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July 2022 A&A Video Summary: Featured Articles

Video Author: Anesthesia & Analgesia Editorial Board
Published on: 06.16.2022
Associated with: Anesthesia & Analgesia. 135(1):6-19, July 2022 Anesthesia & Analgesia. 135(1):26-34, July 2022 Anesthesia & Analgesia. 135(1):39-48, July 2022

Video summary covering three featured articles in the July 2022 issue of Anesthesia & Analgesia.

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August 2022 A&A Video Summary: Featured Articles

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How to Perform Focused Cardiovascular Ultrasound

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PECS I&II blocks

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PIF block

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September 2022 A&A Video Summary: Featured Articles

Creator: Anesthesia & Analgesia Editorial Board

Duration: 3:04

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Video summary covering three featured articles in the September 2022 issue of Anesthesia & Analgesia.

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August 2022 A&A Video Summary: Featured Articles

Creator: Anesthesia & Analgesia Editorial Board

Duration: 2:15

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Video summary covering three featured articles in the August 2022 issue of Anesthesia & Analgesia.

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July 2022 A&A Video Summary: Featured Articles

Creator: Anesthesia & Analgesia Editorial Board

Duration: 3:26

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Video summary covering three featured articles in the July 2022 issue of Anesthesia & Analgesia.

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Inactivation of prefrontal cortex attenuates behavioral arousal induced by bilateral electrical stimulation of basal forebrain in sevoflurane-anesthetized rat.

Creator: Chris W. Fields & Jon G. Dean

Duration: 6:30

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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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Chemogenetic stimulation of basal forebrain cholinergic neurons via local dialysis delivery of Compound 21 in sevoflurane-anesthetized female ChAT-Cre rat produced behavioral arousal.

Creator: Jon Dean & Chris W. Fields

Duration: 2:35

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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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Supplemental video on subparaneural upper trunk block

Creator: Hongye Zhang

Duration: 00:43

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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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June 2022 A&A Video Summary: Featured Articles

Creator: Anesthesia & Analgesia Editorial Board

Duration: 3:07

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Video summary covering three featured articles in the June 2022 issue of Anesthesia & Analgesia.

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May 2022 A&A Video Summary: Featured Articles

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Video summary covering three featured articles in the May 2022 issue of Anesthesia & Analgesia.

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Video summary covering three featured articles in the April 2022 issue of Anesthesia & Analgesia.

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Video that demonstrate the NTA video frame of the isolated EV

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EV- NTA analysis

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March 2022 A&A Video Summary: Featured Articles

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Video summary covering three featured articles in the March 2022 issue of Anesthesia & Analgesia.

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February 2022 A&A Video Summary: Featured Articles

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Duration: 3:12

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Video summary covering three featured articles in the February 2022 issue of Anesthesia & Analgesia.

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January 2022 A&A Video Summary: Featured Articles

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Video summary covering three featured articles in the January 2022 issue of Anesthesia & Analgesia.

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December 2021 A&A Video Summary: Featured Articles

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Video summary covering three featured articles in the December 2021 issue of Anesthesia & Analgesia.

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A Tour of the Paediatric Airway Model

Creator: Lovell, Mark

Duration: 2:46

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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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November 2021 A&A Video Summary: Featured Articles

Creator: Daniel Mount and Jeanette Esau

Duration: 3:20

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Video summary covering three featured articles in the November 2021 issue of Anesthesia & Analgesia.

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Renal Cyst

Creator: A. Y. Denault

Duration: 0:01

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Renal sinus cyst.

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Renal Tumor

Creator: A. Y. Denault

Duration: 0:03

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Renal tumor with color Doppler.

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Renal Artery Doppler Abnormalities

Creator: A. Y. Denault

Duration: 0:24

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Renal artery air embolism upon unclamping at the end of cardiopulmonary bypass.

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Transcranial Doppler

Creator: A. Y. Denault

Duration: 0:04

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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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September 2022 A&A Video Summary: Featured Articles

Creator: Anesthesia & Analgesia Editorial Board

Duration: 3:04

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Video summary covering three featured articles in the September 2022 issue of Anesthesia & Analgesia.

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August 2022 A&A Video Summary: Featured Articles

Creator: Anesthesia & Analgesia Editorial Board

Duration: 2:15

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Video summary covering three featured articles in the August 2022 issue of Anesthesia & Analgesia.

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July 2022 A&A Video Summary: Featured Articles

Creator: Anesthesia & Analgesia Editorial Board

Duration: 3:26

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Video summary covering three featured articles in the July 2022 issue of Anesthesia & Analgesia.

Play

Chemogenetic stimulation of basal forebrain cholinergic neurons via local dialysis delivery of Compound 21 in sevoflurane-anesthetized female ChAT-Cre rat produced behavioral arousal.

Creator: Jon Dean & Chris W. Fields

Duration: 2:35

Show Less

Play

Supplemental video on subparaneural upper trunk block

Creator: Hongye Zhang

Duration: 00:43

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Video that demonstrate the NTA video frame of the isolated EV

Creator:

Duration: 2:00

Show Less

EV- NTA analysis

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Renal Artery Doppler Abnormalities

Creator: A. Y. Denault

Duration: 0:24

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Renal artery air embolism upon unclamping at the end of cardiopulmonary bypass.

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Transgastric Abdominal Ultrasonography View #9

Creator: A. Y. Denault

Duration: 1:31

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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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Splenic Vein Pulsatility and Right Ventricular Failure

Creator: A. Y. Denault

Duration: 0:01

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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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Splenic Vein Pulsatility and Right Ventricular Failure

Creator: A. Y. Denault

Duration: 0:01

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This abnormality was associated with only mild tricuspid regurgitation as seen from a mid-esophageal modified right ventricular inflow view.

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Inferior Vena Cava Spontaneous Contrast

Creator: A. Y. Denault

Duration: 0:01

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Spontaneous contrast in a 55-year-old man before pericardectomy. The right atrial pressure was 20 mmHg.

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Transgastric Abdominal Ultrasonography View #7

Creator: A. Y. Denault

Duration: 0:01

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Transgastric abdominal ultrasonographic view of the spleen.

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Full Stomach

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Duration: 0:01

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Transgastric abdominal ultrasonography images of the stomach at various transducer angles showing a full stomach.

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Full Stomach

Creator: A. Y. Denault

Duration: 0:01

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Transgastric abdominal ultrasonography images of the stomach at various transducer angles show a full stomach.

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Portal Venous Air from Mesenteric Ischemia

Creator: A. Y. Denault

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Hemodynamic instability in an 85-year-old patient after removal of an intra-aortic pump 2 days after cardiac surgery associated with normal cerebral oximetry values but elevated lactate. Upon examination of the liver, air was present in the portal vein. (With permission of Denault et al.59)

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Splenic Artery Air Emboli

Creator: A. Y. Denault

Duration: 0:01

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Despite numerous air emboli in the splenic artery upon unclamping after cardiopulmonary bypass, maximal lactate was 2.3 at the end of the procedure with avoidance of any prolonged intraoperative hypotension.

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Transgastric Abdominal Ultrasonography View #3

Creator: A. Y. Denault

Duration: 0:02

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Transgastric abdominal ultrasonography view of the stomach at 0o.

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Transgastric Abdominal Ultrasonography View #3

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Transgastric abdominal ultrasonography view of the stomach at 90o.

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Peritoneal Fluid

Creator: A. Y. Denault

Duration: 0:03

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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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Normal Stomach

Creator: A. Y. Denault

Duration: 0:01

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Transgastric abdominal ultrasonography images of the stomach at various transducer angles showing a normal stomach.

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September 2021 A&A Video Summary: Featured Articles

Creator: Daniel Mount and Jeanette Esau

Duration: 3:35

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Video summary covering three featured articles in the September 2021 issue of Anesthesia & Analgesia.

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Doppler spectrum recording showing single high-intensity transient signals (HITS). HITS within the Doppler spectrum are indicated by the yellow vertical lines with higher power than the flowing blood. C. HITS with “curtain effect” per 3-5 cardiac cycles.

Creator: Syed M. Imaduddin, SM

Duration: 00:28

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Transcranial Doppler, ultrasound, emboli, HITS

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Creator: Syed M. Imaduddin, SM

Duration: 00:20

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Transcranial Doppler, ultrasound, emboli, HITS

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July 2021 A&A Video Summary: Featured Articles

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Video summary covering four featured articles in the July 2021 issue of Anesthesia & Analgesia.

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Goals of care discussion: measuring success

Creator: Richard D. Urman

Duration: 5:29

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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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DNR orders for operating room procedures

Creator: Richard D. Urman

Duration: 15:57

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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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Preoperative goals of care discussions: what, why, where, and how?

Creator: Richard D. Urman

Duration: 10:22

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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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A sample discussion with a patient in the preoperative setting

Creator: Richard D. Urman

Duration: 6:02

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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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Preoperative DNI/DNR conversations

Creator: Richard D. Urman

Duration: 3:54

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This video describes the basics of conducing a successful do-not-intubate/do-not-resuscitate discussion, including tips for success.

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February 2021 A&A Video Summary: Featured Article 3

Creator: Lance Lichtor

Duration: 3:22

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Video summary of the featured article “Basic Science of Frailty—Biological Mechanisms of Age-Related Sarcopenia” in the February 2021 issue of Anesthesia & Analgesia.

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December 2020 A&A Video Summary

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Video summary of featured articles in Anesthesia & Analgesia for December 2020.

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Supplemental Video 2 - COVID Lung 1

Creator: Butterfly Network, Inc.

Duration: 00:27

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COVID-19 lung ultrasound with thick irregular pleural line, confluent and isolated B lines and A lines

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Method D Taping Technique

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Video showing one method of securing an endotracheal tube with tape.

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SAP block

Creator: Marta Kelava

Duration: 0:39

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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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PIF block

Creator: Marta Kelava

Duration: 0:41

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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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PECS I&II blocks

Creator: Marta Kelava

Duration: 1:16

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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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ESP block

Creator: Marta Kelava

Duration: 0:36

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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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Animated Poincare Plot of Progressive Ataxic Breathing Severity

Creator: Sean Ermer

Duration: 00:13

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This video demonstrates what the Poincare plot looks like as ataxic breathing severity progresses

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Wearable video glasses provide hands-free mechanism for real-time emergency consultation during airway management

Creator: Nicholas Dalesio

Duration: 00:49

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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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Demonstration of ultrasound use for real-time confirmation of caudal block placement.

Creator: Adam C. Adler, MS, MD, FAAP, FASE

Duration: 1:21

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Demonstration of ultrasound use for real-time confirmation of caudal block placement.

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Supplemental Video 1. The ultrasound-assisted paramedian spinal anesthesia without cephalad angulation.

Creator: Sun-Kyung Park

Duration: 00:27

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The performance of spinal anesthesia using preprocedural ultrasound skin marking, via paramedian approach.

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November 2019 A&A Video Summary

Creator: Jeanette Esau

Duration: 1:47

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Video summary of featured articles in Anesthesia & Analgesia for November 2019.

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Xhosa patients information video on spinal anesthesia for cesarean section

Creator: Barry Smit, Craig Kilroe, Dale Hunt, Dr Jessica Purcell-Jones, Dr Rowan Duys.

Duration: 3:37

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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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Prebypass Mid Esophageal TEE views of a Bullet In the Aortic Root

Creator: Lee Goeddel

Duration: 0:14

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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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IPACK Video

Creator: Brianne Aiken

Duration: 3:06

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IPACK block performed for Total Knee Arthroplasty

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March 2019 A&A Video Summary

Creator: Jeanette Esau

Duration: 2:03

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Video summary of featured articles in Anesthesia & Analgesia for March 2019.

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December 2018 A&A Video Summary

Creator: Jeanette Esau

Duration: 1:54

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Video summary of featured articles in Anesthesia & Analgesia for December 2018.

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Rapid Central Vein Assessment and brachiocephalic vein visualization

Creator: Paolo Beccaria

Duration: 0:15

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The video represents RaCeVA method, RaCeVA is the acronyms for Rapid Central Vein Assessment. It is the ultrasound method to identify the adequate site and side to central venous access placement.

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March 2018 A&A Video Summary

Creator: Jeanette Esau

Duration: 1:47

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Video summary of featured articles in Anesthesia & Analgesia for March 2018.

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February 2018 A&A Video Summary

Creator: Jeanette Esau

Duration: 2:35

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Video summary of featured articles in Anesthesia & Analgesia for February 2018.

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Video 2: RV strain measurement using the Vivid E9 System (GE, Chicago, IL, USA)

Creator: Massimiliano Meineri, MD

Duration: 1:15

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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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September 2017 A&A Video Summary

Creator: Jeanette Esau

Duration: 1:58

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Video summary of featured articles in Anesthesia & Analgesia for September 2017.

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Real-time ultrasound-guided left supraclavicular approach to the central vein

Creator:

Duration: 0:15

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Real-time ultrasound-guided left supraclavicular approach to the central vein

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Real-time ultrasound-guided right supraclavicular approach to the central vein

Creator:

Duration: 0:15

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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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Avalon catheter repositioning

Creator: Juan G. Ripoll

Duration: 0:24

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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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Video clip 1. 2D-TEE analysis of two primary cardiac lymphomas

Creator:

Duration: 0:27

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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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July 2017 A&A Video Summary

Creator: Jeanette Esau

Duration: 2:26

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Video summary of featured articles in Anesthesia & Analgesia for July 2017.

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June 2017 A&A Video Summary

Creator: Jeanette Esau

Duration: 2:57

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Video summary of featured articles in Anesthesia & Analgesia for June 2017.

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Cardiac Venous System – Retrograde Blood Cardioplegia.

Creator: Luiz F Maracaja MD

Duration: 0:15

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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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How to Perform Focused Cardiovascular Ultrasound

Creator: Dr. Josh Zimmerman, MD, FASE

Duration: 23:23

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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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Video 1: Normal parasternal long axis

Creator: Dr. Josh Zimmerman, MD, FASE

Duration: 0:08

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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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Video 2: Significant aortic stenosis seen in the PLAX

Creator: Dr. Josh Zimmerman, MD, FASE

Duration: 0:06

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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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Video 3: Mitral valve prolapse seen in the PLAX

Creator: Dr. Josh Zimmerman, MD, FASE

Duration: 0:06

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In systole, the body of both mitral leaflets is above the level of the mitral annulus.

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Video 4: Dilated cardiomyopathy seen in the PLAX

Creator: Dr. Josh Zimmerman, MD, FASE

Duration: 0:08

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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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Video 5: Rheumatic mitral disease seen in the PLAX

Creator: Dr. Josh Zimmerman, MD, FASE

Duration: 0:05

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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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Video 6: Systolic anterior motion of the anterior mitral leaflet in the PLAX

Creator: Dr. Josh Zimmerman, MD, FASE

Duration: 0:07

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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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Video 7: Both pleural and pericardial effusions seen in the PLAX

Creator: Dr. Josh Zimmerman, MD, FASE

Duration: 0:05

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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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Video 8: Normal parasternal short axis (PSAX.)

Creator: Dr. Josh Zimmerman, MD, FASE

Duration: 0:07

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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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Video 9: Parasternal short axis (PSAX) with akinesis of the inferior segment

Creator: Dr. Josh Zimmerman, MD, FASE

Duration: 0:06

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The thinning of this segment suggests a scar consistent with previous myocardial infarction.

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Video 10: Parasternal short axis (PSAX) showing a pericardial effusion

Creator: Dr. Josh Zimmerman, MD, FASE

Duration: 0:07

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A pericardial effusion around the heart, hyperdynamic left ventricular systolic function, and decreased LV filling in diastole.

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Video 11: Parasternal short axis (PSAX) in a patient with septic shock.

Creator: Dr. Josh Zimmerman, MD, FASE

Duration: 0:07

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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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Video 12: Parasternal short axis (PSAX) showing RV pressure overload

Creator: Dr. Josh Zimmerman, MD, FASE

Duration: 0:08

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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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Video 13: Normal apical four chamber (A4).

Creator: Dr. Josh Zimmerman, MD, FASE

Duration: 0:08

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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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Video 14: Apical four chamber showing ischemia in the LAD territory

Creator: Dr. Josh Zimmerman, MD, FASE

Duration: 0:11

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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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Video 15: Apical four chamber showing prolapse

Creator: Dr. Josh Zimmerman, MD, FASE

Duration: 0:09

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Prolapse of both anterior and posterior mitral leaflets with left atrial enlargement.

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Video 16: Apical 4 chamber showing an abnormal mitral valve opening in a patient with rheumatic heart disease

Creator: Dr. Josh Zimmerman, MD, FASE

Duration: 0:09

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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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Video 17: Apical four chamber showing an enlarged right ventricle with decreased RV systolic function

Creator: Dr. Josh Zimmerman, MD, FASE

Duration: 0:09

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Enlarged right ventricle with decreased RV systolic function in a patient with a history of chronic severe pulmonary hypertension.

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Video 18: Apical four chamber zoomed in on the tricuspid valve

Creator: Dr. Josh Zimmerman, MD, FASE

Duration: 0:11

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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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Video 19: Normal subcostal four chamber (SC4)

Creator: Dr. Josh Zimmerman, MD, FASE

Duration: 0:10

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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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Video 20: Subcostal four chamber with right ventricular dilation and hypertrophy

Creator: Dr. Josh Zimmerman, MD, FASE

Duration: 0:10

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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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Video 21: Subcostal four chamber in a patient with pericardial effusion and tamponade.

Creator: Dr. Josh Zimmerman, MD, FASE

Duration: 0:11

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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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Video 22: Normal subcostal IVC view (SC IVC)

Creator: Dr. Josh Zimmerman, MD, FASE

Duration: 0:19

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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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