Check-Check-Check it out!
Check-Check-Check it out!
There has been A LOT of talk about POCUS governance lately – and at USASK we are right in there with a recent publication in The Ultrasound Journal on our efforts to develop a consensus-based multidisciplinary POCUS framework.
This Saturday @USASKEM and @usask_CME are hosting the 11th Saskatchewan Emergency Medicine Annual Conference (SEMAC XI) in Saskatoon, SK. We will be reviewing the recently adopted (province wide) Saskatchewan Emergency Ultrasound Guidelines: STANDARDS FOR EMERGENCY ULTRASOUND Final
These are in keeping (and in fact exceed) the above USASK POCUS Framework and are also well aligned with CAEP’s recent EM POCUS Position Statement.
Here’s the Executive Summary for the Sask EUS Guidelines:
Emergency ultrasound (EUS) comprises a set of focused applications utilized to diagnose life-threatening conditions, guide invasive procedures, and treat emergency medical conditions.  The proposed standards take into account that emergency care, and thus EUS, is within the scope of emergency physicians, family physicians and nurse practitioners. Given the significant contextual and resource differences between urban/tertiary centres and rural/regional sites, recommendations related to training, privileging and quality assurance are tailored accordingly.
These standards represent one of many initiatives developed to help ensure high quality training in, and use of, EUS in the province of Saskatchewan.
The USASK experience with logging scans and the EchoLog App
Big thanks to out-going USUS President Laura Neuburger for submitting this review!
Click on the link for a copy of the update: USUS 2018-2019 Update
We’re excited to be announcing the following fall courses:
The EDE course in Saskatoon, SK on Sept 22nd, 2019.
The EGLS Course in Saskatoon, SK has been scheduled for Oct 7th/2019.
To register or get more info, contact email@example.com
Stay tuned – details including dates and presenters will be coming soon!
REGISTRATION NOW OPEN: https://ccdeconference.usask.ca/index.aspx?cid=408
This year, our “DEEP DIVE” means we will be going beyond test performance metrics, exploring in-depth the role clinical ultrasonography can have in improving patient outcomes and system efficiencies. Our conference includes a range of learning experiences including short lectures, hands on workshops for beginners as well as those already familiar with the basics, a Sono-Round Table to develop a multidisciplinary clinical ultrasonography framework at USASK, supervised scanning with top level coaching, as well as rapid oral abstracts and the always entertaining Sonogames!
As organizers, we are committed to delivering a conference that supports the learning and wellness of all our attendees. We have included several optional opportunities for networking, exercise, relaxation and laughter! We will also have spaces for breastfeeding/pumping for those who may choose to use them, and as organizers, will do our best to help attendees secure quality childcare if needed. We also hope to be a low/minimal waste conference so please consider bringing your own coffee mug and/or water bottle.
7:30: Wellness Opportunity (optional) “Run at the speed of sound” or “Sound walk with talk”. We will provide a meeting location and encourage our attendee runners and walkers to join us for a great start to the day!
8:00 – 9:00 am: Registration and breakfast
9:00 am: Introductions and acknowledgement of our Treaty 6 commitment.
9: 15 am: Dan Kim – Deep Dive into EM POCUS
9:45 am: Dr. Peggy Lambos – Deep Dive into Pediatric POCUS
10:15 am: Nutrition break (Wellness oriented with healthy snacks offered)
10:30 am – 12:00 pm: Morning Concurrent Sessions
FUNdamentals: POCUS 101 will be an introductory session for those new to clinical ultrasonography/Point of Care Ultrasound (POCUS). It will include flipped content sent to you before the conference as well as a quiz. The workshop will include a brief review ovf key concepts and hands on scanning practice of three core applications: scanning for abdominal and pleural fluid as well as pericardial effusion. Completion will include an assessment which, if passed, makes you eligible for more supervised scanning in the afternoon!
PROfound: USask’s first ever multidisciplinary POCUS Round Table will give Saskatchewan clinicians a chance to further guide the adoption and integration of POCUS throughout the province of Saskatchewan. We hope to establish provincial recommendations on training, scope of practice, documentation and quality assurance. Key recommendations will then be shared with the entire conference audience at the last session of the day for feedback and ratification. There will be flipped content sent out for this session including a draft framework document.
SONO EXPO: For those interested in exploring the spectrum of POCUS applications at USASK, we are excited to offer you deep dives into Inflammatory Bowel ultrasound as well as Pediatric EM ultrasound. And as usual, expect at least 30 minutes of hands on scanning and anatomy learning as well! This is a great opportunity for students and residents to explore applications outside the core USASK POCUS curriculum.
12:00 pm – 1:00 pm: Break which includes a nutritious lunch, an optional stretching session, opportunities to connect with old friends and/or make new ones!
1:00 – 4:00 pm: Afternoon Concurrent Sessions
SONO Abstracts and SONOlympiad: Always inspiring, educational and a good time, the students square off with their abstracts and then go head to head in the sonogames.
1:00 pm: SonoAbstracts
2:00 pm to 3:45 pm : SONOlympiad
SUPERVISED SCANNING: Struggling with an application or two? Need some POCUS coaching? Here’s your chance! Instructors qualified in basic, diagnostic and resuscitative POCUS will be on hand to help you take your scanning to the next level for 3 straight hours! And if that seems a bit daunting – don’t sweat it, we’ll offer a mid-point stretch and re-energizing session. This way you’ll be sure to finish strong as you head into the final hour which will include (for section 3 credits) a detailed assessment of your skills!
4 pm: Closing session
SONO ROUND UP: We will present the main recommendations for a USASK POCUS Framework as developed by the Round Table panels and participants. The audience will have the opportunity to provide feedback and vote using an audience response system.
REGISTRATION NOW OPEN: https://ccdeconference.usask.ca/index.aspx?cid=408
CHECK OUT THE TRAILER!
Download the poster (with an active registration link) for distribution to your colleagues!
As the role of clinical ultrasonography continues to grow throughout healthcare, the need for clear communication of bedside findings has never been greater. We know that communication plays a major role in high quality healthcare, and that miscommunication has been identified as a major contributor to medical error and patient complaints.
Last year at SASKSONO17 (Breaking the Sound Barrier), we discussed the need for clear communication amongst clinicians. Our panel of experts (Internist, Intensivist, Emergentologist and Hospitalist) offered great advice on how best to communicate clinical ultrasound (aka POCUS) findings with colleagues and consultants (you can check out the 8 minute video here: https://vimeo.com/215476593).
But clear communication with colleagues is only one piece of the puzzle. The other big piece is clear communication with the patient! And while this may seem self-evident, we suggest there’s more to it than simply applying basic clinician-patient communication skills. For example, I am sure you have heard a trainee or colleague say to their patient, after having completed a bedside scan, that everything looks OK. Seems harmless doesn’t it? But to the patient, there is now a very real potential for misinterpretation of both the purpose of the scan, and the findings! Here at Sasksonic we’ve heard it first hand. Patients have returned to their primary care providers with impressive stories of whole body scans where their liver, spleen and kidneys were evaluated by ultrasound and “Great news doc, everything was OK!”
By not clearly stating the indications for the scan, or not clearly explaining the findings, clinicians may give their patients the wrong impression that they have undergone a much more comprehensive evaluation than intended or necessary. This can lead to a lot of headache and frustration by downstream providers who now find themselves rummaging through the patient’s medical record looking for the “whole body scans” (assumed to be either consultative ultrasound or CT scans) when no such studies were performed. Furthermore, in the absence of a consultative report (or worse yet, no comments regarding to the point of care ultrasound in the visit note), it can also negatively impact the status of clinical ultrasonography in the eyes of our colleagues and patients. As an important and evidence-based part of the clinical assessment (now proposed to be the 5th pillar of the bedside assessment – inspection, palpation, percussion, auscultation and insonation), we need to ensure our colleagues and patients understand the role clinical ultrasonography plays in patient care.
Whenever possible, clearly communicate with patients about the indications, findings and limitations of the clinical ultrasound scan in question. When performing a FAST scan this means letting the patient know you are looking for free fluid in the abdomen or chest, which if seen, would suggest internal bleeding. If no free fluid is seen, instead of saying “everything looks OK” we suggest you say “I don’t see any free fluid on my scan, but this clinical application of ultrasound has limitations and sometimes we miss injuries. Keeping the clinical picture in mind, I think we should proceed with…”
And there’s more! Whenever possible, be sure to give the patient a clear understanding of what the scan will include including where the transducer will be placed. Be sure to warn them about the room temperature gel that often feels ice cold. Then, while scanning, try to talk them through the findings as much as possible (this gets easier as your image generation skills improve). For example, when scanning the gallbladder for suspected cholelithiasis, take time to show them their gallbladder, what the wall looks like and whether there are any stones. Remember, one of the advantages of clinical ultrasonography is that you are learning about your patient’s (patho)physiology in real time at their bedside. So let the patient know what’s going on in the moment, tell them in a way they will understand, and quell their curiosity while also empowering them!
For an example of good communication with a patient (and other aspects of ultrasound etiquette) , check out this short clip we’ve prepared at Sasksonic for our trainees.
Paul Olszynski and Qasim Hussain
Peer Review: Drs. Kish Lyster and Irene Ma
Congrats to “No Pain, No Gain”, our first place team at this year’s SASKSONO conference! Big thanks to all of our participants and to the crowd for cheering the teams on as they battled it out. Also big thanks to Dr. Quinten Paterson (PGY2 EM) and Ms. Alixe Dick (MS2 USASK) for their hard work in preparing the games this year and Drs. Kawchuk and Jelic for their sound judgment!
All in all, a very successful SASKSONO18 – We hope to see you next year at SASKSONO19!
Great news! We’re hosting an IP Core SKanapalouza for Rural and Regional Clinicians on March 10th!
This ultrasound scanning day is to facilitate clinicians seeking to obtain their Canadian Point of Care Ultrasound Society (CPoCUS) CORE Independent Practitioner certification. The intent is to provide clinicians working in rural areas an opportunity to obtain scans towards their certification that are otherwise difficult to achieve in such locations. There will be an opportunity to obtain up to 28 scans towards your certification. All standardized patients will be female to allow for maximum scanning applications. There will be a high instructor to participant ratio to ensuring a quality scanning opportunity.
For more details and to register, click on this link
The Sasksonic Team
Continue reading the full article here
As we wrap up another great year at Sasksonic, we are thrilled to learn that one of our own recently took home POCUS-Toronto’s “Case of the Year” award!
USask EM’s Dr. Puneet Kapur (PGY5 EM, @Kapurp) was recognized for his stellar case submission involving identification and test performance of several transthoracic echo findings as they relate to identifying acute pulmonary embolism. Many of you have heard of the value of each of the following findings as they relate to distinguishing acute from chronic RV strain:
Here are clips from the actual case that show RV dilation in the PSL and McConell’s sign in the A4C. Despite these – it may remain challenging to reliably determine acute vs chronic strain (see details in the cited article below).
Well, don’t give up hope – introducing RVOT systolic excursion! This measurement is obtained using the parasternal short axis view at the level of the aortic valve.
It appears that measuring RVOT systolic excursion (as a percentage of end-diastolic RVOT diameter minus end-systolic RVOT diameter divided by end-diastolic RVOT diameter) is both specific and highly sensitive for acute PE. Analysis of right ventricular outflow tract systolic excursion showed that a value <24.3% can be found in acute pulmonary embolism patients with 100% sensitivity and 95.56% specificity (AUC = 0.987, P < 0.0001).
Sounds promising – looking forward to hearing and learning more about this.
We’re proud of Puneet! And while we’re at it – big thanks to the team at POCUS-Toronto for giving trainees like Dr. Kapur an opportunity to learn and excel in emergency POCUS.
Want to learn more about RVOT systolic excursion and acute RV strain? Check out the article below: