VEXUS

1. Obtain subxiphoid cardiac view: place cardiac probe flat against abdomen and slide towards xiphoid process until see heart.
2. While keeping the heart and right atrium centered on the screen, rotate probe marker vertically + lightly angle probe posteriorly.
3. Visualize the IVC (enters into the RA, thin walled). Slide side to side to ensure visualizing the intrahepatic IVC at largest diameter.
4. Assessment: 
   1. If IVC is less than 2cm = no need to proceed to next steps.
   2. If IVC is greater than 2cm = proceed to next VEXUS step. 

• Note: The video demonstrates an IVC that is greater than 2cm. 

1. Abdominal probe with probe marker towards head place in right posterior axilalry line. 
2. Identify hepatic vein (collapsing) + elongate by rotating + heel/rock to make it as vertical as possible. 
3. Place color doppler (should appear blue = moving away towards IVC). Ensure no speckling (reduce gain till see just the blue). 
4. Place pulse wave doppler gate in hepatic vein. 
5. Ask patient to just stop breathing (not hold breath or deep inhale). 
6. Initiate pulse wave doppler, then freeze image for assessment for severity (see online charts). 

1. Using abdominal probe slide from hepatic vein position more anteriorly towards front of chest (ie 3cm). 
2. Identify portal vein + elongate (rotate) + heel/rock (make as vertical as possible).
3. Place color doppler (want to see red as blood moving towards the liver/probe). Ensure no speckling (reduce gain till just see red). 
4. Place pulse wave doppler within portal vein. 
5. Ask patient to stop breathing (not inhale deeply or hold breath).
6. Initiate pulse wave doppler then freeze image for assessment of severity (see online charts). 

• Note: The video identifies the portal vein by the bright red color! 

1. Abdominal probe to posterior axillary line + center kidney on screen, want to find the long axis. 
2. Center the renal cortex on screen. Click zoom to further visualize.
3. Initiate color doppler (increase and decrease gain to visualize small vessels). 
4. Place pulse wave doppler over vein/artery complex.
5. Ask patient to stop breathing (not deep inhale or breath hold). 
6. Initiate pulse wave doppler tracing + freeze image. Artery (if imaged) will be seen above baseline, vein will be below. 
7. Assess for severity using online charts. 
8. Note: The video demonstrates a clear vein/artery complex and so the doppler is placed right on top (getting a bit of artery is okay).

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