Pre-course: Ultrasound Beginner & Advanced

Saturday 23 September: 09:00-17:00 & Sunday 24 September 09:00-13:30

 

Course Directors

  • Jim Connolly (UK)
  • Beatrice Hoffmann (USA)
  • Hein Lamprecht (South Africa)
  • Michael J. Lambert (USA)

Faculty

  • Zeki Atesli (UK)
  • Tyler Beals (USA)
  • Pete Croft (USA)
  • Rip Gangahar (UK)
  • Katarzyna Hampton (USA)
  • Hani Hariri (Saudi Arabia)
  • Elsie Hart (USA)
  • Robert Jarman (UK)
  • Christine Lee (USA)
  • Nicholas Lim (Ireland)
  • Najib Nasrallah (Israel)
  • Farooq Pasha (Saudi Arabia)
  • Effie Polyzogopoulou (Greece)
  • Gregor Prosen (Slovenia)
  • Hannelore Raemen (Belgium)
  • Arthur Rosendall (The Netherlands)
  • Omer Salt (Turkey)
  • Prem Sukul (The Netherlands)
  • Erden Erol Unluer (Turkey)
  • Philip Verdonck (Belgium)
  • Joe Wood (USA)

Participants

The course is designed for 44 participants (EP, emergency medicine PA’s and nurses).

Ultrasound Beginner

Course description & learning objectives

Image acquisition & 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.

eFast
1. Understand the surface landmarks for appropriate transducer positioning to perform the Extended Focused Assessment With Sonography for Trauma (eFAST) 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.

Vascular Access
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.

Echo and Aorta
1. Understand the surface landmarks for appropriate transducer positioning to perform sonographic examinations of the thoracic and abdominal aorta.
2. Demonstrate the ability to identify and visualize landmarks for the aorta 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. Demonstrate the surface landmarks and transducer position necessary to perform an echocardiogram in the emergency department.
6. Acquire and interpret sonographic images of heart (subcostal, parasternal long, parasternal short and apical windows).
7. Identify pathologic conditions such as pericardial effusion, gross wall motion abnormalities and cardiac tamponade.

Course format

Participants wanted more imaging of the heart and central line placement. Didactic lectures will provide state of the art audiovisual presentation by a veteran faculty, followed by small groups of a maximum four participants / one instructor allowing each individual participant ample time with their hand on the probe. 

Schedule

Saturday 23 September

09:00-09:15 Welcome
09:15-10:00 Image Acquisition and Instrumentation
10:00-10:30 Aorta
10:30-11:00 Coffee Break
11:00-11:45 Echo in the ED 
11:45-12:30 (eFAST) Examination
12:30-13:30 Lunch
13:30-14:00 Vascular Access—central and peripheral lines
14:00-14:45 Hands-on Session #1
14:45-15:30 Hands-on Session #2
15:30-16:00 Coffee Break
16:00-16:45 Hands-on Session #3
16:45-17:00 Wrap up and Adjourn

 

Ultrasound Advanced

Course description & learning objectives

Aorta & IVC

  1. Understand the surface landmarks for appropriate transducer positioning to perform sonographic examinations of the thoracic and abdominal aorta.
  2. Demonstrate the ability to identify and visualize landmarks for the aorta in the transverse and longitudinal scanning planes.
  3. Understand the sonographic findings and pitfalls for identifying pathology including aortic aneurysm.
  4. Describe the surface landmarks and transducer position necessary to perform ultrasound of the inferior vena cava.
  5. Understand the sonographic landmarks and anatomical relationships as it relates to the inferior vena cava
  6. Discuss indications for performing inferior vena cava ultrasound.

Cardiac

  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 in the emergency department.
  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. 

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.

Equipment 

  1. Learn to be an expert on the Sonosite 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 ie; gain, depth, frequency in hands-on session. 
  6. Demonstrate how to properly document an ultrasound study by adding pt. information, text annotation and proper landmarks. 

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, systematic 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 lymphnodes within the neck. 
  5. Describe ultrasound exam techniques to detect upper airway anatomy to guide correct endotracheal tube placement including normal esophagus and appearance of esophageal intubation.  
  6. Understand anatomy of main neck vessels and their relation to other musculoskeletal structures

Hernia  

  1. Understand the two main types of hernia - groin hernias and anterior abdominal wall hernias.
  2. Understand how to differentiate groin hernias - indirect and direct inguinal and femoral types.
  3. Understand landmarks for  abdominal wall hernias include umbilical, linea alba (epigastric and hypogastric), Spigelian, and incisional types.
  4. Understand how to determine content of hernia and if strangulated. 

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 the heart
  2. Demonstrate proper landmark documentation of the fast examination.
  3. Demonstrate proper landmark documentation of the gb and renal
  4. Demonstrate proper landmark documentation of the Aorta
  5. Demonstrate proper landmark documentation of transabdominal OB

MSK - Lower extremity   

  1. Demonstrate the appearances of various soft tissues on diagnostic musculoskeletal ultrasound. 
  2. Correctly apply ultrasound basic concepts so as to ensure proper visualization of musculoskeletal structures. 
  3. Proficiently perform a diagnostic musculoskeletal ultrasound on lower limb structures with emphasis on hip & knee effusions, quad and patellar tendon tears, achilles tendon tears, and TFL injuries of the ankle. 

MSK - Upper extremity   

  1. Demonstrate the appearances of various soft tissues on diagnostic musculoskeletal ultrasound. 
  2. Correctly apply ultrasound basic concepts so as to ensure proper visualization of musculoskeletal structures. 
  3. Proficiently perform a diagnostic musculoskeletal ultrasound on upper limb structures with emphasis on clavicle fractures, shoulder separations, dislocated shoulders, and rotator cuff injuries. 

Ocular

  1. Review and understand how sonography can reveal pathology of the eye and to highlight its usefulness as a simple and cost-effective tool in investigating eye symptoms. 
  2. Understand the normal ultrasound anatomy of the eye, specifically the location of the retina.
  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 diagnosed by ultrasound.

Procedures - bodily fluid removal

  1. Understand how pleural, pericardial and peritoneal fluid appear on ultrasound
  2. Understand the sonographic landmarks and anatomical relationships as they relate to commonly
    performed US guided procedures in the emergency department - pericadiocentesis, pleurocentesis, and paracentesis
  3. Use phantom models demonstrate ultrasound guided technique

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 - 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. Testicular Ultrasound
  4. Learn and demonstrate the landmarks for the testes in the longitudinal and transverse plane.
  5. State the importance of using color Doppler and pulsed wave Doppler to indicate the waveform of vessels in the testes and epididymis.
  6. Review the following disorders of the testis: hydrocele, varicocele, orchitis, epididymitis, and varicocele.

Testicular Ultrasound

  1. Learn and demonstrate the landmarks for the testes in the longitudinal and transverse plane.
  2. State the importance of using color Doppler and pulsed wave Doppler to indicate the waveform of vessels in the testes and epididymis.
  3. Review the following disorders of the testis: hydrocele, varicocele, orchitis, epididymitis, and varicocele.

Ultrasound Program - getting started

  1.  Review the responsibilities of the ultrasound director.
  2. Review the requirements for training faculty and residents and discuss the process of privileging faculty to perform emergency ultrasound.
  3. Review how to establish a quality assurance process and how to report, document and archive images for both teaching and clinical use.
  4. Review equipment necessary to begin a successful program.
  5. Share public domain resources others have used in program initiation.

Course format

This year’s ultrasound courses have been fully updated with participants’ wishes to design the ultimate advanced US course. Participants really wanted more modules. You will have your choice of 5 modules out of a possible 21 different ultrasound applications to chose from. There will be a maximum of four participants per one instructor allowing each individual participant ample time with their hand on the probe.

Schedule

Sunday 24 September

09:00-09:45 Hands-on Session #1
09:45-10:30 Hands-on Session #2
10:30-11:00 Coffee Break
11:00-11:45 Hands-on Session #3 
11:45-12:30 Hands-on Session #4
12:30-13:15 Hands-on Session #5
13:15-13:30 Wrap up session