SonoDoc: Case-based Learning in Bedside Ultrasound

Internet Enduring Material Sponsored by the Stanford University School of Medicine. Presented by the Department of Emergency Medicine at Stanford University School of Medicine.

The American Medical Association has recognized the utility of ultrasound; it recommends training and education standards are developed by each physician’s respective specialty. It has been proven that bedside ultrasound allows the treating physician to more quickly determine the cause of urgent conditions and life-threatening illness and help in guiding resuscitative efforts for patients in shock. If invasive procedures must be performed, they can be done under ultrasound guidance (instead of using blind landmark techniques), decreasing the risk of complications. This has been recommended by the agency for healthcare research and quality as a key intervention. Emergency medicine was an early adopter of bedside focused ultrasound due to the need for rapid evaluation of critically ill patients and patients in acute pain. Now, other specialty organizations, including critical care, surgery, internal medicine, OB-GYN, and pediatrics are starting to include ultrasound during residency training. Many currently practicing physicians were trained before ultrasound training was available and may not realize its utility in their practice. This game-based course will provide strategies on how to use bedside focused ultrasound, image interpretation, and integrate it in the clinical practice.

Intended Audience

This course is designed for physicians, physician assistants and nurse practitioners who specialize in family practice, primary care, general surgery, internal medicine, critical care and emergency medicine.

  Release Date: December 7, 2018
  Latest Review Date: September 15, 2021
  Expiration Date: January 01, 2024
  Estimated Time to Complete: 3.5 Hours

1. Develop skills to screen for and diagnose emergent conditions such as tamponade, abdominal aortic aneurysm, pneumothorax, shock, ruptured ectopic pregnancy, intraperitoneal hemorrhage, acute hydronephrosis, cholecystitis, acute heart strain/failure, cellulitis, abscess, DVT, pulmonary edema, pleural effusion, retinal detachment, orbital rupture, and associated symptoms such as abdominal pain, hematuria, chest pain, shortness of breath, leg edema, skin redness, vision loss, back pain, and pelvic pain.

In support of improving patient care, Stanford Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Credit Designation
American Medical Association (AMA)
Stanford Medicine designates this Enduring Material for a maximum of 3.50 AMA PRA Category 1 Credits^TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Cultural and Linguistic Competency

The planners and speakers of this CME activity have been encouraged to address cultural issues relevant to their topic area for the purpose of complying with California Assembly Bill 1195. Moreover, the Stanford University School of Medicine Multicultural Health Portal contains many useful cultural and linguistic competency tools including culture guides, language access information and pertinent state and federal laws. You are encouraged to visit the Multicultural Health Portal: http://lane.stanford.edu/portals/cultural.html

Bibliography

Branney SW, Wolfe RE, Moore EE, Albert NP, Heinig M, Mestek M, Eule J Quantitative sensitivity of ultrasound in detecting free intraperitoneal fluid. J Trauma. 1995 Aug;39(2):375-80

Diercks DB, et al American College of Emergency Physicians  Clinical policy: critical issues in the evaluation of adult patients presenting to the emergency department with acute blunt abdominal trauma. Ann Emerg Med. 2011 Apr;57(4):387-404. doi: 10.1016/j.annemergmed.2011.01.013

Fox JC, et al  Test characteristics of focused assessment of sonography for trauma for clinically significant abdominal free fluid in pediatric blunt abdominal trauma. Acad Emerg Med. 2011 May;18(5):477-82. doi: 10.1111/j.1553-2712.2011.01071.x.

Lobo V, Daniel Weingrow D, Perera P, Williams S, Gharahbaghian L. Thoracic Ultrasonography. Critical Care Clinics. 2014; 30: 93-117.

Ma OJ, Mateer JR, Ogata M, Kefer MP, Wittmann D, Aprahamian C  Prospective analysis of a rapid trauma ultrasound examination performed by emergency physicians. J Trauma. 1995 Jun;38(6):879-85

Valentino M, De Luca C, Galloni SS, Branchini M, Modolon C, Pavlica P, Barozzi L. Contrast-enhanced US evaluation in patients with blunt abdominal trauma. J Ultrasound. 2010 Mar;13(1):22-7. doi: 10.1016/j.jus.2010.06.002. Epub 2010 Jul 8

Von Kuenssberg, Jehle D, Stiller G, et al. Sensitivity in detecting free intraperitoneal fluid with the pelvic views of the FAST exam. Am J Emerg Med 2003; 21:476-478.

Williams S, Perera P and Gharahbaghian L The FAST and E-FAST in 2013: Trauma Ultrasonography Overview, practical techniques and new frontiers. Critical Care Clinics 2014; 30: 119-150.

More bibliographic information can be found in the Resources and References section of the course

Disclosures

Stanford Medicine adheres to the Standards for Integrity and Independence in Accredited Continuing Education. There are no relevant financial relationships with ACCME-defined ineligible companies for anyone who was in control of the content of this activity.

Laleh Gharahbaghian, MD 
Clinical Associate Professor
Medical Director, Adult Emergency Medicine
Department of Emergency Medicine 
Stanford School of Medicine
Course Director
Author/Reviewer

Viveta Lobo, MD 
Clinical Assistant Professor
Director, Emergency Ultrasound Program 
Co-Director, Emergency Ultrasound Fellowship 
Department of Emergency Medicine 
Stanford School of Medicine
Author

Sarah Williams, MD, FACEP
Clinical Associate Professor
Director of Graduate Medical Education 
Department of Emergency Medicine
Stanford School of Medicine
Program Director, Stanford/Kaiser Emergency Medicine Residency Program
Author

Mansour Jammal, MD
Attending Physician – Emergency Medicine
Author

Josh Ennis, MD
Staff Physician, San Francisco Emergency Medical Associates
St. Joseph Hospital, Eureka Emergency Dept
Author

Stanford University School of Medicine has received and has used undesignated program funding from Pfizer, Inc. to facilitate the development of innovative CME activities designed to enhance physician competence and performance and to implement advanced technology. A portion of this funding supports this activity.