This document describes the emergency department ultrasound service at James Wheeler Hospital. It includes: 1) There are 5 ED consultants with ultrasound qualifications who provide the service from 0800-1800 Monday to Friday, with limited availability after hours. One US fellow is also undergoing training. 2) The service provides full diagnostic scans, focused bedside scans to assist with diagnosis and management, and ultrasound-guided procedures. Common scans include EFAST, AAA, lung/heart/sepsis assessments. 3) The advantages of ED sonographers include timely access, clinical experience to tailor exams, and assistance with procedures and patient management. For appropriate scans, clinical questions and patient preparation are requested. Training opportunities in basic ultrasound

1. James Wheeler

2. The Team
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5 ED Consultants with DDU:
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1 US Fellow
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Diploma of Diagnostic Ultrasound (General) – 2 yrs supervised scanning, Primary and Secondary exams
Can write formal reports – can bill medicare for their imaging!!!! (but we don’t)
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Rippey
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Sweetman
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Hay
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Wheeler
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Gawthrope
Currently undergoing DDU training
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Phillips
1 US Registrar
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Mo Gaber……..?You
Currently trying to complete ED requirements for ACEM competency in: EFAST / AAA scanning
Practicing the art of:
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Procedural ultrasound
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Basic bedside diagnostic sonography
As in all facets of medicine we are all still constantly learning and have different experience levels in
different facets of sonography

3. The Service
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A dedicated US competent ED Physician +/fellow +/- reg rostered for ED sonography:
 0800-1800 Mon-Fri
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A limited service may be available afterhours
dependent on our rostering and the
departmental load
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This is a very unique service in Australia /
Internationally

4. Why have we chosen to do
EDUS?
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We are impatient!
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We really believe it assists in timely and
appropriate patient management

5. How do we use US!
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As a formal investigative imaging test
 ie. full abdomino-pelvic ultrasound
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As an extension of our bedside physical
examination to answer specific clinical
questions to assist in Dx / Mx and disposition
of our patients:
 ie. Focused ultrasound study for Ix of Sepsis / SOB
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To safely and quickly guide bedside
procedures

6. ED Sonography – What we do!
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Full protocol diagnostic sonography
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Focused (bedside) diagnostic sonography:
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Renal Tract
Hepatobilary
Gynaecological / Pelvic
Early Pregnancy
DVT
Achilles
Ocular
Neck masses / Soft tissue masses – to the limit of our experience
EFAST
AAA
SHOCK / SOB / SEPSIS Assessement
Echocardiography
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PE / AMI / Arrest / Effusion / Tamponade
Lung Ultrasound
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PTX / Effussion / HTX / Pneumonia / Collapse / Oedema
?Superficial Abscess
Anything we think appropriate
Procedural
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CVC / IVC / PICC insertion
FNB / FNC
Pericardiocentesis / Paracentesis / Thoracocentesis
Abscess I & D
FB removal
…….

7. ED Sonography – What we DON’T
do!
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Full protocol diagnostic scans in some specialty areas or outside of our
personal experience ie:
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Musculoskeletal
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Vascular Studies:
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Carotids / ABI’s / Flow studies
Transplants
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apart from Achilles
Often need private referral – only one sonographer at SCGH that does this
Renal / Liver
Morphological 2nd & 3rd Trimester Pregnancy Scans
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US studies that are not the correct imaging study for that patient!
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US studies that will not affect the ED Mx of the patient - when there are
other demands on our time!

8. What are the advantages of
using ED sonographers?
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You know us!
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We are nice people!
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We are usually easily accessible & can give you timely
answers!
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We are clinicains
 We will usually re-examine patient and Hx
 We will form our own DDx & tailor our US study to answer both our Q’s
 We are happy to assist with:
○ patient management (including procedures)
○ liasing with inpatient specialties / radiology / other hospitals
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We are keen to teach bedside ultrasound and basic anatomy

9. What we need from you!
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Appropriate patient assessment & consultation:
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An appropriate clinical question/s based on that assessment
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Hx, Ex, Ix (both recent and any old relevant studies)
Not:
Not:
But:
Appropriate preparation of the patient (as far as possible)
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Analgesia (to allow probing!)
Bladder volume (fullish - pelvic & renal tract scans)
Fasting (Abdo scans)
Inform patient / nursing staff
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I want an US.
I want an US to find the cause for this patients pain.
I want an US to rule out / in…. or differentiate….
TV scans for ovaries & early pregnancy
What examining for…
If performing bedside ultrasound and not credentialed – please inform
patient and nursing staff that this is a training study (we are happy to
review and formalise the study)

10. What we want from you!
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Interest in learning US:
 Vascular access
 EFAST
 AAA scanning

11. Feedback?