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William “Never Call Me a Scanimal” Bagley M.D. Ultrasound Fellow

Getting Your Required Scans Well Before Graduation aka Don’t Be Like Bagley: Some Quick Tips/Tricks. William “Never Call Me a Scanimal” Bagley M.D. Ultrasound Fellow SLR Department of Emergency Medicine. Some Prerequisites. You Should be in the Ultrasound Mindset You Must Want

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William “Never Call Me a Scanimal” Bagley M.D. Ultrasound Fellow

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  1. Getting Your Required Scans Well Before GraduationakaDon’t Be Like Bagley: Some Quick Tips/Tricks William “Never Call Me a Scanimal” Bagley M.D. Ultrasound Fellow SLR Department of Emergency Medicine

  2. Some Prerequisites • You Should be in the Ultrasound Mindset • You Must Want to Graduate

  3. It’s Easy. Pace Yourself.Starting Today, Assuming You Have Zero Scans and Need 175Total to Graduate On Time • 3rd Years • 6 scans/week • 2nd Years • 3 scans/week • 1st Years • 2 Scans/week

  4. For Those Who Truly LOVE Ultrasound • Want to Have All Your Scans Done by the Start of Your Third Year? • 2nd Years • 6 Scans/Week • 1st Years • 3 Scans/Week

  5. Contact Us Today! • Or Pretty Soon, So We Can Go Over Your Scanning Totals • For Contact Info and Minimal Requirements: • www.slredultrasound.com

  6. Some Prerequisites • YOU NEED TO THINK AHEAD • You can integrate ultrasounds into many of your patient encounters • The more you scan on shift the less you will be scanning during your free time right before graduation

  7. Some Prerequisites • Certain Chief Complaints • Trigger Instinct to Bring the Ultrasound WITH YOU to the Patient Encounter • Make it Become Like Reflex

  8. DISCLAIMER! • These are Tips to Getting Your Scans • Disposition/Treatment Determined by Your Attending and Credentialing

  9. Rewards for Correct Answers • Automatic Membership to Ultrasound Academy • You Will Receive an Email with a Customized Seal! • (That’s a Scanimal) 

  10. Vaginal Bleeding • UPreg (+) or (–) or sample not given yet. • TransAbdominal Pelvic Scan • If Intrauterine Pregnancy (IUP) Seen, BONUS! ** If Free Fluid Seen, DOUBLE BONUS! Positive FAST and Pelvic scan!

  11. Vaginal Bleeding • If UPreg Turns Out to be (+) and IUP Not Seen on TransAbdominal • Transvaginal Scan

  12. What Views/Measurements are Needed for an Adequate Pelvic Sonogram?

  13. Longitudinal Uterus • Transverse Uterus • Endo-Myometrial Mantle • >8mm • Fetal Heart Rate • Measure with M-Mode

  14. Notification! Cardiac Arrest! • Cardiac Fast • Rule Out Tampanade! • Could Lead to a Cool Procedure • Asystole • Document with M-Mode

  15. Name the 4 Cardiac Views Commonly Taught at SLR

  16. Subxiphoid • Parasternal Long-Axis • Parasternal Short-Axis • Apical 4-Chamber

  17. Which Cardiac View is Described Below? Probe Placed Along the Left Sternal Border 3rd or 4th Intercostal Space Probe Marker Towards the Patient’s Left Hip

  18. Parasternal Long-Axis! • “4th and Long”

  19. Flank Pain • Young Person • Suspecting Kidney Stone from History • Scan the Kidney on the Affected Side • Scan the Bladder **In Females You Can Also Get a TransAb Pelvis at the Same Time

  20. What Views are Needed for an Adequate Renal Scan at SLR?

  21. Longitudinal Kidney • Transverse Kidney • Bladder • Longitudinal and Transverse

  22. Flank Pain • Older Person • Rule Out Abdominal Aortic Aneurysm (AAA) • Suspecting Kidney Stone • Scan the Kidney on the Affected Side • Scan the Bladder

  23. In an Adequate Non-Aneurysmal Sonographic Aorta Scan, How Many Images Should You Have?

  24. 5 • Longitudinal Aorta • Middle or Distal • Transverse Aorta • Proximal, Middle, Distal • Transverse Iliac Bifurcation • Normal Aorta <3cm • Normal Iliacs <1.5cm

  25. Flank Pain • Some Tricks: • If Already Looked at One Kidney and the Bladder *** Throw in a View of the Other Kidney and You Likely Have a Whole Abdominal FAST Exam

  26. Name the 3 Views of the Abdominal FAST Exam

  27. Hepatorenal Recess (Morison’s Pouch) • Splenorenal Recess • Pelvic (Pouch of Douglas)

  28. Epigastric/Upper Abdominal Pain • Check for Murphy’s Sign with the Ultrasound!

  29. Name 4 Sonographic Elements of Acute Cholecystitis

  30. Thickened Gallbladder Wall • >3mm • Enlarged Common Bile Duct • >6mm • Pericholecystic Fluid • Gallstones • Sonographic Murphy’s Sign

  31. What is the Most Sensitive Sonographic Finding for Acute Cholecystitis?

  32. Sonographic Murphy’s Sign • Describe the Pathophysiology That Explains a Positive, Non-Sonographic Murphy’s Sign?

  33. Severe Abdominal Pain/ Unstable Vitals • Rule Out AAA • FAST exam • Females of Childbearing Age • Consider Ectopic, serum HCG • Biliary Exam

  34. Severe Abdominal Pain/ Unstable Vitals • Quick Tips • If Time/Resuscitation/Printer Allows • FAST • Get Transverse Kidney Views and You Have an Adequate Renal Scan • Aorta Scan • Biliary Scan • TransAb Pelvic in Females • 5 scans/1 patient!!!!!

  35. Urinary Retention • Scan the Bladder and Both Kidneys • Almost Guaranteed (+) Hydronephrosis

  36. Ascites! • FAST Exam Goldmine! • You didn’t hear this from me but… • Each individual positive quadrant could be counted as separate positive scans…. • But you didn’t hear that from me • Patients With Low Albumin May Have Pericardial Effusions As Well • Positive Cardiac Scan!

  37. Intubated Patients: Let Your Conscience/Ethics be Your Guide • ULTRASOUND JACKPOT!!! • Cardiac • FAST • Renal • Biliary • Aorta

  38. General Tips/Tricks • Once You’ve Gelled-Up a Patient for One Scan • An unspoken bond usually forms and then they just let you scan away! • “Would you mind if I take a look at your…?” • (Don’t Sound Creepy)

  39. Questions? • Anyone Else Have Some Tips?

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