Ultrasound — Advanced

Thursday, 7 September 2017
08:00-12:30

Course Description

This year’s pre-congress ultrasound course has been fully updated with participants’ wishes to design the ultimate ultrasound course. Each year after reviewing participant comments we construct a new course to address their needs.

Participants loved last year’s course and we have added more modules. Didactic lectures will take place on-line at your convenience. The lectures will be available one month prior and one month following the advanced ultrasound course. There will be a maximum four participants / one instructor allowing each individual participant ample time with their hand on the probe.

Credit Designation Statement
The American Academy of Emergency Medicine designates this live activity for a maximum of 4.25 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

 

Tentative Course Schedule

08:00-08:15	Welcome
08:15-09:00	Hands-on Module 1
09:00-09:45	Hands-on Module 2
09:45-10:30	Hands-on Module 3
10:30-10:45	Coffee Break
10:45-11:30	Hands-on Module 4
11:30-12:15	Hands-on Module 5
12:15-12:30	Wrap up & Adjourn

Pick 5 application modules. Modules are selected in the online registration form.

1. Aorta & IVC 2. Cardiac-Advanced 3. DVT 4. eFast 5. Gallbladder & Renal 6. Gastrointestinal 7. Head & Neck 8. Image Acquisition and Instrumentation 9. Landmark Documentation

10. Musculoskeletal — General 11. Musculoskeletal — Shoulder 12. Ocular 13. Procedures — Nerve Blocks 14. Procedures — Non-Vascular 15. Procedures — Vascular Access 16. Pulmonary 17. Shock 18. Ultrasound Equipment

 

Course Fee*

Ultrasound — Advanced ONLY
Organizing Society Member (AAEM, GREAT, MAEM): $425 USD
Non Members: $465 USD

Special Discount if taking both Ultrasound — Beginner AND Advanced
Organizing Societies (AAEM, GREAT, MAEM): $700 USD
Non Members: $740 USD
*Box lunch included on 6 September Only

 

Course Directors

Michael J. Lambert, MD RDMS FAAEM
Fellowship Director Emergency Ultrasound, Dept. of Emergency Medicine, Advocate Christ Medical Center, Oak Lawn, IL

Joseph P. Wood, MD JD RDMS MAAEM FAAEM
Emergency Medicine Department, Mayo Clinic Hospital, Scottsdale, AZ

 

Course Faculty

Jeffrey Baker, MD FAAEM
Associate Professor, University of Louisville, Louisville, KY

Carrie Aletta Bakunas, MD
Presbyterian Health Care Services, Albuquerque, NM

Ashley Bean, MD MA FACEP
Associate Professor, University of Arkansas, Little Rock, AR

Katharine Burns, MD
Advocate Christ Medical Center, Chicago, IL

Christine Butts, MD FAAEM
Clinical Associate Professor, LSU Health Sciences Center, New Orleans, LA

Eric Chin, MD FAAEM
Program Director, Emergency and Critical Care Ultrasound Fellowship, Program Director, Point-of-care Ultrasound Physician Assistant Fellowship, SAUSHEC, San Antonio Military Medical Center, San Antonio, TX

Ryan Gibbons, MD FAAEM
Assistant Professor of Emergency Medicine, Assistant Director of Ultrasound, Lewis Katz School of Medicine at Temple University, Philadelphia, PA

Elise Hart, MD
Emergency Ultrasound Fellow, Advocate Christ Medical Center, Oak Lawn, IL

Robert Jarman, MBBS MSc FRCSE FRCEM
Consultant, Royal Victoria Infirmary, Newcastle Upon Tyne, United Kingdom

Andrea L. Kaelin, MD
Air Force Ultrasound Director at Wright Patterson AFB, US Air Force Emergency Medicine, San Antonio, TX

Ross Kessler, MD
Co-Director of Clinical Ultrasound, University of Michigan, Ann Arbor, MI

Michael J. Lambert, MD RDMS FAAEM
Fellowship Director Emergency Ultrasound, Dept. of Emergency Medicine, Advocate Christ Medical Center, Oak Lawn, IL

Hein Lamprecht, MD
Director, Emergency Ultrasound, Stellenbosch University, Cape Town, South Africa

Jeffrey D. Morgan, MD FAAEM
Brooke Army Medical Center, Emergency and Critical Care Ultrasound Faculty, San Antonio, TX

Bret P. Nelson, MD RDMS FACEP
Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York, NY

Dan O’Brien, MD FAAEM
Department of Emergency Medicine, University of Louisville, Louisville, KY

Arthur Rosendaal, MD FNVSHA
Emergency Physician, Sint Franciscus Gasthuis, Rotterdam, The Netherlands

Nicholas Thompson, MD
Fellow, Emergency and Critical Care Ultrasound, SAUSHEC/San Antonio Military Medical Center, San Antonio, TX

Marcella T. Torres, MD
Department of Emergency Medicine, Mayo Clinic Arizona, Scottsdale, AZ

Kerri A. Van Arnem, DSc EMPA-C
Emergency Medicine US Fellow, San Antonio Military Medical Center, San Antonio, TX

Komi E. Vovor-Dassu, MD
Assistant Professor, Ultrasound fellow, Department of Emergency Medicine, Division of Ultrasound, Little-Rock, AR

Joseph P. Wood, MD JD RDMS MAAEM FAAEM
Emergency Medicine Department, Mayo Clinic Hospital, Scottsdale, AZ

 

Learning Objectives

Aorta & Inferior Vena Cava            

1. Understand the surface landmarks for appropriate transducer positioning to perform sonographic examinations of the abdominal aorta and Inferior vena cava.
2. Demonstrate the ability to identify and visualize landmarks for the aorta and IVC in the transverse and longitudinal scanning planes.
3. Understand the sonographic findings and pitfalls for identifying pathology including aortic aneurysm.
4. Understand the utility of motion modality (M-mode) and demonstrate its use.
5. Acquire and interpret sonographic images of heart (subcostal) and IVC in the transverse and longitudinal planes.
6. Identify volume status of the IVC based on size and responsiveness to fluid.

Cardiac-Advanced

1. Understand the utility of motion modality (M-mode) and demonstrate its use.
2. Demonstrate the surface landmarks and transducer position necessary to perform an echocardiogram.
3. Acquire and interpret sonographic images of heart (subcostal, parasternal long, parasternal short and apical windows).
4. Identify pathologic conditions such as pericardial effusion, gross wall motion abnormalities and cardiac tamponade.
5. Demonstrate landmarks and measurements for cardiac output.
6. Understand US findings for diastolic and systolic heart failure.

DVT

1. Understand the sonographic landmarks and anatomical relationships as they relate to the vasculature of the neck, upper extremity and lower extremity.
2. Acquire and interpret sonographic images of the internal jugular, femoral, basilic, brachial and axillary veins in live patient models.
3. Demonstrate compression technique of upper and lower extremity veins.

eFast

1. Understand the surface landmarks for appropriate transducer positioning to perform the FAST examination.
2. Understand the sonographic landmarks and anatomical relationships of the heart, liver, spleen and bladder as they relate to the FAST examination.
3. Demonstrate the ability to identify and visualize the areas of potential intra-abdominal and thoracic spaces for free fluid to collect or pneumothorax.
4. Understand the sonographic findings and pitfalls for identifying life-threatening trauma conditions such as cardiac tamponade, hemo/pneumothorax and intra-abdominal hemorrhage.

Gallbladder & Renal         

1. Understand the surface landmarks for appropriate transducer positioning to perform sonographic examinations of the aorta, kidney and gallbladder.
2. Understand the sonographic windows and landmarks of the aorta, kidney and gallbladder.
3. Demonstrate the ability to identify and visualize landmarks for the aorta, kidney and gallbladder in the transverse and longitudinal scanning planes.
4. Understand the sonographic findings and pitfalls for identifying pathology including aortic aneurysm, hydronephrosis and cholelithiasis/cholecystitis.

Gastrointestinal

1. Understand the sonographic appearance of normal stomach, large and small bowel, and pancreas, including normal anatomical structures and normal bowel peristalsis.
2. Describe transducer choices, scanning protocols and patient positions necessary to perform a gastrointestinal examination.
3. Identify and detect gastrointestinal pathology such as ileus, pneumoperitoneum, appendicitis, colitis, diverticulitis, ileitis, intussusception or hernias.
4. Describe common sites of intra-and retroperitoneal free air, examination techniques and pitfalls for appendicitis, pneumoperitoneum, colitis, diverticulitis and hernia.

Head & Neck       

1. Understand the normal sonographic appearance and anatomical landmarks of organs and structures in the head and neck region, including ocular, salivary glands, thyroid gland, the upper airway including larynx and trachea, upper esophagus, facial bones and neck vessels and lymph node anatomy.
2. Describe transducer choices, scanning protocols and patient positions necessary to perform a focused ocular examination to detect retinal detachment, vitreous hemorrhage, lens dislocation, periocular free air or increased intracranial pressure.
3. Understand common thyroid abnormalities such as cysts or masses and the anatomical relation of the parathyroid glands.
4. Describe the appearance of salivary glands and appearance of salivary stones. Identify lymph nodes within the neck.
5. Describe ultrasound exam techniques to detect upper airway anatomy to guide correct ETT placement including normal esophagus and esophageal intubation.
6. Understand anatomy of main neck vessels and their relation to other musculoskeletal structures.

Image Acquisition and Instrumentation

1. Enhance your basic understanding of the basic principles of ultrasound.
2. Apply these principles to the reduction of common artifacts and improvement of high quality diagnostic ultrasound images.
3. Understand the relationship between transducer position and image orientation.
4. Demonstrate the basic operator controls on the ultrasound system required for image acquisition.

Landmark Documentation

1. Demonstrate proper landmark documentation of a central line insertion.
2. Demonstrate proper landmark documentation of the fast examination.
3. Demonstrate proper landmark documentation of the heart (parasternal log, short and subcostal views).
4. Demonstrate proper landmark documentation of the gallbladder.

Musculoskeletal-General

1. Discuss the advantages and disadvantages of diagnostic musculoskeletal ultrasound compared to other imaging modalities.
2. Demonstrate the appearances of various tissues on diagnostic musculoskeletal ultrasound.
3. Correctly apply ultrasound basic concepts so as to ensure proper visualization of musculoskeletal structures.
4. Proficiently perform a diagnostic musculoskeletal ultrasound on various upper and lower limb structures.

Musculoskeletal-Shoulder

1. Understand the indications for shoulder ultrasound - rotator cuff tears, subdeltoid / subacromial bursitis, etc.
2. Understand the clinical presentation of these patients - dull chronic shoulder pain, difficulty sleeping, etc.
3. Learn the technique for scanning the biceps tendon, subscapularis tendon, supraspinatus and infraspinatus tendons.
4. Understand the pitfalls of drop-out due to angulation, shadowing, and fluid in the subdeltoid area, etc.

Ocular

1. Review and understand how sonography can reveal pathology of the eye and usefulness as a simple and cost-effective tool in investigating eye symptoms.
2. Understand the normal ultrasound anatomy of the eye - Cornea, Lens, Posterior chamber, Retina and Macula
3. Know which probe is needed for ultrasound scans of the eye and the method to accurately and safely perform the exam.
4. Visualize an example of a retinal detachment, posterior vitreous hemorrhage, and lens dislocation diagnosed by ultrasound.

Procedures-Peripheral Nerve Blocks

1. Discuss the science and practical performance of brachial plexus, axillary and femoral blockade.
2. Learn the physiology and anatomy of the techniques and factors that influence success and complications.
3. Demonstrate approaches for peripheral nerve blocks in the upper and lower extremity.
4. Demonstrate peripheral nerve block on simulator under ultrasound guidance.

Procedures-Non Vascular

1. Understand the sonographic landmarks and anatomical relationships as they relate to commonly performed procedures in the ED.
2. Acquire and interpret sonographic images of the internal jugular, lung and chest wall, right upper abdominal quadrant and heart.
3. Demonstrate ultrasound guided thoracentesis, paracentesis and pericardiocentesis on patient simulation models.

Procedures-Vascular       

1. Understand the sonographic landmarks and anatomical relationships as they relate to the vasculature of the neck, upper extremity and groin.
2. Acquire and interpret sonographic images of the internal jugular, femoral, basilic, brachial and axillary veins in live patient models.
3. Demonstrate ultrasound guided cannulation on vascular simulator.

Pulmonary

1. Review and understand the sonographic artifacts of normal and pathologic pulmonary conditions that give pulmonary ultrasound its diagnostic capacity. This includes, but is not limited to, pleural imaging, the "lung sliding sign," B-line and comet tail identification for extravascular pulmonary congestion and pleural effusion imaging techniques.
2. Review Demonstrate sonographic landmarks of the ribs, pleura, diaphragm and lung parenchyma.
3. Distinguish between normal and pathologic condition through image review and hands-on imaging practice.

Shock   

1. Provide a sequenced approach to ultrasound in the medical shock patient.
2. Demonstrate the surface landmarks and transducer position necessary to evaluate the heart, IVC, aorta and peritoneum.
3. Review causes and potential responses to treatments of hypotension and tissue malperfusion.

Ultrasound Equipment

1. Learn to be an expert on your ultrasound system.
2. Learn how to safely connect and remove probes from their ports.
3. Learn how to switch between transducers.
4. Learn and demonstrate how to store and review images.
5. Demonstrate adjustments to controls i.e., gain, depth, frequency in hands-on session.
6. Demonstrate how to properly document an ultrasound study by adding patient information, text annotation and proper landmarks.