On July First, while most of us were busy meeting new interns, Mike and Matt from the ultrasound podcast along with Mike Stone have released into the wild their newest creation, sonocloud.
Sonocloud is awesome. Â It is a copyright free compendium of all the clips you wish you had in your ultrasound quiver. Â So next time you are a) putting a talk together and you can’t find you old clip of biceps tendonitis, or b) you get a really cool high quality clip yourself, head over to sonocloud to a) download an open-source clip or b) upload your own for others to use…
Welcome new interns across the land! You will be receiving lots and lots of advice from many sources, so I’d like to pour some ultrasound scanning tips into the information deluge.
Most of these tips were posted here at SinaiEM.us a few years ago, yet they are so classic they they still ring true!
These are mainly directed towards novices, but there may be something useful in there for everyone to remember. Note that I used self-restraint and did NOT list “clean the machine” among the tips. I assume everyone has already built up an impressive list of excuses for not cleaning the machine. That sounds like another post in itself!
- Start with one indication and become comfortable with it, then expand your repertoire
- Before picking up the probe, think about how the results of the scan will change your management and clarify your clinical question (good advice for any diagnostic test)
- Familiarize yourself with the most useful buttonsfirst (every machine has these):
- Power, probe selection, depth, gain, save/print
- Remember you are scanning three-dimensional structures- be sure to fan the ultrasound beam through several planes to visualize the full anatomy
- Practice, and keep practicing. Ultrasound IS operator dependent, just like everything else you do in your practice. So get good at it, just as you became proficient in EKG interpretation or laceration repair.
- When you can’t see anything:
- Use more gel, find a better acoustic window, and check the common buttons (transducer, depth, gain)
- Proper hand position is crucial- hold the probe so you are comfortable and stable
- Check follow-up studies if they are performed, and compare your bedside results to CT scan, operative findings, etc.
- Position the patient, the machine, and yourself for optimal visibility and comfort whenever possible
- Share positive findings with your colleagues! Although pregnancies and gallstones are common, sharing aortic aneurysms or deep vein thromboses will be appreciated.
- Share ‘saves’ with your colleagues! Although most applications for bedside ultrasound are evidence-based, never underestimate the power of the anecdote in changing practice patterns.
Please leave YOUR best scanning tip in the comments.
The current issue of SAEM’s resident newsletter features an interview with Bret Nelson regarding ultrasound training. He and Beatrice Hoffman, MD, PhD, RDMS (Director of Ultrasound Education for the Department of Emergency Medicine at Johns Hopkins School of Medicine) are featured.
They describe their path towards emergency ultrasound, the value of fellowship training, advice for residents, the role of research, and more.