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Knobology Jamie Jenkins MD, RDMS Regional Ultrasound Director FHS St Josephs Medical Center Ultrasound : Zonare

Knobology Jamie Jenkins MD, RDMS Regional Ultrasound Director FHS St Josephs Medical Center Ultrasound : Zonare

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Page 1: Knobology Jamie Jenkins MD, RDMS Regional Ultrasound Director FHS St Josephs Medical Center Ultrasound : Zonare

Knobology

Jamie Jenkins MD, RDMSRegional Ultrasound Director FHS

St Josephs Medical Center

Ultrasound : Zonare

Page 2: Knobology Jamie Jenkins MD, RDMS Regional Ultrasound Director FHS St Josephs Medical Center Ultrasound : Zonare

Core Applications of Ultrasound

Page 3: Knobology Jamie Jenkins MD, RDMS Regional Ultrasound Director FHS St Josephs Medical Center Ultrasound : Zonare

Knobology

How to use the machine

Page 4: Knobology Jamie Jenkins MD, RDMS Regional Ultrasound Director FHS St Josephs Medical Center Ultrasound : Zonare

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?

Page 5: Knobology Jamie Jenkins MD, RDMS Regional Ultrasound Director FHS St Josephs Medical Center Ultrasound : Zonare

Knobology: The Basics

Page 6: Knobology Jamie Jenkins MD, RDMS Regional Ultrasound Director FHS St Josephs Medical Center Ultrasound : Zonare

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.

Page 7: Knobology Jamie Jenkins MD, RDMS Regional Ultrasound Director FHS St Josephs Medical Center Ultrasound : Zonare

Exam Type

Page 8: Knobology Jamie Jenkins MD, RDMS Regional Ultrasound Director FHS St Josephs Medical Center Ultrasound : Zonare

New patient exam

Press new patient key in upper left hand corner of the keyboard

Page 9: Knobology Jamie Jenkins MD, RDMS Regional Ultrasound Director FHS St Josephs Medical Center Ultrasound : Zonare

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

Page 10: Knobology Jamie Jenkins MD, RDMS Regional Ultrasound Director FHS St Josephs Medical Center Ultrasound : Zonare

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

Page 11: Knobology Jamie Jenkins MD, RDMS Regional Ultrasound Director FHS St Josephs Medical Center Ultrasound : Zonare

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

Page 12: Knobology Jamie Jenkins MD, RDMS Regional Ultrasound Director FHS St Josephs Medical Center Ultrasound : Zonare

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

Page 13: Knobology Jamie Jenkins MD, RDMS Regional Ultrasound Director FHS St Josephs Medical Center Ultrasound : Zonare

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

Page 14: Knobology Jamie Jenkins MD, RDMS Regional Ultrasound Director FHS St Josephs Medical Center Ultrasound : Zonare

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) 

Page 15: Knobology Jamie Jenkins MD, RDMS Regional Ultrasound Director FHS St Josephs Medical Center Ultrasound : Zonare

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.

Page 16: Knobology Jamie Jenkins MD, RDMS Regional Ultrasound Director FHS St Josephs Medical Center Ultrasound : Zonare

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

Page 17: Knobology Jamie Jenkins MD, RDMS Regional Ultrasound Director FHS St Josephs Medical Center Ultrasound : Zonare

Transabdominal Ultrasound

Page 18: Knobology Jamie Jenkins MD, RDMS Regional Ultrasound Director FHS St Josephs Medical Center Ultrasound : Zonare

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 

Page 19: Knobology Jamie Jenkins MD, RDMS Regional Ultrasound Director FHS St Josephs Medical Center Ultrasound : Zonare

GallbladderCommon Bile Duct

Page 20: Knobology Jamie Jenkins MD, RDMS Regional Ultrasound Director FHS St Josephs Medical Center Ultrasound : Zonare

Indications: Signs and symptoms of Cholecystitis Most sensitive signs: Stones and sono-murphys

signVery specific signs: Wall thickness,

pericholecystic fluid

Gallbladder Literature

Page 21: Knobology Jamie Jenkins MD, RDMS Regional Ultrasound Director FHS St Josephs Medical Center Ultrasound : Zonare

FASTClips of

RUQLUQSuprapubicCardiac 

Depth: enough to see posterior surface of heart

Pericardial vs Pleural effusion

Parasternal long if unable to get Subxiphoid view

Page 22: Knobology Jamie Jenkins MD, RDMS Regional Ultrasound Director FHS St Josephs Medical Center Ultrasound : Zonare

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

Page 23: Knobology Jamie Jenkins MD, RDMS Regional Ultrasound Director FHS St Josephs Medical Center Ultrasound : Zonare

RenalBilateral Kidney’sTwo views of each:

transverse and longitudinal

Bladder (2 views)Please label your

views

Page 24: Knobology Jamie Jenkins MD, RDMS Regional Ultrasound Director FHS St Josephs Medical Center Ultrasound : Zonare

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

Page 25: Knobology Jamie Jenkins MD, RDMS Regional Ultrasound Director FHS St Josephs Medical Center Ultrasound : Zonare

Questions??????If there are any

questions please feel free to email me.

[email protected]