Ultrasound : Zonare
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Transcript of 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??????