Ultrasound Zonare Knobology Jamie Jenkins MD RDMS Regional

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 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?

Knobology: The Basics

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.

Exam Type

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

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

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

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

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

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

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 >12 weeks BPD <12 weeks crown rump length BPD (Inner to outer walls of the skull) Clips of bilateral adenexa (even if obvious IUP)

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.

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 m. IU/ml 20% will present with a B-hcg less than 500 m. IU/ml Pts who present with a B-hcg less than 1000 m. IU/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.

Transabdominal Ultrasound

Gallbladder Transverse and longitudinal clips through the gallbladder Measurement of the anterior wall of the gallbladder (2 -3 mm) Measurement of the CBD (4 -8 mm) Look for: Stones Wall thickness Pericholecystic fluid Sono-murphys CBD dilation

Gallbladder Common Bile Duct

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

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

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

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

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

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