Resources for ultrasound guided LP:
Literature:
Ultrasound-assisted lumbar puncture in obese patients
Ultrasound guided LP in patients with difficult anatomic landmarks
Procedural descriptions:
Ultrasound guided lumbar puncture
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Category Archives: Ultrasound
Ultrasound Credentialing
By Dr Owen Doran – FACEM, AED lead for ultrasound
Credentialing for bedside ultrasound is essential for the safe and trusted use of ultrasound by Emergency doctors. The ACEM provides guidance for credentialing a practitioner to become an Emergency Medicine Sonologist, and policies can be found on the college website:
Policy on use of bedside ultrasound – click HERE
Policy on use of echo in life support – click HERE
This involves attending a course and performing a minimum number of proctored, documented and acceptable exams in that module, of which at least 50% are indicated and 5 are positive for pathology.
- 15 for AAA
- 25 for other modules
- Basic echo module also requires you to view 25 echocardiograms on ‘file’, some with demonstrated pathology.
You also have to pass an ‘exit exam’ per ACEM & ASUM guidelines, which consists of performing a focused scan on a patient/volunteer while observed by an examiner (radiologist, ultrasonographer or previously accredited EM sonologist).
Each individual department is responsible for adopting and implementing this process.
In practical terms, this usually means a member of the specialist team is identified as the ultrasound champion for the department, and they help to coordinate this process.
Scans can be reviewed realtime, with direct supervision, or more commonly with a review of images. To have reviewed images accepted, they have to be of good quality, with labelling and patient information complete, and a confirmatory imaging or treatment modality must be available. This can be departmental ultrasound, CT or operative findings. The fact that a patient went home and did not come to further harm is not enough.
The easiest way is to keep a log of your scans- I have given an example of this below. This can be done as paper copy, or computer file. I have given an example of a file that might be compiled for review of a FAST scan below:
Ultrasound Credentialing Log – click HERE
FAST images and correlating CT report:
CT report – Owen Doran – click HERE
FAST – the RUQ view
From our colleagues across the Tasman at The Sonocave, HERE is a video tutorial about the RUQ view of the FAST scan. It covers image acquisition, exploration of the entirety of Morrison’s pouch, and interpretation of image findings. note the audio is quiet, so crank the volume up…
free fluid in Morrison’s Pouch
Ultrasound at Adult Emergency Department, Auckland City Hospital
By Dr Owen Doran, ED Specialist, Auckland AED Ultrasound Lead
Philips Sparq
We currently have two ultrasound machines in our department- an older Envisor (Philips) and our new machine, the Sparq (also a Philips machine). We were the first emergency department in Australasia to own the Sparq, and it has been put to good use – its size, manoeuvrability and ease of use have made it popular. The image quality is also an improvement on our older machine.
Positive FAST scan
Being a major trauma centre, the main use of ultrasound in the department is FAST and EFAST in the resuscitation room. This has allowed timely assessment for free intra peritoneal blood in our unstable trauma patients, supporting decisions regarding further management.
We also perform a number of screening scans for AAAs- particularly in older (>50yo) patients with undifferentiated abdominal pain. This has in the past, and will likely in the future been lifesaving.
The third biggest area of use has been procedural ultrasound- particularly for vascular access. As well as using ultrasound for safe central venous access, we are increasing using ultrasound for difficult peripheral access. This certainly saves time and patient discomfort. With the recent purchase of a peripheral and internal jugular phantom, we will be able to improve our teaching of these vital skills.
The next application where I think ultrasound will benefit our patients will be in patients with shock. There are a number of protocols (e.g. RUSH) that have been shown to be beneficial to patients whose shock is poorly differentiated- aiding diagnosis and guiding management. This is an area that I hope we will develop our skills as a group.
Our challenges in the near future include improving our accreditation for our senior doctors, and also developing ultrasound skills amongst our trainees.
Click here for information and documentation regarding accreditation
Click here for a list of web-based ultrasound resources
Emergency Ultrasound Web Resources
By Dr Owen Doran, ED Specialist, Auckland AED Ultrasound Lead
Sonoguide
Essentially an online textbook of Emergency Medicine Ultrasound from ACEP- very well laid out, great graphics, and a relatively easy read.
http://www.sonoguide.com/instructions.html
Life in the Fast Lane
This is a great round up of ultrasound resource from the crew at LITFL- my favourite EM site.
http://lifeinthefastlane.com/2012/10/ultrasound-in-emergency-medicine/
Soundbytes
These downloadable videos are provided free from CME download. A little dated looking, they are from some of the leading lights in Emergency Department ultrasound, and are well worth a look.
http://cmedownload.com/courses/soundbytes
Ultrasound Podcast
An excellent resource from passionate ED sonographers.
http://www.ultrasoundpodcast.com/
HQMEDED
This is a fantastic website from the Hennepin County Medical Centre- there are a few great ultrasound videos, as well as other useful clips.
Winfocus
An organisation dedicated to bringing critical care and emergency ultrasound to the world. If you get a chance to attend one of their conferences- jump at it!
ACEM
For members of the ACEM, there is an ultrasound module as part of the e-learning. This comprises of online lectures, and images for review, with an Australasian bent.
The college website also has guidelines and policies related to ultrasound use in Australasian emergency departments.
http://www.acem.org.au/home.aspx?docId=1
ASUM
The Australasian Society for Ultrasound in Medicine is the peak body for promoting ultrasound in Australasia. As well as education, they are responsible for policy regarding ultrasound, and the promotion of ultrasound in the region.
http://www.asum.com.au/newsite/index.php
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INDUSTRY
Sonosite
Some useful education packages on this website.
http://www.sonosite.com/education
Phillips
Some useful resources on the Phillips website.
http://www.healthcare.philips.com/main/education/index.wpd
Courses/ Training ( see also ASUM)
Australian Institute of Ultrasound
The team at the AIU on the Gold Coast run a range of courses for those interested in Emergency Ultrasound , catering for different levels of training, and also for those wanting more subspecialty areas ( like MSK and ECHO).
Ultrasound Training Solutions
Another popular ultrasound training company.
http://www.ultrasoundtraining.com.au/’
University of Otago
This is a great course that I completed last year- a one year certificate with an excellent faculty and a great way to hone your skills.
http://www.otago.ac.nz/courses/qualifications/pgcertcpu.html
Wellington Ultrasound
This first department in NZ to have their own director of Emergency Ultrasound. They also run courses, so that we don’t have to leave good ole NZ for our sonography training!
Improving care in ED 