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SCGH ED ultrasound service


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SCGH ED ultrasound service

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SCGH ED ultrasound service

  1. 1. James Wheeler
  2. 2. The Team 4 ED Consultants with DDU: 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) ○ Rippey ○ Hay ○ Wheeler ○ Gawthrope 1 US Fellow Currently undergoing DDU training ○ Phillips 1 US Registrar ○ Anu Mascarenhas……..?You Currently trying to complete ED requirements for ACEM competency in: EFAST / AAA scanning Practicing the art of: ○ Procedural ultrasound ○ 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. 3. The Service A dedicated US competent ED Physician +/- fellow +/- reg rostered for ED sonography: 0800-1800 Mon-Fri A limited service may be available afterhours dependent on our rostering and the departmental load This is a very unique service in Australia / Internationally
  4. 4. Why have we chosen to do EDUS? We are impatient! We really believe it assists in timely and appropriate patient management
  5. 5. How do we use US! As a formal investigative imaging test ie. full abdomino-pelvic ultrasound 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 To safely and quickly guide bedside procedures
  6. 6. ED Sonography – What we do! Full protocol diagnostic sonography Renal Tract Hepatobilary Gynaecological / Pelvic Early Pregnancy DVT Achilles Ocular Neck masses / Soft tissue masses – to the limit of our experience Focused (bedside) diagnostic sonography: EFAST AAA SHOCK / SOB / SEPSIS Assessement Echocardiography ○ PE / AMI / Arrest / Effusion / Tamponade Lung Ultrasound ○ PTX / Effussion / HTX / Pneumonia / Collapse / Oedema ?Superficial Abscess Anything we think appropriate Procedural CVC / IVC / PICC insertion FNB / FNC Pericardiocentesis / Paracentesis / Thoracocentesis Abscess I & D FB removal …….
  7. 7. ED Sonography – What we DON’T do! Full protocol diagnostic scans in some specialty areas or outside of our personal experience ie: Musculoskeletal ○ apart from Achilles ○ Often need private referral – only one sonographer at SCGH that does this Vascular Studies: ○ Carotids / ABI’s / Flow studies Transplants ○ Renal / Liver Morphological 2nd & 3rd Trimester Pregnancy Scans US studies that are not the correct imaging study for that patient! US studies that will not affect the ED Mx of the patient - when there are other demands on our time!
  8. 8. What are the advantages of using ED sonographers? You know us! We are nice people! We are usually easily accessible & can give you timely answers! 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 We are keen to teach bedside ultrasound and basic anatomy
  9. 9. What we need from you! Appropriate patient assessment & consultation: Hx, Ex, Ix (both recent and any old relevant studies) An appropriate clinical question/s based on that assessment Not: I want an US. Not: I want an US to find the cause for this patients pain. But: I want an US to rule out / in…. or differentiate…. Appropriate preparation of the patient (as far as possible) Analgesia (to allow probing!) Bladder volume (fullish - pelvic & renal tract scans) Fasting (Abdo scans) Inform patient / nursing staff ○ 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. 10. What we want from you! Interest in learning US: Vascular access EFAST AAA scanning
  11. 11. Feedback?