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How to perform FICB
https://link.springer.com/article/10.1007/s43678-020-00022-6

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Another excellent Point of Care Ultrasound teaching session for our @MyiED Senior Doctors that was delivered by @draroramohit

& @EveryOneNoOne1 @MedEdLeeds

@LeedsHospitals

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The 2021 RCEM Curriculum PoCUS syllabus details...

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The 2021 RCEM Curriculum PoCUS syllabus details...

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Attached is the official PoCUS syllabus for the 2021 RCEM Curriculum, which I was directly involved in working on and writing. It is now widely available on RCEM website alongside other new curriculum information.

The long and short of it is that trainees are required to start basic PoCUS from ST1 and become advanced by ST6, whilst continually demonstrating maintenance and progressions of incompetence by a variety of evidence. It is deemed no longer acceptable to only aim for a single sign-off/finishing school at the end of training to demonstrate competency as seemed to have been in practice for the 2015 RCEM curriculum.

It is likely that Introductory, level 1/core/equivalent, and refresher courses with more advanced components will continue to support the trainees. However local leads, trainers, including those in anaesthetic, critical care, and acute medicine as trainees rotate around will become much more important to gain competencies from, before returning to EM in HST.

For those in the middle of official training, unless the transition period of 1 year or a bit more depending on individual circumstances apply in which case the 2015 RCEM curriculum model still applies for CCT, the new competency model will need to be followed (this also applies to all the CESR as transition period doesn't apply).

More details will be officially announced by RCEM PoCUS Education and Training Subcommittee in the coming weeks to months. So watch the space.

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Leeds ED PoCUS Hub as a concept presented by Nick Mani and Mohit Arora

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Nick Mani founded FOAMed PoCUs Website

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We are back once again

Book either through CEMBook or directly by the following link:

https://leedsededucationbookings.simplybook.it/v2/#book

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EuSEM 2020 Virtual Congress  Ultrasound Poster Presentations 

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EuSEM 2020 Virtual Congress  Ultrasound Poster Presentations 

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Excellent rep & acknowledgement of our hard work on EM PoCUS led by @draroramohit & Gilbert P @vdaga3 at the @EuropSocEM 2020 ConferencePosters by:-
2x @EveryOneNoOne12x
Lydia B
1x @ch5247
@yemus2017 @MyiED
Thanks @MedEdLeeds @LeedsHospitals

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The basics of PoCUS Machine is essential. Pay attention to them.

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Core/Level 1 Finishing School- 2nd Session

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Core/Level 1 Finishing School- 2nd Session

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22 Sep- We ran another successful Yorkshire and Humber Deanery School of EM core/level 1 ultrasound signing off day for our EM trainees led by @yemus2017 @draroramohit (virtual) @EveryOneNoOne1 Gilbert P @MedEdLeeds @MyiED @LeedsHospitals

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the best and most up-to-date resource

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Point of Care Ultrasound Learning Made Easy

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Bigger, Better, Sounder...

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Core/Level 1 Finishing School- 1st Session

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Core/Level 1 Finishing School- 1st Session

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26 Aug- Excellent F2F Y&H deanery ultrasound finishing school today for EM Trainees

@draroramohit@EveryOneNoOne1

GilbertP @MyiED@yemus2017

@ButterflyNetInc

Particularly have an exclusive access to the new

@SonoSite @SonoSiteEurope

PX ultrasound machine, which is excellent (Thank You)
As always thank you to

@MedEdLeeds

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An extensive collection of PoCUS video modules, spanning over 25 hours of learning.

Brought to you by Doctors.net.uk in partnership with 3D4Medical

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Find out about the benefits of joining Doctors.net.uk, which include free accredited online education, discussion forums, clinical resources, daily medical news and a professional email address. Read more ›

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Find out about the benefits of joining Doctors.net.uk, which include free accredited online education, discussion forums, clinical resources, daily medical news and a professional email address. Read more ›

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Month 4- Hypotension ?cause (Is it Tank⛽️/Pipes🥤/Fluid💧🩸)                                   Nov '19

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Month 4- Hypotension ?cause (Is it Tank⛽️/Pipes🥤/Fluid💧🩸)                                   Nov '19

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Situation:
Male in 60s presenting with severe hypotension/Peri-arrest. D&V for few days.
Background:
Multiple comorbidities including CCF/Ventricular shunt for congenital hydrocephalus
Assessment:
Unwell/Peri-arrest. Dehydrated.
A-Intact on 15 Litres NRB FiO2
B-Crackles right side
C-Shutdown peripheral, Central CRT prolonged. HS pure. Lactate 7. IVI ongoing.
D-GCS (E4V1M6) PERL BM normal range
E- SNT Abdo. BS+
Recommendation:
Most likely dehydrated/Septic Shock from chest. Will need to exclude heart pathology (already known CCF/CArdiomyopathy)

Sepsis 6/CXR/ECG (Sinus tachy)/CT head

Critical care/Med Reg review (already had more than 2 litres of fluid, responding but still hypotensive)

RUSH HI-MAP including 2-point DVT scans (https://emcrit.org/rush-exam/)
'Kissing' IVC walls
B-Lines only right chest (CXR haziness of the cardiac and phrenic angle)
LVF hypokinetic

Learning Points:
-PoCUS Hypotension (RUSH HI-MAP)/lung (BLUE) protocols augments clinical assessment
rather than replace it/the other imaging such as CT
-Particularly it can narrow down differentials, as well as help with fluid therapy strategy/monitoring/response to treatment (FALLS protocol)

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Wk 7- Rapid Ultrasound for Shock and Hypotension (Medical/Surgical/Critical Care/PoCUS) Poster 

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Wk 7- Rapid Ultrasound for Shock and Hypotension (Medical/Surgical/Critical Care/PoCUS) Poster 

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Really enjoyed teaching on @UniversityLeeds @LeedsMedHealth Medical Student Ultra Sound Training (MUST) with GilbertP RachelB @jamesnchlsn @MedEdLeeds. Such an excellent idea to have ultrasound in medical school undergrad curriculum.

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Really enjoyed teaching on @UniversityLeeds @LeedsMedHealth Medical Student Ultra Sound Training (MUST) with GilbertP RachelB @jamesnchlsn @MedEdLeeds. Such an excellent idea to have ultrasound in medical school undergrad curriculum.

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Wk 7- Rapid Ultrasound for Shock and Hypotension (Medical/Surgical/Critical Care/PoCUS) 

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Wk 7- Rapid Ultrasound for Shock and Hypotension (Medical/Surgical/Critical Care/PoCUS) 

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PoCUS for differential of shock

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How awesome is this femoral nerve ultrasound phantom made from a few chicken breasts, IKEA bags, a wire and some modelling balloons? Simple + cheap, but great fidelity (fascia even pops!) Great idea @draroramohit @EveryOneNoOne1 @yemus2017 @MyiED #POCUS

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How awesome is this femoral nerve ultrasound phantom made from a few chicken breasts, IKEA bags, a wire and some modelling balloons? Simple + cheap, but great fidelity (fascia even pops!) Great idea @draroramohit @EveryOneNoOne1 @yemus2017 @MyiED #POCUS

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POCUS teaching today with the Yorkshire ST3’s. turns out they are quite competitive with their quizzes and a bit of Xmas background music. Hoping they will benefit from their free NEW BOOKS :) front row @❤️. @yemus2017 @draroramohit @ch5247 @EveryOneNoOne1 @StuartNuttall1

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POCUS teaching today with the Yorkshire ST3’s. turns out they are quite competitive with their quizzes and a bit of Xmas background music. Hoping they will benefit from their free NEW BOOKS :) front row @❤️. @yemus2017 @draroramohit @ch5247 @EveryOneNoOne1 @StuartNuttall1

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Improving the recording and administration of PoCUS

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How awesome is this femoral nerve ultrasound phantom made from a few chicken breasts, IKEA bags, a wire and some modelling balloons? Simple + cheap, but great fidelity (fascia even pops!) Great idea @draroramohit @EveryOneNoOne1 @yemus2017 @MyiED #POCUS

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How awesome is this femoral nerve ultrasound phantom made from a few chicken breasts, IKEA bags, a wire and some modelling balloons? Simple + cheap, but great fidelity (fascia even pops!) Great idea @draroramohit @EveryOneNoOne1 @yemus2017 @MyiED #POCUS

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Month 3- Peri-Arrest Focused Echo ❤️❤️❤️?signs of PE                            Oct '19  

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Month 3- Peri-Arrest Focused Echo ❤️❤️❤️?signs of PE                            Oct '19  

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Situation:
Pt in 50s presented with collapsed, SOB preceding it.
Background:
Not initially known and limited collateral history (later GP records revealed valve pathology and previous surgery/intervention, Asthma, AF on warfarin,T2DM,HTN, Cholesterol)
Assessment:
Hypotensive, Tachycardic, Tachypnoea with ,
Airway obstructed, see saw breathing, peripheral shut-down (later on noted that both legs becoming mottled/cold/pulseless, PERL BM low on VBG, Focal left side neurology and up-going plantars, Abdo SNT, No bleeding signs
Recommendation:
?Life threatening Asthma/Sepsis
?Massive PE (if arrest lysis and prolonged CPR)
?CVA/low BM
Securing Airway with endotracheal intubation (anaesthetic/critical care colleagues fast bleeped)
Breathing adjunct and maneuvers as well as BVM
Circulation filling and adrenaline (helping ?asthma as well)
Correcting BM, and ABx

Focused bedside Echo by ED Reg/PoCUS Fellow, which demo left but not right enlarged atrium and ventricle with a possible thrombus on the inlet of the mitral valve that was evidently functioning abnormally.

Finally pt had CT scan which demonstrated thrombus in the abdominal aorta and iliac arteries, and pt went to vascular.

Learning Points
-IVC could be assessed for signs of RV strain.
-Right heart strain doesn't equal to massive PE. It might be caused be left ventricle failure, lung conditions such as COPD leading to cor pulmonale.
-Proximal deep veins could be scanned at bedside bilaterally at 2 points for signs of DVT
-It is all in the clinical context, and the decision for lysis and prolonged CPR needs to be balanced against the likelihood and futility.
-Focused bedside echo could be very helpful to add more information to the clinical assessment.

Image- Four chambers view with right ventricle enlargement that is on the left upper part of the image, which is bulging into the left ventricle as an example http://www.j-pcs.org/viewimage.asp?img=JPractCardiovascSci_2018_4_2_126_240966_f4.jpg

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Presenting at the EMTA19 Conference PoCUS Break-out Session

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Presenting at the EMTA19 Conference PoCUS Break-out Session

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Guide to level 1 sign off, including logbook and reflection 

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Guide to level 1 sign off, including logbook and reflection 

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Written by Nick Mani & Mohit Arora Oct '19, ED Consultant in Leeds and PoCUS Lead in Yorkshire and Humber Deanery

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@TeddyDanielz “Must Know Sono-Literature for US Fellows” 

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@TeddyDanielz “Must Know Sono-Literature for US Fellows” 

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Continuing our successful PoCUS sim in collaboration with our sim team at the end of level 1 course

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Gilbert P & Lydia B @MyiED @yemus2017 Monday Lunch Time Club teaching echo to our ED colleagues. @jamesnchlsn  @ergemeruk as a volunteer. Excellent teaching and learning platform @MyiED @LeedsHospitals

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Gilbert P & Lydia B @MyiED @yemus2017 Monday Lunch Time Club teaching echo to our ED colleagues. @jamesnchlsn  @ergemeruk as a volunteer. Excellent teaching and learning platform @MyiED @LeedsHospitals

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Guide to level 1 sign off, including logbook and reflection 

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Guide to level 1 sign off, including logbook and reflection 

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Written by Nick Mani Oct '19, PoCUS Senior Clinical Fellow in Leeds ED and HST in Yorkshire and Humber Deanery

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From recent @RCollEM Annual Clinical Conference regarding PoCUS in ED. Food for thought.

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1- Scaleane plane block for rib fracture (US Guided)
2- Reduction of distal radius fracture (US Guided)
3- Peripheral Venous Access (US Guided)
4- Same day DVT scanning in ED (2-point proximal veins)

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30/9/19 Summary Sheet- FAFF/eFAST/Echo in Life Support

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PoCUS in Children with suspected Appendicitis 

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PoCUS in Children with suspected Appendicitis 

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PoCUS might be utilised to diagnose appendicitis in children!

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Interesting analysis of PoCUS in EM by @ECRI_Institute

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Interesting analysis of PoCUS in EM by @ECRI_Institute

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However the glass half full though rather than half empty.
Agree with most if not all the points.
"Point-of-care ultrasound scanners are changing the practice of healthcare in many specialties and safety measures have struggled to keep up."

@ECRI_Institute

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Click on the link below and fellow the screen for the available dates. Once booked on, if unable to attend, please cancel ASAP.

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Educational Bookings | Scheduling and Booking Website

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Select your serviceSelect the date and timeSIM NEWS for all our resources and news

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To be printed off and brought to the assessment day

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Is it worth it or a time waster/distraction?

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Month 2- Difficult Peripheral Venous Access 💉💉💉   Sep '19 

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Month 2- Difficult Peripheral Venous Access 💉💉💉   Sep '19 

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Situation:
50yr  presented with an open ankle fracture which needed to be manipulated on scene due to vascular compromise.
Background:
ex-IVDU with no fixed address.
Assessment:
No other injuries detected. NVI lower limb but an open fracture to the medial side of the ankle joint, but satisfactory position for casting before XR.  IV morphine/paracetamol/antibiotics required ASAP. Systolic 75 responding to lying flat and straight leg raise of the other leg, appears moderately dehydrated needing IVI.
The nurse and ED Reg couldn't find an obvious peripheral vein for access.
Recommendation:
Ultrasound guided peripheral venous access gained in he left brachial vein by the ED Reg.
Learning points:
-Consider intraosseous /external jugular vein venous access in dire emergencies, and do not attempt ultrasound guided venous access as this will waste precious time.
-Ultrasound guided peripheral venous access is an efficient way of gaining access, it might be temporary until patient hydrated before identifying other peripheral veins.
-Basilic/Brachial veins are the most ideal one for ultrasound guided peripheral venous access.
-Utilise a sleeve of a sterile glove with normal gel on the probe on the inner part, and lube gel on the outer part to perform it as aseptically as possible (See the following photo). Avoid tegaderm. Avoid alcoholic solution/wipes on the probes. Both will eventually break the probe crystal covering.
-Utilise the linear probe as high frequency and will give the best resolution and frame rate.
-Remember Hagen-Poiseuille's law for the size of the cannula (see the following illustration)
-Remember the pythagoras theorem for the distance of the needle tip to the vessel, as this is different to the distance of the probe to the vessel as shown on side of the screen (see the following illustration).
-In-plane/out of plane/alternating between the two views.
-Once flashback of blood is seen, put away the probe and concentrate on advancing the cannula and securing it.

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Make your first attempt your best attempt: IV cannulation with ultrasound

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Month 2- How to keep the probe aseptic for procedures? 

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Month 2- How to keep the probe aseptic for procedures? 

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A surgical gloves will do as shown below. Sleep the probe into the sleeve with some gel. Add aseptic gel to the other side of the glove.  Alternatively the orange sterile bag in the sterile pack. there are formal ultrasound probe sheath, but expensive and cost adds on over time.

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Month 2- The theory behind ultrasound guided peripheral venous access

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Month 2- The theory behind ultrasound guided peripheral venous access

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Pythagoras theorem
Hagen-Poiseuille's law
Out-of-plane and in-plane views

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Really enjoyed being part of an excellent faculty for the first official Leed Cadaveric Ultrasound Guided Regional/Nerve Block Course for EM & anaesthetic. Absolutely fantastic way to teach/learn/ teamwork @yemus2017 @draroramohit @GilbertP @vdaga3 @KMekala @JennyF-G @UniversityLeeds @LeedsHospitals @MyiED 24/09/2019  

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Really enjoyed being part of an excellent faculty for the first official Leed Cadaveric Ultrasound Guided Regional/Nerve Block Course for EM & anaesthetic. Absolutely fantastic way to teach/learn/ teamwork @yemus2017 @draroramohit @GilbertP @vdaga3 @KMekala @JennyF-G @UniversityLeeds @LeedsHospitals @MyiED 24/09/2019  

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An excellent example of a logbook template:-

https://www.ranzcr.com/documents/180-ultrasound-log-book-rad/file

https://scghed.com/wp-content/uploads/2013/09/AAA-Logbook.pdf

https://scghed.com/wp-content/uploads/2013/09/EFAST-Ultrasound-Logbook.pdf

https://scghed.com/wp-content/uploads/2015/04/Ultrasound-Logbook.pdf

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BodyWorks Eve is a state-of-the-art ultrasound patient simulator (https://www.intelligentultrasound.com/bodyworks/)
Hopefully we can invest in one for the department in the near future

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Month 1- Pulsatile Mass in the Abdomen 💓💓💓         August '19  

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Month 1- Pulsatile Mass in the Abdomen 💓💓💓         August '19  

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Situation:
A lady in her early 60s presenting with 1/7 abdo and back pain (new onset), vomit 1x (no blood). Sx still ongoing.
Background-:
HTN/Smoker/Borderline T2DM/High Cholesterol
Assessment:
Obs stable, but hypertensive.
Seen ED Junior Dr, felt a large pulsatile mass in the abdo and asked ED Reg.
Recommendation:
The ED Reg did abdo aorta PoCUS, demonstrating a 6-7cm AAA. Moved to resus, 2x large venous access and cross-match bloods, VBG normal. vascular team urgently called at the same time. CT angiogram confirmed the aneurysm, no leak/rupture/dissection.
Pt went to theatre urgently for a repair.

Learning Point:
- PoCUS is usually a rule-in test, can't demo leak/rupture until at least 150-200ml of blood in abdo cavity (but retroperitoneal aorta most likely tamponade itself)
- Do not mistake the spinous process of the vertebrae for AAA.
- Do a quick swipe down the abdo aorta first before doing the specific measurements. This is done to save time if there is a AAA, in which case not all views are required.
-Need 4x AP measure (Proximal, Mid, Distal for abdo aorta, and Proximal for common iliac arteries) and 1-2x longitudinal (to look for dissection flap/saccular aneurysm)
- Measure from inner to inner lumen, from outer of the thrombus if one present.
- When performing longitudinal view, don't mistake IVC for abdo aorta (tip- fan the prob to the right and identify IVC and then to the left to locate aorta)
- Label you images with at least performer, full name and DOB of pt, the sections scanne. Currently these are printed and attached to pt notes. Soon will be able to upload onto PACS.
- Write a basic report, including indications for the scan, findings, outcome. Need to include competency of the performer (accredited/unaccredited)
- Move pt to resus and call vascular urgently. 2x large bore cannula and take cross-match/group specific depending on the urgency. Could also activate the majot haemorrhage protocol.
- If pt haemodynamic unstable, aim for systolic of 80/conscious pt (permissive hypotension)
- 95% of AAA are infrarenal, can be repaired endo-vasular (EVAR)/surgery. If at renal level or higher, then it makes it extremely complicated, and might require FEVAR.
- Risk of Rupture of Aneurysm depends mostly on the size.
https://www.researchgate.net/profile/Jason_Chuen/publication/239732234/figure/tbl2/AS:392838480187394@1470671400110/12-month-AAA-rupture-risk-by-diameter.png
- If ruptured at presentation, 50/50 chance of survival.

Resources/Links:
See the relevant section on this webpage for guidelines/videos for performing abdominal aorta PoCUS.

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3D How to: Abdominal Aorta Ultrasound - SonoSite Ultrasound

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Enjoyed teaching day on wed for our junior clinical fellows @MyiED with @LeedsEDSim @AlexNevard @Mayada70 @ch5247 organising. Amongst other sessions, we did ultrasound guided vascular access and fascia iliaca block with a quiz made on Google @yemus2017. Hope something was learnt!

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Enjoyed teaching day on wed for our junior clinical fellows @MyiED with @LeedsEDSim @AlexNevard @Mayada70 @ch5247 organising. Amongst other sessions, we did ultrasound guided vascular access and fascia iliaca block with a quiz made on Google @yemus2017. Hope something was learnt!

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23 Aug 2019

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It was absolutely fantastic & a joy teaching our juniors doctors @MyiED with my own  🦋 probe @ButterflyNetInc and ipad pro @Apple, and letting them all practice doing ultrasound guided peripheral vascular acess @draroramohit @yemus2017

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It was absolutely fantastic & a joy teaching our juniors doctors @MyiED with my own  🦋 probe @ButterflyNetInc and ipad pro @Apple, and letting them all practice doing ultrasound guided peripheral vascular acess @draroramohit @yemus2017

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29 Aug 2019

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It started with stethoscope like devices and currently it is at portable ultrasounds such as Butterfly iQ/Philips Lumify/SoniSite iViz models

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Ultrasound history Past, Present and future

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'Seagull' sign for coeliac axis and 'snowman' sign for the Superior Mesenteric Artery (SMA)

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Myo 2019

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We are back with an exciting new programme courtesy of Lydia

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We are back with an exciting new programme courtesy of Lydia

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Sign up now via https://leedsededucationbookings.simplybook.it/v2/​

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Butterfly Gallery

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Disrupting an entire industry comes with a learning curve. We've designed Butterfly Education to make this learning curve seamless. The Butterfly Education platform is a diverse video library of ultrasound education taught by experts. Learn how to evaluate dyspnea, diagnose sepsis, or perform upper extremity vein access - and so much more.
Browse

You probably know the fundamentals. Now, let's master your interpretation skills.

For you, speed is everything. Learn the ins and outs of the Butterfly iQ so you can assess confidently in seconds.

Get the basics down pat so you can thrive, as practice becomes your practice.

Your iQ membership grants you access to this evolving and ever-growing platform designed to educate, one video at a time.

Image acquisition.

While the iQ's simplicity is refreshing, its features run deep and making the most of this depth requires some knowledge. Don't worry, our image acquisition videos can teach you everything you need to know.

Image interpretation.

Our image interpretation videos will help you understand exactly what you're looking at and will instill the confidence to make decisions based on what you are capturing.

Learn more

Not a Butterfly user ... yet?

Buy now

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Disrupting an entire industry comes with a learning curve. We've designed Butterfly Education to make this learning curve seamless. The Butterfly Education platform is a diverse video library of ultrasound education taught by experts. Learn how to evaluate dyspnea, diagnose sepsis, or perform upper extremity vein access - and so much more.

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Butterfly Network

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Clinical images and short video tutorials for everyone, anywhere. Ultrasound has never looked so good, see why.

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Framework for reporting/sorting

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Clinical Images and Videos Library

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Clinical Ultrasound Images and Videos | US | Sonosite

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Browse ultrasound images and videos organized by practice and system in Sonosite's comprehensive Clinical Media Gallery.

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Making a massive difference in the developing world

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Rodgers Ssekawoko Muhumuza, left, checked Owamani Bruce for pneumonia with a portable ultrasound scanner in the Kabale district in western Uganda.

Global health

A hand-held device brings medical imaging to remote communities, often for the first time.

Rodgers Ssekawoko Muhumuza, left, checked Owamani Bruce for pneumonia with a portable ultrasound scanner in the Kabale district in western Uganda. Credit...

BUSHORO, Uganda - Lying on a church pew with his arm over his head, 6-year-old Gordon Andindagaye whimpered a bit - in fear, not pain - as Dr. William A. Cherniak slowly swept a small ultrasound scanner up and down his chest.

Dr. Cherniak and Rodgers Ssekawoko Muhumuza, the Ugandan clinical officer he was training, stared at the iPhone into which the scanner was plugged, watching Gordon's lung expand and contract.

"O.K.," Dr. Cherniak finally said. "What do you recommend?"

Gordon had a persistent cough and swollen lymph nodes, and looked tired and unwell. As other boys ran around outside, kicking a soccer ball made of rags and twine, he clung weakly to his mother. The scan on the iPhone's screen suggested his lungs had fluid in them.

As Dr. Cherniak nodded approval, Mr. Muhumuza prescribed an antibiotic, and ordered blood tests to rule out tuberculosis, malaria and H.I.V. He arranged for Gordon and his mother to get a ride to a local clinic for an X-ray and a night of observation.

Dr. Cherniak, an emergency medicine specialist from Canada, said he would upload the scan that evening so an ultrasound specialist in Toronto could double-check the diagnosis: early-stage pneumonia.
[Like the Science Times page on Facebook.| Sign up for the Science Times newsletter.]
The diagnosis was made possible by a new invention that Dr. Cherniak hopes will revolutionize front-line global medicine: a hand-held ultrasound scanner called the Butterfly iQ.

The Butterfly is about the size of an electric shaver. It is battery-powered and contains microchips rather than piezoelectric crystals, so it usually won't break if dropped. (That was accidentally tested a few times during a week that a reporter spent in rural Uganda with Dr. Cherniak's team.)

For Butterfly Network, the Connecticut company that makes it, the profitable target customers are doctors and nurses who can afford a $2,000 device that fits in a coat pocket and is as portable as a stethoscope.

Image

Dr. William Cherniak with a patient and other health workers. Dr. Cherniak founded Bridge to Health, a Canadian charity, which is testing the scanners in remote areas.

But the scanner also has huge potential in rural Africa, Asia and Latin America, where the nearest X-ray machine may be hours away and the only CT and MRI scanners may be in the nation's capital.

"That was my real motivation for making it," said Jonathan Rothberg, Butterfly's founder, who initially pursued the goal because one of his daughters had a disease that caused kidney cysts needing regular scans.

"Two-thirds of the world's population gets no imaging at all," he added. "When you put something on a chip, the price goes down and you democratize it."

The Bill and Melinda Gates Foundation is one of his backers, as are the investment arms of other family philanthropies.

"My team is engineers and computer scientists," he said. "We'd love to be able to save lives the way doctors do, but we can't - so every tweet from Africa about the Butterfly is an incredible adrenaline shot for us."

He has donated scanners to medical charities working in 13 low-income countries, seven of them in Africa. Several went to Bridge to Health, a Canadian charity that Dr. Cherniak founded six years ago; it works closely with Kihefo, a medical charity based in western Uganda.

For now, the scanners are primarily used to check for pneumonia, which is a major killer of children in poor countries and is frequently misdiagnosed. But Dr. Cherniak's team has found other fascinating uses for the devices - which they deployed under conditions almost as stark and dusty as those found in battlefield medicine.

Kihefo runs what might be described as a traveling medical circus. Each day at dawn, its roustabouts drive a truck loaded with collapsible tents into a different village and erect them on whatever flat ground they find - perhaps a patch of goat-gnawed grass between the school and the church.

To improvise examination tables, they borrow the wooden school desks and church pews, pad them with yoga mats and screen them with thin purple curtains.

An hour later, the Canadian-Ugandan "brigade" rolls in - vans full of doctors, nurses, dentists, chiropractors, gynecologists, ophthalmologists and pharmacists, accompanied by local clinical officers and medical students, all toting huge bags of equipment. (Yes, hockey bags - it's a Canadian charity.)

While the dental team fills cavities and the ophthalmologists check eyes, the medical team sees one patient after another, from newborns to nonagenarians.

On a recent visit to this village, the doctors used their Butterflies not just to screen for pneumonia, but to scan other organs.

Checking a large goiter on the neck of a 42-year-old woman, they learned that it was pressing on her windpipe, meaning she would soon need surgery, even though she had no breathing problems yet.

They scanned the lungs of a frighteningly emaciated baby to see if she had tuberculosis. They scanned the swollen testicle of a 54-year-old man and determined that he probably had cancer rather than their first tentative diagnosis - fluid draining from worm-infested lymph glands.

Scanning the abdomen of a child with a penis birth defect, they learned that his urine was backing up, threatening him with kidney damage - a problem that a simple operation could correct. They scanned a lump in the chest of a 96-year-old man and concluded that it was probably not cancerous because it lacked blood vessels.

Particularly challenging was the case of a 51-year-old woman with a lump on her neck. In part because she described a long history of what sounded like tuberculosis, they initially suspected scrofula.

(Scrofula - once called "the King's Evil" because medieval monarchs claimed to cure it by touch - is caused by TB bacteria clumping under the skin. )

"I went to a healer who stabbed me with fire," the woman said, describing a traditional method for draining an abscess: heating a knife in a fire and plunging it into the lump. It hurt a lot and healed nothing, she said.

Scanning the lump, Dr. Cherniak saw that it had veins, meaning it was not an abscess and appeared to be attached to a blood vessel.

"See it pulsing away?" he said to his trainee as they looked at his phone. "You don't want to go anywhere near that. If I did a biopsy, it could bleed a lot. Now I know not to muck around with it and get her to a surgeon."

Some cases remained mysterious. A knotty lump in a 70-year-old woman's thigh seemed to be neither a tumor, cyst, abscess nor fat deposit. Dr. Cherniak's best guess was that it was the broken-off tip of a stick she said she had been stabbed with decades earlier.

Through a translator, he explained that he could remove it surgically, but the procedure would be painful and the wound might get infected.

"It's like a bullet you leave if it's safer to not remove it," he said.

She decided to live with it.

Even more mystifying was a woman who appeared to be over 70 but whose belly was so swollen that she looked pregnant.

Doctor after doctor tried scanning her; the gallons of fluid in her abdomen had shoved her organs far from their customary places. Surprisingly, her liver seemed normal - doctors initially had guessed the swelling resulted from alcoholic cirrhosis.

But no one could find her spleen. "What if it's ALL spleen?" Dr. Cherniak mused. "Could it really get that big?"

Various theories - a blocked liver vein, lesions from a sand-fly parasite, a mucus-emitting tumor - were discussed. Finally, all agreed that she needed further scans that only a hospital could do.

The Butterfly's diagnostic potential is enormous, Kihefo's founder, Dr. Geoffrey Anguyo, said enthusiastically: "But the question is, how much training is adequate?"

Learning to interpret the fuzzy black-and-white images on a cellphone screen and recognize all the organs, blood vessels, valves and whatnot inside the body - and to do it well enough to spot tumors and other anomalies - is a skill that can take months to learn.

The Gates Foundation, Dr. Rothberg said, is writing software intended to guide untrained users as they scan. For now, Bridge to Health is focusing on teaching Kihefo's clinical officers, who get up to four years medical training but are not physicians, to diagnose pneumonia.

Success will be achieved, Dr. Anguyo and Dr. Cherniak agreed, when the officers' diagnoses agree with those of the ultrasound specialists in Toronto at least 80 percent of the time.

That's where another aspect of the Butterfly comes in handy: iPhones make it easy to upload scans to the internet.

In Gordon's case, a Canadian reviewer confirmed the diagnosis but said Mr. Muhumuza needed to improve his technique by holding the scanner at a sharper angle and setting it to project sound waves deeper.

Five years ago, Bridge to Health and Kihefo jointly pioneered another imaginative use for ultrasound.

Knowing how hard it is to convince rural women to visit doctors early in their pregnancies, they acquired some portable briefcase-sized scanners and then aired radio ads announcing where Kihefo would set up next the next morning.

" You will be able to see your unborn baby," they promised.

Attendance at their antenatal clinics shot up sixfold, and women who had previously seen only traditional healers began coming in.

That was important because doctors could offer many kinds of care. Problems that can kill a mother or baby can be detected and prevented early in pregnancy, including H.I.V., syphilis, vitamin deficiencies and high blood pressure.

The success of that program "was how we were able to get support from U.S.A.I.D.," said Dr. Anguyo, referring to the United States Agency for International Development.

"U.S.A.I.D. was looking for unique ways to check women aged 15 to 30 for H.I.V., and we had a very good 'trap' for catching those women," he said.

Now, with American grants for the war on AIDS shrinking, Kihefo is hunting for new ways to raise money.

One new project, Dr. Anguyo said, helps local farmers switch from raising chickens to raising rabbits. Rabbits eat grass, which costs nothing, so the profit margin is greater than for chickens, which need corn.

Kihefo encourages its farmers to eat some rabbits for protein and sell the rest to pay their national health insurance premiums.

Better pneumonia diagnosis can also slow the overprescription of antibiotics, which hastens the rise of antibiotic-resistant strains of bacteria.

Of the 91 children with fevers and coughs the team scanned in a week, only one in the village - Gordon - had confirmed pneumonia.

That, Dr. Cherniak surmised, was probably because modern vaccines against pneumonia-causing bacteria are working well.

All the children got antibiotics anyway, because Ugandan national medical protocols require a prescription for every child with high fever and cough. That's common in poor countries, where it is often impossible to get confirmatory X-rays.

(Kihefo's only X-ray machine, for example, is closed down because the charity cannot afford to build lead walls around it.)

Eventually, if ultrasound gains acceptance, the national protocols should change. "If a clinical officer can say, 'It's viral, you can go home,'" Dr. Cherniak said, "you can decrease those wrong prescriptions."

For Gordon, the prompt diagnosis worked out: a visit to the Kihefo clinic 24 hours after he started his antibiotics found him sitting up in bed, smiling and feeling much better.

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In African Villages, These Phones Become Ultrasound Scanners

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Global health A hand-held device brings medical imaging to remote communities, often for the first time. Rodgers Ssekawoko Muhumuza, left, checked Owamani Bruce for pneumonia with a portable ultrasound scanner in the Kabale district in western Uganda. Credit...

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Position statement from the initial working group

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The official booklet/curriculum/syllabus

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The Pathway for training in PoCUS

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The official college PoCUS page

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Welcome to the ultrasound training and practice section of the RCEM website. There is also a complementary section with additional resources on RCEMLearning.

Regional ultrasound leads

We want to ensure each of the regions of the United Kingdom and Ireland have leads for ultrasound training. The leads are primarily responsible for overseeing ultrasound training for emergency medicine trainees; however, they will also be tasked with promoting PoCUS and identifying problems to the Education Committee and Training Standards Committee. An up to date list of these leads can be found here: US Regional Leads . The roles and responsibilities for the regional ultrasound leads can be found here: Roles and Responsibilities of the Regional Reps.

Training in point-of-care ultrasound

From 2010, the higher specialty curriculum for emergency medicine incorporated PoCUS as a mandatory element. This means that from 2013 trainees need to be signed off at CORE level prior to CCT being awarded. Regional panels will not allow an EM trainee to pass the final ARCP without Final Sign-off documentation being presented.

The pathway for training follows key steps which are shown here: Pathway for PoCUS. There are many applications for PoCUS; an application being a discrete focused use, for example evaluation of the abdominal aorta for abnormal dilation. For higher specialty training in emergency medicine there are four clinical applications, termed CORE (formerly Level 1):

Focused Assessment with Sonography in Trauma (FAST)

Assessment of the Abdominal Aorta for Aneurysm (AAA)

Focused Echocardiography in Life Support (ELS)

Ultrasound Guided Vascular Access (VA)

There are also two components to training that are mandatory for any PoCUS practice:

Understanding the Physics of Ultrasound

Good Governance in PoCUS

There are modules in RCEMLearning for all of the above (ELS is currently in development and will be available imminently).
The RCEM EMUS booklet is our core guide which includes information on the assessment process.

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training; ultrasound; us; pocus; ultrasound sub-committee; ussc

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Welcome to the ultrasound training and practice section of the RCEM website. There is also a complementary section with additional resources on RCEMLearning. Regional ultrasound leads We want to ensure each of the regions of the United Kingdom and Ireland have leads for ultrasound training.

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So excited about my own portable PoCUS, which can improve patient care and safety as well as teaching and training.

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The clear answer in point-of-care ultrasound | Butterfly iQ3

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Welcome to connected medicine. Butterfly brings the power of ultrasound into your assessment, diagnosis and treatment process. One probe. Whole-body imaging. For any medical system.

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Excited to be part of the new RCEM PoCUS working group the  curriculum 2021. Please complete the RCEM survey/contact me to have your say!(https://www.surveymonkey.co.uk/r/RCEMcurriculumSurvey)

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Can relate real scan images to the three-dimensional anatomy of the structures in a cartoon format

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Welcome

Welcome to the Point of Care Ultrasound (POCUS) Web site. This site provides teaching resources that can be used by medical educators in the classroom, and by trainees for self-study.

The introduction of high fidelity portable and hand held ultrasound systems has allowed physicians to use ultrasound at the point of care for rapid assessment of the patient's condition and determine appropriate therapy. Point of care ultrasound (POCUS) for assessing the heart using a protocol called Focused Cardiac Ultrasound (FOCUS) has provided clinically important information within minutes to guide decision-making in critically ill patients. The FOCUS cardiac protocol is becoming widely used by non-cardiologists in many clinical settings. POCUS protocols have also been developed for rapid assessment of the lungs, abdomen and vessels.

The modules on this POCUS website are intended to help the user to relate ultrasound images to the three-dimensional anatomy of the structures they are viewing. This site contains three teaching and learning modules: the newest module, Ultrasound in Trauma: eFast, teaches the 9 eFast views, the focused cardiac ultrasound module covers the five views used in FOCUS assessment and the last module teaches with the 6 views used in the ultrasound assessment of the lung.

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Point of Care Ultrasound: TTE, PIE, Toronto General Hospital Department of Anesthesia, FOCUS, FATE, Focused Cardiac Ultrasound Lung

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Welcome to the Point of Care Ultrasound (POCUS) Web site. This site provides teaching resources that can be used by medical educators in the classroom, and by trainees for self-study. The introduction of high fidelity portable and hand held ultrasound systems has allowed physicians to use ultrasound at the point of care for rapid assessment of the patient's condition and determine appropriate therapy.

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Yorkshire Emergency Medicine Ultrasound School Twitter

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Training and Teaching Summary and consent for photograph

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Focused Assessment for Free Fluid (FAFF)

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Focused Assessment for Free Fluid (FAFF)

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PoCUS for free fluid in Non-traumatic Patients

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29/07/2019 Summary Sheet- FAFF/eFAST/Vascular access

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Month 1- Abdominal Aorta with a graft in-situ PoCUS  

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Month 1- Abdominal Aorta with a graft in-situ PoCUS  

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Endoleak (blood flow in aneurysm sack) might be demonstrated with a doppler which is beyond competency of ED level 1. CT Angio is recommended and discussion with vascular before deciding to transfer to a tertiary centre. It effect 15-25% of patients with a EVAR graft in-situ.

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Excited to be testing out two different new SoniSite PoCUS for the next two weeks at Leeds ED.

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Excited to be testing out two different new SoniSare PoCUS for the next two weeks at Leeds ED.

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Fascia Iliaca Block Procedure

Academic Life in Emergency Medicine Website

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An 82-year-old woman presents with left hip pain after a mechanical fall while cleaning the kitchen floor. When EMS arrived, the left leg was foreshortened and externally rotated. The paramedics administered 10 mg of IV morphine, but she is still writhing in pain on arrival. The AP pelvic x-ray demonstrates a left femoral neck fracture (arrow). You consider performing a fascia iliaca nerve block for better pain control.

Why do a fascia iliaca nerve block?

Multiple studies have shown decreased in-hospital mortality and complications when regional anesthesia is performed. Specifically for hip fractures, fascia iliaca blocks led to a reduction of postoperative complications from 33% to 20% along with decreased mortality, deep vein thromboses, altered mental status, and pulmonary complications.

Goal of the fascia iliaca nerve block

The goal of this nerve block is to maximize analgesia, while minimizing side effects such as respiratory depression, delirium, hypotension, and nausea/vomiting that may be associated with IV opioid administration. The target of the anesthetic injection is the potential space between the iliacus muscle and the fascia that overlies it (fascia iliaca), within which the femoral nerve and lateral femoral cutaneous nerve (LFCN) course. A large volume injection (40 mL) will lead to appropriate fascial spread and anesthesia of the femoral nerve (88%), LFCN (90%), and sometimes the obturator nerve.

When should I not perform the fascia iliaca block (contraindications)?

Any anticoagulation, besides aspirin and NSAIDs

Overlying cellulitis at the skin puncture site

Ipsilateral fractures at high risk of compartment syndrome, such as tibial plateau fractures

Equipment

Figure 2. A layout of the equipment needed for a fascia iliaca nerve block

The necessary equipment for this nerve block includes the following:

Sterile precautions

Sterile ultrasound probe cover

Sterile gloves

ChloraPrep wipe

Identifying the anatomy

Bedside ultrasound with a linear transducer

Instilling the anesthetic

Lidocaine 1% (2-5 mL) for local wheal of anesthetic

Local long-acting anesthetic (e.g., 40 mL of 0.2% ropivacaine) for nerve block

Sterile saline flush

10 mL syringe

60 mL syringe

Extension tubing

18-gauge needle

25-gauge needle

21-gauge nerve block needle

Figure 3. Syringe and nerve block needle set-up for administration of anesthetic agent

Anesthetic medication options

For a longer period of regional anesthesia, we recommend ropivacaine or bupivacaine. Given the higher cardiac toxicity of bupivacaine due it's highly lipophilic nature compared to other local anesthetics, we suggest 40 mL of 0.2% ropivacaine as the first-line agent. Lidocaine is not preferred given it's shorter duration of action, which is contradictory to the goal of prolonged analgesia.

Local anesthetic agent

Relative potency

Duration of action

Maximum allowable subcutaneous dose (mg/kg)

Figure 4. Local amide-based anesthetic agents and their pharmacokinetic effects, adapted from Goldfrank's Toxicologic Emergencies

Technique

Equipment positioning

Start by setting up an equipment stand on the same side of the bed as the patient's fracture, with the ultrasound machine on the contralateral side of the fracture. You will stand on the side of the fracture facing towards the head of the bed and looking across the patient's body at the ultrasound machine.

Wipe the ipsilateral inguinal area with the ChloraPrep and drape the area.

Fill the 60 mL syringe with 4 mL of 0.2% ropivacaine.

Attach the syringe to the extension tubing and nerve block needle.

Remove air from the tubing and "prime it" with the ropivacaine from the syringe.

Place the sterile ultrasound probe cover on the probe.

Sterile preparation

Position the linear, high-frequency ultrasound probe held in horizontal orientation with the probe marker pointed towards the patient's right side (Figure 5).

Locate the femoral vessels ideally at the level of the common femoral artery and vein.

Slide the probe laterally until you see the iliacus and sartorius muscles (Video 1). The iliacus muscle will be in the same plane as the femoral vessels, and the sartorius will be superior and lateral (Figure 6).

Anatomy identification

Using a 10 mL syringe and 25 gauge needle, deposit a small wheal of local anesthetic (e.g. lidocaine) directly adjacent to the lateral surface of the ultrasound probe.

Switch to the longer 21 gauge nerve block needle, which is affixed to an extension tubing and 60 mL ropivacaine-filled syringe (Figure 3). The primary operator should be sterilely gowned and hold the nerve block needle, while a secondary operator should hold the ropivacaine syringe, being in charge of instilling the anesthetic when needed.

Primary operator: Insert the nerve block needle at a steep 45-60 degree angle through the wheal and advance in a plane through the subcutaneous tissue until you visualize the tip of the needle underneath the fascia iliaca. You will likely feel pop or change in resistance as you pass through the fascia iliaca.

Secondary operator: Once the needle is appropriately positioned by the primary operator, inject a micro-aliquot of anesthetic (0.5 to 1 mL) to see if the fascia iliaca appropriately dissects off the iliacus muscle (Video 2).

Video 2. Ultrasound image of the left hip, showing an in-plane view of the nerve block needle and appropriate dissection of the fascia iliaca from the iliacus muscle with a micro-aliquot injection of anesthetic

If the needle tip is placed inappropriately above (superficial to) the fascia iliaca in the subcutaneous tissue or within the iliacus muscle, make in-plane adjustments of the needle tip and instill additional micro-aliquots until appropriate localization.

Once the needle is appropriately positioned, inject the entire volume of the 40 mL 0.2% ropivacaine. Clear the ropivacaine remaining in the extension tubing with a few mL's of the sterile saline flush after swapping the 60 mL syringe with a sterile saline flush.

Adequate anesthesia can take up to 30-60 minutes as the ropivacaine tracks upwards into the pelvis.

Instillation of anesthetic agent

Alternative Technique

A suprainguinal approach may lead to more proximal spread of anesthetic and more successful pain control; however, the approach relies on adequate visualization of the patient's internal oblique muscle, which is often tiny and hard to see in the elderly. The suprainguinal approach mirrors the above approach to identify the iliacus muscle. Then slide the probe superiorly along the iliacus muscle until the probe is above the inguinal canal. Then rotate the probe marker 90 degrees so that it points towards the umbilicus. The sartorius and internal oblique muscles will form a "bowtie" shape with the iliacus muscle below them. Inject the anesthetic in between the bowtie, aiming just below the fascia iliaca as described in the traditional approach (Figure 8).

Kaufman R. Local Anesthetics. In: Goldfrank L, ed. Goldfrank's Toxicologic Emergencies. New York, NY: McGraw-Hill; 2011:967.

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Fascia iliaca nerve block: A hip fracture best-practice Fascia iliaca nerve block: Best practices for your patient with a hip fracture

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An 82-year-old woman presents with left hip pain after a mechanical fall while cleaning the kitchen floor. When EMS arrived, the left leg was foreshortened and externally rotated. The paramedics administered 10 mg of IV morphine, but she is still writhing in pain on arrival.

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PoCUS resources

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You have the highest standards when it comes to your clinical ultrasound program

Demonstrate to your patients, your institution and your payers that you have a quality program that meets ACEP's high standards for point-of-care ultrasound.

No need to try to fit your practice into some other discipline's criteria.

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Demonstrate to your patients, your institution and your payers that you have a quality program that meets ACEP's high standards for point-of-care ultrasound. No need to try to fit your practice into some other discipline's criteria.

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Fascia Iliaca Block Procedure-anatomical vs. ultra-sound guided!

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Fascia Iliaca Block Procedure-anatomical vs. ultra-sound guided!

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Are you dealing with a NOF#? Look no further than this excellent document.

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Fascia Iliaca Block - The two ultra-sound guided approaches!

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Fascia Iliaca Block - The two ultra-sound guided approaches!

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Traditional inguinal vs modern infra-inguinal methods

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Annually, more than 300,000 adults older than age 65 are hospitalized for hip fractures, which frequently result from ground-level falls. ¹ Emergency medical professionals are tasked with providing care and analgesia for patients with femoral neck fractures. Monotherapy with intravenous opioids can often lead to undesired complications (eg, delirium, diminished respiratory drive, and nausea). ²⁻⁴ The ultrasound-guided femoral nerve block (USGFNB) and ultrasound-guided fascia iliaca compartment block (USGFICB) offer improved pain control as well as reduced side effects in comparison with monotherapy with intravenous opioids. 4,5

Even though USGFNB has been described extensively in the emergency medicine literature, its use has not become commonplace. The perceived technical difficulty of the USGFNB may contribute to its current underutilization in acute traumatic femoral neck fractures. 6,7 However, the USGFICB may be a potentially easier technique for the novice sonographer. Evidence supporting this theory includes the technique's proven efficacy in the hands of a variety of clinicians, including resident physicians, nurses, and paramedics. ⁸⁻¹⁰

Anatomy

Sensory innervation of the femoral neck is primarily provided by articular branches of the femoral nerve with minor contributions from the obturator nerve and the superior and inferior gluteal nerves. The femoral nerve (L2-L4) and the obturator nerve (L2-L4) both transverse a compartment that spans the lower abdomen and anterior thigh and is confined anteriorly by the fascia iliaca (ie, fascia iliaca compartment). While both the femoral and obturator nerves course through the same compartment, deposition of large volumes of local anesthesia under the fascia iliaca (as with USGFICB) seldom successfully blocks the obturator nerve. ¹¹ That said, available evidence also suggests that the obturator nerve minimally contributes to distal sensory innervation. ¹²

To perform a USGFICB, two approaches exist. Both have the goal of injecting local anesthetic into the compartment lateral to the femoral nerve, which lies lateral and adjacent to the vascular bundle (see Figure 1). The two approaches are the infrainguinal (see Figure 2A) and the suprainguinal (see Figure 2B).

Supplies

1. High-frequency linear transducer (6-10 MHz) with sterile lubricant

2. 0.5% ropivacaine (5 mg/mL): dilute 30 mL 0.5% ropivacaine into 30 mL 0.9% normal saline

1. Max dose is commonly considered 3 mg/kg.

2. Ropivacaine is the preferred local anesthetic due to its long-acting duration with a greater safety profile than bupivacaine.¹³

3. Mixing of local anesthetics is not currently advised due to less predictable onset, duration, and potency.¹³

3. 22-gauge blunt-tipped echogenic needle (Whitacre and Sprotte needles are blunt-tipped needles, which provide better tactile feedback when "popping through" the fascia lata and fascia iliaca.)

4. IV tubing connected to a 30 or 60 mL syringe

5. Chlorhexidine scrub or alcohol prep sponge

6. Local anesthetic for cutaneous anesthesia (eg, 12% lidocaine without epinephrine)

7. Personal protection equipment including sterile gloves

8. Second provider present for assistance

9. Airway supplies and 20% lipid emulsion available

​With​ ​the above​ ​supplies​ ​prepared​ ​and​ ​on​ ​standby,​ ​perform​ ​a​ ​preprocedure​ ​scan​ ​to determine​ ​the patient's​ ​specific​ ​anatomy. ​Prepare ​the​ ​​selected​ ​injection​ site with chlorhexidine or isopropyl alcohol​​. A skin marker may help maintain proper orientation to the injection site. Next, flush the premixed 30​ ​mL​ ​of​ ​ropivacaine​ ​and​ ​normal saline​​ ​through​ the line and echogenic needle.

Preprocedural Nerve Block

As with any proximal nerve block, several steps should be addressed prior to beginning the procedure. First, a thorough neurological exam should be performed. Discussion with the orthopedic service at your institution is recommended before US-guided nerve blocks for hip fractures are performed. A detailed lower extremity neurovascular examination must be performed and documented. Patients should be placed on continuous cardiac monitoring and pulse oximetry to monitor for local anesthetic systemic toxicity. The risk of local anesthetic systemic toxicity (both neurological and cardiovascular) is highest in cases of unintentional intravascular injection. In addition to supportive, anti-seizure, and cardiac resuscitation measures, early administration of lipid emulsion antidote is recommended with prolonged seizure and/or any cardiac arrhythmia. Providers should be aware of Intralipid (20% lipid emulsion) availability and dosing prior to injecting large volumes of local anesthetic. ¹⁴ Lipid emulsion effectively creates a "lipid sink" where the local anesthetic is soluble with, and bound by, the lipid molecules.

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Control Hip Fracture Pain Without Opioids Using Ultrasound-Guided Fascia Iliaca Compartment Block - ACEP Now

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ACEP Now offers real-time clinical news, news from the American College of Emergency Physicians, and news on practice trends and health care reform for the emergency medicine physician. ACEP Now is an official publication of the American College of Emergency Physicians.

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General reference for performing and interpreting PoCUS

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Focus Assessed Transthoracic Echo (FATE) for performing and interpreting echo

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Airway/Breathing- Thoracic PoCUS flow diagram

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Airway/Breathing- Thoracic PoCUS flow diagram

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The BLUE protocol is well known for helping to differentiate different thoracic pathology. For example useful when CXR shows opacity fluid vs. consolidation differentiating is not possible, whereas this protocol can help differentiate before/without CT.

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FALLS-protocol: lung ultrasounding hemodynamic assessment of shock

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FALLS-protocol: lung ultrasounding hemodynamic assessment of shock

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Lichtenstein '13

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The RUSH protocol well known for helping to differentiate different pathology leading to shock.

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Practical guide

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Some really useful PoCUS free (apart from the first one) iBooks in the top row of my iBook library.

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The recommended book for studying and referencing

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We will be back  with a new and exciting programme! This will include working more closely with the sim team and providing more support to the trainees/consultants with PoCUS skills and knowledge.

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The official booklet/curriculum/syllabus

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Rapid Ultrasound for Shock and Hypotension (RUSH)

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Rapid Ultrasound for Shock and Hypotension (RUSH)

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PoCUS for differential of shock

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Abdominal and Cardiac Evaluation with Sonographyin Shock (ACES)

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Abdominal and Cardiac Evaluation with Sonographyin Shock (ACES)

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PoCUS for differential of shock

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CP/SOB/Hypotension in ED

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focused cardiac ultrasound sound (FoCUS) in shock patients

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Clinical assessment of critically ill patients by whole-body PoCUS

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Clinical assessment of critically ill patients by whole-body PoCUS

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Comparing different studies

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The teaching and training feedback form

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Google Forms - create and analyze surveys, for free.

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Leeds ED Consultant, POCUS lead in Leeds and Yorkshire/Humber Deanery. Knows everything about PoCUS and make it look so easy.

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Leeds ED Consultant with sub-speciality in PoCUS. Excellent ultra-sound knowledge and skills.

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EM HST/Senior Clinical Fellow in PoCUS. A nerd, who never wants to stop learning.

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EM HST/Senior Clinical Fellow in PoCUS. Kick started the ED PoCUS fellowship revolution in Leeds ED, and set-up the Monday launch Club, amongst other achievements of hers so far.

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The award winning Leeds ED Sim team

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Excellent page on Leeds sim news and relevant information/resources. It is the blueprint and idea for this page.

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The excellent Emergency Department, who are very supportive of education and training

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Watch this space. There will be a process in ensuring that all appropriate written consent is gained from patient, and the identifiable information is deleted as much as possible.

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For the first time, along with our wonderful sim team, we piloted sim scenarios in our level 1 course. It was very well ran and received by the candidates with excellent feedback.