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Ultrasound : Zonare

Ultrasound : Zonare. Knobology Jamie Jenkins MD, RDMS Regional Ultrasound Director FHS St Josephs Medical Center. Core Applications of Ultrasound. Knobology. How to use the machine. Medical Legal Aspect. Only 21% of EM physicians personally perform bedside ultrasound

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Ultrasound : Zonare

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

  2. Core Applications of Ultrasound

  3. Knobology How to use the machine

  4. 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?

  5. Knobology: The Basics

  6. Changing probes • Press the transducer key and then use the soft keys to select which transducer you need • Please do not change the Transducer plug-ins.

  7. Exam Type

  8. New patient exam Press new patient key in upper left hand corner of the keyboard

  9. New Patient: Non-credentialed physicians, Training scans at all hospitals • Last name: Training • First name: EDUS • Do not fill out MR number • Operator: Your name • Press exit • On first page, press space bar and type in pt name and MR number

  10. New Patient: Credentialed physicians At St Joes & St Francis • Enter an order in EPIC • Click worklist • Select patients name from list • The screen will self populate • Fill in your name under operator • Press exit and start scanning

  11. New Patient: Credentialed physicians at St Anthony & St Clare • Last name: Patients last name • First name: Patients first name • ID: MR number • Operator: Your last name • Press exit and start scanning • Print images and attach to a paper with pts sticker and give to HUC to scan in for HIM

  12. If you manually enter info instead of using worklist: St Josephs & St Francis • If you manually enter the patient information including the MR number • No leading zeros • No dashes • No FIN numbers • Ex: MR number is 001-234-567 • Enter 1234567 • At St Josephs and St Francis you still need to enter an order after you finish the scan • It is preferred that you use the worklist

  13. Central Lines • Document on central line section of the note • Wire or needle seen in lumen • Image saved to patients permanent record • You must save an image of this. • There is an EPIC smart Phrase under my name (Jamie Jenkins) .eduscentralline

  14. OB/ IUP • OB/ Pregnancy Scan • OB mode • Calc button will give you options for fetal dates/ FHT • Transabdominal views of the uterus • transverse and longitudinal • 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) 

  15. Fetal Heart Tones • Please use M –mode to document FHT. • Press M-mode once and the screen will change, • Align the line with the fetal heart • When you have the image you want press freeze • Press calc, select FHT/ HR and measure the distance between beats.

  16. 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.

  17. Transabdominal Ultrasound

  18. Gallbladder • Transverse and longitudinal 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 • Pericholecystic fluid • Sono-murphys • CBD dilation 

  19. Gallbladder • Common Bile Duct

  20. Gallbladder Literature • Indications: Signs and symptoms of Cholecystitis • Most sensitive signs: Stones and sono-murphys sign • Very specific signs: Wall thickness, pericholecystic fluid

  21. FAST • Clips of • RUQ • LUQ • Suprapubic • Cardiac  • Depth: enough to see posterior surface of heart • Pericardial vs Pleural effusion • Parasternal long if unable to get Subxiphoid view

  22. 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

  23. Renal • Bilateral Kidney’s • Two views of each: transverse and longitudinal • Bladder (2 views) • Please label your views

  24. Credentialing • 50 scans to remain credentialed in all areas of ultrasound over 2 years • CME is required as well • This lecture • Scanning shifts with me • Ultrasound courses/lectures at conferences

  25. Questions?????? • If there are any questions please feel free to email me. • Jamiegoodis@gmail.com

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