Getting Your Required Scans Well Before Graduation

akaDon’t Be Like Bagley:

Some Quick Tips/Tricks

William “Never Call Me a Scanimal” Bagley M.D.Ultrasound Fellow

SLR Department of Emergency Medicine

Some Prerequisites

You Should be in the Ultrasound Mindset

You Must Want to Graduate

It’s Easy. Pace Yourself.Starting Today,

Assuming You Have Zero Scans and Need 175Total to Graduate On Time

3rd Years6 scans/week

2nd Years3 scans/week

1st Years2 Scans/week

For Those Who Truly LOVE

Ultrasound

Want to Have All Your Scans Done by the Start of Your Third Year?

2nd Years6 Scans/Week

1st Years3 Scans/Week

Contact Us Today!

Or Pretty Soon, So We Can Go Over Your Scanning Totals

For Contact Info and Minimal Requirements:

www.slredultrasound.com

Some Prerequisites

YOU NEED TO THINK AHEAD

You can integrate ultrasounds into many of your patient encounters

The more you scan on shift the less you will be scanning during your free time right before graduation

Some Prerequisites

Certain Chief Complaints Trigger Instinct to Bring the Ultrasound WITH YOU to the Patient Encounter

Make it Become

Like Reflex

DISCLAIMER!

These are Tips to Getting Your Scans

Disposition/Treatment Determined by Your Attending and Credentialing

Rewards for Correct Answers

Automatic Membership to Ultrasound Academy

You Will Receive an Email with a Customized Seal!

(That’s a Scanimal)

Vaginal Bleeding

UPreg (+) or (–) or sample not given yet.

TransAbdominal Pelvic Scan

If Intrauterine Pregnancy (IUP) Seen, BONUS!

** If Free Fluid Seen, DOUBLE BONUS! Positive FAST and Pelvic scan!

Vaginal Bleeding

If UPreg Turns Out to be (+) and IUP Not Seen on TransAbdominal

Transvaginal Scan

What Views/Measurements are Needed for an Adequate Pelvic

Sonogram?

Longitudinal Uterus

Transverse Uterus

Endo-Myometrial Mantle>8mm

Fetal Heart RateMeasure with M-Mode

Notification! Cardiac Arrest!

Cardiac FastRule Out Tampanade!

Could Lead to a Cool Procedure

AsystoleDocument with M-Mode

Name the 4 Cardiac Views Commonly Taught at SLR

Subxiphoid

Parasternal Long-Axis

Parasternal Short-Axis

Apical 4-Chamber

Which Cardiac View is Described Below?

Probe Placed Along the Left Sternal Border 3rd or 4th Intercostal Space

Probe Marker Towards the Patient’s Left Hip

Parasternal Long-Axis!

“4th and Long”

Flank Pain

Young PersonSuspecting Kidney Stone from History

Scan the Kidney on the Affected Side

Scan the Bladder**In Females You Can Also Get a TransAb Pelvis

at the Same Time

What Views are Needed for an Adequate Renal Scan at

SLR?

Longitudinal Kidney

Transverse Kidney

BladderLongitudinal and Transverse

Flank Pain

Older PersonRule Out Abdominal Aortic Aneurysm

(AAA)

Suspecting Kidney StoneScan the Kidney on the Affected Side

Scan the Bladder

In an Adequate Non-Aneurysmal Sonographic Aorta Scan, How

Many Images Should You Have?

5Longitudinal Aorta

Middle or Distal

Transverse AortaProximal, Middle, Distal

Transverse Iliac Bifurcation

Normal Aorta <3cmNormal Iliacs <1.5cm

Flank Pain

Some Tricks:If Already Looked at One Kidney and the Bladder

*** Throw in a View of the Other Kidney and You Likely Have a Whole Abdominal FAST Exam

Name the 3 Views of the Abdominal FAST Exam

Hepatorenal Recess

(Morison’s Pouch)

Splenorenal Recess

Pelvic

(Pouch of Douglas)

Epigastric/Upper Abdominal Pain

Check for Murphy’s Sign with the Ultrasound!

Name 4 Sonographic Elements of Acute

Cholecystitis

Thickened Gallbladder Wall>3mm

Enlarged Common Bile Duct>6mm

Pericholecystic Fluid

Gallstones

Sonographic Murphy’s Sign

What is the Most Sensitive Sonographic Finding for

Acute Cholecystitis?

Sonographic Murphy’s Sign

Describe the Pathophysiology That Explains a Positive, Non-Sonographic Murphy’s Sign?

Severe Abdominal Pain/Unstable Vitals

Rule Out AAA

FAST examFemales of Childbearing Age

Consider Ectopic, serum HCG

Biliary Exam

Severe Abdominal Pain/Unstable Vitals

Quick TipsIf Time/Resuscitation/Printer Allows

FAST – Get Transverse Kidney Views and You Have an

Adequate Renal Scan

Aorta Scan

Biliary Scan

TransAb Pelvic in Females

5 scans/1 patient!!!!!

Urinary Retention

Scan the Bladder and Both KidneysAlmost Guaranteed (+) Hydronephrosis

Ascites!

FAST Exam Goldmine!You didn’t hear this from me but…

Each individual positive quadrant could be counted as separate positive scans….

– But you didn’t hear that from me

Patients With Low Albumin May Have Pericardial Effusions As Well

Positive Cardiac Scan!

Intubated Patients: Let Your Conscience/Ethics be

Your Guide

ULTRASOUND JACKPOT!!!Cardiac

FASTRenal

Biliary

Aorta

General Tips/Tricks

Once You’ve Gelled-Up a Patient for One Scan

An unspoken bond usually forms and then they just let you scan away!

“Would you mind if I take a look at your…?”

(Don’t Sound Creepy)

Questions?

Anyone Else Have Some Tips?