SSNV (supra-sternal notch view)

Why? Search for aortic dissection!

• Direct sign: a flap

  • ***Please note: a flap is a wire attached to the aortic wall that oscillates with the heartbeat. Several linear artifacts can occur during vascular studies, and care must be taken to avoid mixing with them.

• Indirect sign: dilation of the aortic arch (>3.5cm)

How :

1. Position the patient in the supine position with the neck extended

   1. Optimally, if the patient allows, an object (e.g., towels) should be placed between the patient's shoulder blades. This will elevate the thorax and force neck extension to clear the suprasternal space. It's not very comfortable, but it's for a good cause.

2. Ask the patient to rotate his head slightly to the right.

   1. This will clear the space needed to move your probe. If your chin is in the way...SSNV will not be possible!

3. Insert your probe into the suprasternal space with your marker toward the patient's left cheek (approximately at one o'clock).

4. Tilt the probe to orient it towards the inside of the chest! Too often I see people set up without tilting...

Now, no matter how great your technique is... it's hit or miss!! You'll either get a great panoramic view, or you won't be able to recognize anything! If that's the case, don't dwell on it.