Ultrasound Advanced

Sunday, 22 September 2019
13:00 – 17:15

 

Course Description

This year’s MEMC pre-conference ultrasound course has been updated to reflect participants’ wishes in designing the ultimate ultrasound course. Each year after reviewing participant comments we construct a new course to address their needs.

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 hands-on time for ultrasound scanning.

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Add a pre-congress course when you register for MEMC19.

 

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Course Fee

• Organizing Society Member (AAEM, MAEM): $475 USD
• Non Member: $525 USD
• June Flash Sale: Save $50 USD on pre-congress courses when you register between 1-30 June 2019!

Special Discount if taking both Ultrasound Courses - Beginner and Advanced

• Organizing Society Member (AAEM, MAEM): $760 USD
• Non Member: $800 USD

 

Tentative Course Schedule

Sunday, 22 September 2019

 

Modules

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. Transesophageal Echo (TEE)

 

Course Directors

Katharine Burns, MD FAAEM
Assistant Fellowship Director, Emergency Ultrasound, Advocate Christ Medical Center, Oaklawn, IL, USA

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

Michael Lambert, MD RDMS FAAEM
Fellowship Director, Emergency Ultrasound, Advocate Christ Medical Center, Oaklawn, IL, USA

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

 

Course Faculty

Jeff Baker, MD FAAEM
Associate Program Director, University of Louisville, Louisville, KY, USA

Tyler Beals, MD
Emergency Medicine Physician, Beth Israel Deaconess, Boston, MA, USA and St Vincent Hospital, Worcester, MA, USA

Ralphe Bou Chebl, MD FAAEM
Assistant Professor of Emergency Medicine, Residency Program Director, Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon

Eric Chin, MD MBA FAAEM
Program Director, Emergency & Critical Care Ultrasound and Point-of-Care Ultrasound Physician Assistant Fellowships, San Antonio Military Medical Center/SAUSHEC, San Antonio, TX, USA

Jared L. Cohen, MD MA
Ultrasound Fellow, Brooke Army Medical Center, San Antonio, TX, USA

Felix Gendebien, MD
Emergency Medicine Specialist, Pocus PgC, University Hospital of Brussels (UCL Brussels), Brussels, Belgium

Claire L. Heslop, MD PhD FRCPC
Co-Lead of Emergency Ultrasound, University Health Network, Toronto, Canada

Dallas Holladay, DO
Assistant Director of Ultrasound, Rush University Medical Center, Chicago, IL, USA

Beatrice Hoffmann, MD, PhD, FAAEM
Emergency Ultrasound Division Director, Beth Israel Deaconess Medical Center, Associate Professor, Harvard Medical School, Boston, MA, USA

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

John G. Knight Jr., MD
US Army Physician, BAMC, San Antonio Uniformed Services Health Education Consortium, San Antonio, TX, USA

Hein Lamprecht, MD PhD FCEM(SA) FRCEM
Senior Emergency Medicine Physician, Clinical Ultrasound Programme Director, Stellenbosch and Cape Town Universities, Cape Town, South Africa

Chris Muhr, MD
Karolinska Hospital, Stockholm, Sweden

Bret P. Nelson, MD, FACEP
Chief, Division of Emergency Ultrasound, Icahn School of Medicine at Mount Sinai, New York, NY, USA

Mark A. Newberry, DO FAAEM FACEP
Director of Emergency Ultrasound at Mt Sinai Medical Center, Miami Beach, FL, USA

Felipe Teran MD, MSCE
Clinical Instructor, University of Pennsylvania, Philadelphia, PA, USA

Nicholas S. Thompson, MD FAAEM
Emergency Physician, United States Army, San Antonio, TX, USA

 

Module 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, axillary, femoral and popliteal 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 kidney and gallbladder.
2. Understand the sonographic windows and landmarks of the kidney and gallbladder.
3. Demonstrate the ability to identify and visualize landmarks for the kidney and gallbladder in the transverse and longitudinal scanning planes.
4. Understand the sonographic findings and pitfalls for identifying pathology including 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 including gain, depth and frequency.

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 long, parasternal short, apical 4-chamber, 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 nerve 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 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-lines and comet tail identification for extravascular pulmonary congestion and pleural effusion imaging techniques.
2. Demonstrate sonographic landmarks of the ribs, pleura, diaphragm and lung parenchyma.
3. Distinguish between normal and pathologic conditions 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.

Transesophageal Echo (TEE)

1. Understand the mechanics of the TEE probe and how to manipulate the omniplane and flexion control wheels.
2. Identify relevant cardiac anatomy based on the planes of movement of the TEE transducer including omniplane angle adjustment, rotation of the probe, anteflexion, and retroflexion.
3. Aquire and interpret sonographic images of the heart (midesophageal 4-chamber, midesophageal long-axis, transgastric short axis).
4. Identify basic pathology including pericardial effusion, hypovolemia, right and left heart dysfunction.
5. Understand the indications for TEE during emergency resuscitation as well as contraindications to TEE use.

 

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