N T R O Ultrasound Skills T O C L I N I C A L P R A C T I C E 1 - - PowerPoint PPT Presentation

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N T R O Ultrasound Skills T O C L I N I C A L P R A C T I C E 1 - - PowerPoint PPT Presentation

Oct 16, 2023 104 likes •695 views

N T R O Ultrasound Skills T O C L I N I C A L P R A C T I C E 1 Welcome + Overview 2 U/S Curriculum ICP Foundations JVP Pneumothorax Course 8 FAST Lung U/S POCUS (Point Of Care UltraSound) Image acquisition Image interpretation

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N T R O

T O C L I N I C A L P R A C T I C E

Ultrasound Skills

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Welcome + Overview

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U/S Curriculum

ICP

Foundations JVP Pneumothorax

Course 8

FAST Lung U/S

POCUS (Point Of Care UltraSound)

Image acquisition Image interpretation Clinical application

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Foundations

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How does U/S generate images?

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Define penetration, attenuation, and reflection (wave properties).

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Image Source: EDE1 Book
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Attenuation

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Reflection

SKIN TISSUE

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How do different tissue densities (e.g. fluid, solid organ, bone, air) appear on U/S, and why?

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Fluid

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Solid Organ

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Bone (Spine)

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Air

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Image Source: http://www.startradiology.com/internships/general-surgery/abdomen/ultrasound-abdomen-general/
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What is an acoustic window?

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LIVER HEART

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What are shadowing and enhancement artifacts?

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Shadowing

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Enhancement

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Define hyperechoic, hypoechoic, and anechoic.

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Hyperechoic (diaphragm) Hypoechoic (renal cortex)

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Anechoic

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What is depth and gain?

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Object of interest

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Too Deep = wasted screen space Too Shallow = entire object of interest not in screen

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Gain

Undergained: Tissue inappropriately appears anechoic Overgained: Fluid has internal echoes

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What are common probe types and its uses?

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Linear 5-10 MHz Curvilinear 2-5 MHz Phased Array 1-5 MHz

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Procedures Vessels Pleura Skin MSK Abdomen Lung IVC Abdomen Lung IVC Heart

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What is frequency, and how does this relate to penetration and resolution?

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Taken from Soni, et al. Point of Care Ultrasound 2015. Elsevier.

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What is B mode and M mode?

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B Mode M Mode

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Foundations Walk-Through

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JVP Demo and Practice

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IJ Carotid Thyroid SCM

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Clinical Application Use ultrasound JVP the same as visual JVP: to estimate CVP

Deol et al CHEST 2011;139;95-100

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PTX Demo and Practice

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RIB

Must identify pleura in the ribspace

Exam Technique

PLEURA AIR ARTIFACT

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Pneumothorax

  • 1. No lung sliding
  • 2. A lines in absence of B lines
  • 3. Lung Point
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Sliding Pleura: Normal

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Seashore: Normal

SEA SHORE

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Bar Code: Pneumothorax

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B-Lines: No pneumothorax

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A-Lines: Normal Pleura (or pneumothorax)

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Lung Point: Pneumothorax

Infant with respiratory distress syndrome. B-lines present on one side. Transition to an area (pneumothorax) where A-lines (horizontal lines) are present without B-lines (comet tails). The transition point is the LUNG POINT.

Image Source: https://www.researchgate.net/figure/Static-image-of-lung-point-arrow-in-an-infant-suffering-from-RDS-Note-the-coalescent-B_fig1_301830426

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Interpretation Summary Pneumothorax excluded: lung-sliding, seashore sign, B-line (lung rocket) Pneumothorax possible: lung-sliding absence & barcode sign Other causes of no lung-sliding:

COPD/asthma attack (stiff lungs) Effusions Consolidations Adhesions Chest tubes Pleurodesis Subcutaneous emphysema

Pneumothorax present: lung-point

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Ultrasound Machine Care

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Ultrasound Machine Care

Never drop transducers Never roll over cords Keep machine plugged in after use Clean after use with appropriate wipes Use least energy possible (avoid Doppler, minimize scan time, turn off after use)

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Relay Race

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1. Seashore Sign 2. Two anechoic structures near each other 3. Two hyperechoic structures near each other 4. Hepatorenal interface 5. IJ Taper (Longitudinal View)

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Questions?

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YOUR FEEDBACK IS IMPORTANT ! Feedback helps improve

This session Your facilitators The MED SCHOOL EXPERIENCE

Workshop Credits

  • Workshop by Anthony Seto
  • Objectives and design contributions by Irene Ma
  • Workshop lesson plan reviewed by Ryan Lenz, Irene Ma, and Rob Warren
  • Picture contributions from Ryan Lenz