3 ru module 1   introduction presentation 09
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3 ru module 1   introduction presentation 09 3 ru module 1 introduction presentation 09 Presentation Transcript

  • Clinical Ultrasound Course
    Thomas Cook, MD, Program Director, Emergency Medicine
    Patrick Hunt, MD, Emergency Ultrasound Fellowship Director
    Palmetto Health Richland
    Columbia, South Carolina
  • 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.
    Slide 2
  • 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.
    http://www.ob-ultrasound.net/history1.html
    Slide 3
  • MODULE 1Introduction to Clinical Ultrasound
    • A Brief History of Ultrasound
    • Why are we doing this?
    • Program Goals
    • Course Curriculum
    • Post-Course Learning Opportunities
    Slide 5
    LECTURE OBJECTIVES
  • A Brief History of Ultrasound
  • Slide 7
    A BRIEF HISTORY OF ULTRASOUNDOrigins of Ultrasound
    • “Discovery” in the 1820’s
    • Industrial Use
    • Military Use (SONAR)
    • Medical use begins in1950’s
  • Slide 8
    A BRIEF HISTORY OF ULTRASOUNDEarly Machines & Innovations
  • Slide 9
    A BRIEF HISTORY OF ULTRASOUNDEarly Ultrasound Images
  • A BRIEF HISTORY OF ULTRASOUNDEarly “Users”
    • 1950’s - Radiology
    • 1960’s – Cardiology
    • 1970’s – Obstetrics & Gynecology
    Slide 10
  • A BRIEF HISTORY OF ULTRASOUNDEVERYTHING CHANGES
    Slide 11
  • Slide 12
    A BRIEF HISTORY OF ULTRASOUNDComputer Technology Explosion
  • Slide 13
    A BRIEF HISTORY OF ULTRASOUNDCircuit Boards to ASICs
  • Slide 14
    A BRIEF HISTORY OF ULTRASOUNDSmaller and Smaller
  • Slide 15
    A BRIEF HISTORY OF ULTRASOUNDNerd to Chic
  • Slide 16
    A BRIEF HISTORY OF ULTRASOUNDIT Computing Technology
    • Effect on Diagnostic Ultrasound
    • Created environment similar to personal computers versus mainframes 25 years ago.
  • Slide 17
    A BRIEF HISTORY OF ULTRASOUNDEffects on Ultrasound Systems
  • Slide 18
    1970
    1985
    1990
    1995
    2000
    2002
    2005
    A BRIEF HISTORY OF ULTRASOUNDEffects on Imaging
  • Slide 19
    A BRIEF HISTORY OF ULTRASOUNDEVERYTHING CHANGES
    (AGAIN)
  • Slide 20
    CT-scan
    Nuclear
    X-Ray
    MRI
    A BRIEF HISTORY OF ULTRASOUNDComparison to Other Imaging
    • VERY LARGE Infrastructure Requirements
    • Necessitates Separate Departments (Radiology)
    • Equipment
    • Space
    • Personnel
  • Slide 21
    CT-scan
    Nuclear
    X-Ray
    MRI
    A BRIEF HISTORY OF ULTRASOUNDComparison to Other Imaging
    ENORMOUS Data Management Requirements
    Picture Archive Communication System
  • Slide 22
    CT-scan
    Nuclear
    X-Ray
    MRI
    A BRIEF HISTORY OF ULTRASOUNDComparison to Other Imaging
    “PACS”
    • RELATIVELY small INFRASTRUCTURE
    • Ubiquitous Presence at the Bedside
    • Limited Equipment Needs
    • Small Space Requirement
    • Small Data Loop
    • Reduced Work Flow Needs
    “PACS”
    Slide 23
    A BRIEF HISTORY OF ULTRASOUNDComparison to Other Imaging
  • Slide 24
    A BRIEF HISTORY OF ULTRASOUNDEffects on Ultrasound Labs
    • New Users of Ultrasound
    • 1980’s and beyond
    • General Surgery & Trauma
    • Emergency Medicine
    • Anesthesia
    • Critical Care
    • Orthopedics
    • EMS, USAR, Military, NASA
    Slide 25
    A BRIEF HISTORY OF ULTRASOUNDUltrasound Uses in Medicine
  • Slide 26
    A BRIEF HISTORY OF ULTRASOUNDTheoretical Considerations
    CLINICAL Medicine
    Versus RADIOLOGY
    Specific Indications & Goals
  • Why are we doing this?
  • COMPARISON OF EFFECTIVENESS OF HAND-CARRIED ULTRASOUND TO BEDSIDE CARDIOVASCULAR PHYSICAL EXAMINATION
    Kobal, S.L., et al, Am J Card 96(7):1002, October 1, 2005
    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.
    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.
    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.
    Slide 28
    WHY ARE WE DOING THIS?Can we do better?
    . . . . (Hand-Carried Ultrasound) exams by the (medical) students were also more accurate than physical exams by the cardiologists (without ultrasound) . . . .
  • 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
    Slide 29
    WHY ARE WE DOING THIS?Why Do We Need Ultrasound for Vascular Access?
  • Appropriate use of prophylaxis to prevent venous thromboembolism in patients at risk;
    Use of perioperative beta-blockers in appropriate patients to prevent perioperative morbidity and mortality;
    Use of maximum sterile barriers while placing central intravenous catheters to prevent infections;
    Appropriate use of antibiotic prophylaxis in surgical patients to prevent postoperative infections;
    Asking that patients recall and restate what they have been told during the informed consent process;
    Continuous aspiration of subglottic secretions (CASS) to prevent ventilator-associated pneumonia;
    Use of pressure relieving bedding materials to prevent pressure ulcers;
    Use of real-time ultrasound guidance during central line insertion to prevent complications;
    Patient self-management for warfarin (Coumadin™) to achieve appropriate outpatient anticoagulation and prevent complications;
    Appropriate provision of nutrition, with a particular emphasis on early enteral nutrition in critically ill and surgical patients; and
    Use of antibiotic-impregnated central venous catheters to prevent catheter-related infections.
    Slide 30
    WHY ARE WE DOING THIS?Why Do We Need Ultrasound for Vascular Access?
  • Slide 31
    WHY ARE WE DOING THIS?Standard Imaging Paradigm
  • Slide 32
    WHY ARE WE DOING THIS?Standard Imaging Paradigm
    What happens when they are not available?
  • Slide 33
    WHY ARE WE DOING THIS?New Paradigm
  • Program Goals
  • PROGRAM GOALSVision & Mission Statements
    VISION STATEMENT
    Diagnostic ultrasound will become an integral component of the training and practice of clinical medicine.
    MISSION STATEMENT
    We will empower clinicians with a comprehensive curriculum to learn and integrate ultrasound technology into their patient management.
    Slide 35
  • Slide 36
    PROGRAM GOALSThree Components of Skill Acquisition
    Introductory Leaning
    Practice-Based
    Learning
    Use in Clinical
    Decision Making
  • Slide 37
    PROGRAM GOALSThree Components of Skill Acquisition
    Introductory Leaning
    Practice-Based
    Learning
    Use in Clinical
    Decision Making
  • Slide 38
    PROGRAM GOALSEUC Offerings
    Introduction to
    Emergency Ultrasound
    Introduction to
    Vascular Access
    Introduction to
    Trauma Ultrasound
    Introduction to
    Critical Care Ultrasound
    Advanced
    Emergency Ultrasound
  • Slide 39
    PROGRAM GOALSThree Components of Skill Acquisition
    Introductory Leaning
    Practice-Based
    Learning
    Use in Clinical
    Decision Making
  • Slide 40
    PROGRAM GOALSThree Components of Skill Acquisition
    Introductory Leaning
    Practice-Based
    Learning
    Use in Clinical
    Decision Making
  • Course Curriculum
  • Slide 42
    COURSE CURRICULUMCourse Modules
  • Slide 43
    Live Lectures
    Training Labs
    Cardiac Ultrasound
    Web-Based
    Educational Tools
    Web-Based Testing
    COURSE CURRICULUMModular Learning
  • POST-COURSE ACTIVITIES & LEARNINGOn-Line Access to Course Lectures
    Requires Subscription Fee
    emergencyultrasound.com
    Slide 44
  • Slide 45
    POST-COURSE ACTIVITIES & LEARNINGOn-Line Scan Review
    Requires Separate Subscription Fee
  • Slide 46
    POST-COURSE ACTIVITIES & LEARNING Exam Review Portal
    • Physician performs exam
    • Device “auto archives” directly into credentialing system
  • Final Thoughts
  • Slide 48
    COURSE INTRODUCTIONFinal Thoughts
    A Historic Opportunity
    A pivotal movement in the future of clinical medicine
  • ULTRASOUND-GUIDED PROCEDURESFor More Information
    Slide 49