“This day’s an invitation
And it’s just for you
You’ve got a reservation
For the 17th of June
Open your eyes and let the sun break in for a while
There may be something
That you’ve never seen inside”
It may not have been the 17th of June – nor 1984 for that matter – but it was European “Summer” in Berlin, it was 26th June and with it came the invitation to participate in a full day of Das SMACC pre-conference workshops
This year in Berlin, SMACC featured the most spectacular ultrasound extravaganza to date. There were 6 separate US tracks on the pre conference day followed by 9 SIM HAUS sessions and 6 Sonobytes presentations on stage. The US workshop series proved to be very popular and was sold out months in advance.
In the next exciting instalment of our DasSMACC POCUS Summary Luke, Cian, Oriana & Suean Summary will walk you through some of the best learning points from the pre-conference Ultrasound and Cadaver workshops. Led by a world-class faculty, participants were able to scan the amazing medical student volunteers from head to toe and use phantoms to perform procedures on. Here is our summary of the day
Pre-Hospital and Emergency Ultrasound Workshop Series
Trish Henwood, Adaira Chou, Vicki Noble, James Rippey, Daniel Lichtenstein, Arun Nagdev, Cian McDermott, Casey Parker, Ian Gawthrope, Gaynor Prince, Justin Bowra, Kylie Baker, Leanne Hartnett, Catherine Nix
Session 1: Dying in Pain! Ultrasound for Undifferentiated Abdominal Pain
The morning session session was led by Trish Henwood and the wonderful all-star female cast of Adaira Chou and Vicki Noble. Learners got the opportunity to use traditional and novel abdominal applications from FAST and aorta imaging to small bowel obstruction and appendicitis POCUS protocols. The key learning point from this session – ‘scan every abdomen’ that you find on your shop floor. Look for the ‘sick’ gallbladder, kidneys, small bowel and appendix every time!
Session 2: Ultrasound in Acute Respiratory Failure: The Blue Protocol
Next session up was a treat for the POCUS purists. Daniel Lichtenstein is a true pioneer of lung ultrasound and he regaled the captive audience with his experience developing the famous BLUE lung protocol in his hospital in Paris, France. For faculty and learners alike, it was an honour to be in the presence of Daniel’s great mind!
SMACC has seen the creative powers of James Rippey in the Gold Coast, Chicago and Dublin. Who will ever forget the giant lung that he created on stage at SMACC Dub?! This year James built his very own lung simulator and really got to the core of explaining tricky concepts such as the US appearance of B lines, oedema and consolidation. Learners then had the opportunity to practice scanning our team of models
Session 3: Emergent Procedures Perfected with Ultrasound
In this afternoon session convened by Cian McDermott and Arun Nagdev, participants were able to practice identifying and scanning landmarks on real patients before moving to ultrasound phantoms to perform US guided procedures. It was all hands-on with teaching done at each station. Learners performed nerve blocks, pericardiocentesis, arthrocentesis, thoracocentesis and central venous access under expert supervision. Some of the important learning points from some of the stations and links to procedures are outlined below
- Identify largest and most superficial pocket of fluid to direct your needle to
- Sit down, get comfortable if you can
- Use a curvilinear probe to guide you needle in line rather than the phased array cardiac probe. The phased array probe has poor needle visualisation as it is better for viewing objects in motion.
- It is likely to be a 2 person procedure – one to hold the probe, the other to complete the procedure
- A central line kit can be a quick way to get a long enough needle and wire set if you do not have a pericardiocentesis kit.
- Knee Arthrocentesis
- Use ultrasound to identify largest pocket of fluid in the supra-patella fossa which is intra-capsular but extra-articular. This avoids damage to mensici and articular cartilage.
- Place colour Doppler over area you are interested in before inserting the needle to avoid blood vessels
- Use linear high frequency probe. Can be done with skin marking or with direct needle visualisation
- See our previous post on identifying pleural effusions
- Identify the largest pocket of fluid. Use phased array probe to get between the rib space to identify this and a linear probe for US guided needle visualisation
- Beware changes in respiratory cycle with lung and diaphragm position.
- You can measure distance from skin to the effusion and from effusion to lung
- Supraclavicular Subclavian Vein Access
- Central venous access tips are covered in our Vascular access module
- Supraclavicular access occurs where the SCV meets the internal jugular vein
- SCV is shallow and easily visualised compared to infra-clavicular approach.
- In plane technique can be utilised for this method.
- Can be difficult in patients with big necks or higher BMI as probe cannot be placed in supraclavicular notch.
The session was both educational and a lot of fun. We had some excellent discussions between participants and the instructors and participants were able to learn some new tricks which will hopefully make my procedures safer for patients
ECHO & Critical Care Ultrasound Workshop Series
Session 1: ECHO Made Easy
This session was led by Rachel Liu. This was a rapid fire, hands on critical care ultrasound skills lab that covers the basics of cardiac US. Topics that were explored included echo windows and probe skills on the chest, differentiating the tamponade from a pericardial effusion and assessment of the left and right side of the heart
Session 2: Multisystem Critical Care Ultrasound
The next session went a little further down the rabbit hole for sick patients, focussing on more specific topics rather than general concepts. Jacob Avila and Ben Smith tag teamed to explore really interesting topics – McConnell’s sign and 60/60 sign for PE. After that Jacob showed us how he scans the lungs using a quick and logical protocol
Session 3: Master Disaster! Critical Care US Cases
Next stop – gamification in POCUS education! Just in case the energy levels were fading after lunch, Morton Boetker injected a change of learning pace using a case based approach to critical care ultrasound. Our team aced the massive PE and thoracic aortic dissection cases and this was my favourite session of the day as everyone’s competitive streak shone through. Prizes were handed over and everyone went home a winner!
The organising committee had invited DAS SMACC participants to ‘choose your adventure or join the legendary DAS SMACC ultrasound team for all 3 workshops. What an adventure it turned out to be!
My favourite aspect of the DAS SMACC POCUS workshops was the international networking opportunities it created. In a safe shared learning environment, we met and shared experiences and POCUS tips and thus expanded our personal learning networks in person
Procedural Skills Cadaver Lab
The half day procedural skills cadaver lab, provided fortunate participants to observe, learn and perform a range of invasive procedures. As sonographers – rather than physicians – the opportunity to access a cadaver lab is rare; such access provides the chance to perform invasive procedures under ultrasound guidance not normally afforded in our training or clinical career.
Having participated in a number of cadaver labs over the past few years, the focus of our participation in the dasSMACC lab was to perform a range of nerve blocks (particularly femoral and median) as well as complete a pleurocentesis and paracentesis. Our ultimate aim was to fully experience the physical (and emotional) sensations associated with the procedures to further inform our ultrasound education programs.
The labs were located at the Medizin im Grünen – Center for Learning and Education approximately 70km south-east of Berlin. Leaving Berlin early with a busload of medical professionals from a range of backgrounds and countries, we were unexpectedly treated to an impromptu Contiki Tour of outer Berlin compliments of unanticipated roadworks.
On arrival we were greeted at the very impressive medical training and research facility by Dr Heiko Ziervogel (facility manager) and Dr Chris Ross (Chair of the workshops (Attending Emergency Physician Rockford Memorial Hospital, ACEP (International Medical Education Committee/National Procedural Skills Director/Program Committee/International Director of Medical Education)). A short briefing provided an overview of the mechanics of the day, a prayer offered in thanks to the individuals that had donated their bodies to science and the day began.
Occupying three operating rooms – two for procedures, one for demonstrations – each lab station was attended by six participants, and a full range of invasive procedures performed. With a low instructor:student (1:2) ratio all had the opportunity to explore the finer points of each process of interest with a highly experienced and knowledgeable faculty. During our time at the table we were witness to the full range of procedures, but focused on performing the ultrasound guided nerve blocks and drainage. Using the new GE Venue, we were easily able to achieve our learning objectives.
On completing the workshops, and talking to other participants on the journey home, we all came away impressed; everyone had ample opportunity to learn, refine and explore the procedures of interest, all the while supported by the knowledge and professionalism of the training team in a high quality facility.
So you get a flavour of what you missed or if you want to consolidate your learning from Berlin, here is a curated list of all the FOAMed links for the DASSMACC POCUS workshops
Stand by for the next blogpost – all about GELFEST!!