Tag Archives: point of care ultrasound

ED, Vascular

DVT 101

Looking for deep vein thrombosis (DVT) of the lower extremity is a common request. The most important aspect of a DVT ultrasound is the compression of the vein.

On ultrasound, vessels look black, or anechoic, due to the fact that they are fluid filled. You can also use colour Doppler to see the flow of blood within these vessels.

Holding your probe in transverse on the patient’s leg, find the common femoral artery and vein at the proximal thigh. By applying firm pressure with the probe to the patient, the vein should easily collapse. Follow the vein from the thigh to behind the knee, to the popliteal vein.

sfv-comp-norm.jpg

However, if the vein does not compress, this should raise suspicion for a DVT. Often, you will be able to see clot within the vein, as the vessel is no longer anechoic, but filled with hypoechoic clot. Also, if you turn on colour Doppler there will be no colour flow within the vessel.

DVT +

clot

Images:

http://www.nuemblog.com/dvt

https://radiopaedia.org/cases/lower-limb-deep-venous-thrombosis-dvt

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General

Learning bedside ultrasound – Time and practice

If you are medical student, this is easy as everyone assumes you are learning all the time and you don’t have all the answers. Take every opportunity to grab the machine and practice on patients, volunteers, your friends etc.  Practice at lunchtime, before work, after work. I guarantee you, the portable machine will be available most of the time. Start with the easy stuff then, when you are comfortable with that, move on. Practice, practice, practice, day in, day out. It all adds up in the end.

If you are a qualified physician, it’s a tad more difficult. Patients might expect you to give them answers. Explain that you are still learning and adopt the attitude that although it might give you positive useful information, but it also might not. In the grand scheme of things, no opportunity to learn is ever wasted.

 

General

Learning bedside ultrasound – Good learning resources

Start by finding a hands-on course or organize an elective or fellowship. No one learns to drive a car by reading a book, listening to didactic lectures or watching YouTube videos. Getting your hands on the probe early with a trainer next to you on a real human subject will orientate you to probe handling and hand-eye-screen coordination. This will give you a basic grounding.

Next find a good book or online resource with videos starting with the basics and building up. Aim to practice regularly what you are learning from reading and watching the videos on real subjects.

General

Why should I learn to do bedside ultrasound?

We live in exciting times. We know ultrasound imaging provides valuable clinical information. It was the case that the machines were large, expensive, and difficult to use. They were also kept in the radiology department under lock and key. But technology moves fast. Now the machines are small, portable, user-friendly and much less expensive which means ultrasound is available to anyone who is willing to take the time and learn how to use it. And if you can use it, it can help narrow down your differential diagnosis; it can help you manage the patient, not in the morning, not the next day, but now. Bedside or point of care ultrasound is joining forces with clinical history taking and examination. In the near future, as the technology shrinks further, we might see an ultrasound unit in the pocket of every clinician right along side their stethoscope.