SCGH ED ultrasound service

1. James Wheeler

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
○ Prince
 1 US Registrar
○ Kyle Kophamel……..?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. 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. Why have we chosen to do
EDUS?
 We are impatient!
 We really believe it assists in timely and
appropriate patient management

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

11. Feedback?