Resuscitation Ultrasound (resUS)

Parasternal Short

There are 4 levels in the parasternal long axis (PLA) the aortic valve (AV), mitral valve (MV), papillary and apex.

Transducer Position (Figure 1)

Start at the parasternal long axis (PLA) rotate the transducer clockwise 90
Then rotate from the 2-10 o’clock position until the indicator bisects the left clavicle
By tilting the transducer base to the apex, obtain different short axis images

Image orientation (Figure 2, Figure 3)

Aortic Valve (Figure 4)

Tilt/fan the transducer up towards the patients head until the centrally located AV comes into view
Adjust until the AV appears a perfect quarter sized circle in the middle of the screen
If the MV is seen first, tilt the transducer face slightly up to get the AV window

Mitral Valve (Figure 5)

From the AV tilt the transducer face down to open the mitral valve

Papillary Muscle (Figure 6)

From the MV tilt the face down until the round papillary muscles are seen
Adjust the depth so that the LV fills about three quarters of the screen

Apex

Continue to tilt the transducer down towards the patient’s feet to obtain an image of the tip of the LV

Assessments and Measurements

Aortic Valve

AV function
Peak Velocity Tricuspid jet
Estimate pulmonary systolic artery pressure

Mitral Valve

MV function

Papillary Muscle

Right ventricular function
Right ventricular pressure and/or volume overload
Septal flattening, D-shaped LV

Apex

Apical dyskinesia
Apical aneurysm

Tip

Some centers do apex to base, either is fine so long as it is systematic

Figures

Figure 1 - PSA Transducer Placement

Figure 2 - PSA Levels

Figure 3 - PSA Levels

Figure 4 - PSA Ideal Aortic Valve Level

Figure 5 - PSA Ideal Mitral Valve Level

Figure 4 - PSA Ideal Papillary Muscle Level

References

Moore, Christopher L., and Joshua A. Copel. “Point-of-care ultrasonography.” New England Journal of Medicine 364.8 (2011): 749-757.