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There is a lot of confusing language and acronyms in the arena of ultrasound. What we’re basically talking about here is ultrasound provided at the point of care, at the patient’s bedside. The “bedside” could be the preop clinic, the OR, the wards, the ER, the ICU, or wherever you interact with your patients.
When we use the acronym PoCUS we mean point-of-care ultrasound. Unless you’re a cardiologist or radiologist this is what you’re likely to be doing (and if you are, you’ll be doing PoCUS sometimes too.) PoCUS can include cardiac ultrasound, vascular for access or DVT, lung, abdominal, musculoskeletal, ultrasound guided regional anesthesia, ocular, and more. It would technically also include perioperative TEE. Whatever type of ultrasound or where it’s performed, the exam is done by the physician rather than a sonographer and is interpreted in real time. When we refer to FoCUS we mean focused cardiovascular ultrasound, which is a subset of PoCUS because it’s performed at the point of care. I’ll make the distinction between FoCUS and limited TTE in the lectures below.
- If you wonder why cardiac ultrasound is for you, take a look at this talk. If you’re already convinced you can watch it because it’s a fun talk but you could also move onto the vast sea of ‘How-to’ below.
What exactly is ”FoCUS”? (30 min)
- An introduction to the concept of FoCUS as described by the American Society of Echocardiography (and interpreted by our echo group.) Before you embark on your ultrasound training it is important for us to be on the same page regarding not only the immense value of these techniques but also their limitations.
- A brief review of anatomy to refresh your memory before beginning to scan. Remember that the image is not the thing, and we’re always trying to construct a mental picture of our patient’s actual anatomy from the images we create.
HeartWorks How-to (10 min)
- An introduction to the use of the excellent, valuable HeartWorks simulator. I would encourage you all to make use of simulation frequently during your ultrasound training. It might be useful to listen to this lecture while you’re actually working with the simulator. Obviously not everyone will have access to one of these, sorry!
Basic Concepts of Ultrasound (22 min)
- Don’t be scared, this isn’t your college physics class reprised. You don’t have to be able to calculate a Doppler shift to start using ultrasound in your practice, I promise! You do need a basic understanding of how an ultrasound image is formed, how to adjust basic image settings, and what common artifacts look like. That’s what Dr. Decou will review here.
FoCUS How-To (90 min)
- It’s hard to spend too much time with the basics, and these are absolutely the basics. What do you do when you put the probe on the patient? Watch these talks now, then come back to them as you continue to develop your skills.
- I’m not sure, this may count as a shameless plug. This is a link to my recent article in Anesthesia and Analgesia that describes the performance of FoCUS. There is a link in the article to another how-to video and the graphics and clips in the article should serve as good examples.
Global Left Heart Evaluation (30 min)
- Assessment of the structure and global function of the left ventricle with Dr. Bledsoe. The goal here is not to distinguish between an ejection fraction of 34% vs 36%! We want to know if our patients’ LV function is not too bad, not so good, or terrible.
- Similar concepts apply to Dr. Bledsoe’s discussion of global right ventricular function. We’d like to know if our patient’s problem (clinical evidence of heart failure, hemodynamic instability, etc) could be related to global dysfunction of the right ventricle.
- Identification of subtle regional wall motion abnormalities is challenging even for very experienced echocardiographers. What you’re trying to identify is large areas of hypokinesis that could explain hypotension, or perhaps areas of scar that suggest old myocardial infarctions. These are less subtle. In this talk Dr. Curtis will review concepts of normal and abnormal myocardial wall motion and sequelae of infarction.
Basic Valvular Assessment (80 min)
- In this series of three lectures, we’ll review the normal anatomy of the aortic, mitral, and tricuspid valves as well as discuss findings of significant valvular stenosis and regurgitation.
FoCUS to the Rescue! (120 min)
- In this series of lectures, I’ll review the application of FoCUS in the assessment of the hemodynamically unstable patient. This topic is a ton of fun, but there’s a lot to cover so I’ve broken the 200-some slides into more bite-sized portions.
- Pneumothorax is one of the easiest critical questions to address with bedside ultrasound, and this lecture will get you started.
- This is slightly more advanced lung ultrasound, get ready. This talk reviews the evaluation of pleural effusion and pulmonary edema.
Point of Care DVT Ultrasound (30 min)
- Do you take care of patients who are hypercoagulable, pregnant, have cancer, are immobile, have trauma, undergo major surgery? Of course you do! Do you ever have unstable patients where you’re considering the possibility of DVT with PE? Yes, yes. Can you perform limited ultrasound to identify DVT? You will soon!
Point of Care Gastric Ultrasound (30 min)
- Take a curvilinear probe, put it over your stomach, watch that thing trying to digest your breakfast, and then try to tell me this isn’t awesome! (Coming soon…)
**If you’re attending one of our FoCUS workshops, you can stop with the above**
TTE for the Expert Perioperative Echocardiographer
- The FoCUS lectures above provide an introduction to bedside cardiac ultrasound for the physician with limited or no experience in echocardiography. These lectures are the next level, for those with experience in TEE who “only” need to add transthoracic windows to their arsenal. We’ll add some quantification of chamber size, systolic function, valvular disease, and diastolic function. Piece of cake, right?
Introduction and Parasternal Imaging (35 minutes)
Apical Imaging (35 minutes)
Subcostal Imaging (15 minutes)
- This will be a growing area of content where we place short (10-15 minute) video cases with brief discussions of the pertinent findings. This will serve to supplement the above lectures and there will be points pertinent to both FoCUS-level and advanced TTE trained practitioners. Enjoy!