Point of Care ultrasound: new tool for all clinicians
Transcript of Point of Care ultrasound: new tool for all clinicians
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POINT OF CARE ULTRASOUND:FOR ALL CLINICIANS
Vicki E Noble MD RDMSDirector, Emergency UltrasoundMassachusetts General HospitalAssistant Professor, Harvard Medical SchoolBoston MA
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Why ultrasound?
Portable
Safe
Repeatable
Digital
Decision support
Battery operated
Cost-effective
Multi-use
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Why wait for specialization?
Why not in medical school??
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Pneumothorax
FAST
AAAPregnancy
Central Line placementAbscess drainage
Thoracentesis
Paracentesis
Gallstones
Ecohcardiography
IVC- volume assessment
B-lines – pulmonary fluid
Foreign body ID
DVT Peripheral IV placement
With one machine
Liver and spleenHypotension, fluid status
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Usefulness scoreLapostolle F et al Am J Emerg Med 2(3):1076
Push clinician toward the right diagnosis
Push clinician toward the wrong diagnosis
toward right diagnosis+ value
Clinical diagnosis
toward wrong diagnosis- value
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Objectives
Clinical scenarios – making the case
Literature support – but is it safe?
Seeing the larger picture -
universal training and quality assurance issues
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80 yo with dyspnea
HR 110 O2 sat 88% 99F
Pursed lips
Scattered wheezes
Decreased air movement
Distended tender abdominal exam
Asymmetric leg swelling
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What does the clinician need to know?
BNP
Ddimer
CXR
CT
LENI
EKG
Albuterol
Lasix
Steroids
Heparin
Differential:
CHF
COPD exacerbation
PTX
PE
Hemorrhage/hypovolemia
Pleural effusions
Pneumonia
Anxiety
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What are the pressures on the clinician?
Time
Disposition
Cost
Outcomes
Accuracy
Patient satisfaction
Quality Measures
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What does the clinician need to know? CHF vs COPD – A-lines vs B-lines
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What does the clinician need to know? PTX – lung sliding yes or no
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What does the clinician need to know? Hemorrhage ?
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How can point of care ultrasound help? PE – R heart size, DVT
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How can point of care ultrasound help?
Bring the physician back to the bedside
Education
Visual teaching tool
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How can point of care ultrasound help?
EXPEDITE CARE - Know the studies First trimester – decreased LOS Burgher et al
1998
Biliary colic – decreased return visits Durston et al 2001
DVT – decreased LOS, Blaivas et al 2000
Trauma – decreased LOS, decreased CT Melnikeret al 2003
Cardiac trauma/AAA – time to OR, Plummer et al 1992
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BUT IS IT SAFE???
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Accuracy
FOCUSED QUESTIONS
Know the studies
First trimester – Stein et al 2010 Acad Emerg Med
AAA –Tayal et al 2003 Acad Emerg Med
Gallstones - Durston et al 2001 Am J Emerg Med
DVT - Blaivas et al 2000 Acad Emerg Med
Cardiac function – Moore et al 2002 Acad EmergMed
Pericardial effusions – Alexander et al 2004 Am Heart J
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Not to minimize competency…
Develop training program
Documentation
Reporting – visible and transparent
Quality assurance program
Use on line resources
In the beginning you have to be perfect
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MANDATORY FIRST STEP
CHAMPION OF THE CAUSE
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Know the resources
www.sonoguide.com
http://hqmeded.com
http://pointofcare.blogspot.com/
http://www.sonoworld.com
http://www.ultrasoundvillage.com
http://www.echobasics.de/tte-en.html
http://msksono.com/index.html
Emedicine procedures
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QUESTIONS?
Thank you