TEE Compared to Transthoracic Echocardiography

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Position TTE transducer in the subxiphoid region of the abdomen with transducer flat and push down with a slight tilt to the patient’s right. Orientation marker  pointing towards the left shoulder (3 o’clock),  adjust the sector depth to 16-24 cm to image the entire LA and LV. Usually great for pericardial effusion, LV/RV function, wall motion and LV filling, and atrial septal/ventricular septal defects

Best seen as anechoic region in pericardium, degree of tamponade physiology determined by amount of "trampoline right atrium" and measurement of effusion

Position TTE transducer on the subxiphoid region of the abdomen, tilt to the patient’s left. From the SC 4 chamber view rotate the probe 90 degrees counterclockwise while keeping the right atrium in view with the index marker pointing towards the head (12 o’clock). Adjust the sector depth to 16-24 cm to see the entire IVC

Volume status is assessed by measuring the IVC diameter and collapsibility during deep inspiration or valsalva (similar to pulse pressure variability). Here M-Mode is used to assess collapsibility over time along with diameter. The IVC is less than 2 cm and collapses greater than 50%, such that the CVP is less than 5 mmHg and the patient would benefit from volume resuscitation.

Position the TTE transducer in the 3rd or 4thintercostal space at the left parasternal border with the index marker pointing towards the right shoulder (11 o’clock). Adjust the sector depth to 10-16 cm to see the descending aorta in short axis, then increase depth to 20 cm to assess the left pleural space

Estimating function is a big part of what we do with TTE/FATE in managing hemodynamics. I recommend the Utah website for excellent examples and testing in getting this "eyeball EF" skillset down.

Position the TTE transducer in the 4th or 5th intercostal space in the midclavicular line or at the point of apical pulsation with the index marker pointing towards the left (3 o’clock). Best if the patient is in left lateral position to bring chest closer to the chest wall, left arm raised to spread ribs. Adjust the sector depth to 14-18 cm to image the atria, 6-10 cm to assess the LV apex

Classic PE here with McConnell's Sign (dead RV free wall, RV apex still beating). Wide open TR, you can calculate the PA systolic from the TR jet. 

The transducer is placed on the lateral thoracic wall at approximately the 8th rib on left, 10th rib on right. Scanning is initiated posteriorly in the upper abdomen with orientation marker cephalad with phased array probe. Slide cephalad until the diaphragm is visible. As the patient inspires a curtain of gray artifact sweeps from left to right obliterating the view of the diaphragm, liver and/or spleen

Typically pulmonary ultrasound uses artifacts (A line and B lines), the absence of air means fluid of some type. A more caudal scan typically gets the "spine sign" where the beam bounces off the spine.