www.sonocloud.org - lots of clips of abnormal pathology images with user-generated content

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Point of Care Ultrasound Book:

 

Introduction to Bedside Ultrasound iBook, Volume 1: Volume 1 & 2 are great resources assembled by the well-know EM docs behind US podcast

 

Introduction to Bedside Ultrasound iBook, Volume 2: Volume 1 & 2 are great resources assembled by the well-know EM docs behind US podcast

On Twitter follow:

@ReneeDversdal

@Sonointernist

Search hashtags

#IMpocus

#FOAMus

#FOAMed

Websites

 

Society for US in Med Ed Learning Modules: Comprehensive modules covering basics through some organ specific uses

University of S Carolina videos: Brief YouTube videos covering anatomy & physiology

Asynchronous Crowdsourced Education for Clinical Ultrasound: Amazing database of Free Open Access Medical Education for Clinical Ultrasound!

Ultrasound of the Week: “Learn bedside ultrasound, one week at a time”

5 minute Sono:

SonoGuide: “US Guide for Emergency Physicians”

SonoInternist Site: Created by former US fellow at U S Carolina & includes a map of fellow IM US enthusiasts

Cardiovascular Limited Ultrasound Exam Facebook page: Central location for educational videos, most recent summary paper link, etc

ACEP Emergency  Ultrasound Collaborative Resource: Dense but thorough overview of US in EM

AIUM Ultrasound in Medical Ed Portal: “clearinghouse of resources related to facilitating the integration of ultrasound into medical school education

Stanford Echocardiography in ICU: Basic echo overview

Online Echo Modules: First 4 are free

SonoCloud: database with tons of searchable images & clips


Apps

Ultrasound REsources

Free open access medical education (FOAMed) has been a key component to the development of ultrasound education. Internationally, there has been a relatively large, enthusiastic group of educators who have dedicated themselves to sharing their knowledge of POCUS. You will find a number of these resources here. We understand that learners have their unique styles of learning, so we encourage you to try some of these different resources and let us know what you find useful.


Ultrasoundpodcast.com: Mike, Matt, and Jacob "Making horrible doctors decent and good doctors great."

5 Minute Sono: Jacob Avila and Ben Smith excellent podcast with short clips perfect for just-in-time learning.

Society for US in Med Ed Learning Modules: Comprehensive modules covering basics through some organ specific uses.

Ultrasound leader Chris Fox and UC Irvine's itunes podcast series found here for iPad users.

Podcasts/Videos


Abbott Northwestern's IM Residency has an fabulous POCUS training program. Their content is hosted here

Irene Ma, an EM Ultrasound trained Internist/Nephrologist, Internal Medicine POCUS website.

Emergency Ultrasound Teaching has a bunch of pooled lectures, test questions, and images.

UCLA's procedure focused POCUS website, created by Jason Williams.

Philips has published an ibook formatted website with a lot of different ultrasound applications.

123 Sonography first several echo lectures are free. These are high quality.

Ultrasound of the Week frequently published cases where ultrasound saved the day.

SonoGuide: an EM-based, collaborative ultrasound website with great content.

Websites


Point of Care Ultrasound Book, Nilam Soni et al: Most med schools have access to clinicalkey.com where anyone can access the book.

Introduction to Bedside Ultrasound iBook, Volume 1 and Volume 2: Volume 1 & 2 are great resources assembled by the well-know EM docs behind US podcast. 

Books


Ultrasound-users have gravitated to twitter to share great cases. Here are some people worth following and #tags used by the community:

Twitter

 

@jchristianfox

@Yale_EUS

@Benjikmathews

@UTS_Australia

@CreaghB

@5MinSono

#IMpocus,  #POCUS,  #FOAMus,  #FOAMed

@ReneeDversdal

@US_pyro

@Sonointernist

@pdxfutbal

@irenema99

@ultrasoundpod

@ultrasoundjelly

Intern Intensive

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instructors.PNG

Ambulatory Material

Background/Basic Cardiac

AIUM Webinar


Session #2 - Cardiac and Lung

* 123sonography with a nice webinar on diastology.


Session #3

*Nice review on Abbott Northwestern's website of evaluation for cardiac tamponade.

*I like this case/paper: “Point-of-Care Diagnosis of Cardiac Tamponade Identified by the Flow Velocity Paradoxus - Shyy - 2017 - Journal of Ultrasound in Medicine - Wiley Online Library.” http://onlinelibrary.wiley.com/doi/10.1002/jum.14251/full.

*Did you find other helpful resources? Email me at piro@ohsu.edu so I can keep tabs on the best resources for learners.


Background and Physics

Aim: To learn how to perform basic operation of an ultrasound and to also understand the physics behind ultrasound wave formation and properties and image generation.

Click for background/physics resources

Click for background/physics resources

Basic Background

Please review some of the materials from this link so that you understand the essential background of POCUS, as described in the objectives linked above. Then take the SURVEY by clicking the button below.

Click for a bit more to get you up to speed

Click for a bit more to get you up to speed

Added Complexity

Coming Soon

Click for mastery

Click for mastery

Expert

Coming Soon

THE DATA:

 

 

 

Suggested Background Resources

Review chapter 2-6 in Nilam Soni's, Point-of-care Ultrasound.

Soni, Nilam, Robert Arntfield, and Pierre Kory. Point of Care Ultrasound. Elsevier Saunders, 2015.

Introduction to Bedside Ultrasound

Reading


Please refer to these websites I have compiled to explore on your own.

Websites


Physics Videos

Brief physics primer from Mike Stone, US extraordinaire and current ED physician practicing in the Portland area.

Video, Estimated Time: 18 min.

Mike Stone goes over Doppler if you are interested.

Video, Estimated Time: 23 min.

Dr. Resa Lewiss has a background physics hosted under the "Physics" tab on the EM ultrasound website.

Video, Estimate Time: 18 min


Ultrasound pocket card for reference with the quick and dirty of what you need to know.

US Basics Cheatsheet


Sonosite Edge Operation

Sonosite Edge operational videos, which provide basic instruction on how to adjust image quality and use the different modes.

Video 1, Estimated Time: 7 min.

Video 2, Estimated Time: 9 min.

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ProcEdure Block

Aim: to provide practitioners with basic understanding of how to systematically use ultrasound to guide procedures. At the completion of the procedure block, the practitioner should be able to use ultrasound to aid paracentesis, thoracentesis, lumbar puncture, knee arthrocentesis, and placement of peripheral IVs.

Click for required material

Click for required material

Required

Please complete the following learning exercises prior to 1:1 scanning on Monday morning. Then take the Quiz by clicking the button below.

Click for a bit more to get you up to speed

Click for a bit more to get you up to speed

Added Complexity

More material covering central and arterial lines and more!

Click for mastery

Click for mastery

Expert

Coming Soon

Basic Procedure Pre-Learning

Thoracentesis

* Ultrasound in the diagnosis and management of pleural effusions. Soni N Franco R Velez M Schnobrich D Dancel R Restrepo M Mayo P Journal of hospital medicine 2015 vol: 10 (12) pp: 811-6.

Please read from "Pleural Ultrasound Examination" through "Pleural Fluid Drainage"

Estimated time: 5 min

* Just-in-time learning video from Sonosite. Estimated time: 2 min

* UC Irvine's has a lecture covering LP, paracentesis, and thoracentesis. Start at the 9 minute point and listen to the end of the lecture for the thoracentesis section.

Start with the phased array probe. I recommend starting with the transducer marker oriented cranially to map out the pleural effusion, and then rotating the marker to the patient's left to identify your puncture site. Consider using the linear transducer to help with needle guidance.


Paracentesis

* The gentleman at Ultrasoundpodcast.com put together this short paracentesis video.

Pearls:

Consider performing FAST exam if you have difficulty finding abdominal free fluid.

Consider using color to identify vasculature at chosen puncture site.

Estimated time: 3 min

* UC Irvine's lecture covering procedures. Listen starting at the 5 minute point to 9 minutes. Estimated time: 4 min


Lumbar Puncture

* UC Irvine's lecture covering procedures. Listen to the first 5 minutes of the video for explanation of how to use US guidance during a LP.


Knee Arthrocentesis


Jacob Avila's ultrasound guided IV placement video

http://5minsono.com/ugiv/

Estimated time: 6 min

IV Placement

Intermediate Procedure Pre-Learning

Central Line Access

Central line placement and confirmation videos courtesy of Jacob Avila.


Arterial Line

Coming Soon


More Procedures

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More Procedures


Banner Picture.jpg

Lung Ultrasound

Aim: Lung ultrasound is a powerful tool that can be used to identify artifacts that correlate with abnormal pathology. Lung ultrasound has been shown to have higher sensitivity for consolidations that chest x-ray, be an effective tool to rule out acute heart failure exacerbation, and to accurately identify pleural effusions, among many other applications. At the completion of this module, the internist should be able to identify relevant anatomy, differentiate A-line from B-line pattern, recognize consolidations, and use ultrasound findings to guide their clinical management of patients.

Click to review suggested background material

Click to review suggested background material

Suggested Material

A list of suggested materials can be found here for your review. Please complete the below survey after you complete your review.

Click for a bit more to get you up to speed

Click for a bit more to get you up to speed

Added Complexity

Coming Soon

Click for mastery

Click for mastery

Expert

Coming Soon

THE DATA:

 

 

 

Lung Objectives.PNG

Suggested Lung Exercises

 

Book Material

Point-of-Care Ultrasound book, Lung material, pgs. 49-81.

Philips has a chapter on lung ultrasound on an e-book. Requires Adobe Flash Player 10.

Introduction to bedside ultrasound. This is a free ibook that can be obtained from itunes for Appple users (found here).



Websites

Abbott NW lung material is found here.


The Ultrasound Podcast guys' fantastic lecture series about lung ultrasound. Well worth a slightly deeper dive.

Video 1, Estimated time: 30 min

Video 2, Estimated time: 25 min

Jacob Avila's 5 min sono website has several brief, excellent videos that cover the lung examination.

Video 1, Technical Perfomance of lung examination, Estimated time: 9 min

Video 2, Pulmonary Edema, Estimated time: 9 min

Video 3, Pleural Effusion, Estimated time: 5 min

Video 4, Pneumonia, Estimated time: 5 min

Video 5, Pneumothorax, Estimated time: 5 min

Lung Ultrasound Videos


BLUE Protocol

The Blue Protocol shows how (figure 8 only!) to see how you can utilize the information you obtain from lung ultrasound to help formulate your thinking.

Estimated time: 3 min


CLUE Protocol

After the completion of the Cardiac Modules, you should understand how lung ultrasound fits into the CLUE protocol. Included here are the steps included in the CLUE protocol.

Focused CardiaC Ultrasound

Part 1: Basic

Aim: Focused cardiac ultrasound (FCU) is the most challenging, but arguably the most useful tool in the sonologist's clinical toolbag. Several methods have been studied to simplify the interpretation of a basic echocardiography and help the bedside physician identify heart failure with reduced ejection fraction, left atrial enlargement, pericardial effusion, and other pathology. At the completion of this module, the bedside physician should be able to perform cardiac imaging from the parasternal long axis (PLAX) and subcostal window, and integrate these views with lung ultrasound to complete the Cardiovascular Limited Ultrasound Examination (CLUE). A complete understanding of cardiac anatomy is critical to cardiac ultrasound and it is recommended that you review normal anatomy in relationship to each window obtained in FCU. The physician should be able to describe E-point septal separation indications, uses, and pitfalls and use the "eyeball test" to recognize left atrial enlargement and pericardial effusions. The subcostal view should be used to compare the LV to the RV and additionally confirm findings from the PLAX view. Finally, a determination of preload should be made by looking at the IVC and understanding its limitations to use.

Click for basic material

Click for basic material

Beginner

Please complete the following learning exercises prior to scanning with your assigned group. Then take the Quiz by clicking the button below.

Click for a bit more to get you up to speed

Click for a bit more to get you up to speed

Intermediate

Coming Soon

Click for mastery

Click for mastery

Expert

Coming Soon

Basic Cardiac Material

Cardiac Anatomy

* Please email us if you would like to checkout a SonoSim to explore anatomy. You can use this to help you understand the 3D Anatomy.

* Review chapter 13 in Nilam Soni's, Point-of-care Ultrasound.

Soni, Nilam, Robert Arntfield, and Pierre Kory. Point of Care Ultrasound. Elsevier Saunders, 2015.

* HIGHLY RECOMMENDED - watch this video and build a dough heart. Knowing anatomy is key to doing cardiac ultrasound and one group has shown that this activity significantly cuts down on your time to learn the technique.


Scanning Technique

* University of South Carolina with short videos on the PLAX and subcostal views of the heart. Est time 2 min each.

* Dr. Kimura of Scripps Mercy in San Diego walking you through CLUE in a short video, est time 2 min.


Assessing for Pathology

* 5 min Sono videos with Ben Smith and Jacob Avila.

  1. LV Function Video, est time 6 min.
  2. Pericardial Effusion, est time 5 min.

* Website with explanation of FCU for EM physicians ... still a lot applicable to internists. Focus on PLAX, subcostal (subxiphoid), and IVC (especially the table with correlation to CVP).

* Dr. Kimura's paper detailing the indications and pitfalls of CLUE, as well as the evidence supporting the use of technique, est time 30 min.

* Use of the IVC can be very useful, but one must know the indications before interpretting. Here is a great review article. Est time 20 min.

* Review chapter 14-18 in Nilam Soni's, Point-of-care Ultrasound.

Soni, Nilam, Robert Arntfield, and Pierre Kory. Point of Care Ultrasound. Elsevier Saunders, 2015.


Banner Picture.jpg

Focused CardiaC Ultrasound

Part 2: Advanced

Aim: Focused cardiac ultrasound (FCU) is the most challenging, but arguably the most useful tool in the sonologist's clinical toolbag. Several methods have been studied to simplify the interpretation of basic echocardiography and help the bedside physician identify heart failure with reduced ejection fraction, left atrial enlargement, pericardial effusion, and other pathology. At the completion of this module, the bedside physician should be able to perform the advanced views of the heart, including the apical four chamber and parasternal short axis, in addition to the PLAX and subcostal views covered in the basic cardiac module. A complete understanding of cardiac anatomy is critical to cardiac ultrasound and it is recommended that you review normal anatomy in relationship to each window obtained in FCU. The physician should be able to compare relative chamber size, describe wall thickness, and globally assess ventricular function. These views should be used to augment the basic cardiac exam and confirm findings that you see in your cardiac assessment.

Click to review suggested background material

Click to review suggested background material

Beginner

A list of suggested materials can be found here for your review. Please complete the below survey after you complete your review.

Click for a bit more to get you up to speed

Click for a bit more to get you up to speed

Intermediate

Coming Soon

Click for mastery

Click for mastery

Expert

Coming Soon

Advanced Cardiac Material

Cardiac Anatomy

* Please email us if you would like to checkout a SonoSim to explore anatomy. You can use this to help you understand the 3D Anatomy.

* Review chapter 13 in Nilam Soni's, Point-of-care Ultrasound.

Soni, Nilam, Robert Arntfield, and Pierre Kory. Point of Care Ultrasound. Elsevier Saunders, 2015.

* Introduction to bedside ultrasound. This is a free ibook that can be obtained from itunes for Appple users (found here). Review cardiac material.

* HIGHLY RECOMMENDED - watch this video and build a dough heart. Knowing anatomy is key to doing cardiac ultrasound and one group has shown that this activity significantly cuts down on your time to learn the technique.


Scanning Technique

* University of South Carolina with short videos on the PSAX and apical 4 chamber views of the heart. Est time 2 min each.

* SonoSite has short videos on the PSAX and the A4C views as well.


Assessing for Pathology

* Website with explanation of FCU for EM physicians ... still a lot applicable to internists. Focus on PSAX and apical material..

* Review chapter 14-18 in Nilam Soni's, Point-of-care Ultrasound, specifically paying attention to PSAX and apical 4 chamber material.

Soni, Nilam, Robert Arntfield, and Pierre Kory. Point of Care Ultrasound. Elsevier Saunders, 2015.

*123sonography has 4 free echo videos. Lesson 1 covers a lot of basic principles of echo, with a deeper dive in lessons 2, 3, and 4. Each of these is between 30-40 min long.


Deeper Dive Advanced Cardiac

Valvular Disease

* Great 2 part lecture by Rob Arntfield covering valve assessment at the point-of-care. Part 1 and Part 2.


Diastology

* 123sonography with a nice webinar on diastology.


Pericardial Tamponade

*Nice review on Abbott Northwestern's website of evaluation for cardiac tamponade.

*I like this case/paper: “Point-of-Care Diagnosis of Cardiac Tamponade Identified by the Flow Velocity Paradoxus - Shyy - 2017 - Journal of Ultrasound in Medicine - Wiley Online Library.” http://onlinelibrary.wiley.com/doi/10.1002/jum.14251/full.

*Did you find other helpful resources? Email me at piro@ohsu.edu so I can keep tabs on the best resources for learners.


Focused CardiaC Ultrasound

Part 2

Aim: Focused cardiac ultrasound (FCU) is the most challenging, but arguably the most useful tool in the sonologist's clinical toolbag. Several methods have been studied to simplify the interpretation of a basic echocardiography and help the bedside physician identify heart failure with reduced ejection fraction, left atrial enlargement, pericardial effusion, and other pathology. In this module, we will focus on learning to evaluate the heart from the subcostal window. At the completion of this module, the bedside physician should be able to describe how to perform subcostal imaging of the heart and identify relevant anatomy with subsequent discrimination of relative normal chamber size and of the existence of pericardial effusion. The physician should be able to describe how to image the IVC and apply its appearance to assess volume in both spontaneously breathing and ventilated patients.

Click for required material

Click for required material

Required

Please complete the following learning exercises prior to scanning with your assigned group. Then take the Quiz by clicking the button below.

Click for a bit more to get you up to speed

Click for a bit more to get you up to speed

Added Complexity

Coming Soon

Click for mastery

Click for mastery

Expert

Coming Soon

THE DATA:

 

 

 

***

Aim: ***

Click for required material

Click for required material

Required

Please complete the following learning exercises prior to scanning with your assigned group. Then take the Quiz by clicking the button below.

Click for a bit more to get you up to speed

Click for a bit more to get you up to speed

Added Complexity

Coming Soon

Click for mastery

Click for mastery

Expert

Coming Soon

THE DATA:

 

 

 

Required * Material


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Quisque congue porttitor ullamcorper. Suspendisse nec congue purus. Vivamus sit amet semper lacus, in mollis libero. Mauris egestas at nibh nec finibus. Nullam sit amet nisi condimentum erat iaculis auctor. Suspendisse nec congue purus.*



The following is placeholder text known as “lorem ipsum,” which is scrambled Latin used by designers to mimic real copy. Aliquam bibendum, turpis eu mattis iaculis, ex lorem mollis sem, ut sollicitudin risus orci quis tellus. Vestibulum ante ipsum primis in faucibus orci luctus et ultrices posuere cubilia Curae. Aenean eu justo sed elit dignissim aliquam. Class aptent taciti sociosqu ad litora torquent per conubia nostra, per inceptos himenaeos.

Quisque congue porttitor ullamcorper. Suspendisse nec congue purus. Vivamus sit amet semper lacus, in mollis libero. Mauris egestas at nibh nec finibus. Nullam sit amet nisi condimentum erat iaculis auctor. Suspendisse nec congue purus.



The following is placeholder text known as “lorem ipsum,” which is scrambled Latin used by designers to mimic real copy. Aliquam bibendum, turpis eu mattis iaculis, ex lorem mollis sem, ut sollicitudin risus orci quis tellus. Vestibulum ante ipsum primis in faucibus orci luctus et ultrices posuere cubilia Curae. Aenean eu justo sed elit dignissim aliquam. Class aptent taciti sociosqu ad litora torquent per conubia nostra, per inceptos himenaeos.

Quisque congue porttitor ullamcorper. Suspendisse nec congue purus. Vivamus sit amet semper lacus, in mollis libero. Mauris egestas at nibh nec finibus. Nullam sit amet nisi condimentum erat iaculis auctor. Suspendisse nec congue purus.


Ultrasound Question Bank

 
 

It all started when...

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Point OF Care Ultrasound Faculty

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