It truly is the year of ultrasound — and it isn’t even 2013 yet. Groundbreaking article on lung ultrasound by our Jim Tsung who found point of care ultrasound to be 86% sensitive and 89% specific in detecting pneumonia up to age 21. ePub is available ahead of print in JAMA’s Archives of Pediatric and Adolescent Medicine. Time to say goodbye to ionizing radiation!
Prospective Evaluation of Point-of-Care Ultrasonography for the Diagnosis of Pneumonia in Children and Young Adults
Vaishali P. Shah, MD; Michael G. Tunik, MD; James W. Tsung, MD, MPH
Arch Pediatr Adolesc Med. 2012;():1-7. doi:10.1001/2013.jamapediatrics.107.
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.
Finally- a little recognition! We were named one of the top 50 continuing medical education blogs by Nurse E.D.U.
Although there is no mention that they were listed in any particular order, we will consider ourselves in the top 20 of that list since that’s where we fell.
Today, Nurse E.D.U.
Tomorrrow, The Huffington Post!