1. (Point of Care Ultrasound for Family Medicine)
An Intro To POCUS
(Point of Care Ultrasound for Family Medicine)

2. Road Map Lectures with breakout components
POCUS and US Basics (15 min)
Hands-On Ultrasound Time (15 min)
FAST (15 min)
Hands-On Ultrasound Time (40 min)
Evaluation (5 min)

3. Objectives Gain confidence using US as a point-of-care tool
Demonstrate the basics of using an US machine to one of your colleagues
Preform an eFAST exam on one of your friends

4. Shout out to Contra Costa
Thanks Guys!

5. Why POCUS? Utilization by US is becoming more ubiquitous
Family Doctors are already using ultrasound
Underserved component to POCUS has been overlooked

6. The POCUS Philosophy Quick bedside answers to focused questions
No diagnosis or procedure solely dependent on US
aid to diagnosis like an EKG or CXR or as an adjunct to doing a procedure
Bedside US is an extension of the PE
STFM POCUS 2017

7. My Vision Yearly POCUS training during resident school
Twice Monthly Trainings on the IPS
Fall 2017 Faculty Training
Expanded Yearly Resident Training?
More robust US applications in clinic?

9. The Basics
Transmission
Probes
Orientation
Knobs and Buttons

13. Orientation US Machine should be on the patient’s right
Indicator should point to
Head (longitudinal)
Patient’s right side (transverse)
Indicator on the screen should match the probe

14. Modes Settings Depth Gain 2D Color M Mode
Software changes the image based on the setting
Depth
Indicators on the side of the image
Gain
Brightness of the image
Near and far gain

15. Your Mission (15 min): US Probes – What are they for? Settings
Orientation of Machine and Indicators
Gain
Depth
If there’s time… try M Mode
Normal Lung VS Pneumothorax

17. Focused Assessment with Sonography in Trauma
The eFAST Exam
Focused Assessment with Sonography in Trauma

18. Santa Rosa, NM 35yo male headed to the Pecos River in VW Van
Head on collision with an elk
Exam –
HR 120, BP 120/70, RR 25, O2 90%
Contusions to the left flank
Decreased left sided BS

19. FAST Overview Clinical Questions Relevant windows of the fast exam
Normal and Abnormal

20. 2 questions Is there fluid in the abdomen?
Is there fluid in the pericardium?

21. Windows… Use a Phase Array or Curvelinear Probe
Hepatorenal (Morison’s Pouch)
Subcostal
Perisplenic
Suprapubic

22. Hepatorenal (Morison’s Pouch)
Longitudinal plane
Axillary Line
7-9th intercostal space

23. Morison’s Pouch

24. Perisplenic Recess Posterior axillary line 5-7th intercostal space
“knuckles to the bed”

25. Perisplenic

26. Suprapubic Transverse View Low in the pelvis
Look for fluid behind the bladder.

27. Longitudinal View
More sensitive for free fluid

28. Subxiphoid Probe marker to right Under the xiphiod process
Look to the left.
Real time subxiphoid view
Pericardial Effusion

29. eFAST

30. eFAST
Is there free fluid in the thorax?
Is there a pneumothorax?

32. Pleural Line Look for sliding sign
Still above the pleura and movement below
Comet tails
M mode – Sands on the beach

33. A video…
Normal Lung VS Pneumothorax

34. Santa Rosa, NM 35yo male headed to the Pecos River in VW Van
Head on collision with an elk
Exam –
HR 120, BP 120/70, RR 25, O2 90%
Contusions to the left flank
Decreased left sided BS

35. Your Mission (40 min): Identify the 4 windows of the fast exam
Add the pulmonary exam to look for fluid in the thorax and pneumothorax

36. Evaluations please!