Bedside Ultrasound With Confidence How to Start? Paul Elbers, MD, PhD - Intensivist ICARUS - Intensive Care Ultrasound

The diagnosis of hyponatremia makes the distinction between the lucky doctors who master its physiopathologic mechanism, and the others

Life without ultrasound…

At least some support by cardiologist and radiologist is required

Direct supervision by a colleague is extremely helpful

Competence vs Certification

Clearly define local competence EG: our Basic CCE does not cover valves And define what this implies EG: if clinical picture cannot be adequately explained by our basic CCE, cardiologist consultation is needed

To store or not to store? Not storing –Addition to physical examination –No medicolegal issues Storing –Good for teaching –Review your own images

Certification Stronger need for advanced ultrasound –No need for basic ultrasound? Route to certification –By previous experience –By additional training –Within existing critical care training

The Ideal World Ultrasound is taught bedside –By experienced colleague –With clearly defined goals General Critical Care Ultrasound Basic Critical Care Echocardiography Advanced Critical Care Echocardiography Full support by cardiology and radiology No medicolegal issues Certification for all

Diagnosis determines therapy Edema Embolism Pneumonia COPD / Astma Pneumothorax

Ultrasound correlations Diagnosis Ultrasound Images ???

Pulmonary Edema SlidingAnteriorPLAPS 52/54YesBNo

Pneumonia (1 of 3 slides) SlidingAnteriorPLAPS 34/83YesA 9/83NoCYes

Ultrasound correlations Diagnosis Ultrasound Images ???

Sliding, A dominance and PLAPS

Sliding, B dominance (any PLAPS)

PPV NPV

Although physicians applying ultrasound raise concerns about the medicolegal implications should their diagnosis or resultant management be incorrect, the opposite also has to be considered. When the considerable benefits it confers to patients are well known, not utilizing ultrasound in the management of patients could be considered inexcusable.

A structured certification program is probably the best approach to equip practitioners with the necessary skills and knowledge. Although from the medicolegal perspective, competence rather than certification is important, the latter greatly assists in achieving relevant standards of practice

ICARUS VUmc Amsterdam –Local ICU fellows and Anesthesia Residents Also for doctors outside Vumc –Course continues in own hospital Tailored to intensive care practice –Strong focus on lung –Standardized ICARUS views –30 supervised ultrasound exams –Compulsory recording and reporting

ICARUS - Lung

ICARUS – Heart

ICARUS reporting

PDMS based

ICARUS VUmc Amsterdam –Local ICU fellows and Anesthesia Residents Also for doctors outside Vumc –Course continues in own hospital Tailored to intensive care practice –Strong focus on lung –Standardized ICARUS views –30 supervised ultrasound exams –Compulsory recording and reporting