1. P A Sufi Consultant Surgeon Whittington Health

2. In 1598 AD, Portuguese sailors landing in Mauritius discovered a previously unknown species of bird, the Dodo. Having been isolated from contact with humanity, the dodo greeted the new visitors with a child-like innocence. The sailors mistook the gentle spirit of the dodo, and its lack of fear of the new predators, as stupidity. They dubbed the bird "dodo" (meaning something similar to a simpleton in the Portuguese tongue). Many dodo were killed by the human visitors, and those that survived man had to face the introduced animals. Dogs and pigs soon became feral when introduced to the Mauritian eco-system. By the year 1681, the last dodo had died, and the world was left worse with its passing. [David Reiley]

5. The Barber Surgeon was one of the most common medical practitioners of medieval Europe – generally charged with looking after soldiers during or after a battle. In this era, surgery was not generally conducted by physicians, but by barbers. Physicians tended to be academics, working in universities, and mostly dealt with patients as an observer or a consultant. They considered surgery to be beneath them. [Wikepedia]medicalmedieval Europesoldiersbattlesurgerybarbers

6. The General Surgeon, traditionally charged with invasive interventions in the 20 th century, was one of the rare medical practitioners of England by the late half of 21 st century. In this era, invasive procedures were not generally conducted by surgeons, but by cardiologists, radiologists and physicians who tended to carry out interventional, radiological and endoscopic procedures to perform revascularisation, drainage, reconstructions, repairs etc. [Wikepedia] medicalEnglandinvasive proceduresradiologists

8. Background – shift to Point of Care Trauma – Hospital vs HEMS POC Diagnostics and Treatment Imaging Department US vs POCUS Funny video 1 Ultrasound Basics Ultrasound in Surgery Guidelines and Statements History Terminology POCUS Echo FAST Abdomen Funny video 2 Chest BLUE RUSH Thanks Funny video 3

9. Patient brought to the expertise and care Expertise and care brought to the patient, when needed Old paradigm New paradigm

10. Ophthalmology – Eye ultrasound Gynaecology – TVUS Cardiology – ECHO, Catheter A&E – FAST, RUSH Critical Care – Ultrasound, Endoscopy Theatres – Central venous lines, Nerve blocks Urology – Outpatient cystoscopy Vascular Surgery – Doppler Orthopaedics – Musculoskeletal Respiratory - Bronchoscopy

11. General Surgeons – ?????

12. Patient brought to Imaging Department Ultrasound brought to bedside in A&E, ITU, Outpatient and the Ward in selected patients

13. https://www.youtube.com/watch?v=kcrtjSCyjEQ

14. Australia Austria Germany Czech Republic USA [ST-31] Ultrasound Examinations by Surgeons Ultrasonography is a technology applicable in a wide variety of surgical practices and surgical specialties, and has become a routine tool for non-invasive evaluation of many organ systems and targeting areas for intervention. Examples include ultrasonic evaluation of the eye, the neck, reproductive organs, and the vascular, nervous, and musculoskeletal systems. Clinical applications of ultrasound require unique knowledge and skill…………… American College of Surgeons Committee on Emerging Surgical Technology and Education (CESTE) February 1998 Ultrasound for Surgeons The surgeon’s use of ultrasound in North America is already reaching the fifteen-year mark. Ultrasound as used by surgeons has staying power and clearly advances in technology as well as books such as this one are integral to our progress. Grace S. Rozycki, M.D., F.A.C.S. Emory University School of Medicine Atlanta, Georgia, U.S.A. 2005 http://www.scribd.com/doc/15928523/7106223-Ultrasound-for-Surgeons Evaluation of Office Ultrasound Usage among Australian and New Zealand Breast Surgeons The majority of breast surgeons from Australia and New Zealand have adopted office US to varying degrees. World Journal of Surgery September 2013, Volume 37, Issue 9, pp 2148-2154 Ultrasound in Trauma - The FAST Exam Physicians in Germany and Japan began using routine bedside ultrasound for trauma patients in the 1970's.(1) In the United States emergency physicians started using this tool in the 1980’s (2,3) and it has now become the initial imaging test of choice for trauma care in the United States and is part of the Advanced Trauma Life Support (ATLS) protocol developed by the American College of Surgeons. Ultrasound Guide for Emergency Physicians. Robert Reardon, M.D. 2008http://www.sonoguide.com/

15. Training in Diagnostic Ultrasound: Essentials, Principles and Standards WHO Technical Report Series 875: 1998 Statements of the American College of Surgeons Ultrasound Examinations by Surgeons: 1998 Ultrasound Training Recommendations for Medical and Surgical Specialities (The Royal College of Radiologists): 2005 Minimum Training Requirements For The Practice Of Medical Ultrasound in Europe (EFSUMB): 2006 Level 1:EFSUMB 2006 Practice at this level would usually require the following abilities: a. to perform common examinations safely and accurately b. to recognise and differentiate normal anatomy and pathology c. to diagnose common abnormalities within certain organ systems d. to recognise when referral for a second opinion is indicated RCR 2005WHO 1978

16. Lazzaro Spallanzani Born 10 January 1729 Scandiano Died 12 February 1799 Pavia Nationality: Italian Field: Biology – known for Interpreting digestion, saying that it is a process of chemical solution Animal echolocation and Helping disprove the concept of spontaneous generation Source: Wikepedia Donald Redfield Griffin Born 3 August 1915 New York Died 7 November 2003 Massachusetts Nationality: USA Field: Zoology – known for Animal echolocation and Animal consciousness Source: Wikepedia

17. Probe orientation - coronal

18. Hyperechoic Hypoechoic Anechoic Isoechoic Mirror imageReverberation

19. https://www.youtube.com/watch?v=j8h3HR2MfdM&list=PL975B4EAB53796888

23. Pleural effusion Pulmonary oedema

26. Cardiac IVC FAST Lungs Aorta DVT Ectopic How is the pump (heart)? Tamponade Contractility RV strain (PE) How is the tank (full/leaking)? Haemorrhage / Hypovolaemia IVC / Jugular veins Pneumothorax Sepsis How are the pipes? AAA / DTA DVT

27. HypovolaemicCardiogenicObstructiveDistributive Pump (Heart) Hypercontractile heart Small chambers Hypocontractile heart Dilated chambers Hypercontractile heart Pericardial fluid (tamponade) Right ventricular strain Hypercontractile heart (early sepsis) Hypocontractile heart (late sepsis) Tank (IVC) Flat IVC Flat Jugular veins Peritoneal fluid Pleural fluid Distended IVC Distended Jugular veins Peritoneal fluid (ascites) Pleural fluid (effusions) Lung rockets (pulmonary oedema) Distended IVC Distended Jugular veins Absent lung sliding) (pneumothorax) Normal or small IVC (early sepsis) Peritoneal fluid (peritonitis) Pleural fluid (empyema) Pipes (Aorta, arteries, capillaries) AAA DTA NormalDVTNormal

28. https://www.youtube.com/watch?v=36b9ox8iF24

29. https://www.youtube.com/watch?v=-zJWdkOhYbk

30. Thank you! Take Home Message Ultrasound scans are being used by many specialities at bedside General surgeons are successfully using this to improve care of their patients in other countries. Ultrasound scan can be used by surgeons to assist in rapid diagnosis and perform therapeutic interventions safely. Ultrasound should be an adjunct used by surgeons.