Check out this new POCUS learning tool from the folks at 5 minute sono. The have loads excellent teaching videos and resources. Great job!
Check out the latest Cool Sono, Bro!@UltrasoundJelly and I made this amazing learning tool: The Wheel Of Echo!https://t.co/fegrANNaxm pic.twitter.com/MxCz1xWbZ1
— 5 Minute Sono (@5MinSono) April 3, 2017
Great example of bedside ultrasound to rule out pneumothorax. Credit to @RBuhmaid
#POCUS for pneumothorax confirmed by absent lung sliding + lung point #FOAMus #FOAMed #FOAMcc pic.twitter.com/HLHRN0bKRI
— Rasha Buhumaid (@RBuhumaid) March 15, 2017
Excellent example of RV strain in a patient with massive pulmonary embolism. Credit to @EM_RESUS
"D-Sign" in a young man with Saddle PE
RV Strain flattens septum & smashes LV – looks like a Capital "D"
This is how PE Kills!#FOAMed pic.twitter.com/COejSPtTNA
— Sam Ghali, M.D. (@EM_RESUS) March 16, 2017
Great case of the week from Yale EM Ultrasound. This is a great POCUS education site.
Yale case of the week! 77yo s/p surgery with abdominal pain and distension – not subtle but quick diagnosis… #POCUS @yaleem2 pic.twitter.com/pi2tatxK7E
— Yale EM Ultrasound (@Yale_EUS) January 10, 2017
Hyperactive, dilated small bowel loops with free intraperitoneal fluid. (c.f. paralytic ileus where bowel loops are dilated but static)
Ultrasound can be used to assess the main vascular structures in the abdomen. The most common examination is to look for an Abdominal Aortic Aneurysm (AAA).
To find your aorta, start by placing the probe on the patients’ abdomen in transverse, just below the xiphoid process. You will see anechoic oval and circle, above a crescent shadow. These represent the IVC, Ao and Vertebra, respectively. Using firm pressure, slide probe downwards toward the umbilicus, at which you should see the Ao bifurcate into the Iliac arteries. Once found in transverse, try this motion while the probe is in the sagittal plane.
An aortic aneurysm is a focal dilation of the Aorta, and should be greater than 3.0 cm when measured from anterior to posterior.
The IVC is located just right of midline, and can be seen by the liver. It is best appreciated in the sagittal plane. Notice how the IVC is phasic, changing size with respiration. If you ask your patient to breathe in, or “sniff”, you should see the vessel collapse more than 50%, demonstrating a normal venous pressure.
![C60_Liver_IVC_Midline[3]_1](https://i0.wp.com/www.figbus.net/wp-content/uploads/2017/02/C60_Liver_IVC_Midline3_1.jpg?resize=326%2C217)
Images:
http://reference.medscape.com/features/slideshow/ultrasound
http://www.sonosite.cn/clinical-media
Depth, Focus, Gain
When it comes to image quality, if you follow these easy steps for every image, you can’t go wrong! First, adjust your depth. Is the structure you are imaging, say the aorta, way at the top of the screen? Decrease your depth so your image ends just below the area of interest. Is the lower pole of the kidney cut off? Increase your depth to include a few centimeters below the kidney border.
Now that you’ve adjusted your depth, apply the focus! By tapping or twisting the focus knob, place your focal zone at or just below the structure of interest. This will place optimal resolution at the organ you want to see.
Finally, tweak the gain. Usually a dial on the main console, twist to increase or decrease the brightness of the image. Your goal: Make anechoic structures, such as vessels or the bladder black, but still bright enough to see surrounding structures.
With these three steps, your images will be picture perfect!
Want to know the impact that Point of Care Ultrasound is having on the practice of Emergency Room Physicians and their patients? Just watch Chris Fox’s talk at TEDxUCIrvine 2015.
It’s easy to get carried away when doing your own bedside ultrasound but it’s important to know your limits. Pablo Blanco and Giovanni Volpicelli have published an excellent article in Critical Ultrasound Journal 26 Oct. on some of the most common mistakes and pitfalls when performing point of care ultrasound. You can find it here.
In a recent online published study out of the children’s hospital in Barcelona, chest ultrasound outperformed fluoroscopy in the detection of diaphragmatic paralysis (Pediatric Critical Care Medicine Oct 28). This will save patients radiation and can be performed at the bedside. You can read more at about it at Health Imaging.
We’re so excited! After a long gestation, our first book is finally out. It’s geared to those starting out in bedside ultrasound and offers a basic grounding in US technique. Concise and pocket-sized, it contains chapters on basic scanning of the most common applications such as scrotum, leg veins, abdomen, OB, lung and cardiac. Packed with tips and tricks it also has a chapter on US guided procedures and what to look for when buying your own machine. It’s available direct from our publisher or from Amazon. E-book versions are also available from iTunes and the Amazon Kindle store. To check it out, click on the link.