SCGH ED ultrasound service

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Information about SCGH ED ultrasound service
Health & Medicine

Published on February 19, 2014

Author: jameswheeler001



SCGH ED ultrasound service

James Wheeler

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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