Ultrasound : Zonare
Knobology
Jamie Jenkins MD, RDMS
Regional Ultrasound Director FHS
St Josephs Medical Center
Core Applications of Ultrasound
Knobology
How to use the machine
Medical Legal Aspect
 Only 21% of EM physicians personally perform bedside
ultrasound
 Standard of Care: Central lines
 No lawsuits for misreads as of 2007
 3 lawsuits for failure to use
 2 with AAA
 1 with rule out ectopic
 Credentialing
 Can we hide behind it or with out it?
Knobology: The Basics
Changing probes
 Press the transducer key
and then use the soft keys
to select which transducer
you need
 Please do not change the
Transducer plug-ins.
Exam Type
New patient exam
 Press new patient key in
upper left hand corner of the
keyboard
New Patient: Non-credentialed physicians,
Training scans at all hospitals
 Last name: Training
 First name: EDUS
 Do not fill out MR number
 Operator:Your name
 Press exit
 On first page, press space bar
and type in pt name and MR
number
New Patient:
Credentialed physicians
At St Joes & St Francis
 Enter an order in EPIC
 Click worklist
 Select patients name from list
 The screen will self populate
 Fill in your name under
operator
 Press exit and start scanning
New Patient: Credentialed physicians at St
Anthony & St Clare
 Last name: Patients last name
 First name: Patients first name
 ID: MR number
 Operator:Your last name
 Press exit and start scanning
 Print images and attach to a paper
with pts sticker and give to HUC
to scan in for HIM
If you manually enter info instead
of using worklist: St Josephs & St Francis
 If you manually enter the patient information including the MR
number
 No leading zeros
 No dashes
 No FIN numbers
 Ex: MR number is 001-234-567
 Enter 1234567
 At St Josephs and St Francis you still need to enter an order after
you finish the scan
 It is preferred that you use the worklist
Central Lines
 Document on central line
section of the note
 Wire or needle seen in
lumen
 Image saved to patients
permanent record
 You must save an image of
this.
 There is an EPIC smart
Phrase under my name
(Jamie Jenkins)
.eduscentralline
OB/ IUP
 OB/ Pregnancy Scan
 OB mode
 Calc button will give you options for
fetal dates/ FHT
 Transabdominal views of the uterus
 transverse and longitudinal
 Fetal Heart Tones (m-mode)
 Fetal dates
 >12weeks BPD
 <12weeks crown rump length
 BPD (Inner to outer walls of the skull)
 Clips of bilateral adenexa (even if
obvious IUP)
Fetal Heart Tones
 Please use M –mode to




document FHT.
Press M-mode once and the
screen will change,
Align the line with the fetal
heart
When you have the image you
want press freeze
Press calc, select FHT/ HR and
measure the distance between
beats.
Early Pregnancy Ultrasound
 Misconception: A very low B-HCG rules out ectopic
pregnancy
 Truth: 40% of ectopic pregnancies will present with a B-hcg
less than 1000 mIU/ml
 20% will present with a B-hcg less than 500 mIU/ml
 Pts who present with a B-hcg less than 1000 mIU/ml have a
higher risk of ectopic pregnancy
 Keep in mind with ectopics all you may see is an empty
uterus and free fluid in the pelvis.
Transabdominal Ultrasound
Gallbladder
 Transverse and longitudinal clips
through the gallbladder
 Measurement of the anterior wall
of the gallbladder
 (2-3 mm)
 Measurement of the CBD
 (4-8mm)
 Look for:
 Stones
 Wall thickness
 Pericholecystic fluid
 Sono-murphys
 CBD dilation
Gallbladder
 Common Bile Duct
Gallbladder Literature
 Indications: Signs and symptoms of Cholecystitis
 Most sensitive signs: Stones and sono-murphys sign
 Very specific signs: Wall thickness, pericholecystic fluid
FAST
 Clips of




RUQ
LUQ
Suprapubic
Cardiac
 Depth: enough to see
posterior surface of heart
 Pericardial vs Pleural effusion
 Parasternal long if unable to
get Subxiphoid view
Aorta
 Transverse View
 epigastric and infra-renal
 Measure the outer to outer
wall of the Aorta
 Nl <3cm
 longitudinal views of the
aorta in the epigastric region
 Bifurcation of the iliacs
Renal
 Bilateral Kidney’s
 Two views of each:
transverse and longitudinal
 Bladder (2 views)
 Please label your views
Credentialing
 50 scans to remain credentialed in all areas of ultrasound
over 2 years
 CME is required as well
 This lecture
 Scanning shifts with me
 Ultrasound courses/lectures at conferences
Questions??????
 If there are any questions
please feel free to email
me.
 Jamiegoodis@gmail.com