Point of Care Ultrasonography (POC-US) is being recognized as an adjunct to musculoskeletal assessment in hemophilia care. It fits into the realm of usage by the physiotherapist to enhance the joint and muscle assessment which is the core of the physiotherapy evaluation. Ninety percent of the bleeding due to hemophilia occurs in the musculoskeletal system, with 80% occurring in the joints. Therefore, POC-US adds value to the assessment as it is available to answer the clinical questions which arise such as, “Is this synovial swelling or actual blood in the joint?”, “Is this pain arthritis or an active joint bleed?” Answers to these clinical questions guide appropriate treatment options, enhancing the team discussion and leads to an appropriate care plan.

This intervention also has the capacity to act as a teaching tool. The client having this bedside education involving a picture of exactly what is occurring in their tissues (muscles or joints), allows for an enhanced conversation on appropriate treatment options. Therefore the next steps to developing an action plan are often met with more involvement of the client.

Physiotherapists need education and training to provide this enhanced assessment with the use of POC-US. A specialized course in POC-US for hemophilia physiotherapists was developed at McMaster University and Mohawk College in Hamilton Ontario. JoAnn Nilson, physiotherapist for the Saskatchewan Bleeding Disorders Program (SBDP) completed this course in December 2015. Andrea Willenborg, also a physiotherapist, will take the course Dec. 10-11, 2016.  A published article highlights the program from Mohawk College (Strike et al., 2015). The SBDP purchased a portable ultrasound machine in June 2016. Enhanced assessment with the use of POC-US is now being offered to answer clinical questions during the musculoskeletal evaluations.

 

References to support the use of ultrasound in Hemophilia care.

1. Point of care ultrasonography in haemophilia care: recommendations for training and competency evaluation (pages 828–831)

K. L. Strike, A. Iorio, S. Jackson, W. Lawson, L. Scott, S. Squire and A. K. Chan Article first published online: 24 JUL 2015 | DOI: 10.1111/hae.12767

2. Point-of-care ultrasonography

K. L. Strike and S. Squire.  Hemophilia Today, Nov. 2016, Vol 51, No 3 (page 11). http://www.hemophilia.ca/files/HT%20November%202016%20-%20final.pdf

 

JoAnn Nilson

Saskatchewan Bleeding Disorders Program

Royal University Hospital
Saskatoon, Saskatchewan

Email: joann.nilson@saskatoonhealthregion.ca

 

Sandra Squire

BC Bleeding Disorders – Adult Division

St. Paul’s Hospital

Vancouver, BC

Email: ssquire@providencehealth.bc.ca

You can now track your scans using your smartphone!

Check out the link to the app store here! (or paste this in your browser) https://goo.gl/cPhIIe

Our first year med students are heading into the u/s-guided anatomy lab once again – this time to learn Head and Neck anatomy (Jugulars, Carotids, Thyroids and all!). And while the anatomy makes up the driving objectives for the sessions, its always nice to consider the clinical applications down the road –  u/s-guided CVL placement in the internal jugular vein being perhaps the most obvious. For those pursuing careers as endocrinologists, the thyroid certainly is readily assessed with ultrasound right there in the clinical environment. But the new kid on the block is ultrasound for confirmation of endotracheal intubation. The folks at the American Heart Association made the update last year, and though there are certainly several ways to confirm ETT placement, it may just be that ultrasound could be one of the very fastest way to spot trouble before its too late – by identifying esophageal intubation sooner than any other modality short of a video. Have a look below with an image from CanadiaEM‘s site, as well as from EMdocs.net.

Combining anatomy learning with the practicality of ultrasound in mind certainly makes learning that much more relevant, doesn’t it?

Cheers,

Paul O

The good people at ACEP’s Emergency Ultrasound Section have released their updated Ultrasound Guidelines (previous update was from 2008). It is an impressive document – with significant breadth and depth. One of the key items is an updated set of definitions addressing the use of ultrasound. Check it out!

To register for the conference – check out the link below!

http://www.usask.ca/cmelearning/semac-viii.php

 

It is going to be a busy spring in Saskatchewan with 4 courses lined up!

April 8th and 9th – IP Boot Camp in Prince Albert (FULL)

April 23rd – the EDE course in North Battleford (FULL)

May 6th and 7th – EDTU in Regina (FULL)

May 26th – EGLS in Saskatoon (FULL)

Stay tuned for details on upcoming courses!

With great student turn out, and help from our faculty and residents, our first ever sono symposium was a HUGE success.

With a fantastic venue offering multiple screen displays, plenty of space for live scanning during presentations and the sonogames, and heaps of room for a big audience – looks like we are well positioned to start a new Usask tradition!

If you’re interested in being involved (calling all medical schools!), contact our student interest group Usask Ultrasound (UofSus@gmail.com) or Usask’s Point of Care Ultrasound program at sasksonic@gmail.com.

Check out the link below for snapshots of the day (thank you Larissa Padayachee – @larissa23_01), and stay tuned because SASKSONO17 is going to be even better!

https://storify.com/larissa23_01/sasksono