Tag Archives: FOAMus

Sono Short: POCUS for Thoracic Dissection

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Ultrasound for suspected thoracic dissection is an excellent tool to decrease time to diagnosis and treatment for this high mortality diagnosis. When scanning for suspected thoracic dissection, combine a parasternal long view with an abdominal aorta view for maximum sensitivity. Start with the parasternal view to look for dilation of the aortic root > 4 cm or a visible dissection flap. You should also look for a flap in the descending thoracic aorta (found just deep to the left atrium). A quick peek at the abdominal aorta can also give you valuable information. If there is visible dissection flap in the setting of chest pain, this suggests there’s also a thoracic dissection. If you have a positive scan for dissection that has fluid around the heart, this is extra bad and resources should be mobilized ASAP. Just like any test, you have to know its limitations. With sensitivities ranging from 77-96% it’s not a sufficient rule out test for dissection. Think of ultrasound as a rule in test that will save time to diagnosis and treatment for this life threatening condition, so pick up the probe the next time you think thoracic aortic dissection.

Sono Pro Tip: Going Deep

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Even time you use too much depth a kitten dies…. or you greatly reduce your image quality and image the bed instead of the patient. Not only does it shrink the size of what you’re looking at, but it also moves your structure of interest out of the focal zone (you know the area of highest image resolution in the mid field of the ultrasound screen). Plus it adds poor quality images to the patient’s chart with your name, so don’t do it and think of the kittens.

Happy scanning everyone!

 

Sono Pro Tip: Distinguishing Right from Left Heart

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Know your right from left heart. In a perfect world probe positioning would be right every time and you’d just know the right heart is on screen left. However no one is perfect and it’s important to know your right from left heart to prevent errors like calling right heart strain when there isn’t. Here are some tips to help (even when your image is flipped like this one):

  1. Descending thoracic aorta is associated with the left atrium
  2. Look for left ventricular outflow tract/aortic valve in left ventricle
  3. Tricuspid valve insertion onto septum is more apical
  4. Tapered right ventricle shape
  5. Moderator band is sometimes visible in the right ventricle

Happy scanning everyone!

SonoSave – It’s Just Sepsis

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Hemodynamically unstable, sick patient have high mortality and morbidity. Their physical exam findings can be misleading and the diagnosis still broad or unclear even after examination. When time counts and your patient is sick, bedside ultrasound can quickly make the diagnosis to help you provide appropriate and definitive care when it matters most. This is the basis for the SonoSave series, which examines ultrasound saves and the critically ill patients alive today because of point of care ultrasound.   

Intro

Ultrasound is a lifesaver and luckily for a recent patient I mean this literally. Thanks to the early use of ultrasound a life was saved that would have been lost. A critical diagnosis was made within 5 minutes of arrival, preventing investment of precious time in ineffective treatments or delaying definitive care and making me look real slick in the process. The patient was successfully treated and admitted to the ICU. When I walk into work the next day, I find out the patient is not only alive but sitting up in bed talking to the team! With some simple ultrasound views and less than 2 minutes, the direction of our treatment completely changed and a man lived to see his family that I doubt would have otherwise. Two minutes to save a life… that’s some good stuff and even better ultrasound! These are the moments that make medicine worth it.  

That Feeling When You Walk Out of Your Shift After A Good Save Continue reading SonoSave – It’s Just Sepsis →

Getting to the Point of Ultrasound Assisted Lumbar Punctures

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The Case

There are a few cases I could talk about… Ultrasound guided LPs have turned out to be a surprisingly useful skill. Lucky for you, I’ve restrained myself.

The first time I heard about ultrasound guided LPs was during a spectacular yearlong ultrasound elective in medical school. I was sitting in the doctor’s pod with THE ultrasound attending of ultrasound attendings. He casually asked “Have you ever heard of ultrasound guided LPs?” Never. “Do you want to see one?” Obviously. He explained how ultrasound guided LPs follow the principle of “Measure twice. Cut once.” He spent a minute (and I mean literally just one minute) visualizing the spinal landmarks and marking them on a somewhat altered, seriously chunky patient. He proceeded to get the LP in one stick! I remember thinking he was a wizard in that moment, a wizard who uses ultrasound to elevate patient care to another level; and that I want to be the badass attending that gets LPs on obese, altered patients in one stick. I had to learn this skill… Continue reading Getting to the Point of Ultrasound Assisted Lumbar Punctures →

SonoMojo Featured on Critical Care Practioner Podcast

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Hey sono enthusiasts! Exciting news! SonoMojo was recently featured on Critical Care Practioner Podcast! “Episode 37: How to Make Ultrasound Easier” features myself and the SonoMojo site in an episode discussing how to make learning ultrasound easier through #FOAMed resources and strategies for learning ultrasound. I’m so thrilled about the whole experience and getting to work with fellow FOAMer Jonathan Downham. Jonathan is a class act and he’s put together a great episode! Be sure to check it out!

Life in the eFAST Lane: Sonography for Trauma (Part 2)

Learning Bedside Ultrasound, SonoMojo, Ultrasound, , ,

That’s right! The Life in The eFAST Lane series is back! Last time we reviewed eFAST basics and half of the eFAST technique. Hopefully you’ve been practicing the heart, RUQ, and LUQ scans like my friend below. So without further adieu…. I give you eFAST Part Deux!

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Figure 1 – An eFAST Rockstar in Action

Figure 1 – An eFAST Rockstar in Action

How to Do I Perform an eFAST? (Continued from Part 1)

Pelvis

Probe position

  • Probe marker towards patient’s head (longitudinal view) or towards patient’s right (transverse view).
  • Place the probe just above the pubic symphysis and look for the bladder in men and both the bladder and uterus in women.
    • If it’s not awkward, it’s not right and you’re not low enough.
  • Once you’ve completed the longitudinal view, turn your probe 90° for the transverse view.  Both views should be evaluated to avoid false positives.

Continue reading Life in the eFAST Lane: Sonography for Trauma (Part 2) →

FOAMed Ultrasound Curriculum

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This curriculum is entirely FOAMed based! That means that all the education provided by these links is free. These resources are from the best of the best in ultrasound, so the education is some of the highest quality available. The curriculum is broken down into sections (like cardiac or procedures) with modules containing a collection of resources for a particular scan. This is by far the most useful SonoMojo resource and my favorite part of the site, so please enjoy! And as always, feedback is welcome!

Ultrasound Basics

Orientation & Ultrasound Resources Module

  • Essential iBooks & Web Resources, Intro to Bedside Ultrasound, Knobology, & Basic Physics

Intro to Bedside Ultrasound Module

  • Physics, Transducers, Modes, Orientation & Resolution, & Artifacts

Focused Ultrasound Exam Modules

Abdominal Ultrasound Module

  • Renal, Appendix,Small Bowel Obstruction, Gallbladder, Liver, Spleen, Bladder, Hernia

Trauma Ultrasound Module

  • eFAST, Advanced Trauma, & SUSS IT

Fluid Responsiveness Module

  • IVC, Carotid VTI, & Integrated Approach

Soft Tissue Ultrasound Module

  • Soft Tissue Infections & Foreign Bodies

Vascular Ultrasound Module

  • DVT, Aorta, & IVC

 Lung Ultrasound Module

  • Lung, Dyspnea, & PE

Cardiac Ultrasound Module

  • Basic Views, LV Function, Wall Motion Abnormalities, Diastology, Pericardial Tamponade, & Transesophageal Echo

Ocular Ultrasound Module

  • Basics, Lens Dislocation, Globe Rupture, Retinal Detachment, Vitreous Hemorrhage, Retrobulbar Hemorrhage, & Optic Nerve Sheath Diameter

RUSH Protocol Module

  • Rapid Ultrasound for Shock and Hypotension (RUSH) Protocol (5 quick scans in a couple minutes for lots of answers… when time counts!)

Female Pelvic Ultrasound Module

  • Basics, First Trimester, Intrauterine Pregnancy Assessment, & Transvaginal Ultrasound

Small Parts Ultrasound Module

  • Testicular, Peritonsilar Abscess, & Thyroid

Musculoskeletal Ultrasound Module

  • Basics, Hips, Shoulder, Fractures, & Joint Injections

Pediatric Ultrasound Module

  • Basics, Peds ECHO, Pyloric Stenosis, & Intussusception

Useful Ultrasound Protocols Module

  • RUSH Protocol, Echo-Guided Life Support, & Focused Sonography for HIV-Associated TB (FASH) Protocol

Ultrasound Guided Procedure Modules

Ultrasound Guided Vascular Access Module

  • Peripheral IVs, Central Lines, & Arterial Lines

Ultrasound Guided Nerve Blocks Module

  • Brachial Plexus, Upper Extremity, & Lower Extremity Blocks

More Ultrasound Guided Procedures Module

  • Airway, LPs, Thoracentesis, Paracentesis, & Pericardiocentesis

More Topics in Ultrasound Modules

Ultrasound in Medical Education Module

  • Ultrasound in Medical Education

Knowing Your Stuff Module

  • Preventing Errors & Advanced Physics

SonoMojo USIG Toolbox

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An Ultrasound Interest Group (USIG) is student-run ultrasound education organization. To offer student-driven ultrasound education takes a little work and some organization. To make this easier we’ve developed a “How To” guide for starting, organizing, and running a USIG. It’s based on the experience of creating a USIG from nothing and managing it at a medical school without any ultrasound in the curriculum. Learn from our experience in creating student-sponsored ultrasound education and start your own USIG to bring ultrasound to your school!

Basic USIG Components

The basic picture of a USIG is student-organized ultrasound education. This takes place in the form of:

  • Hands-on ultrasound workshops
  • Interest group meetings
  • Independent study (using USIG provided self-study materials)
  • Group practice sessions (in ultrasound practice lab hours arranged by the USIG)
  • Optional but fun USIG features (USIG member of the month, Ultrasound Honors, case of the month, USIG twitter account, etc.)

The heart of the group is the hands-on teaching workshops that put ultrasound skills in the hands on the students. This uses “student mentors” to teach the hands-on components and faculty, when available, to give the lecture component of ultrasound education. The group also provides support for students interested in ultrasound. This comes in the form of creating a community, organizing curriculum integration efforts, and other features of the club (access to independent ultrasound practice, ultrasound competitions, FOAMed-based self study curriculum, etc.). More information about “Medical Student Driven Ultrasound Education” can be found in this presentation.

Starting a USIG

To start you will need student leaders. These are the people who will make ultrasound education a reality. We’ve outlined the essential components of USIG leadership below to help you get your USIG off to a strong start with a strong leadership model.

How to: Set Up USIG Leadership

After establishing your leadership, you will need to figure out ultrasound workshops. This is the most important activity of a USIG, so start working on this early! It’s going to provide your members with access to the ultrasound education that probably don’t have access to. Below you’ll find all the info you need to create hands-on ultrasound workshops.

How to: Create Ultrasound Workshops

Your also going to need a website! Having a site allows USIG students to quickly connect to USIG activities and essential info. It allows you to easily share ultrasound resources with USIG students, so you can orient them to the available ultrasound education resources and allow them easily access ultrasound learning whenever, wherever. And lastly, having a site makes your USIG more visible to students and medical school administrators. Highlighting the activities and success of your USIG and its members, and drawing attention to student interest in bedside ultrasound allows your USIG website to support efforts for ultrasound curriculum integration.

How To: Create a USIG Website

Example to check out: University of Kentucky USIG Site

You’ll also need some basic resources (like ultrasounds, money, instructors, etc.) for your USIG. Below are some helpful tips for getting the resources you need to start and maintain your USIG.

How To: Get Resources for Your USIG

Once you’ve gotten the basics elements of your USIG put together, it’s time to have some fun with it. There are lots of exciting and fun things you can do with your USIG! Like seriously cool features you can add to your USIG to make learning ultrasound even more awesome!

How To: Add Awesome Extras Your USIG

USIG Membership with Distinction & Ultrasound Honors Program

USIG Ultrasound Curriculum

When starting a new ultrasound education group, there is NO need to re-invent the wheel when it comes to curriculum! There are ton of great ultrasound education resources out there. We’ve sorted through all of them and collected the best of them into a comprehensive FOAMed-based curriculum. The SonoMojo FOAM Curriculum is broken down into learning modules by scan, so you can easily learn the scan of your choice. You can find the curriculum on our FOAMed Ultrasound Curriculum page HERE or download a copy.

FOAMed Ultrasound Curriculum

Ultrasound Curriculum Integration

Making an Ultrasound Elective

There’s no need to wait for your medical school administration or course directors to provide you with ultrasound education. Not only can you create ultrasound education through your USIG, but also through forming official ultrasound electives for yourself and your fellow ultrasound students. Most medical schools allow students to create independent study electives to satisfy their specific learning interests. Simply find a faculty sponsor and submit one of the elective request template below.

First/Second Year Ultrasound Elective:

Ultrasound Elective Request Letter – Introduction to Ultrasound Elective

Fourth Year Ultrasound Electives: 

Ultrasound Elective Request Letter – Advanced Ultrasound Elective (for EM students)

Ultrasound Elective Request Letter – Advanced Ultrasound Elective (for non-EM students)

Coming Soon… “How a USIG Can Promote Ultrasound Curriculum Integration” & “Collecting Data to Support Curriculum Integration”

Incorporating Ultrasound into Your Clinical Education

SonoMojo Vimeo: “Incorporating Ultrasound into Your Clinical Education at an Ultrasound Naïve Institution”

Keeping a Record of Your Scans

Demonstrate your experience by keeping a record of it. Document how many scans you’ve done and how much time you’ve put into learning ultrasound. Record these to know/document for residency applications, for ultrasound credentialing exams, or to measure your experience for your own knowledge. It’s easy. Just create a Google Form and add a link to the home screen of your mobile devices. When you complete a scan, tap the home screen icon, fill out the form (15 seconds max), and submit. Google forms will automatically log all your scans into a spread sheet and keep a record for you. The same goes for logging hours. Learn more about Google Forms HERE.

Sample: Ultrasound Scans Log & Sample: Ultrasound Hours Log

Coming Soon… “Guide: How to Incorporate Ultrasound into Your Clinical Education in an Ultrasound Naive Institution”