CRIT/ER Conference

2017

Point-of-Care Ultrasound: Beyond the Basics and Into the Resuscitation Room

Welcome to this section on "POCUS: Beyond the Basics and Into the Resuscitation Room." We are providing you with some focused materials to get you engaged prior to the workshop. We hope attendees have a basic understanding in machine knobology, probe use & applications. If not, we will work with you to bring you up to speed. The overarching goal of this workshop is to allow you to bring a new/refreshed skill set of US to the resuscitation room to resolve challenging scenarios seen peri-resuscitation. Our dedicated workshop will blend hands-on training with interactive image interpretation to help you apply your skills to challenging scenarios. Come prepared to work as a team of adult learners to troubleshoot imaging acquisition and interpretation at the bedside.

Our learning outcomes for this workshop include:

  1. Describe indications and critical application of multi-modality point-of-care ultrasound in the care of the critically ill patient in the emergency room.
  2. Describe and apply focused thoracic ultrasound to identify/ rule out pneumothorax, troubleshoot peri-intubation cardio-respiratory instability, and pleural effusions (including hemothoraces).
  3. Describe defining echocardiographic features of a pericardial effusion; distinguishing from pleural effusion, and discerning features of tamponade.
  4. Describe and identify defining echocardiographic features of RV failure and RV pressure overload.

Ultrasound essentials

First, get to know your machine you have access to in *your resuscitation room or emergency department. We will have selected machines available at the course, but what really matters is what you will use in your own environment. So take a picture of your machine and get to know the knobs and buttons.

Many of you will arrive already having experience with probe handling. You may not know that movements are standardize by international convention. Understanding probe movements is critical to advancing your skill and may be the difference between satisfactory and excellent images.

Familiarize yourself with these basic imaging planes. They will help you understand image acquisition, particularly in thoracic ultrasound. Although cardiac ultrasound has its own unique planes, almost all other modalities generally use this framework.

Notably, imaging orientation is different between cardiology and traditional radiological standards. This image to the left shows a visual representation of these differences. Although some existing training programs (i.e. EDE US) uses one orientation for all applications, we will be exploring pathology using conventional standards that are accepted internationally.

You will need to understand basic echocardiography views. You can look under "focused echocardiography" on this website to learn or to refresh your understanding of these critical views. Gaining new skills in interrogation of life-threatening conditions requires a strong visual reference library of "normals".

Thoracic Ultrasound in the Resuscitation Room

Landmarks

Landmarks for thoracic ultrasound are generally centred on *4 spaces a. anterior chest wall 2nd ICS (mid-clavicular), b. anterior chest wall 4-5th ICS (anterior-axillary line), c. lowest costal margin (mid-axillary line) and d. posterior thoracic space. All views are in the para-sagittal plane, except for the mid-axillary (costal margin) view, which lies in the coronal plane. The probe must be perpendicular to the anatomical structures (pleural line, thoracic space) and properly adjusted for depth (6-10 cm anterior chest wall and ~15-18 cm for thoracic space).

Detection of pneumothorax

Please view the following video for a short tutorial on the use of lung ultrasound for detection of pneumothorax. You will find the password in an email sent to you as part of the workshop. We will use and expand upon this knowledge and skill set on the day of the course.

Detection of Hemothorax

Please view the following video for a short tutorial on the use of lung ultrasound for detection of hemothorax. You will find the password in an email sent to you as part of the workshop. We will use and expand upon this knowledge and skill set on the day of the course.

Cardiac Ultrasound in the Resuscitation Room

Detection & management of RV Dysfunction

Please view the following video for a tutorial on the use of focused cardiac ultrasound for detection and management of RV dysfunction including cor pulmonale and RV failure.

Detection & management of pericardial effusions

Please view the following video for a tutorial on the use of focused cardiac ultrasound for detection and management of pericardial effusions. We will also review evaluation for hemodynamic consequences.