Point of Care Ultrasound UCSF Continuing Medical Education Skin and - - PowerPoint PPT Presentation

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Point of Care Ultrasound UCSF Continuing Medical Education Skin and Soft Tissue and Central Venous Cannulation Brandon Boesch, DO October 21-22, 2018 Disclosure I have no relevant financial relationships with any companies related to the

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October 21-22, 2018

Point of Care Ultrasound UCSF Continuing Medical Education Skin and Soft Tissue and Central Venous Cannulation Brandon Boesch, DO

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Disclosure

I have no relevant financial relationships with any companies related to the content of this course.

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Skin and Soft Tissue Ultrasound

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SSTI Ultrasound

US can differentiate between cellulitis and abscess Reverberation artifact can show air in soft tissue representing necrotizing fasciitis

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Transducer

High frequency linear transducer for depth up to 4 cm

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Normal skin and soft tissues by ultrasound. B, bone; F, fascia; M, muscle; V, superficial vein; S, subcutaneous tissue.

Soni N., Arntfield R., & Kory P. (2015) Point-of-Care ultrasound. Philadelphia: Elsevier

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Cobblestoning

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Abscess

Soni N., Arntfield R., & Kory P. (2015) Point-of-Care ultrasound. Philadelphia: Elsevier

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Abscess with ?Nec Fasc

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Rib Fracture

Soni N., Arntfield R., & Kory P. (2015) Point-of-Care ultrasound. Philadelphia: Elsevier

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Goals for scanning

Look at the soft tissue planes in the leg
Identify vessels, bone, muscle, possibly

lymph nodes

Can look at the abdominal wall to see rectus

and epigastric vessels

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Central Venous Cannulation

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Pre Procedure Technique

Position the machine for easy viewing Check Lung Sliding Look at entire vessel on both sides of the neck Look for compressibility, clot, stenosis

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Identify the Vein Not always this obvious

Compression technique Color Doppler

Soni N., Arntfield R., & Kory P. (2015) Point-of- Care ultrasound. Philadelphia: Elsevier

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Soni N., Arntfield R., & Kory P. (2015) Point-of-Care ultrasound. Philadelphia: Elsevier

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Use Color Doppler

Red means flow towards the probe, not arterial flow To identify the artery, look for pulsatile appearance and disappearance of color Mosaic, continuous flow indicates a vein

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Technique

Prepare all materials in order needed for procedure on sterile tray or drape Select best target site Place needle with real time US guidance Visualize wire in vein with US prior to dilation Check lung sliding after procedure

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Out of plane

visualization

Longitudinal Approach Transverse Approach

SLIDE 19 19 Soni N., Arntfield R., & Kory P. (2015) Point-of-Care ultrasound. Philadelphia: Elsevier

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Visualize the Wire

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Scanning Today

Visualize the right and left IJ, carotid, and

surrounding structures

Figure out the best location to place a line on

your model and demonstrate with your finger

At the table IV models, try to follow your

needle tip into the vessel in both transverse and longitudinal

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