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Clinical Ultrasound Course<br />Thomas Cook, MD, Program Director, Emergency Medicine<br />Patrick Hunt, MD, Emergency Ult...
The indications & techniques presented in this cousre have been recommended in the medical literature and/or conform to th...
3rd Rock Ultrasound would like to give a special thanks to Dr. Joseph Woo for his permission to use the historical picture...
MODULE 1Introduction to Clinical Ultrasound<br />
<ul><li>A Brief History of Ultrasound
Why are we doing this?
Program Goals
Course Curriculum
Post-Course Learning Opportunities</li></ul>Slide 5<br />LECTURE OBJECTIVES<br />
A Brief History of Ultrasound<br />
Slide 7<br />A BRIEF HISTORY OF ULTRASOUNDOrigins of Ultrasound<br /><ul><li>“Discovery” in the 1820’s
Industrial Use
Military Use (SONAR)
Medical use begins in1950’s</li></li></ul><li>Slide 8<br />A BRIEF HISTORY OF ULTRASOUNDEarly Machines & Innovations<br />
Slide 9<br />A BRIEF HISTORY OF ULTRASOUNDEarly Ultrasound Images<br />
A BRIEF HISTORY OF ULTRASOUNDEarly “Users”<br /><ul><li>1950’s - Radiology
1960’s – Cardiology
1970’s – Obstetrics & Gynecology</li></ul>Slide 10<br />
A BRIEF HISTORY OF ULTRASOUNDEVERYTHING CHANGES<br />Slide 11<br />
Slide 12<br />A BRIEF HISTORY OF ULTRASOUNDComputer Technology Explosion<br />
Slide 13<br />A BRIEF HISTORY OF ULTRASOUNDCircuit Boards to ASICs<br />
Slide 14<br />A BRIEF HISTORY OF ULTRASOUNDSmaller and Smaller<br />
Slide 15<br />A BRIEF HISTORY OF ULTRASOUNDNerd to Chic<br />
Slide 16<br />A BRIEF HISTORY OF ULTRASOUNDIT Computing Technology<br /><ul><li>Effect on Diagnostic Ultrasound
Created environment similar to personal computers versus mainframes 25 years ago.</li></li></ul><li>Slide 17<br />A BRIEF ...
Slide 18<br />1970<br />1985<br />1990<br />1995<br />2000<br />2002<br />2005<br />A BRIEF HISTORY OF ULTRASOUNDEffects o...
Slide 19<br />A BRIEF HISTORY OF ULTRASOUNDEVERYTHING CHANGES<br />(AGAIN)<br />
Slide 20<br />CT-scan<br />Nuclear<br />X-Ray<br />MRI<br />A BRIEF HISTORY OF ULTRASOUNDComparison to Other Imaging <br /...
Necessitates Separate Departments (Radiology)
Equipment
Space
Personnel</li></li></ul><li>Slide 21<br />CT-scan<br />Nuclear<br />X-Ray<br />MRI<br />A BRIEF HISTORY OF ULTRASOUNDCompa...
Slide 22<br />CT-scan<br />Nuclear<br />X-Ray<br />MRI<br />A BRIEF HISTORY OF ULTRASOUNDComparison to Other Imaging <br /...
<ul><li>RELATIVELY small INFRASTRUCTURE
Ubiquitous Presence at the Bedside
Limited Equipment Needs
Small Space Requirement
Small Data Loop
Reduced Work Flow Needs</li></ul>“PACS”<br />Slide 23<br />A BRIEF HISTORY OF ULTRASOUNDComparison to Other Imaging <br />
Slide 24<br />A BRIEF HISTORY OF ULTRASOUNDEffects on Ultrasound Labs<br />
<ul><li>New Users of Ultrasound
1980’s and beyond
General Surgery & Trauma
Emergency Medicine
Anesthesia
Critical Care
Orthopedics
EMS, USAR, Military, NASA</li></ul>Slide 25<br />A BRIEF HISTORY OF ULTRASOUNDUltrasound Uses in Medicine<br />
Slide 26<br />A BRIEF HISTORY OF ULTRASOUNDTheoretical Considerations<br />CLINICAL Medicine <br />Versus RADIOLOGY<br />S...
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  1. 1. Clinical Ultrasound Course<br />Thomas Cook, MD, Program Director, Emergency Medicine<br />Patrick Hunt, MD, Emergency Ultrasound Fellowship Director<br />Palmetto Health Richland<br />Columbia, South Carolina<br />
  2. 2. The indications & techniques presented in this cousre have been recommended in the medical literature and/or conform to the clincial practice of OUR faculty.The equipment has not necessarily been approved by the Food and Drug Administration (FDA) for use in the techniques for which they are recommended. The package insert for the equipment should be consulted for use as recommended by the FDA. Because standards, practices and recommendations change, it is advisable to keep abreast of revised recommendations, particularly those concerning new drugs and techniques. While the techniques described are successfully used in our practice, they should be followed with discretion since their complications may be dependent on the operator, patient and/or other accompanying clinical circumstances. The equipment discussed in this course is shown solely for teaching purposes. Similar equipment from other manufacturers may produce similar clinical results to ours.<br />Slide 2<br />
  3. 3. 3rd Rock Ultrasound would like to give a special thanks to Dr. Joseph Woo for his permission to use the historical pictures of ultrasound systems in this presentation.For more information about Dr. Woo’s work on the history of obstetrical ultrasound, please see the URL below.<br />http://www.ob-ultrasound.net/history1.html<br />Slide 3<br />
  4. 4. MODULE 1Introduction to Clinical Ultrasound<br />
  5. 5. <ul><li>A Brief History of Ultrasound
  6. 6. Why are we doing this?
  7. 7. Program Goals
  8. 8. Course Curriculum
  9. 9. Post-Course Learning Opportunities</li></ul>Slide 5<br />LECTURE OBJECTIVES<br />
  10. 10. A Brief History of Ultrasound<br />
  11. 11. Slide 7<br />A BRIEF HISTORY OF ULTRASOUNDOrigins of Ultrasound<br /><ul><li>“Discovery” in the 1820’s
  12. 12. Industrial Use
  13. 13. Military Use (SONAR)
  14. 14. Medical use begins in1950’s</li></li></ul><li>Slide 8<br />A BRIEF HISTORY OF ULTRASOUNDEarly Machines & Innovations<br />
  15. 15. Slide 9<br />A BRIEF HISTORY OF ULTRASOUNDEarly Ultrasound Images<br />
  16. 16. A BRIEF HISTORY OF ULTRASOUNDEarly “Users”<br /><ul><li>1950’s - Radiology
  17. 17. 1960’s – Cardiology
  18. 18. 1970’s – Obstetrics & Gynecology</li></ul>Slide 10<br />
  19. 19. A BRIEF HISTORY OF ULTRASOUNDEVERYTHING CHANGES<br />Slide 11<br />
  20. 20. Slide 12<br />A BRIEF HISTORY OF ULTRASOUNDComputer Technology Explosion<br />
  21. 21. Slide 13<br />A BRIEF HISTORY OF ULTRASOUNDCircuit Boards to ASICs<br />
  22. 22. Slide 14<br />A BRIEF HISTORY OF ULTRASOUNDSmaller and Smaller<br />
  23. 23. Slide 15<br />A BRIEF HISTORY OF ULTRASOUNDNerd to Chic<br />
  24. 24. Slide 16<br />A BRIEF HISTORY OF ULTRASOUNDIT Computing Technology<br /><ul><li>Effect on Diagnostic Ultrasound
  25. 25. Created environment similar to personal computers versus mainframes 25 years ago.</li></li></ul><li>Slide 17<br />A BRIEF HISTORY OF ULTRASOUNDEffects on Ultrasound Systems<br />
  26. 26. Slide 18<br />1970<br />1985<br />1990<br />1995<br />2000<br />2002<br />2005<br />A BRIEF HISTORY OF ULTRASOUNDEffects on Imaging<br />
  27. 27. Slide 19<br />A BRIEF HISTORY OF ULTRASOUNDEVERYTHING CHANGES<br />(AGAIN)<br />
  28. 28. Slide 20<br />CT-scan<br />Nuclear<br />X-Ray<br />MRI<br />A BRIEF HISTORY OF ULTRASOUNDComparison to Other Imaging <br /><ul><li>VERY LARGE Infrastructure Requirements
  29. 29. Necessitates Separate Departments (Radiology)
  30. 30. Equipment
  31. 31. Space
  32. 32. Personnel</li></li></ul><li>Slide 21<br />CT-scan<br />Nuclear<br />X-Ray<br />MRI<br />A BRIEF HISTORY OF ULTRASOUNDComparison to Other Imaging <br />ENORMOUS Data Management Requirements<br />Picture Archive Communication System<br />
  33. 33. Slide 22<br />CT-scan<br />Nuclear<br />X-Ray<br />MRI<br />A BRIEF HISTORY OF ULTRASOUNDComparison to Other Imaging <br />“PACS”<br />
  34. 34. <ul><li>RELATIVELY small INFRASTRUCTURE
  35. 35. Ubiquitous Presence at the Bedside
  36. 36. Limited Equipment Needs
  37. 37. Small Space Requirement
  38. 38. Small Data Loop
  39. 39. Reduced Work Flow Needs</li></ul>“PACS”<br />Slide 23<br />A BRIEF HISTORY OF ULTRASOUNDComparison to Other Imaging <br />
  40. 40. Slide 24<br />A BRIEF HISTORY OF ULTRASOUNDEffects on Ultrasound Labs<br />
  41. 41. <ul><li>New Users of Ultrasound
  42. 42. 1980’s and beyond
  43. 43. General Surgery & Trauma
  44. 44. Emergency Medicine
  45. 45. Anesthesia
  46. 46. Critical Care
  47. 47. Orthopedics
  48. 48. EMS, USAR, Military, NASA</li></ul>Slide 25<br />A BRIEF HISTORY OF ULTRASOUNDUltrasound Uses in Medicine<br />
  49. 49. Slide 26<br />A BRIEF HISTORY OF ULTRASOUNDTheoretical Considerations<br />CLINICAL Medicine <br />Versus RADIOLOGY<br />Specific Indications & Goals<br />
  50. 50. Why are we doing this?<br />
  51. 51. COMPARISON OF EFFECTIVENESS OF HAND-CARRIED ULTRASOUND TO BEDSIDE CARDIOVASCULAR PHYSICAL EXAMINATION<br />Kobal, S.L., et al, Am J Card 96(7):1002, October 1, 2005 <br />METHODS: The authors, from Cedars-Sinai Medical Center and UCLA, compared the diagnostic accuracy of physical examination performed by one of five board-certified cardiologists, and use of a hand-carried ultrasound (HCU) device (OptiGo, Philips) by one of two first-year medical students in 61 patients with clinically significant cardiac disease. The students received 18 hours of training in use of the HCU device, which provides two-dimensional and conventional color- flow Doppler imaging, including four hours of lectures and 14 hours of practical experience. Expert echocardiography was the diagnostic gold standard. <br />RESULTS: Standard echocardiography identified 239 abnormalities in these patients (average, 3.9 per patient). Using the HCU, the students recognized 75% of these abnormalities compared with 49% identified by the cardiologists on physical examination (p<0.001). Corresponding specificities were 87% vs. 76% (p<0.001). The students were significantly more accurate than the cardiologists in the recognition of the most severe cases of left ventricular (LV) dysfunction and severe valvular disease (96% vs. 68%, p<0.001), and HCU exams by the students were also more accurate than physical exams by the cardiologists in the recognition of lesions that cause systolic or diastolic murmurs. <br />CONCLUSIONS: These findings reflect the inherent difficulties in evaluation of organ systems through percussion, palpation and auscultation, and the utility of technology developed to facilitate patient assessment at the bedside.<br />Slide 28<br />WHY ARE WE DOING THIS?Can we do better?<br />. . . . (Hand-Carried Ultrasound) exams by the (medical) students were also more accurate than physical exams by the cardiologists (without ultrasound) . . . .<br />
  52. 52. Making Health Care Safer: A Critical Analysis of Patient Safety PracticesAgency for Healthcare Research & QualityU.S. Department of Health & Human ServicesShojania KG, et al. University of California at San Francisco / Stanford University<br />Slide 29<br />WHY ARE WE DOING THIS?Why Do We Need Ultrasound for Vascular Access?<br />
  53. 53. Appropriate use of prophylaxis to prevent venous thromboembolism in patients at risk;<br />Use of perioperative beta-blockers in appropriate patients to prevent perioperative morbidity and mortality;<br />Use of maximum sterile barriers while placing central intravenous catheters to prevent infections;<br />Appropriate use of antibiotic prophylaxis in surgical patients to prevent postoperative infections;<br />Asking that patients recall and restate what they have been told during the informed consent process;<br />Continuous aspiration of subglottic secretions (CASS) to prevent ventilator-associated pneumonia;<br />Use of pressure relieving bedding materials to prevent pressure ulcers;<br />Use of real-time ultrasound guidance during central line insertion to prevent complications;<br />Patient self-management for warfarin (Coumadin™) to achieve appropriate outpatient anticoagulation and prevent complications;<br />Appropriate provision of nutrition, with a particular emphasis on early enteral nutrition in critically ill and surgical patients; and<br />Use of antibiotic-impregnated central venous catheters to prevent catheter-related infections.<br />Slide 30<br />WHY ARE WE DOING THIS?Why Do We Need Ultrasound for Vascular Access?<br />
  54. 54. Slide 31<br />WHY ARE WE DOING THIS?Standard Imaging Paradigm<br />
  55. 55. Slide 32<br />WHY ARE WE DOING THIS?Standard Imaging Paradigm<br />What happens when they are not available?<br />
  56. 56. Slide 33<br />WHY ARE WE DOING THIS?New Paradigm<br />
  57. 57. Program Goals<br />
  58. 58. PROGRAM GOALSVision & Mission Statements<br />VISION STATEMENT<br />Diagnostic ultrasound will become an integral component of the training and practice of clinical medicine.<br />MISSION STATEMENT<br />We will empower clinicians with a comprehensive curriculum to learn and integrate ultrasound technology into their patient management.<br />Slide 35<br />
  59. 59. Slide 36<br />PROGRAM GOALSThree Components of Skill Acquisition<br />Introductory Leaning<br />Practice-Based<br />Learning<br />Use in Clinical<br />Decision Making<br />
  60. 60. Slide 37<br />PROGRAM GOALSThree Components of Skill Acquisition<br />Introductory Leaning<br />Practice-Based<br />Learning<br />Use in Clinical<br />Decision Making<br />
  61. 61. Slide 38<br />PROGRAM GOALSEUC Offerings<br />Introduction to <br />Emergency Ultrasound<br />Introduction to <br />Vascular Access<br />Introduction to <br />Trauma Ultrasound<br />Introduction to <br />Critical Care Ultrasound<br />Advanced <br />Emergency Ultrasound<br />
  62. 62. Slide 39<br />PROGRAM GOALSThree Components of Skill Acquisition<br />Introductory Leaning<br />Practice-Based<br />Learning<br />Use in Clinical<br />Decision Making<br />
  63. 63. Slide 40<br />PROGRAM GOALSThree Components of Skill Acquisition<br />Introductory Leaning<br />Practice-Based<br />Learning<br />Use in Clinical<br />Decision Making<br />
  64. 64. Course Curriculum<br />
  65. 65. Slide 42<br />COURSE CURRICULUMCourse Modules<br />
  66. 66. Slide 43<br />Live Lectures<br />Training Labs<br />Cardiac Ultrasound<br />Web-Based <br />Educational Tools<br />Web-Based Testing<br />COURSE CURRICULUMModular Learning<br />
  67. 67. POST-COURSE ACTIVITIES & LEARNINGOn-Line Access to Course Lectures<br />Requires Subscription Fee<br />emergencyultrasound.com<br />Slide 44<br />
  68. 68. Slide 45<br />POST-COURSE ACTIVITIES & LEARNINGOn-Line Scan Review<br />Requires Separate Subscription Fee<br />
  69. 69. Slide 46<br />POST-COURSE ACTIVITIES & LEARNING Exam Review Portal<br /><ul><li>Physician performs exam
  70. 70. Device “auto archives” directly into credentialing system</li></li></ul><li>Final Thoughts<br />
  71. 71. Slide 48<br />COURSE INTRODUCTIONFinal Thoughts<br />A Historic Opportunity<br />A pivotal movement in the future of clinical medicine<br />
  72. 72. ULTRASOUND-GUIDED PROCEDURESFor More Information<br />Slide 49<br />
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