7/24/2017

Leo Lamsen, MD, FAAFP, RDMS Introduction to EM Fellowship Director, UT Medical Center Bedside 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 Wall motion Cardiac abnormality R Flank Valvular problems IVC eFAST PTX Aorta

Pleural effusion L Flank Kidney Bladder Suprapubic Pneumonia OB Lamsen Lamsen

Gallstones Acute cholecystitis

Lamsen

Lamsen

Cardiac function

Lamsen Lamsen Lamsen

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Closed-loop obstruction

Lamsen

Cardiac funtion Kidney 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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Let your voice be heard! Evaluate workshops on the NC app

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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