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Ultrasound : Zonare

Ultrasound : Zonare. Knobology and Criteria Jamie Jenkins MD Regional Ultrasound Director FHS St Josephs Medical Center. Medical Legal Aspect. Only 21% of EM physicians personally perform bedside ultrasound Standard of Care: Central lines No lawsuits for misreads as of 2007

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Ultrasound : Zonare

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  1. Ultrasound : Zonare Knobology and Criteria Jamie Jenkins MD Regional Ultrasound Director FHS St Josephs Medical Center

  2. Medical Legal Aspect • Only 21% of EM physicians personally perform bedside ultrasound • Standard of Care: Central lines • No lawsuits for misreads as of 2007 • 3 lawsuits for failure to use • 2 with AAA • 1 with rule out ectopic • Credentialing • Can we hide behind it or with out it?

  3. Core Applications of Ultrasound

  4. Knobology How to use the machine

  5. Start • Press new patient key in upper left hand corner of the keyboard

  6. New Patient • Last Name • First Name • ID=MR number • Operator: your name • Press exit and start scanning

  7. New Patient

  8. Knobology

  9. Changing probes • Press the transducer key and then use the soft keys to select which transducer you need

  10. Exam Type

  11. OB/ IUP • OB/ Pregnancy Scan • OB mode: Calculations • Transabdominal views of the uterus • transverse and horizontal • Fetal Heart Tones (m-mode) • Fetal dates • >12weeks BPD • <12weeks crown rump length  • -BPD (Inner to outer walls of the skull) • Clips of bilateral adenexa (even if obvious IUP) 

  12. Early Pregnancy Ultrasound • Misconception: A very low B-HCG rules out ectopic pregnancy • Truth: 40% of ectopic pregnancies will present with a B-hcg less than 1000 mIU/ml • 20% will present with a B-hcg less than 500 mIU/ml • Pts who present with a B-hcg less than 1000 mIU/ml have a higher risk of ectopic pregnancy • Keep in mind with ectopics all you may see is an empty uterus and free fluid in the pelvis.

  13. Transabdominal Ultrasound:

  14. Gallbladder • Transverse and horizontal clips through the gallbladder • Measurement of the anterior wall of the gallbladder • (2-3 mm) • Measurement of the CBD •  (4-8mm) • Look for: • Stones • Wall thickness • Pericholeycystic fluid • Sonomurphys • CBD dilitation

  15. Gallbladder • Common Bile Duct

  16. Gallbladder Literature • Indications: Signs and symptoms of Choleycystitis • Most sensitive signs: Stones and Sono Murphys sign • Very specific signs: Wall thickness, pericholeycystic fluid

  17. FAST • Clips of • RUQ • LUQ • Suprapubic • Cardiac  • Depth •  Pericardial vs Pleural effusion • Parasternal long if no SX view

  18. Aorta • Transverse View • epigastric and infra-renal • Measure the outer to outer wall of the Aorta • Nl <3cm • longitudinal views of the aorta in the epigastric region • Bifurcation of the iliacs

  19. Questions??????

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