ultrasound : zonare

Knobology and Criteria

Jamie Jenkins MDRegional Ultrasound Director FHS

St Josephs Medical Center

Ultrasound : Zonare

Only 21% of EM physicians personally perform bedside ultrasound

Standard of Care: Central linesNo lawsuits for misreads as of 20073 lawsuits for failure to use

2 with AAA 1 with rule out ectopic

Credentialing Can we hide behind it or with out it?

Medical Legal Aspect

Core Applications of Ultrasound

Knobology

How to use the machine

StartPress new patient

key in upper left hand corner of the keyboard

New PatientLast NameFirst NameID=MR numberOperator: your

namePress exit and start

scanning

New Patient

Knobology

Changing probesPress the

transducer key and then use the soft keys to select which transducer you need

Exam Type

OB/ IUP OB/ Pregnancy Scan

OB mode: Calculations Transabdominal views of

the uterus transverse and horizontal

Fetal Heart Tones (m-mode) Fetal dates

>12weeks BPD <12weeks crown rump

length  -BPD (Inner to outer walls

of the skull) Clips of bilateral adenexa

(even if obvious IUP) 

Misconception: A very low B-HCG rules out ectopic pregnancy

Truth: 40% of ectopic pregnancies will present with a B-hcg less than 1000 mIU/ml20% will present with a B-hcg less than 500

mIU/mlPts who present with a B-hcg less than 1000

mIU/ml have a higher risk of ectopic pregnancy

Keep in mind with ectopics all you may see is an empty uterus and free fluid in the pelvis.

Early Pregnancy Ultrasound

Transabdominal Ultrasound:

Gallbladder

Transverse and horizontal clips through the gallbladder

Measurement of the anterior wall of the gallbladder (2-3 mm)

Measurement of the CBD  (4-8mm)

Look for:StonesWall thicknessPericholeycystic fluidSonomurphysCBD dilitation 

GallbladderCommon Bile Duct

Indications: Signs and symptoms of Choleycystitis Most sensitive signs: Stones and Sono Murphys

signVery specific signs: Wall thickness,

pericholeycystic fluid

Gallbladder Literature

FASTClips of

RUQLUQSuprapubicCardiac 

Depth Pericardial vs

Pleural effusionParasternal long if

no SX view

AortaTransverse View

epigastric and infra-renal

Measure the outer to outer wall of the Aorta

Nl <3cm

longitudinal views of the aorta in the epigastric region

Bifurcation of the iliacs

Questions??????