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Knobology
Jamie Jenkins MD, RDMSRegional Ultrasound Director FHS
St Josephs Medical Center
Ultrasound : Zonare
Core Applications of Ultrasound
Knobology
How to use the machine
Medical Legal AspectOnly 21% of EM physicians personally
perform bedside ultrasoundStandard of Care: Central linesNo lawsuits for misreads as of 20073 lawsuits for failure to use
2 with AAA 1 with rule out ectopic
Credentialing Can we hide behind it or with out it?
Knobology: The Basics
Changing probesPress the
transducer key and then use the soft keys to select which transducer you need
Please do not change the Transducer plug-ins.
Exam Type
New patient exam
Press new patient key in upper left hand corner of the keyboard
New Patient: Non-credentialed physicians, Training scans at all hospitals
Last name: TrainingFirst name: EDUSDo not fill out MR
numberOperator: Your namePress exitOn first page, press
space bar and type in pt name and MR number
New Patient: Credentialed physicians At St Joes & St Francis
Enter an order in EPICClick worklistSelect patients name
from listThe screen will self
populate Fill in your name under
operatorPress exit and start
scanning
New Patient: Credentialed physicians at St Anthony & St Clare
Last name: Patients last name
First name: Patients first name
ID: MR numberOperator: Your last
namePress exit and start
scanningPrint images and attach
to a paper with pts sticker and give to HUC to scan in for HIM
If you manually enter info instead of using worklist: St Josephs & St Francis
If you manually enter the patient information including the MR numberNo leading zerosNo dashesNo FIN numbers
Ex: MR number is 001-234-567Enter 1234567
At St Josephs and St Francis you still need to enter an order after you finish the scan
It is preferred that you use the worklist
Central Lines Document on
central line section of the noteWire or needle seen
in lumen Image saved to
patients permanent record
You must save an image of this.
There is an EPIC smart Phrase under my name (Jamie Jenkins) .eduscentralline
OB/ IUPOB/ Pregnancy ScanOB mode
Calc button will give you options for fetal dates/ FHT
Transabdominal views of the uterus transverse and longitudinal
Fetal Heart Tones (m-mode)
Fetal dates >12weeks BPD <12weeks crown rump
length BPD (Inner to outer walls of
the skull)Clips of bilateral adenexa
(even if obvious IUP)
Fetal Heart TonesPlease use M –mode to
document FHT. Press M-mode once and
the screen will change, Align the line with the
fetal heartWhen you have the
image you want press freeze
Press calc, select FHT/ HR and measure the distance between beats.
Misconception: A very low B-HCG rules out ectopic pregnancy
Truth: 40% of ectopic pregnancies will present with a B-hcg less than 1000 mIU/ml20% will present with a B-hcg less than 500
mIU/mlPts who present with a B-hcg less than 1000
mIU/ml have a higher risk of ectopic pregnancy
Keep in mind with ectopics all you may see is an empty uterus and free fluid in the pelvis.
Early Pregnancy Ultrasound
Transabdominal Ultrasound
Gallbladder
Transverse and longitudinal clips through the gallbladder
Measurement of the anterior wall of the gallbladder (2-3 mm)
Measurement of the CBD (4-8mm)
Look for:StonesWall thicknessPericholecystic fluidSono-murphysCBD dilation
GallbladderCommon Bile Duct
Indications: Signs and symptoms of Cholecystitis Most sensitive signs: Stones and sono-murphys
signVery specific signs: Wall thickness,
pericholecystic fluid
Gallbladder Literature
FASTClips of
RUQLUQSuprapubicCardiac
Depth: enough to see posterior surface of heart
Pericardial vs Pleural effusion
Parasternal long if unable to get Subxiphoid view
AortaTransverse View
epigastric and infra-renal
Measure the outer to outer wall of the Aorta
Nl <3cm
longitudinal views of the aorta in the epigastric region
Bifurcation of the iliacs
RenalBilateral Kidney’sTwo views of each:
transverse and longitudinal
Bladder (2 views)Please label your
views
Credentialing50 scans to remain credentialed in all
areas of ultrasound over 2 years
CME is required as wellThis lectureScanning shifts with meUltrasound courses/lectures at conferences