Point of Care Ultrasound – It’s for Everyone!

TTE

Welcome!  I’m stoked that you share my enthusiasm for point-of-care ultrasound.  Our team runs a variety of workshops and provides education to colleagues in numerous specialties.  This growing lecture series now comprises over a dozen hours of didactics and represents an important collaboration between the University of Utah and the George E Wahlen VA Medical Center.  We’ll start at the beginning, assuming this is the first time you’ve held an ultrasound probe.  We start with the basics of focused cardiovascular ultrasound, then we add lung, DVT, gastric, and on, and on…What are you waiting for, get cracking!  (Note: If you’re attending one of our courses, you can find your specific content here.) (Note:  if you want to sign up for our ultrasound clip of the day you can click here.)

We are now offering CME credit for our FoCUS content! Of course, all of the educational materials and videos below are free to access. However, if you would like to receive credit for the time you’ve taken to learn these important clinical principles and skills, then register here.

Recommended (Required) Readings

  • You don’t necessarily have to read all of this before you dive into the videos, but some may find it helpful.  If you’re attending one of our workshops, I’ll tell you this is all “required reading” and I may quiz you on it while we’re together!  

Why Focused Cardiac Ultrasound: A Case-Based Discussion (30 min)

  • 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 point of care ultrasound (POCUS) with an emphasis on how we distinguish focused cardiac ultrasound (FOCUS) from echocardiography.  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.
  • After watching the lecture, test your knowledge with this quiz.

Cardiac Anatomy for the New Echocardiographer (20 min)

  • 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.
  • After watching the lecture, test your knowledge with this quiz.

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.
  • After watching the lecture, test your knowledge with this quiz.

FoCUS How-To (130 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.
  • Check your skills.  After learning how to perform focused cardiac ultrasound, see if you can answer these questions correctly.  I have confidence in you!

Cognitive Bias and Errors in Point of Care Imaging

  • I think this would be a good time to pause and consider why beginners (and experts) are prone to errors when they perform point of care imaging.  A fascinating topic and not as straightforward as one might think!

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.
  • Think you’ve got it?  Test your knowledge with this quiz.  

Global Assessment of the Right Ventricle (30 min)

  • 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.
  • Test your knowledge with this quiz!

Basic LV Regional Wall Motion Evaluation (2o min)

  • 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.

Point of Care Lung Ultrasound – Part 1, Intro and PTX (30 min)

  • Pneumothorax is one of the easiest critical questions to address with bedside ultrasound, and this lecture will get you started.
  • If you’re like me, you enjoy reading about topics you’re getting excited about.  Here’s a nice review of the techniques of performing and interpreting perioperative lung ultrasound:  PMID: 29411300

Point of Care Lung Ultrasound – Part 2, Fluid (20 min)

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!
  • Test your knowledge with this quiz!

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!
  • Test your knowledge with this quiz!

**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)

Cases in Perioperative Ultrasound

  • 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!

Congratulations, you have now completed the FoCUS course! Please click here to claim CME credit.