Published on February 19, 2014
The Team 5 ED Consultants with DDU: 1 US Fellow 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 ○ Sweetman ○ Hay ○ Wheeler ○ Gawthrope Currently undergoing DDU training ○ Phillips 1 US Registrar ○ Mo Gaber……..?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
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
Why have we chosen to do EDUS? We are impatient! We really believe it assists in timely and appropriate patient management
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
ED Sonography – What we do! Full protocol diagnostic sonography Focused (bedside) diagnostic sonography: 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 ○ 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 …….
ED Sonography – What we DON’T do! Full protocol diagnostic scans in some specialty areas or outside of our personal experience ie: Musculoskeletal ○ ○ Vascular Studies: ○ Carotids / ABI’s / Flow studies Transplants ○ apart from Achilles Often need private referral – only one sonographer at SCGH that does this 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!
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
What we need from you! Appropriate patient assessment & consultation: An appropriate clinical question/s based on that assessment Hx, Ex, Ix (both recent and any old relevant studies) Not: Not: But: 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 ○ ○ 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)
What we want from you! Interest in learning US: Vascular access EFAST AAA scanning
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