Conquering Clinical Pivot Points-Ultrasound · • Introduction to ultrasound physics and...
Transcript of Conquering Clinical Pivot Points-Ultrasound · • Introduction to ultrasound physics and...
Conquering Clinical Pivot Points with Point-of-Care Ultrasound
Workshop Instructors
Jabraan Pasha, MD, RDMS
Workshop Instructors
Mary Mao, MD
Workshop Instructors
Mark Perdue MHS, PA-C
Workshop Instructors
Bobby Bosse, PA-C
Workshop Instructors
Jacob Murray, MD
Workshop Objectives
Workshop Objectives• Understand the principles of point-of-care
ultrasound
Workshop Objectives• Understand the principles of point-of-care
ultrasound
• Introduction to ultrasound physics and knobology
Workshop Objectives• Understand the principles of point-of-care
ultrasound
• Introduction to ultrasound physics and knobology
• Learn image acquisition and interpretation of pulmonary, renal and cardiac ultrasound
Point-of-Care Ultrasound? What’s That?
Point-of-Care Ultrasound? What’s That?
What it’s not:
Point-of-Care Ultrasound? What’s That?
What it’s not:• A comprehensive radiologic
study
Point-of-Care Ultrasound? What’s That?
What it’s not:• A comprehensive radiologic
study• A general screening test
Point-of-Care Ultrasound? What’s That?
What it is:
Point-of-Care Ultrasound? What’s That?
What it is:• A focused and goal-directed exam
Point-of-Care Ultrasound? What’s That?
What it is:• A focused and goal-directed exam• Quickly performed
Point-of-Care Ultrasound? What’s That?
What it is:• A focused and goal-directed exam• Quickly performed • Performed at patient’s bedside
Ultrasound physics
Ultrasound physics
ProbesPhased Array• Cardiac• Abdominal
ProbesLinear• Soft Tissue• Pulmonary• Lines
ProbesCurvilinear Probe• Abdominal• Chest*
Orientation
• Screen marker on left of screen (except cardiac)
• Probe marker to patients right or patients head
Orientation
Acoustic Windows• Good conductors
• Solid• Flexible
• Liver• Spleen• Kidney• Bladder
Acoustic Windows• Poor conductors
• Air• Not Flexible
• Lung• Bone• Bowel
Acoustic Windows
Acoustic Windows
Acoustic Windows
Acoustic Windows
Echogenicity
Gain
• Affects the brightness of the image
Gain
Depth
• Changes the depth of the beam
• Image should be in the center of the screen
Artifacts
• Mirror image artifact
Artifacts• Post Acoustic Shadowing
Artifacts
• Reverberation
Planes
Case #165 y/o male with h/o COPD and CHF presents to ED with dyspnea on exertion and hypoxia. On exam, there is scattered wheezes and crackles heard at the bases. CXR shows enlarged lung fields and increased vascular congestion
Case #1
COPD exacerbation vs CHF exacerbation
Application #1: Pulmonary Ultrasound
Application #1: Pulmonary Ultrasound
• Clinical Question:
Application#1: Pulmonary Ultrasound
• Clinical Question: Is there significant pulmonary edema?
Application #1: Pulmonary Ultrasound
Patient and Probe Positioning• Patient supine• Abdominal probe in sagittal plane
in mid-clavicular line• Depth set to 12cm
Application #1: Pulmonary Ultrasound
Clinical Question:
Application #1: Pulmonary Ultrasound
Clinical Question: Is there significant pulmonary edema?
Application #1: Pulmonary Ultrasound
Application #1: Pulmonary Ultrasound
Application #1: Pulmonary Ultrasound
• Lung ultrasound study• B-Lines present in100% of patients with
pulmonary edema• Absent In 92% of patients with COPD
exacerbation• Absent in 98.8% of patients with normal
lungs
Bonus Application: Pneumothorax
Bonus application: Pneumothorax
Patient and Probe Positioning• Patient supine• Linear probe in sagittal plane in
mid-clavicular line• Depth set to 4cm
Bonus application: Pneumothorax
Clinical Question: Is there a pneumothorax?
Bonus application: Pneumothorax
Bonus application: Pneumothorax
Bonus application: Pneumothorax
Bonus application: Pneumothorax
Pulmonary Ultrasound Breakout Session
Case #2
65 yo male with h/o BPH and arthritis, seen in clinic for elevated creatinine of 2.6 (baseline 1.1)
Case #2
Extrinsic vs Intrinsic Renal Disease
Application #2: Renal Ultrasound
Application #2: Renal Ultrasound
• Clinical Question:
Application #2: Renal Ultrasound
• Clinical Question: Is there hydronephrosis
Application #2: Renal Ultrasound• Clinical Question: Is there hydronephrosis?
• Patient supine• Curvilinear or phased array probe in coronal
plane at rib 8-12• Depth set to approx. 14cm• Left kidney is often more posterior/superior
Application #2: Renal Ultrasound
Application #2: Renal Ultrasound
Application #2: Renal Ultrasound
Application #2: Renal Ultrasound
Application #2: Renal Ultrasound
Application #2: Renal Ultrasound
Application #2: Renal Ultrasound
Application #2: Renal Ultrasound
Application #2: Renal Ultrasound
Application #2: Renal Ultrasound
Renal Ultrasound Breakout Session
BREAK TIME!
Case #3
75 yo male with h/o CAD and recent worsening dyspnea on exertion
Application #3: Cardiac Ultrasound
• Clinical Question: Is the EF reduced?
Application #3: Cardiac Ultrasound
Application #3: Cardiac Ultrasound
• Clinical Question: Is the EF reduced? • Parasternal Long axis view• Left parasternal between ribs 2 and 5
Application #3: Cardiac Ultrasound• Clinical Question: Is the EF reduced?
• Screen marker on right• Probe marker towards patient’s right
shoulder• Often helpful if patient lying on left side
with left arm behind head
Application #3: Cardiac Ultrasound
Application #3: Cardiac Ultrasound
Application #3: Cardiac Ultrasound
Cardiac Ultrasound Breakout Session
Questions?
Thank You!!