hello my name's Tom cook today I'm going to show you how to use something called a super sternal notch view so when would you use this well let's say you got a patient who comes in maybe they're older and they've got a little bit of hypertension and they complain this real terrible pain and uh they say well God it just feels like it's ripping right through my body and of course a lot of us we'd go for a parisal long AIS view which I'm demonstrating here and we notice when we look at the aortic root that perhaps it's dilated or it appears a little bit funny and we really start to think about uh the idea that maybe this person has a dissection so what we can do is take our transducer and place it in the super sternal notch and we can take it an angle the transducer towards the patient's left shoulder what we're trying to do is pick up a long axis view of this patient's aortic Arch now you can see in this particular situation the almost the entire arch in fact you can see not only the arch itself but you can see the takeoff of the left karate and the left subclavian and if I angle it a little bit more this way we can also pick up the takeoff of the nominate artery going to the right side of the body so this is a fantastic view to get it's not consistently available in all patients but when you are able to obtain it in those patients you're very suspicious of having dissection and you see evidence of aortic pathology in the arch it really helps you manage that patient quickly and efficiently obviously we need to get the blood pressure down we need to get cardiothoracic surgery involved very very quickly and this can really be literally a lifesaver if you know how to use it
