DAS SMACC POCUS Summary Part 1

What an amazing 4 days we have had at Das SMACC. The Tempodrom was such a fantastic venue for a conference and the program was full of POCUS goodness with world class demonstrators and speakers. Over the coming few weeks we plan to bring you a round-up of all the best bits of the conference. Myself, Cian and our friends Suean Pascoe & Oriana Tolo from Ultrasound Training Solutions will give you a summary of the key learning points and fun from the Workshops, #GELFEST, SIM Haus and from the lecture program.

Warming Up for the Opening Ceremony (Picture Luke Phillips)

In our first installment Suean and Oriana will walk you through the lectures and the dedicated Sonobyte series. Ultrasound was a featured throughout #dasSMACC. The overall theme woven through the three days was that ultrasound is a cost effective and safe modality that can, and should be utilised to deliver better patient outcomes wherever it can.

Haney catching up with the team
(Picture: Suean Pascoe )


Session: The John Hinds Plenary

  • Prehospital Care: The Future is Now
    • Brian Burns touched briefly on the use of POCUS in his review of technology applications in the context of pre-hospital trauma.
    • He provided a glimpse of the future where remote imaging could be sent back to a trauma base in real time to be interpreted to plan patient management.
    • We would maintain that training pre-hospital professionals in image acquisition and interpretation is important too – our Victorian HEMS team are currently performing eFAST examinations and are able to notify the trauma centres of positive scans.
“Despite not knowing one another the ground team, air team and hospital trauma team are connected by the patients physiology”  Amazing on Stage Extraction and Resuscitation from ATACC Team. Picture from @EMS_Nation

Session: The Bench and Bedside

  • Four Tragic Dog Deaths: Lessons in Program Design and Development
    • While linked to but not specific to ultrasound, Resa Lewiss (our SonoAus friend) talked on four ways a training program can be sabotaged.
    • Drawing analogies to how four of her dogs came to an unfortunate demise, Resa highlighted that a training program can be undermined by:
      • The cancer of non-supportive people, attitudes and machinery.
      • The stones thrown by those not wanting you to succeed.
      • Self-harming through a lack of investment of time and effort.
      • Old age through a lack of program reinvention and refreshing.
    • Resa summed up that training programs will succeed only by embracing collaboration, being professional and gracious and by strengthening the four key pillars of clinical excellence, research, education and administration along the way

Session: SonoBYTEs

  • Ultrasound in Extreme Environments
    • Gaynor Prince (UTS alumnus 2009) introduced the first of the SonoBYTEs, discussing the use of ultrasound in extreme environments – in particular how POCUS provided her the comfort to delay the evacuation of a patient from Antarctica and providing a safer evacuation process for a retrieval team.
    • Ian Gawthorpe followed with a discussion on ultrasound as applied to diving medicine and utilisation in hyperbaric chambers.

  • Global Relief Ultrasound 
    • Trish Henwood, President & Co-Founder of the PURE Initiative: Point-of-care Ultrasound in Resource-limited Environments discussed how POCUS was changing outcomes in remote & resource limited environments, where access to other imaging modalities was not possible
    • Trish highlighted how effective the local nurses and doctors had become at fully utilising and exploiting ultrasound, how this had inspired teaching and an exponential learning curve to the point where some of their clinicians go to the USA to teach.
    • Also check out Trish’s talk from SMACCDub


Session: How I deal with an emergency (and why)

  • Whole Body Ultrasound Centered on the Lung: A Holistic Approach
    Daniel Lichtenstein in the round and in a t-shirt!
    (Picture: Suean Pascoe)
    • Daniel Lichtenstein – the godfather of the lung ultrasound and POCUS – discussed the birth of lung ultrasound, his battles to get the approach recognised and the eventual development of the SESAME, BLUE and FALLS protocols.
    • Those in the crowd who had seen or heard Daniel were waiting for mention of a 1992 “portable” machine and/or convex probe – and weren’t disappointed! Daniel did a great job in the round – his advice for those wanting to change the world with ultrasound – “Start young”.
    • An underground video has been made available of this session.

Session: Sonobytes

  • Just Passing Through
    • Leanne Hartnett presented a case where a patient requiring a CT pulmonary angiography was breathless lying flat, and on further ultrasound investigation was found to have a big right ventricle, flat septum and a clot in transit within the right atrium.
    • Leanne identified that patient mortality may be better with thrombolysis or embolectomy, referencing the following paper.

  • ECHO in Cardiac Arrest
    • Haney Mallemat discussed using trans-oesophageal echocardiography (TOE) in the ED – and addressed the controversy of complications such as perforations with the quote “You can’t get any deader than dead”!
    • Haney discussed how if you can interpret a trans-thoracic echo (TTE) you can interpret a TOE scan, and identified a number of benefits from the approach via cases including:
      • Imaging during a cardiac arrest but not interrupting a code for pulse checks where there are poor sonographic windows.
      • Guidance of CPR efficacy by looking at compression of the left ventricle and looking at the depth of compression using M-Mode (this is not recommended for novices!)


Session: Sonobytes

  • Airway Ultrasound
    • Jacob Avila and Ben Smith provided an overview of how to confirm endotracheal tube placement when intubating using ultrasound by watching for expansion of trachea when the cuff is inflated..
    • For Jacob’s “how-to” on this go and visit his overview at 5min SONO
  • The Incidentaloma
  • The final POCUS presentation was delivered by James Rippey who provided us with a very personal and emotional overview of the risks associated with POCUS.
  • James recounted the story of practicing ultrasound on his son with a portable system, only to find a retroperitoneal tumour – which after surgical removal was fortunately found to be benign.
  • James identified that 40% of scans have incidental findings – with only 1% being significant – and was clear to point out that while ultrasound was a safe imaging modality, its use carried other risks.
  • Take home message – “a focused scan should remain focused”.
The incidentaloma
(Picture: @FOAMpodcast – http://www.foamcast.org/)

Without hyperbole the POCUS sessions were filled with pearls, pitfalls, laughter and tears – from Antarctica to Africa, trauma to TOE (excuse the pun) the sessions captured the diversity that this imaging modality is becoming known for. We hope our summaries convey some of the emotion and learning points.

See you at SMACC in Sydney, February 2019.

The POCUS Geelong Team Enjoying Das SMACC

Look out for our summaries of #GELFEST, the SMACC workshops and the SIM Haus coming over the next few weeks.

If this left you needing more then check out these excellent summaries from our #FOAMED friends:


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