Tutorials – Western Sono

Basic Applications – FAST Exam – Part II

EmergGuy — Fri, 20 Jun 2014 21:53:33 +0000

Dr. Hames has recorded a second chapter for the FAST component of our Point of Care Ultrasound Series.

This screencast spends more time on identifying potential errors leading to false negative and false positive studies.

Lung Ultrasound – Interpreting the lung and pleural “signatures”

arntfield — Sat, 12 Oct 2013 20:41:53 +0000

In follow up to the tutorial on lung ultrasound image acquisition, this tutorial reviews the essential “signatures” of lung and pleural ultrasound that guide image interpretation.

Go ahead – take 20 minutes and unlock the power of lung ultrasound through this review of the 5 essential findings:

1. Lung sliding (along with lung pulse, lung point)
2. A lines
3. B lines
4. Consolidation
5. Effusion

[youtube=http://www.youtube.com/watch?v=uv6zI4QHYss&w=420&h=315]

Lung Ultrasound – Where do I put my probe?

arntfield — Sun, 30 Jun 2013 19:09:45 +0000

For lung and pleural ultrasound the abundance of acoustic windows can be overwhelming. Our approach here at Western (based on the literature, including the Blue Protocol) is a 4 point assessment of each hemithorax. For more see this new tutorial created by Rob Arntfield.

Hydronephrosis Tutorial: Behzad Hassani

arntfield — Tue, 30 Apr 2013 18:04:43 +0000

Dr. Behzad Hassani has authored the excellent tutorial below to guide you in the interpretation and gradation of hydronephrosis for point of care ultrasound assessment of the kidney. Determining the presence or absence of hydro on renal sonography, particularly in the ED, may help you risk stratify patients with potential renal calculi and can rapidly narrow your differential diagnosis in patients with new renal failure without an etiology.

[wpvideo prqQMbEE]

Ultrasound Fundamentals – self-directed learning module for ultrasound basics

arntfield — Sun, 24 Feb 2013 23:05:52 +0000

We are pleased to launch a new educational resource in the form of this interactive learning module on the fundamentals of point of care ultrasound. This module is appropriate for anyone new to the topic of point of care ultrasound, and we are hopeful it proves to be a solid foundation for further learning and hands-on training. In addition to providing an overview of the physics, knobology and instrumentation of ultrasound, the module also introduces learners to image acquisition and interpretation. Enjoy!

LV Function – anywhere, anytime, anyplace

arntfield — Thu, 17 Jan 2013 15:04:12 +0000

The point of care ultrasound revolution has brought a renaissance to providers of resuscitative care: No longer is determination of shock something that requires invasive monitoring (e.g. Swan Ganz) or an ICU admission. Instead, with good image acquisition and image interpretation skills, point of care echo can answer this question anywhere in the hospital – the ED, the ward, the ICU and, the CT scanner or the cafeteria.

Assessing LV function at the point of care is typically used for patients in shock. Compromised LV function may either be the cause or may significantly complicate shock management. Our approach for managing shock based on LV function is shown in this flowsheet.

The “eyeball” method for addressing LV function is acceptable and even necessary in the point of care setting. Exact determination of ejection fraction (EF) is time consuming and the additional investment in acquiring a more “precise” number does not typically provide incrementally better or more detailed care. A patient with an EF of 20% and one with an EF 25% are typically resuscitated in a similar fashion, for instance.

Not that there should be any doubt, but studies are out there that strongly support the ability of non-cardiologists to interpret LV function accurately.(1-3)

We have just recently released a very helpful tutorial produced by Danny Peterson, MD (a PGY5 in our EM program) on the interpretation of various, broad categories of LV function to assist in managing your patient in shock (See below). If you are interested in learning more about how to perform and interpret point of care echo, consider enrolling in our critical care ultrasound course to be held this August.

1. Moore, Christopher L., et al. “Determination of left ventricular function by emergency physician echocardiography of hypotensive patients.” Academic emergency medicine 9.3 (2002): 186-193.

2. Melamed, Roman, et al. “Assessment of left ventricular function by intensivists using hand-held echocardiography.” CHEST Journal 135.6 (2009): 1416-1420.

3. Randazzo, Marco R., et al. “Accuracy of emergency physician assessment of left ventricular ejection fraction and central venous pressure using echocardiography.” Academic emergency medicine 10.9 (2003): 973-977.

How to clear the Sonosite hard drive

arntfield — Sat, 29 Dec 2012 21:41:48 +0000

See the below tutorial on how to clear the hard drive of the Sonosite machines found in our hospital. A full hard drive can get in the way of your archiving and even slow down machine function. It is easy to do, just watch!

[wpvideo Xi7pHCIf]

Qpath – Home Access

arntfield — Wed, 12 Sep 2012 03:09:05 +0000

It is commonly asked how to get home access to Qpath. Here’s how:

1. You must first have home access to the LHSC “VPN” via Juniper. (If you don’t have this, it is not hard to get but you must first login to https://lh01.lhsc.on.ca from a WORK computer and go through the setup.)

2. Access the start page where you should be greeted by the login box after agreeing to LHSC’s terms

3. Login

4. From the Juniper “dashboard” click on the NNC folder.

5. Then choose “IE_Qpath”

6. A Citrix popup window will then open (make sure you grant permission to popups on your browser if asked). Click on this Citrix window as it instructs you to:

7. After at least 1 full minute, you should be greeted by the qpath login screen and the rest should be familiar to you. If just learning to use Qpath, check out the basics and beyond the basics tutorials.

Sterile Technique for US Guided Central Line

arntfield — Mon, 27 Aug 2012 03:28:19 +0000

Sterile Technique for US Guided Central Line

Dr Jeff Granton (Critical Care/Anesthesia) demonstrates the technique and pointers on becoming maximally sterile for an invasive procedure (such as an ultrasound guided central venous catheter insertion):

What clips should I save in the ED?

arntfield — Thu, 12 Jul 2012 03:00:53 +0000

As you become familiar with Qpath and how to archive your clips you will want to be sure you are capturing good quality clips for review.

This document reviews our ED point of care ultrasound program’s recommended standards.