortic valve. NCC= Non-coronary cusp of the aortic valve.
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Creator: Brianne Aiken
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IPACK block performed for Total Knee Arthroplasty
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Video summary of featured articles in Anesthesia & Analgesia for March 2019.
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Video summary of featured articles in Anesthesia & Analgesia for December 2018.
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Creator: Paolo Beccaria
Duration: 0:15
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Creator: Jeanette Esau
Duration: 1:47
Video summary of featured articles in Anesthesia & Analgesia for March 2018.
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Creator: Jeanette Esau
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Video summary of featured articles in Anesthesia & Analgesia for February 2018.
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Creator: Massimiliano Meineri, MD
Duration: 1:15
The ME four chamber view is analyzed using the Automated Function Imaging (AFI) software package. The LV long axis strain model is applied to the RV to allow correct labeling of septal segments. Tracking quality is automatically assessed for each segment (green: good or red: poor). Parametric display provides measurements for each of the six RV and global strain. The latter is normal at – 22.3% with regional peak variability with basal segments below normal limits. RV myocardial region of interest is redefined and the septum de-selected to obtain RV free wall strain that is measured at approximately -22%
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Creator: Jeanette Esau
Duration: 1:58
Video summary of featured articles in Anesthesia & Analgesia for September 2017.
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Creator:
Duration: 0:15
Real-time ultrasound-guided left supraclavicular approach to the central vein
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Creator:
Duration: 0:15
Identify the right jugular vein and carotid artery at the level of the thyroid cartilage on the short-axis view. Then, the probe is moved caudally following the internal jugular vein in the center of the monitor. Once the probe has reached the clavicle, it is inclined following the internal jugular vein to identify where it merges with the right subclavian vein and the underlying pleura on the long-axis view. The puncture needle is inserted using the long-axis view and advanced while identifying the needle point in real-time, until it reaches the right brachiocephalic vein.
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Creator: Juan G. Ripoll
Duration: 0:24
Initially, by using a two-dimensional transthoracic echocardiography IVC subcostal view, the Avalon Elite catheter was not visualized within the inferior vena cava (IVC). Upon successful catheter repositioning, the catheter was imaged inside the IVC.
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Creator:
Duration: 0:27
First part: The modified ME5ch view demonstrates two masses (“proximal” and “distal”). The echogenicity of the distal mass is lower than that of the proximal mass. Second part: Simultaneous orthogonal plane to the proximal mass. Third part: Simultaneous orthogonal plane to the distal mass. Fourth part: Color flow Doppler (CFD) analysis in the ME bicaval view. Fifth part: ME RV inflow-outflow view. Sixth part: CFD analysis in the ME RV inflow-outflow view. Seventh part: ME 4-chamber view. Eighth part: CFD analysis in the ME 4-chamber view. ‘#’ indicates intra-mass calcification.
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Creator: Jeanette Esau
Duration: 2:26
Video summary of featured articles in Anesthesia & Analgesia for July 2017.
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Creator: Jeanette Esau
Duration: 2:57
Video summary of featured articles in Anesthesia & Analgesia for June 2017.
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Creator: Luiz F Maracaja MD
Duration: 0:15
1. Starting with ME 2-chamber view, activate the orthogonal imaging by aiming the cursor into the atrioventricular groove underneath the left atrial appendage lateral to the CX. 2. Activate CFD with a low-velocity scale (15–30 cm/s). Then, by moving the CFD sector over the atrioventricular groove lateral to the CX, one can display an image of the great cardiac vein (GCV) 3. The orthogonal plane displays retrograde blood cardioplegia flowing anteriorly from the coronary sinus (CS) to GCV and tributaries. The GCV wraps around the left side of the heart and posteriorly merges with the CS.
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Creator: Dr. Josh Zimmerman, MD, FASE
Duration: 23:23
A brief, screen-in-screen review of the techniques required to perform bedside cardiac ultrasound at the parasternal, apical, and subcostal windows.
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Creator: Dr. Josh Zimmerman, MD, FASE
Duration: 0:08
The right ventricle is under the transducer. There is normal excursion and coaptation of the aortic and mitral valves. The chambers are normal in size. There is brisk excursion of the aortic root, brisk opening of the mitral valve, a normal descent of the base of the MV, and normal thickening of the left ventricular segments.
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Creator: Dr. Josh Zimmerman, MD, FASE
Duration: 0:06
The aortic valve is heavily calcified and does not open well. The degree of stenosis cannot be quantified from this view, but with excursion this limited the assumption should be that the patient has severe stenosis until it is proven otherwise. In addition to aortic valve calcification, the mitral annulus is heavily calcified, there is left ventricular hypertrophy, and the left atrium is enlarged.
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Creator: Dr. Josh Zimmerman, MD, FASE
Duration: 0:06
In systole, the body of both mitral leaflets is above the level of the mitral annulus.
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Creator: Dr. Josh Zimmerman, MD, FASE
Duration: 0:08
The RVOT, LA, and LV are all dilated and appear proportionally large compared to the aortic annulus and root. Compare the relative sizes with Video 1 (normal PLAX.) There is evidence of decreased LV systolic function, with decreased motion of the aortic root, decreased excursion of the anterior mitral leaflet, decreased mitral annular excursion, and decreased thickening of the left ventricular segments. There is also a left pleural effusion.
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Creator: Dr. Josh Zimmerman, MD, FASE
Duration: 0:05
Left ventricular and aortic valve function appear normal. There is thickening of the tips of the mitral leaflets, with diastolic bowing seen particularly in the anterior mitral leaflet (the “hockey stick” appearance). The left atrium appears enlarged as well, consistent with elevated left atrial pressure from mitral stenosis.
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Creator: Dr. Josh Zimmerman, MD, FASE
Duration: 0:07
Multiple beats are shown in this clip and the image does not remain still because the patient was severely dyspneic. The patient has significant hypertrophy of the anterioseptal wall of the left ventricle. In multiple cardiac cycles the anterior mitral leaflet can be seen to impinge on the left ventricular outflow tract.
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Creator: Dr. Josh Zimmerman, MD, FASE
Duration: 0:05
The descending thoracic aorta is outside the pericardium, and a pericardial effusion will be seen extending between the heart and the aorta in this view while a pleural effusion will be seen deep and lateral to the aorta.
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Creator: Dr. Josh Zimmerman, MD, FASE
Duration: 0:07
The right ventricle is seen to the left of the screen, with the anterior portion of the left ventricle closest to the probe. The papillary muscles are seen, identifying this as the mid-portion of the left ventricle. Six segments of the left ventricle are seen, representing all three main coronary artery territories.
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Creator: Dr. Josh Zimmerman, MD, FASE
Duration: 0:06
The thinning of this segment suggests a scar consistent with previous myocardial infarction.
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Creator: Dr. Josh Zimmerman, MD, FASE
Duration: 0:07
A pericardial effusion around the heart, hyperdynamic left ventricular systolic function, and decreased LV filling in diastole.
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Creator: Dr. Josh Zimmerman, MD, FASE
Duration: 0:07
Septic shock, decreased left ventricular (LV) afterload, and increased cardiac output. The LV is full in diastole and empty in systole, consistent with the patient’s low-afterload state.
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Creator: Dr. Josh Zimmerman, MD, FASE
Duration: 0:08
The interventricular septum (IVS) is normally convex with respect to the left left ventricle throughout the cardiac cycle. In this case the IVS is flat in both systole and diastole, suggesting that the right and left ventricular pressures are similar (near systemic pulmonary artery pressures.)
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Creator: Dr. Josh Zimmerman, MD, FASE
Duration: 0:08
The apex of the left ventricle is directly under the ultrasound transducer. All four chambers can be visualized. There is normal global and regional biventricular systolic function, normal excursion and coaptation of the mitral and tricuspid valves, and normal chamber sizes.
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Creator: Dr. Josh Zimmerman, MD, FASE
Duration: 0:11
A large portion of the myocardium at the LV apex is not thickening. There is decreased global LV systolic function and left atrial enlargement as well.
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Creator: Dr. Josh Zimmerman, MD, FASE
Duration: 0:09
Prolapse of both anterior and posterior mitral leaflets with left atrial enlargement.
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Creator: Dr. Josh Zimmerman, MD, FASE
Duration: 0:09
Abnormal mitral valve opening in a patient with rheumatic heart disease. The tips of the mitral leaflets are thickened. The left atrium appears qualitatively enlarged compared with the size of the left ventricle.
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Creator: Dr. Josh Zimmerman, MD, FASE
Duration: 0:09
Enlarged right ventricle with decreased RV systolic function in a patient with a history of chronic severe pulmonary hypertension.
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Creator: Dr. Josh Zimmerman, MD, FASE
Duration: 0:11
Apical four chamber zoomed in on the tricuspid valve. This valve does not coapt well in systole, suggesting the presence of significant tricuspid regurgitation.
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Creator: Dr. Josh Zimmerman, MD, FASE
Duration: 0:10
At the top of the image is the liver. The right atrium and right ventricle are seen well, as is the left ventricle. There is normal global biventricular systolic function. It is important to remember that, while this view often shows all four cardiac chambers, the cross section is not exactly the same as the apical four chamber.
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Creator: Dr. Josh Zimmerman, MD, FASE
Duration: 0:10
Subcostal four chamber with right ventricular dilation and hypertrophy. The free wall of the RV appears as thick as the left ventricle. The RV appears larger than the LV, suggesting significant enlargement.
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Creator: Dr. Josh Zimmerman, MD, FASE
Duration: 0:11
Subcostal four chamber in a patient with pericardial effusion and tamponade. The effusion is seen as a large echolucent space around the heart. The right atrium appears collapsed in ventricular systole and the right ventricle appears compressed in ventricular diastole. These findings are both consistent with tamponade physiology.
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Creator: Dr. Josh Zimmerman, MD, FASE
Duration: 0:19
The liver is at the top of the screen, with the thin-walled IVC seen entering the right atrium. There is more than 50% collapse of the IVC when the patient sniffs.
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Creator: Dr. Josh Zimmerman, MD, FASE
Duration: 0:10
Subcostal IVC in a patient with cardiac tamponade. The IVC appears dilated and does not collapse as the patient sniffs.
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Creator: Dr. Josh Zimmerman, MD, FASE
Duration: 0:14
Subcostal IVC in a patient with hypovolemia. The IVC is small and collapses completely as the patient breathes.
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Creator: Jeanette Esau
Duration: 2:33
Video summary of featured articles in Anesthesia & Analgesia for February 2017.
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Creator: Jeanette Esau
Duration: 2:22
Video summary of featured articles in Anesthesia & Analgesia for September 2016.
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Creator: Jeanette Esau
Duration: 1:36
Video summary of featured articles in Anesthesia & Analgesia for July 2015.
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Creator: Edward C. Nemergut, MD
Duration: 5:10
Video summary of featured articles in Anesthesia & Analgesia for June 2014.
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Creator: Edward C. Nemergut, MD
Duration: 6:09
Video summary of featured articles in Anesthesia & Analgesia for June 2013.
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