7/24/2017
Leo Lamsen, MD, FAAFP, RDMS Introduction to EM Fellowship Director, UT Medical Center Bedside Ultrasound Medical Simulation Fellow, UT Medical Center
Learning Objectives • Define point-of-care ultrasound and describe its uses. • Learn basic knobology and scanning techniques to optimize image acquisition. • Apply principles to perform the extended Focused Assessment with Sonography for Trauma (eFAST) Exam. • Review obtained images for quality assurance.
Point-of-Care Ultrasound • Clinician performed and interpreted • Limited exam • Extension of physical exam • Helps determine diagnosis and guide clinical practice • Prioritize patient care • Patients like it
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Ma and Mateers’s Emergency Ultrasound
Ma and Mateers’s Emergency Ultrasound Ma and Mateers’s Emergency Ultrasound
Gain Basic Knobology • Gain • Time gain compensation • Depth • Zoom
• Freeze Lamsen • Measuremants and Calculations
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Time Gain Compensation Depth
Ma and Mateers’s Emergency Ultrasound Ma and Mateers’s Emergency Ultrasound
Zoom Measurements and Calculations
Lamsen Lamsen Lamsen Lamsen
Ultrasound Modes
• B-mode • M-mode • Color • Doppler
B-mode
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M-mode Color
Lamsen Lamsen Ma and Mateers’s Emergency Ultrasound
Doppler Duplex
Ma and Mateers’s Emergency Ultrasound Ma and Mateers’s Emergency Ultrasound
Artifacts Shadowing • Shadowing • Acoustic enhancement • Mirror artifact • Gas • Ring-down artifact
Lamsen
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Posterior acoustic enhancement Posterior acoustic enhancement
Lamsen Lamsen
Mirror artifact Ring-down artifact
Ma and Mateers’s Emergency Ultrasound Ma and Mateers’s Emergency Ultrasound
Bowel gas Image Acquisition • Gel • Transducer movements • Position • Compression • Augment
Lamsen
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Lamsen
Lamsen
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Ma and Mateers’s Emergency Ultrasound
Mid-axillary line between the 8th and 11th ribs in a coronal plane • Pleural space • Subphrenic space
• Morrison’s pouch
• Inferior pole of kidney • Colic gutter Ma and Mateers’s Emergency Ultrasound
Posterior-axillary line between the 8th and 11th ribs in a coronal plane • Pleural space • Subphrenic space
• Splenorenal space
• Inferior pole of spleen • Inferior pole of
Ma and Mateers’s Emergency Ultrasound kidney
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Angle down just above the pubic symphysis
Ma and Mateers’s Emergency Ultrasound
Ma and Mateers’s Emergency Ultrasound
Posterior-axillary line between the 8th and 11th ribs in a coronal plane
• Probe parallel with patient’s body
• Use liver as an acoustic window
Ma and Mateers’s Emergency Ultrasound Lamsen Third IC space left of sternum with probe marker facing R shoulder
Intercostal space in sagittal plane
Ma and Mateers’s Emergency Ultrasound
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Transducer Positions 1. Subxiphoid 2. Intercostal oblique (right) 3. Hepatorenal 4. Intercostal oblique (left) 5. Splenorenal Leo Lamsen, MD, FAAFP, RDMS 6. Pouch of Douglas Introduction to EM Fellowship Director, UT Medical Center Medical Simulation Fellow, UT Medical Center 7. eFAST views Bedside Ultrasound Ma and Mateers’s Emergency Ultrasound
Summary Agenda • Probe marker orientation
• Depth and gain are most commonly adjusted Introduction Practice Conclusion • • Knobology • 4 main stations • Scan review B-mode is the most commonly used mode • Image acquisition • Rotate every 12 min • Post-test • Don’t get fooled by artifacts • FAST Exam • 2 mini-stations • Evaluation • Gel is your friend • eFAST Exam is used to detect free fluid
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Cardiac funtion Kidney Hydronephrosis Wall motion Cardiac abnormality Gallbladder R Flank Valvular problems IVC eFAST PTX Aorta
Pleural effusion L Flank Kidney Pulmonary Edema Bladder Suprapubic Pneumonia OB Lamsen Lamsen
Gallstones Acute cholecystitis
Lamsen
Lamsen
Cardiac function Pleural Effusion
Lamsen Lamsen Lamsen
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Closed-loop obstruction
Lamsen
Cardiac funtion Kidney Pregnancy Wall motion Cardiac abnormality Gallbladder R Flank Valvular problems IVC eFAST PTX Aorta
Pleural effusion L Flank Kidney Pulmonary Edema Bladder Suprapubic Pneumonia OB Lamsen
Humerus fracture Retinal detachment
Lamsen ACEP.org
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Deep venous thrombosis
Leo Lamsen, MD, FAAFP, RDMS Introduction to EM Fellowship Director, UT Medical Center Medical Simulation Fellow, UT Medical Center Lamsen Lamsen Bedside Ultrasound
Conclusion • Ultrasound is the new stethoscope • The eFAST exam is your gateway ultrasound exam • Key to learning is knowing where to start • Practice makes permanent • Q&A Share your skills with others
References • Ma OJ, Mateer J, Reardon RF, Joing SA. Ma and Mateer’s Emergency Ultrasound, Third Edition. (2013) • Edelman SK. Understanding Ultrasound Physics, Fourth Edition. (2012) • American College of Emergency Physicians Policy Leo Lamsen, MD, FAAFP, RDMS Statement: Emergency Ultrasound Guidelines. (2008) Introduction to EM Fellowship Director, UT Medical Center Bedside Ultrasound Medical Simulation Fellow, UT Medical Center
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Leo Lamsen, MD, FAAFP, RDMS Introduction to EM Fellowship Director, UT Medical Center Bedside Ultrasound Medical Simulation Fellow, UT Medical Center
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