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Focused Echocardiography in Life Support: The Subcostal Window

What the Surgeon Should Know for Critical Care Applications

  • Focus on Ultrasound in Trauma and Emergency Surgery
  • Published:
European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Context:

Focused echocardiography evaluation in life support (FEEL) for emergency and critical caremedicine is an innovative approach to introducing limited-in-scope echocardiography in a timely fashion into periresuscitation care. FEEL is an advanced life support-conformed concept and a simple procedure that can be readily used in shock roomor pre-hospital scenarios as an extension of focused abdominal sonography for trauma (FAST). The subcostal window plays a pivotal role in this context, because it can easilybe applied inthesupine position, and is usually better than other windows in patients with mechanical ventilation or during resuscitation maneuvers. Most information can be obtained at a glance.

Aim:

As the FAST exam was not developed for implementation in resuscitation or cardiac arrest procedures, herewedescribe an accurate and easymethod that allows non-cardiologists to add FEEL to the FAST exam. As a result, it conforms to actual resuscitation guidelines. To perform the FEEL procedure and the subcostal window, a specific training seems to bemandatory. The aim of this paper is to set special emphasis on the use of the subcostal window.

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Authors and Affiliations

  1. Clinics of Anesthesiology, Intensive Care Medicine and Pain Therapy, Hospital of the Johann Wolfgang Goethe-University, Frankfurt am Main, Germany

    Raoul Breitkreutz MD & Hendrik Ilper

  2. Trauma Surgery, Hospital of the Johann Wolfgang Goethe-University, Frankfurt am Main, Germany

    Felix Walcher

  3. Department of Cardiology, Hospital of the Johann Wolfgang Goethe-University, Frankfurt am Main, Germany

    Florian H. Seeger

  4. Adult Intensive Care Unit, Royal Brompton Hospital, London, UK

    Susanna Price

  5. 1st Department of Anesthesia and Intensive, Care, Fondazione, IRCCS Policlinico San Matteo, P.zzale Golgi 2, 27100, Pavia, Italy

    Gabriele Via

  6. Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany

    Holger Steiger

  7. Clinics of Anesthesiology, Intensive Care Medicine and Pain Therapy, Hospital of the Johann Wolfgang Goethe-University, Frankfurt am Main, Germany

    Raoul Breitkreutz MD

Authors
  1. Raoul Breitkreutz MD
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  2. Felix Walcher
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  3. Hendrik Ilper
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  4. Florian H. Seeger
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  5. Susanna Price
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  6. Gabriele Via
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  7. Holger Steiger
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Correspondence to Raoul Breitkreutz MD.

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Breitkreutz, R., Walcher, F., Ilper, H. et al. Focused Echocardiography in Life Support: The Subcostal Window. Eur J Trauma Emerg Surg 35, 347–356 (2009). https://doi.org/10.1007/s00068-009-9093-1

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  • DOI: https://doi.org/10.1007/s00068-009-9093-1

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