The FATE Ultrasound Exam by Critical Care Specialist Liz Turner, MD

Dr. Liz Turner’s YouTube video, the FATE exam (Focused Assessment of Thoracic Echocardiography), discusses the views of this bedside ultrasound exam and gives examples of the use of FATE exam in critical care decision making. This video is simply outstanding.

All that follows is from Dr. Turner’s video:

The Goals of the FATE exam are:

  1. Evaluate obvious cardiac pathology
  2. Assess wall thickness and chamber dimensions
  3. Assess contractility
  4. Image the pleura bilaterally
  5. Relate the findings to the clinical context (that is, use the findings to improve clinical decision making)

The purpose of the FATE exam is always to answer a question. Why is this patient hypotensive? Why is this patient short of breath? Does the patient need more fluid? Or does the patient need diuresis?

The FATE exam consists of four views (which are well demonstrated in the video):

  1. The subcostal window
  2. The apical window
  3. The parasternal window
  4. The bilateral pleural windows

The Inverior Vena Cava is assessed from the subcostal window for evidence of fluid status.

To obtain the apical two chamber view, you obtain an apical four-chamber view and then rotate the probe 90 degrees and angle the beam a little towards the patient’s left.

Dr. Turner states that it is at the papillary muscle level of the parasternal short axis view of the heart that we assess volume status and contractility. And we want to get a view where the left ventricle is round for our assessment. If we can’t get a round view of the LV no matter how we move the probe, then there is pathology.

Mirror image artifact (of liver) behind  [really meaning the above the diaphragm in the chest cavity] the diaphragm indicates normal lung. Explanation is in the video from 28:30 to 29:20

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