Getting Your Required Scans Well Before Graduation aka Don’t Be Like Bagley: Some Quick Tips/Tricks William “Never Call Me a Scanimal” Bagley M.D. Ultrasound Fellow SLR Department of Emergency Medicine

Some Prerequisites You Should be in the Ultrasound Mindset You Must Want to Graduate

It’s Easy. Pace Yourself. Starting Today, Assuming You Have Zero Scans and Need 175 Total to Graduate On Time 3 rd Years 6 scans/week 2 nd Years 3 scans/week 1 st Years 2 Scans/week

For Those Who Truly LOVE Ultrasound Want to Have All Your Scans Done by the Start of Your Third Year? 2 nd Years 6 Scans/Week 1 st Years 3 Scans/Week

Contact Us Today! Or Pretty Soon, So We Can Go Over Your Scanning Totals For Contact Info and Minimal Requirements:

Some Prerequisites YOU NEED TO THINK AHEAD You can integrate ultrasounds into many of your patient encounters The more you scan on shift the less you will be scanning during your free time right before graduation

Some Prerequisites Certain Chief Complaints Trigger Instinct to Bring the Ultrasound WITH YOU to the Patient Encounter Make it Become Like Reflex

DISCLAIMER! These are Tips to Getting Your Scans Disposition/Treatment Determined by Your Attending and Credentialing

Rewards for Correct Answers Automatic Membership to Ultrasound Academy You Will Receive an with a Customized Seal! (That’s a Scanimal) 

Vaginal Bleeding UPreg (+) or (–) or sample not given yet. TransAbdominal Pelvic Scan If Intrauterine Pregnancy (IUP) Seen, BONUS! ** If Free Fluid Seen, DOUBLE BONUS! Positive FAST and Pelvic scan!

Vaginal Bleeding If UPreg Turns Out to be (+) and IUP Not Seen on TransAbdominal Transvaginal Scan

What Views/Measurements are Needed for an Adequate Pelvic Sonogram?

Longitudinal Uterus Transverse Uterus Endo-Myometrial Mantle >8mm Fetal Heart Rate Measure with M-Mode

Notification! Cardiac Arrest! Cardiac Fast Rule Out Tampanade! Could Lead to a Cool Procedure Asystole Document with M-Mode

Name the 4 Cardiac Views Commonly Taught at SLR

Subxiphoid Parasternal Long-Axis Parasternal Short-Axis Apical 4-Chamber

Which Cardiac View is Described Below? Probe Placed Along the Left Sternal Border 3 rd or 4 th Intercostal Space Probe Marker Towards the Patient’s Left Hip

Parasternal Long-Axis! “4 th and Long”

Flank Pain Young Person Suspecting Kidney Stone from History Scan the Kidney on the Affected Side Scan the Bladder **In Females You Can Also Get a TransAb Pelvis at the Same Time

What Views are Needed for an Adequate Renal Scan at SLR?

Longitudinal Kidney Transverse Kidney Bladder Longitudinal and Transverse

Flank Pain Older Person Rule Out Abdominal Aortic Aneurysm (AAA) Suspecting Kidney Stone Scan the Kidney on the Affected Side Scan the Bladder

In an Adequate Non-Aneurysmal Sonographic Aorta Scan, How Many Images Should You Have?

5 Longitudinal Aorta Middle or Distal Transverse Aorta Proximal, Middle, Distal Transverse Iliac Bifurcation Normal Aorta <3cm Normal Iliacs <1.5cm

Flank Pain Some Tricks: If Already Looked at One Kidney and the Bladder *** Throw in a View of the Other Kidney and You Likely Have a Whole Abdominal FAST Exam

Name the 3 Views of the Abdominal FAST Exam

Hepatorenal Recess (Morison’s Pouch) Splenorenal Recess Pelvic (Pouch of Douglas)

Epigastric/Upper Abdominal Pain Check for Murphy’s Sign with the Ultrasound!

Name 4 Sonographic Elements of Acute Cholecystitis

Thickened Gallbladder Wall >3mm Enlarged Common Bile Duct >6mm Pericholecystic Fluid Gallstones Sonographic Murphy’s Sign

What is the Most Sensitive Sonographic Finding for Acute Cholecystitis?

Sonographic Murphy’s Sign Describe the Pathophysiology That Explains a Positive, Non-Sonographic Murphy’s Sign?

Severe Abdominal Pain/ Unstable Vitals Rule Out AAA FAST exam Females of Childbearing Age Consider Ectopic, serum HCG Biliary Exam

Severe Abdominal Pain/ Unstable Vitals Quick Tips If Time/Resuscitation/Printer Allows FAST –Get Transverse Kidney Views and You Have an Adequate Renal Scan Aorta Scan Biliary Scan TransAb Pelvic in Females 5 scans/1 patient!!!!!

Urinary Retention Scan the Bladder and Both Kidneys Almost Guaranteed (+) Hydronephrosis

Ascites! FAST Exam Goldmine! You didn’t hear this from me but… Each individual positive quadrant could be counted as separate positive scans…. –But you didn’t hear that from me Patients With Low Albumin May Have Pericardial Effusions As Well Positive Cardiac Scan!

Intubated Patients: Let Your Conscience/Ethics be Your Guide ULTRASOUND JACKPOT!!! Cardiac FAST Renal Biliary Aorta

General Tips/Tricks Once You’ve Gelled-Up a Patient for One Scan An unspoken bond usually forms and then they just let you scan away! “Would you mind if I take a look at your…?” (Don’t Sound Creepy)

Questions? Anyone Else Have Some Tips?