Creating an ultrasound workshop should start with a set of objectives, as well as an understanding of the applications to be learned.
Primary Care/EM or Surgery practice POCUS applications:
- DVT- application takes less than 4 minutes to complete with nearly 100% sensitivity.
- Lung- PTX, effusion, atelectasis, pneumonia, PE
- Heart-Pericardial effusion, ejecting fraction, heart strain, aortic diameter, IVC/central venous pressure
- Heart Primary Care- Evaluation for pneumonia, CHF, pleural effusion, COPD
- Gall Bladder-Stones, sludge, CBD size cholecystitis vs lithiasis
- Small bowel obstruction/intussusception- takes minutes to perform with 91% sensitivity vs 47%, compared to X-ray. Appendicitis, pyloric stenosis, volvulus
- OB/gyn- ectopic pregnancy, ovarial cysts, IUP viability, masses
- AAA-Unites States Preventative Services Task Force recommends a screening.
- Soft Tissue -Cellulitis vs Abscess Vs Nec Fasciitis
- Needle placement to include central lines, Peripheral IV, joint aspirations and injections
- Regional anesthesia
- Cervical Plexus block(at the Scalene, sup/subclavicular, Axillary regions)
- Superficial Cervical Plexus
- Plane blocks (Serratus, TAP, PECS I&II)
- Upper extremity (Radius, Ulnar, Median, Musculocutaneous, Axillary Nerve, Suprascapular Nerve)
- Lower extremity (Ankle Block, Saphenous Nerve, Femoral, Iliacus, 3 in 1 block, sciatic)
- Renal- Bladder retention and hydronephrosis, renal stones.
- Thoracentesis/pericardiocentesis/paracentisis via ultrasound guidance
- FAST exam, free fluid, trauma/ectopic pregnancy
- Musculoskeletal- Fractures, joint reductions, joint effusions, tendonopathies, rotator cuff tears
- Airway- ET tube placement, Cricothyrotomy identification
- Thyroid-masses, cysts enlargement
- Testicular-torsion, vs masses, vs epididymitis.
- Ocular- retinal detachment, foreign body, optic nerve sheath diameter for intracranial pressure.
- We could also cover Protocols that allow for evaluation of clinical scenarios
- Volume assessment- Fluid responsiveness
- RUSH- Rapid ultrasound for shock and hypotension- exam to evaluate for shock
- Dyspnea- this includes evaluation of causes shortness of breath (PN vs CHF vs, COPD vs ARDs vs PTX vs MI)
- FASH-Focused Assessment with Sonography for HIV/TB
- EGLS-Echo guided life support
Logistics of the Workshop- Two weeks prior to the workshop, the attendees will be provided with web based videos which will provide the attendees with the didactic content related to each ultrasound applications. The attendees will also be given access to an eBook, Introduction to Bedside Ultrasound Volume 1 & 2.
On the day of the workshop, attendees will first receive a didactic block of the instruction, followed by a hands on portion where they will practice their ultrasound skills, and learn the pearls and pitfalls while scanning. Maximal time scanning with the instructors provides the attendees with the hand eye coordination, the psychomotor skills, as well as the pattern recognition skills necessary to obtain, capture and interpret the images.
Attendee "probe time" is dependent on maintaining a 4:1 cadre to student ratio at each ultrasound learning station. This method of teaching will allow the student to return to their home institutions, practice their skills, and apply for credentialing. Therefore, a workshop with 52 attendees will have 13 instructors, plus support staff and personnel. Understanding this principle helps to drive the concept of how long to make the workshop. Travel and Lodging for 13 instructors is the same there is a one day or two day workshop, therefore it is advantageous to have at least a two day event.
STUDENTS- SPOCUS will include free student teaching in every workshop they develop. These students will then serve as models for the formal ultrasound workshop. The models will be comprised of students from the local university.
Machines- The ultrasound machines will be sourced from the manufacturers, and the phantoms for needle placement will be provided by SPOCUS.