ULTRASOUND ENHANCED
CRITICAL MANAGEMENT
COURSE
“USCMC BL1 – PROVIDER” CERTIFICATION
April 23-24, 2009 ~ h 8:00-17:30
~ MILAN, ITALY ~
FONDAZIONE SAN RAFFAELE DEL MONTE TABOR MILANO (VIA OLGETTINA 60 - 20132 MILANO)
ABCDE MODULE
EMPOWERING LIFE SUPPORT PROTOCOLS
www.winfocus.org
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WINFOCUS (World Interactive Network Focused On Critical UltraSound)
The world leader scientific organization committed to develop point-of-care ultrasound
practice, research, education, technology, and networking, addressing
the needs of patients, institutions, services, and communities in “critical” scenarios.
WINFOCUS Vision and Mission Statements
Improving Primary, Emergency, and Critical Care Medicine, by incorporating "point-of-care"
Ultrasound into Clinical Practice … bringing quality “Point-of-care” Ultrasound to the patient
in all out-of-hospital and in-hospital “critical” scenarios, by developing and fostering,
on a global and multi-disciplinary basis, Ultrasound Education, Technological Development,
Evidence-based Research, and International Teamwork.
DIRECTORS
FACULTY
Luca Neri (Milan, Italy)
Enrico Storti (Milan, Italy)
Francesca Cortellaro (Milan, Italy)
Emanuele Catena (Milan, Italy)
Cristina Frigerio (Milan, Italy)
Marco Garrone (Torino, Italy)
Giuseppe Gullace (Lecco, Italy)
Carmela Graci (Milan, Italy)
Cristiano Perani (Brescia, Italy)
Angelo Vanzulli (Milan, Italy)
Gabriele Via (Pavia, Italy)
PROJECT MANAGER
Francesca Nanni (Noema)
WINFOCUS CONTACTS
Secretariat Office – Noema srl
Via Orefici, 4 - 40124 Bologna, ITALY
Tel +39 051 230385
Fax +39 051 221894
noema.secretariat@winfocus.org
www.noemacongressi.it
Executive Office - Board
Via Borgonuovo, 4 - 20124 Milano, ITALY
Tel +39 333 5404074
Fax +39 02 700531930
winfocus@winfocus.org
www.winfocus.org
REGISTRATION
ONLINE REGISTRATION:
Go to http://winfocus.org/registration.html, make your choice and follow the procedure
OFF-LINE REGISTRATION:
Find attached or download the form at http://winfocus.org/registration.html, then send it
by FAX to +39 051221894 or by EMAIL to noema.secretariat@winfocus.org
“CRITICAL ULTRASOUND”
The concept of 'critical ultrasound' evolved recently from 'emergency ultrasound' performed at
the 'point-of-care' in scenarios such as emergency departments, ICUs, pre-hospital care, austere
environments, disaster scenes, tactical operations, and humanitarian care missions.
Clinical scenarios turn into 'critical' ones when there is a dangerous performance gap between
the patient status and the resources available for an appropriate decision making and problem
solving.
In such settings point-of-care image acquisition and interpretation, integrated with advanced life
support protocols (ACLS, ATLS) according 'ABCDE' and 'Head-to-toes' -type approaches, allows
for rapid and effective decision making, enhanced triage, diagnosis, therapy, monitoring, and
follow up.
This typically occurs in the acutely ill patient (Emergency US) or intensive (Intensive/Critical Care
US), and/or where human or technical resources are particularly limited (Screening US, Triage
US, Remote US, Primary US).
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COURSE PROGRAM
The ABCDE Primary Management
[USCMC BL1 Provider – Entry Module]
First Day
08:00
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08:00
REVIEW, DEBRIEFING, Q/A
08:30
Point-of-care US in Primary, Emergency and
Critical Care Medicine: empowering life support
protocols
08:30
ASSESSMENT:
Peritoneal effusion: FAST windows.
08:50
Critical ultrasound techniques: image generation,
acquisition, interpretation & administration.
08:50
ASSESSMENT:
N/ retro-peritoneal, parenchymal and soft tissue
haematomas.
09:10
ASSESSMENT:
Obstruction/atelectasia, tracheal displacement
and lesions, emphysema. Prandial status.
PROCEDURES:
ETT, crico-tyroidotomy, tracheo-tomy/-stomy.
MANAGEMENT:
09:30
09:50
10:10
Airway Protocols & Interactive Cases
[US-AIR]
ASSESSMENT:
Pleural effusion, alveolar consolidation, interstitial
syndrome, pneumothorax. Diaphragm impairment.
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PROCEDURES:
Needle aspiration, thoraco-centesis, chest tube
insertion, thoracotomy.
09:10
09:30
09:50
PROCEDURES:
Defibrillation, TC & IV pacing.
Pericardiocentesis, pleurocentesis.
Paracentesis, DPL, laparotomy.
10:10
11:10
ASSESSMENT:
Introduction to echocardiography.
Cardiac and caval vein windows.
11:30
ASSESSMENT:
Critical hemodynamic assessment: heart
morphology/performance/filling state, pericardial
effusion/tamponade, caval vein variations.
11:50
ASSESSMENT:
Thrombo-embolic disease: deep venous
thrombosis, pulmonary embolysm.
10:30
10:50
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HEAD
-TOTOES
11:10
12:30
17:30
LUNCH
US HANDS-ON & SIMULATION:
[HUMAN MODELS, PHANTOMS & ULTRASOUND SIMULATOR]
Machine orientation.
Signs & patterns, sono-anatomy.
Airway, Breathing, Circulation, Disability.
SESSION CLOSURE
EQUIPPED BY:
COFFEE BREAK
ASSESSMENT:
Optic nerve sheath/disc, pupil assessment
(+midline shift, cervical fracture, neonatal assessment).
Neurological Protocols & Interactive Cases [US-NEU]
11:30
US ABCDE PRIMARY MANAGEMENT:
- US Trauma Life Support [US-TLS]
- US Advanced Cardiac Life Support [US-ACLS]
- US-Triage & US-EMS/HEMS
11:50
CONCEPTS ON HEAD-TO-TOES
SECONDARY MANAGEMENT & MONITORING:
- Head, Thorax, Abdomen, Limbs
- Assessment, treatment, monitoring, and follow-up
CME 12:10
12:30
TRAINING
TRAINING
13:30
Cardio-circulatory Protocols & Interactive Cases
[FEEL, FATE, L/H/CV]
Cardio-circulatory Protocols & Interactive Cases
[FAST, EFAST, FAST-ABCDE, L/H/CV]
MANAGEMENT:
MANAGEMENT:
12:10
PROCEDURES:
Peripheral & central venous catheterization.
MANAGEMENT:
Respiratory Protocols & Interactive Cases
[BLUE]
COFFEE BREAK
ASSESSMENT:
Abdominal & thoracic aortic aneurysm: detection,
measurement, N/ dissection and rupture.
ASSESSMENT:
O&G emergencies: ectopic vs intrauterine,
retroplacentar haematoma, placenta previa.
Fetus: movements, heart beat, position, presentation.
MANAGEMENT:
10:30
10:50
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REGISTRATIONS & PRE-COURSE TEST
Second Day
13:30
17:30
Ultrasound education and development:
WINFOCUS global initiative for PHC, EM and CCM.
LUNCH
US HANDS-ON & SIMULATION:
[HUMAN MODELS, PHANTOMS & ULTRASOUND SIMULATOR]
Dyspnea, shock, coma.
US Trauma Life Support [US-TLS].
US Advanced Cardiac Life Support [US-ACLS].
POST-COURSE TEST & CLOSURE
ENDORSED BY:
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USCME GLOBAL PROGRAM DIRECTORS:
Luca Neri (Milan, Italy), Enrico Storti (Milan, Italy), Michael Blaivas (Atlanta, GA, USA), Daniel Lichtenstein
(Paris, France)
USCME LEARNING CONTENTS AND FORMAT :
The applications reviewed in the workshop are the educational and clinical targets of the USCME (US-enhanced
Critical Management Education) program. They rely on the most recent literature and recommendations, and
refer mostly to the “Critical Care Medicine Journal” Supplement fully dedicated to the ultrasound applications in
the acute and critical patients (Crit Care Med 2007;35[Suppl]), written by a few dozens of the actual major
world experts in the field, coordinated by Blaivas, Kirkpatrick and Sustic, and mostly involved in the Board of
WINFOCUS. Proposed educational formats and pathways refer to a working document, published in its earliest
version in the same supplement (Neri L, Storti E, Lichtenstein D, Toward an ultrasound curriculum in critical
care medicine. Crit Care Med 2007;35[Suppl]:S290–S304), starting point of an International evidence- and
consensus-based process, join to the USEBM and ILCEUS projects (please, see details in www.winfocus.org).
USCME EDUCATIONAL CERTIFICATION ROADMAP :
Certification steps are implemented along the three EFSUMB levels of proficiency (www.efsumb.org):
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Level 1 (BL1 & AL1, Basic and Advanced) - Common, general, focused competency
Level 2 (BL2 & AL2, Basic and Advanced) - Comprehensive, specialized competency
Level 3 (beyond standards, still to be defined) - Outstanding clinical, educational, research expertise
Each level includes Provider and Trainer competence-based modules (see below as ex. the USCMC roadmap):
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USCMC BL1 Provider >> Trainer (“ABCDE” conformed, non-specialty-specific, general)
USCMC AL1 Provider >> Trainer (“Head-to-Toes” conformed, setting/specialty-specific, general)
USCMC BL2 Provider >> Trainer (Problem-based, setting/specialty-specific, specialized)
USCMC AL2 Provider >> Trainer (Organ/District-based, setting/specialty-specific, sub-specialized)
Ex. ECHO-AL2 Provider >> Trainer (Advanced “Echo-Doppler in ICU” competences)
According specific performance needs, several Level 1 and 2 (L1, L2) US-enhanced Life Support and
Procedural modules are available, both for Providers and Trainers (P, T):
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US-TLS
EFAST
(US Trauma Life Support) L1&2
(Extended Focused Assessment with Sonography for Trauma) L1
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US-ACLS
(US Advanced Cardio-pulmonary Life Support) L1&2
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US-PALS
(US Pediatric Advanced Life Support) L1&2
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US-PHT (US PreHospital Care & Disaster Medicine Triage) L1&2
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US-SEPS
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WIN-ECHO (Echocardiography Modular Training) L1&2
US-MON
(US ABCDE Monitoring)
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US-GPE
US-NURSE
US-PHC
(US General Practice in Emergency) L1&2
(US Nursing care in Emergency) L1
(US Primary Health Care in scarce-resource-setting) L1&2
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US-AIR
US-CVA
US-PVA
US-BLOCK
(US Airway Management) L1
(US Central Vascular Access Management) L1
(US Peripheral Vascular Access Management) L1
(US-guided Nerve Blockage) L2
(US Sepsis Management) L1&2
Note: USCMC BL1 Certification includes US-TLS, US-PHT, EFAST, US-BLS, US-ACLS credentialing.
Each certification module is developed along three learning phases and a final examination:
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Part I: preliminary e-learning (lectures, interactive sessions, references)
Part II: 2 days introductory course (theory, hands on, and simulation components)
Part III: 2-6 months proctored practice (specific minimal requirements)
Part IV: 1 day credentialing examination (presentation, questionnaire, simulation-based practice)
Each credential profile undergoes maintenance and quality assurance processes:
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Refresh: 1 day course (every 2 years; specific annual minimal requirements)
USCME AUDIENCE TARGETS :
- Health care professionals: Physicians, Nurses, Paramedics, Midwives, and Technicians … working in
- “Critical” scenarios: EM, CCM/ICU, Acute/Trauma Surgery, HEMS/EMS, PHC, Pediatric, Sport, Tactical, Remote,
Rural, Wilderness, Scarce-resource settings.
Further details at www.winfocus.org - Education
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