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Clinical Ultrasound CourseThomas Cook, MD, Program Director, Emergency MedicinePatrick Hunt, MD, Emergency Ultrasound Fellowship DirectorPalmetto Health RichlandColumbia, South Carolina
The indications & techniques presented in this cousre have been recommended in the medical literature and/or conform to the clincial practice of OUR faculty.The equipment has not necessarily been approved by the Food and Drug Administration (FDA) for use in the techniques for which they are recommended. The package insert for the equipment should be consulted for use as recommended by the FDA.  Because standards, practices and recommendations change, it is advisable to keep abreast of revised recommendations, particularly those concerning new drugs and techniques. While the techniques described are successfully used in our practice, they should be followed with discretion since their complications may be dependent on the operator, patient and/or other accompanying clinical circumstances. The equipment discussed in this course is shown solely for teaching purposes.  Similar equipment from other manufacturers may produce similar clinical results to ours.Slide 2
3rd Rock Ultrasound would like to give a special thanks to Dr. Joseph Woo for his permission to use the historical pictures of ultrasound systems in this presentation.For more information about Dr. Woo’s work on the history of obstetrical ultrasound, please see the URL below.http://www.ob-ultrasound.net/history1.htmlSlide 3
MODULE 1Introduction to Clinical Ultrasound
A Brief History of Ultrasound
Why are we doing this?
Program Goals
Course Curriculum
Post-Course Learning OpportunitiesSlide 5LECTURE OBJECTIVES
A Brief History of Ultrasound
Slide 7A BRIEF HISTORY OF ULTRASOUNDOrigins of Ultrasound“Discovery” in the 1820’s
Industrial Use
Military Use (SONAR)
Medical use begins in1950’sSlide 8A BRIEF HISTORY OF ULTRASOUNDEarly Machines & Innovations
Slide 9A BRIEF HISTORY OF ULTRASOUNDEarly Ultrasound Images
A BRIEF HISTORY OF ULTRASOUNDEarly “Users”1950’s - Radiology
1960’s – Cardiology
1970’s – Obstetrics & GynecologySlide 10
A BRIEF HISTORY OF ULTRASOUNDEVERYTHING CHANGESSlide 11
Slide 12A BRIEF HISTORY OF ULTRASOUNDComputer Technology Explosion
Slide 13A BRIEF HISTORY OF ULTRASOUNDCircuit Boards to ASICs
Slide 14A BRIEF HISTORY OF ULTRASOUNDSmaller and Smaller
Slide 15A BRIEF HISTORY OF ULTRASOUNDNerd to Chic
Slide 16A BRIEF HISTORY OF ULTRASOUNDIT Computing TechnologyEffect on Diagnostic Ultrasound
Created environment similar to personal computers versus mainframes 25 years ago.Slide 17A BRIEF HISTORY OF ULTRASOUNDEffects on Ultrasound Systems
Slide 181970198519901995200020022005A BRIEF HISTORY OF ULTRASOUNDEffects on Imaging
Slide 19A BRIEF HISTORY OF ULTRASOUNDEVERYTHING CHANGES(AGAIN)
Slide 20CT-scanNuclearX-RayMRIA BRIEF HISTORY OF ULTRASOUNDComparison to Other Imaging VERY LARGE Infrastructure Requirements
Necessitates Separate Departments (Radiology)
Equipment
Space
PersonnelSlide 21CT-scanNuclearX-RayMRIA BRIEF HISTORY OF ULTRASOUNDComparison to Other Imaging ENORMOUS Data Management RequirementsPicture Archive Communication System
Slide 22CT-scanNuclearX-RayMRIA BRIEF HISTORY OF ULTRASOUNDComparison to Other Imaging “PACS”
RELATIVELY small INFRASTRUCTURE
Ubiquitous Presence at the Bedside
Limited Equipment Needs
Small Space Requirement
Small Data Loop
Reduced Work Flow Needs“PACS”Slide 23A BRIEF HISTORY OF ULTRASOUNDComparison to Other Imaging
Slide 24A BRIEF HISTORY OF ULTRASOUNDEffects on Ultrasound Labs
New Users of Ultrasound
1980’s and beyond
General Surgery & Trauma
Emergency Medicine
Anesthesia
Critical Care
Orthopedics
EMS, USAR, Military, NASASlide 25A BRIEF HISTORY OF ULTRASOUNDUltrasound Uses in Medicine
Slide 26A BRIEF HISTORY OF ULTRASOUNDTheoretical ConsiderationsCLINICAL Medicine Versus RADIOLOGYSpecific Indications & Goals

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3 ru module 1 introduction presentation 09

  • 1. Clinical Ultrasound CourseThomas Cook, MD, Program Director, Emergency MedicinePatrick Hunt, MD, Emergency Ultrasound Fellowship DirectorPalmetto Health RichlandColumbia, South Carolina
  • 2. The indications & techniques presented in this cousre have been recommended in the medical literature and/or conform to the clincial practice of OUR faculty.The equipment has not necessarily been approved by the Food and Drug Administration (FDA) for use in the techniques for which they are recommended. The package insert for the equipment should be consulted for use as recommended by the FDA. Because standards, practices and recommendations change, it is advisable to keep abreast of revised recommendations, particularly those concerning new drugs and techniques. While the techniques described are successfully used in our practice, they should be followed with discretion since their complications may be dependent on the operator, patient and/or other accompanying clinical circumstances. The equipment discussed in this course is shown solely for teaching purposes. Similar equipment from other manufacturers may produce similar clinical results to ours.Slide 2
  • 3. 3rd Rock Ultrasound would like to give a special thanks to Dr. Joseph Woo for his permission to use the historical pictures of ultrasound systems in this presentation.For more information about Dr. Woo’s work on the history of obstetrical ultrasound, please see the URL below.http://www.ob-ultrasound.net/history1.htmlSlide 3
  • 4. MODULE 1Introduction to Clinical Ultrasound
  • 5. A Brief History of Ultrasound
  • 6. Why are we doing this?
  • 10. A Brief History of Ultrasound
  • 11. Slide 7A BRIEF HISTORY OF ULTRASOUNDOrigins of Ultrasound“Discovery” in the 1820’s
  • 14. Medical use begins in1950’sSlide 8A BRIEF HISTORY OF ULTRASOUNDEarly Machines & Innovations
  • 15. Slide 9A BRIEF HISTORY OF ULTRASOUNDEarly Ultrasound Images
  • 16. A BRIEF HISTORY OF ULTRASOUNDEarly “Users”1950’s - Radiology
  • 18. 1970’s – Obstetrics & GynecologySlide 10
  • 19. A BRIEF HISTORY OF ULTRASOUNDEVERYTHING CHANGESSlide 11
  • 20. Slide 12A BRIEF HISTORY OF ULTRASOUNDComputer Technology Explosion
  • 21. Slide 13A BRIEF HISTORY OF ULTRASOUNDCircuit Boards to ASICs
  • 22. Slide 14A BRIEF HISTORY OF ULTRASOUNDSmaller and Smaller
  • 23. Slide 15A BRIEF HISTORY OF ULTRASOUNDNerd to Chic
  • 24. Slide 16A BRIEF HISTORY OF ULTRASOUNDIT Computing TechnologyEffect on Diagnostic Ultrasound
  • 25. Created environment similar to personal computers versus mainframes 25 years ago.Slide 17A BRIEF HISTORY OF ULTRASOUNDEffects on Ultrasound Systems
  • 26. Slide 181970198519901995200020022005A BRIEF HISTORY OF ULTRASOUNDEffects on Imaging
  • 27. Slide 19A BRIEF HISTORY OF ULTRASOUNDEVERYTHING CHANGES(AGAIN)
  • 28. Slide 20CT-scanNuclearX-RayMRIA BRIEF HISTORY OF ULTRASOUNDComparison to Other Imaging VERY LARGE Infrastructure Requirements
  • 31. Space
  • 32. PersonnelSlide 21CT-scanNuclearX-RayMRIA BRIEF HISTORY OF ULTRASOUNDComparison to Other Imaging ENORMOUS Data Management RequirementsPicture Archive Communication System
  • 33. Slide 22CT-scanNuclearX-RayMRIA BRIEF HISTORY OF ULTRASOUNDComparison to Other Imaging “PACS”
  • 39. Reduced Work Flow Needs“PACS”Slide 23A BRIEF HISTORY OF ULTRASOUNDComparison to Other Imaging
  • 40. Slide 24A BRIEF HISTORY OF ULTRASOUNDEffects on Ultrasound Labs
  • 41. New Users of Ultrasound
  • 48. EMS, USAR, Military, NASASlide 25A BRIEF HISTORY OF ULTRASOUNDUltrasound Uses in Medicine
  • 49. Slide 26A BRIEF HISTORY OF ULTRASOUNDTheoretical ConsiderationsCLINICAL Medicine Versus RADIOLOGYSpecific Indications & Goals
  • 50. Why are we doing this?
  • 51. COMPARISON OF EFFECTIVENESS OF HAND-CARRIED ULTRASOUND TO BEDSIDE CARDIOVASCULAR PHYSICAL EXAMINATIONKobal, S.L., et al, Am J Card 96(7):1002, October 1, 2005 METHODS: The authors, from Cedars-Sinai Medical Center and UCLA, compared the diagnostic accuracy of physical examination performed by one of five board-certified cardiologists, and use of a hand-carried ultrasound (HCU) device (OptiGo, Philips) by one of two first-year medical students in 61 patients with clinically significant cardiac disease. The students received 18 hours of training in use of the HCU device, which provides two-dimensional and conventional color- flow Doppler imaging, including four hours of lectures and 14 hours of practical experience. Expert echocardiography was the diagnostic gold standard. RESULTS: Standard echocardiography identified 239 abnormalities in these patients (average, 3.9 per patient). Using the HCU, the students recognized 75% of these abnormalities compared with 49% identified by the cardiologists on physical examination (p<0.001). Corresponding specificities were 87% vs. 76% (p<0.001). The students were significantly more accurate than the cardiologists in the recognition of the most severe cases of left ventricular (LV) dysfunction and severe valvular disease (96% vs. 68%, p<0.001), and HCU exams by the students were also more accurate than physical exams by the cardiologists in the recognition of lesions that cause systolic or diastolic murmurs. CONCLUSIONS: These findings reflect the inherent difficulties in evaluation of organ systems through percussion, palpation and auscultation, and the utility of technology developed to facilitate patient assessment at the bedside.Slide 28WHY ARE WE DOING THIS?Can we do better?. . . . (Hand-Carried Ultrasound) exams by the (medical) students were also more accurate than physical exams by the cardiologists (without ultrasound) . . . .
  • 52. Making Health Care Safer: A Critical Analysis of Patient Safety PracticesAgency for Healthcare Research & QualityU.S. Department of Health & Human ServicesShojania KG, et al. University of California at San Francisco / Stanford UniversitySlide 29WHY ARE WE DOING THIS?Why Do We Need Ultrasound for Vascular Access?
  • 53. Appropriate use of prophylaxis to prevent venous thromboembolism in patients at risk;Use of perioperative beta-blockers in appropriate patients to prevent perioperative morbidity and mortality;Use of maximum sterile barriers while placing central intravenous catheters to prevent infections;Appropriate use of antibiotic prophylaxis in surgical patients to prevent postoperative infections;Asking that patients recall and restate what they have been told during the informed consent process;Continuous aspiration of subglottic secretions (CASS) to prevent ventilator-associated pneumonia;Use of pressure relieving bedding materials to prevent pressure ulcers;Use of real-time ultrasound guidance during central line insertion to prevent complications;Patient self-management for warfarin (Coumadin™) to achieve appropriate outpatient anticoagulation and prevent complications;Appropriate provision of nutrition, with a particular emphasis on early enteral nutrition in critically ill and surgical patients; andUse of antibiotic-impregnated central venous catheters to prevent catheter-related infections.Slide 30WHY ARE WE DOING THIS?Why Do We Need Ultrasound for Vascular Access?
  • 54. Slide 31WHY ARE WE DOING THIS?Standard Imaging Paradigm
  • 55. Slide 32WHY ARE WE DOING THIS?Standard Imaging ParadigmWhat happens when they are not available?
  • 56. Slide 33WHY ARE WE DOING THIS?New Paradigm
  • 58. PROGRAM GOALSVision & Mission StatementsVISION STATEMENTDiagnostic ultrasound will become an integral component of the training and practice of clinical medicine.MISSION STATEMENTWe will empower clinicians with a comprehensive curriculum to learn and integrate ultrasound technology into their patient management.Slide 35
  • 59. Slide 36PROGRAM GOALSThree Components of Skill AcquisitionIntroductory LeaningPractice-BasedLearningUse in ClinicalDecision Making
  • 60. Slide 37PROGRAM GOALSThree Components of Skill AcquisitionIntroductory LeaningPractice-BasedLearningUse in ClinicalDecision Making
  • 61. Slide 38PROGRAM GOALSEUC OfferingsIntroduction to Emergency UltrasoundIntroduction to Vascular AccessIntroduction to Trauma UltrasoundIntroduction to Critical Care UltrasoundAdvanced Emergency Ultrasound
  • 62. Slide 39PROGRAM GOALSThree Components of Skill AcquisitionIntroductory LeaningPractice-BasedLearningUse in ClinicalDecision Making
  • 63. Slide 40PROGRAM GOALSThree Components of Skill AcquisitionIntroductory LeaningPractice-BasedLearningUse in ClinicalDecision Making
  • 66. Slide 43Live LecturesTraining LabsCardiac UltrasoundWeb-Based Educational ToolsWeb-Based TestingCOURSE CURRICULUMModular Learning
  • 67. POST-COURSE ACTIVITIES & LEARNINGOn-Line Access to Course LecturesRequires Subscription Feeemergencyultrasound.comSlide 44
  • 68. Slide 45POST-COURSE ACTIVITIES & LEARNINGOn-Line Scan ReviewRequires Separate Subscription Fee
  • 69. Slide 46POST-COURSE ACTIVITIES & LEARNING Exam Review PortalPhysician performs exam
  • 70. Device “auto archives” directly into credentialing systemFinal Thoughts
  • 71. Slide 48COURSE INTRODUCTIONFinal ThoughtsA Historic OpportunityA pivotal movement in the future of clinical medicine