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US guided nerve block and vascular acccess
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Point of Care Ultrasound
Hands on Workshop
Dates / Locations Email: echo-info@unimelb.edu.au
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Point of Care Ultrasound - Hands on Workshop
The Point of Care Ultrasound course is a stand alone hands-on workshop, independent from the Postgraduate Diploma in Perioperative and Critical Care Course. Registrants do not need to have enrolled in the Postgraduate Diploma in order to attend the Point of Care Ultrasound course.
Registration fee for the Point of Care course for 2008 is:
$1200 (inclusive of GST) AUD
How to get someone to Pay for the Training
Workshops are designed for Anaesthetists, Intensive Care and Emergency Department Physicians who wish to learn how to use Point of Care (POC) transthoracic and vascular ultrasound techniques.
Point of Care Ultrasound for Perioperative & Critical Care Subjects
This Workshop is an introduction to a variety of surface ultrasound applications in perioperative and critical care medicine.
Core learning areas
1 Basic transthoracic imaging
2 Haemodynamic state assessment including the measurement of cardiac output
3 Use of ultrasound to identify major nerve bundles for regional anaesthesia
4 Identification of vessels for cannulation including internal jugular, femoral, and forearm vessels
5 Trauma ultrasound and ultrasound of the chest, limbs, venous duplex, joint examination, eye, neck and vocal cords and additional vascular access
1. Development of This Course
Echocardiography has seen a meteoric rise in use in ultrasound since the mid-1990s in Australia, and around the world in general. The use of ultrasound to guide procedures has been used extensively by radiologists for years, but in recent times anaesthetists, intensivists and ED physicians have embraced the technology.
2. The Course Development Team
The course is administered through the University of Melbourne. We've chosen the University because it has the extensive infrastructure required to run an educational programme of this nature. The course directors are Colin and Alistair Royse, who head the Human Cardiovascular Research Laboratory in the Cardiovascular Therapeutics Unit, Department of Pharmacology, University of Melbourne. In setting up this course, we have recruited a steering committee comprised of experienced educators in echocardiography within Australia and New Zealand. The members of the steering committee are involved in setting the educational objectives, coordinating subjects, liaising with individual tutors, and setting examinations. They include Roman Kluger, Paul Soeding, Michael Veltman, Ajay Kumar, Lenore George, Konstantin Yastrebov and John Farris. We have also asked James Lai, Chris Nixon and Neil McLennan from the Auckland City Hospital in New Zealand, and Peter Hebbard from Wangaratta to be contributors to this course, as well as a number of colleagues from Westmead Hospital including Alwin Chan, Chris Ashley, Clement Fong, and Nav Gupta. Many of these colleagues will be involved in either course preparation or conduct of the hands on workshops. I am also indebted to our administrative staff including Marcelle Wood, Kerrie Edmond and Danielle Nicholas (Cardiac Sonographer).
3. Course overview
This course is divided into two components. The first component you have received in this package, which is the theoretical part of it. It consists of 5 interactive tutorials on DVD, with integration of text and images. It is vital that you study these tutorials and be familiar with the work before you come to the weekend aspect of the course. We will not go over the theory on the weekend, because we want to reserve that for as much hands-on practice as is possible, facilitated by tutors.
The second part of the course is the two days that you come to practice “hands-on”. There are five stands, and delegates are divided into five groups. The idea is that you rotate through each of the five stands in order to cover all aspects of the course. We will start each session with the tutor demonstrating how to perform the echocardiography or ultrasound examination relevant to each stand. We will then rotate the delegates to have hands on practice, aiming for at least two practices per person per stand. Of course we will welcome any questions you have that you may not have understood from the tutorials, but our experience with this type of is that there is a lot of information in the tutorials, and most people seem to be able to learn that information really well prior to practising the actual technique.
Some of you may have enrolled or completed the Postgraduate Diploma of Perioperative and Critical Care Echocardiography. You'll notice that some of the tutorials are modified from the Postgraduate Diploma course. For the others, you will identify the type of teaching that we do in the Postgraduate Diploma course. The aim of the tutorials, however, are to provide you with extensive knowledge in that area, and the aim over the two days is to practice it in order to give you enough confidence to start doing it yourself in practice.
The Topics and Table of Contents of the Subjects
1.
Basic transthoracic imaging
Authors: John Faris and Michael Veltman
Table of Contents
Point of Care Ultrasound for Perioperative and Critical Care
Transthoracic and Surface Ultrasound
Tutorials 4 Basic Transthoracic Echocardiography Examination (TTE) and Two Dimensional (2D) Echocardiography
Section 1 Authors
Section 2 Overview
Section 3 Statement of Objectives
Section 4 Effective Learning Content
4.1 Introduction
4.1.1 Indications and benefits for TOE
4.1.1.1 Imaging of valves
4.1.1.2 Imaging of atrial related structures
4.1.1.3 Imaging of the descending aorta
4.1.1.4 Technical difficulty in performing TTE
4.1.2 Indications and benefits for TTE
4.1.2.1 Imaging of ventricular walls and function
4.1.2.2 Haemodynamic assessment of ventricular diastolic function
4.1.2.3 Haemodynamic assessment of valve function
4.1.2.4 Favourable risk benefit ratio
4.1.2.5 Repeatability
4.1.2.6 Speed of assessment
4.1.2.7 Technical difficulty of TOE
4.1.3 Optimising the examination
4.1.4 Recording information
4.2 Transthoracic viewing windows
4.2.1 The parasternal window
4.2.1.1 Long axis
4.2.1.2 Short axis
4.3 The apical window
4.3.1 4 chamber
4.3.2 2 chamber
4.3.3 Long axis
4.4 The subcostal window
4.4.1 4 chamber
4.4.2 Short axis
4.4.3 Liver
4.4.4 Descending aorta
4.5 The suprasternal window
4.5.1 Ascending Aorta
4.5.2 Descending Aorta
4.6 Less commonly used windows
4.6.1 Modified subcostal window
4.6.2 The right parasternal window
4.6.3 The Left Axillary Window
4.7 The Standardised Examination
4.7.1 Parasternal window
4.7.2 Apical window
4.7.3 Subcostal window
4.7.4 Suprasternal window
4.7.5 Summary of the Key Features of the Transthoracic Echocardiography Examination
Section 5 Glossary
Section 6 References
2. Haemodynamic state assessment including the measurement of cardiac output
Authors: Colin Royse and Leslie Donelan
Table of Contents
Point of Care Ultrasound for Perioperative and Critical Care
Assessment of the Basic Haemodynamic State
Section 1 Author
Section 2 Overview
Section 3 Statements of Objectives
Section 4 Effective Learning Content
4.1 Introduction
4.2 What Is a "Haemodynamic State"
4.3 Step 1: Estimate Left Ventricular End Diastolic Volume (Preload)
4.4 Step 2: Estimate Systolic Function
4.4.1 TTE estimation of function
4.4.4.1 Semiquantative (Eyeball) method of assessing ventricular function.........
4.4.4.2 Fractional shortening (FS)
4.5 Step 3: Estimate Left Atrial Pressure
4.5.1 Estimation of left atrial (LA) pressure using TTE..
4.6 Step 4: Final Assessment
4.7 Summary: How Can Diagnosis of the Basic Haemodynamic State Influence Management?
4.8 Cardiac Output estimation
Section 5 Glossary
Section 6 References
3. Use of ultrasound to identify major nerve bundles for regional anaesthesia
Authors: Paul Soeding
Table of Contents
Point of Care Ultrasound for Perioperative and Critical Care
Transthoracic and Surface Ultrasound
Brachial Plexus blocks under ultrasound guidance
Section 1 Author
Section 2 Overview
Section 3 Statement of Objectives
Section 4 Effective Learning Content
4.3. Technique of US Guided Brachial Plexus Anaesthesia
4.3.1 Probes
4.3.2 Technique
4.3.3 Injectate
4.4 Implications
4.4.1 Evidence for accuracy
4.4.2 Clinical Benefits
Section 5 Glossary
Section 6 References
4. Identification of vessels for cannulation including internal jugular, femoral, and forearm vessels
Author: Colin Royse
Table of Contents
Point of Care Ultrasound for Perioperative and Critical Care
Transthoracic and Surface Ultrasound
Epivascular Imaging for Vessel Cannulation
Section 1 Author
Section 2 Overview
Section 3 Statements of Objectives
Section 4 Effective Learning Content
4.1 Introduction
4.2 Probe Types and General Principles of Imaging Vessels for Cannulation
4.2.1 Tips on obtaining good imaging
4.2.2 “Find and Mark" Technique Using Ultrasound
4.2.3 "Cannulate under direct vision" approach
4.3 Imaging of the Internal Jugular Vein
4.4 Imaging of the Femoral Vessels
4.5 Imaging of the Radial Artery
4.6 Imaging of the Arm Veins for PICC Line Insertion
Section 5 Glossary
Section 6 References
5. Trauma ultrasound and ultrasound of the chest, limbs, venous duplex, joint examination, eye, neck and vocal cords and additional vascular access
Authors: Alistair Royse, James Lai, James Rippey and Kean Soon
Table of Contents
Point of Care Ultrasound for Perioperative and Critical Care
Additional Surface Ultrasound Use in Emergency and Critical Care Settings
Section 1 Author
Section 2 Overview
Section 3 Statement of Objectives
Section 4 Effective Learning Content
4.1 Introduction
4.2 Pneumothorax Detection
4.3 Principles of ultrasound guided cannulation
4.4 Identify central veins and cannulation
4.5 Pleural Effusion, detection and drainage
4.6 Abdominal Aortic Aneurysm Detection
4.7 Deep vein thrombosis
4.8 Examine the Eye with Ultrasound
4.9 Explore the neck in the midline
4.10 Examine the forearm and hand with Ultrasound
5 Glossary
Point of Care Ultrasound for Perioperative and Critical Care
FOCUSSED ABDOMINAL SONOGRAPHY IN TRAUMA
(FAST)
Section 1 Author
Section 2 Overview
Section 3 Statements of Objectives
Section 4 Effective Learning Content
4.1 Introduction
4.2 Anatomy of the peritoneum relevant to FAST
4.3 Sonoanatomy and technique of FAST
4.4 Outline of the FAST views
4.5. Indications for FAST
4.6. Evidence for FAST
Section 5 Glossary
Section 6. References