Point of Care ultrasound is moving from the radiology suite to the battlefield. Dr. Weymouth discusses creation of a medic centered point of care ultrasound curriculum and some brief case discussions.
CME is no longer available for this lecture. However, GSACEP members can access the full presentation and slides at https://gsacep.tradewing.com/event/fC7PFy6FJd2brZRaf.
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My name is wells Weymouth. And I'll be giving this talk in conjunction and with a lot of help from Kim and Baines for the GSS 2021 short lecture series for the point of care ultrasound medic curriculum. And normally, we would be asking the government to come pay for us to get some exciting and stimulating lecture talks. And while networking and seeing some old friends and meeting some new ones, I think it is very unfortunate that this is now virtual, but I will say big thanks to Dr. Tyler Davis for setting it up, and still allowing us to get all the educational benefit of this even though it's not in person. So for our talk, we have no disclosures. A little bit of background. So there is an intro to ultrasound curriculum built into the SOCCOM Special Operations comic medic pipeline takes about five to six hours and it spread over a couple core modules from AWHONN trauma to ultrasound Familiarity is based after that on individual experience. So if they're not learning it back at their respective units, they are simply not learning it. And there are no formal education courses readily available that are utilized by medics. Typically, if they do, it's a very expeditious, Medicare ambitious one, those are typically geared towards the providers. And then as we know, medics operate with relative autonomy, and extremely austere locations where ultrasound would be perfect. So what we thought is how can we provide an ultrasound curriculum for medics who are chilling on their bed on ployment, or on the back of a bird while they are waiting for something else to happen? So we did is we did didactic and hands on sessions, we introduced these on a weekly basis to our medics and showed them, hey, this is the cool stuff that you can do with ultrasound, neuro wwox Looking vessels, and then we said, hey, I think you should learn more about this. And if you're interested, we would like you to join our Google classroom or Blackboard. You know, we used a couple different ways. And we placed these modules into there. And all of these modules were then followed by a short quiz. And then an end of Module test, students were required to score 7% on the test to receive a module complete checkmark, all of this information and all this material was relatively easy to find online. We basically collated it and then added some key learning points. So after this, we sent our medics are continued to send our medics into their respective austere locations. And they started coming back with some cases. So we'll start with the most extreme case, in my view, to 43 year old male contractors with history of hypertension, who presented with fatigue for three weeks and mild intermittent central chest pain for two days. The vital signs show that he's mildly hypertensive, which he says is not completely abnormal for him. As physical exam is normal EKG is read as normal, there's another provider present during this encounter, he says EKG is normal. And then they get an eye stat, which is normal except for granted in a 311, which is abnormal for this gentleman. So they're thinking maybe he's a little dehydrated. But let's just go ahead and get the ultrasound and we're going to do is we're going to do an echo. And we're going to do a renal ultrasound, and in particular, on the renal ultrasound, they end up capturing this image, which is highly concerning, and they send him immediately to the URL to your facility. And it turns out, he has a massive type B aortic dissection. So amazing pickup by the ultrasound truly, I'm not sure if it would have happened that fast. And I think this man has ultrasound skills to thank for his expeditious care. Moving on to the next case, there was a 52 year old male pilot with sudden onset left leg pain while playing basketball, vital signs normal and then he's got pain with any movement of the left foot.Unknown:
So we were able to obtained an x ray because there was a rudimentary extra machine available, which really shows nothing he's got maybe in a puff seal injury from long ago maybe a little bit of tissue edema. Good The exam is extremely difficult because of this gentleman's pain. So we were able to obtain an ultrasound which shows just complete tear of the Achilles tendon and then some surrounding fluid and edema, and he gets a appropriate splint and then gets evacuated. So, great case for ultrasound where the exam was difficult to kind of clinch the diagnosis for us. Then we saw another night, a 27 year old female contractor who presented with vaginal bleeding and pelvic pain. So this is every, at least for my medics, every medics worst nightmare, sort of vital signs normal and then the urine HCG is positive. So there's initial concern is this topic is this really is this ectopic, that torsion was very low on the differential appendicitis extremely low. And were able to obtain this beautiful ultrasound, which shows very clearly a high up. And while this person was eventually evacuated from theater, it was not nearly as expeditious as the original idea was, and therefore we were able to save some air assets and a lot of heartache from several commanders. We had another 31 year old female with left breast pain, vital normal, well, she had a left breathless, induration and erythema in the sort of the anterior and superior region. And the medic was saying, well, Doc, I think we could just do antibiotics in return, I said, oh, let's just put a probe on there and see what you got. And lo and behold, a large fluid pocket, which obviously requires drainage. So he was able to, in fact, drain the abscess, and she came back the next day, and it was draining very well and then follow up later that week, everything went really well. So potential delay of care with just using antibiotics. But again, ultrasound comes in saves the day. So next case, we have a 23 year old male whose left foot was rendered by razor, they're the kind of utility vehicles that are just from personal experience, incredibly fun to drive around. So he's got pain with range of motion, he's got a laceration president, there is some concern for fracture, given the amount of pain he's in. But the medic of the time says, Well, we could just suture advantage it and then have him seen by our experts, because he's in a different country where the medical care may not be as good. And the idea is floated. But we really say now we think you need some X rays first, and then if, if you can just go ahead and get an ultrasound. So the X rays were pretty obvious for a fracture, the ultrasound also showed a fracture. So I don't think the ultrasound necessarily changed this person's course. But it was an easy, quick and effective test to get pre hospital. Last case, so we had a 35 year old US citizen contractor complained of chest pain and vomiting. This was his EKG, again, really read as a normally Hedgy by provider at the time. And then there was an ER doc there and the ultrasound was read as absence of beelines Sliding long, and a normal echo, really not concerning for much of anything. So he was sent home with some PPIs and really treated for GERD. Now, later on, it was discovered that this chest pain really was likely due to esophageal stricture, and possible Achalasia. But what we didn't have to do is spin up a bunch of assets in order to get him seen by a cardiologist immediately, right, so that's always a nice thing when you have a little time and that's really what the ultrasound bought us in this case. So, really, in conclusion, point of care ultrasound we believe can be effectively integrated into existing medical curriculums, or non existing medical exams. And then it really does need to be covered by some small group hands on sessions when you can write so they can get the basic block of instructions through the app. or whatnot, and then get the hands on part later on. Medics perceived Ultrasound Training as just incredibly valuable and understanding human anatomy and diagnosis critical disease. So it was not just a clinical tool, it was an educational tool. The ultrasound training was downloaded for offline use reference during patient encounters, which is exactly what you want. And then our future goals include expanding on this work to incorporate expanded modules because there really is no limit to what you can put on these new iPhones or Android. So thank you so much for having us here today. Really appreciate it. I can be reached by email. And thanks again to Dr. Davis and all the people who put this on and I look forward to seeing everyone in person some of the time