Point-of-care Ultrasound in Acute Care Medicine

Basic and Advanced Applications Workshop

Saturday September 30th, 2017 and Sunday October 1st, 2017
Toronto General Hospital
Wightman-Berris Academy
200 Elizabeth Street
Toronto, Ontario – Canada

7.0 CME Credits

Cost: $1,200

The continuing education event indicated has been designated as U of T Accredited and awarded with the following credits.

  • Royal College of Physicians & Surgeons of Canada – 14.5 Section 3 hours (Simulation-based)

Program

Pre-Course

Saturday, September 30th, 2017

07:45-08:00 Registration
08:00-08:10 Welcome

Session 1 – Introduction

08:10-08:25 The Critical Care Ultrasound Concept
Goals and Objectives: After active engagement in this session, participants will be better able to:

  • Understand principles and evidence-based recommendations of point-of-care critical care ultrasound (problem-based, goal-oriented, physician-performed, extension of physical examination)
  • Apply a model / mnemonic for teaching and performing ultrasound (Indication / Acquisition / Image Interpretation / Clinical Decision-Making)
  • Identify limits and pitfalls of point-of-care ultrasound
Goffi

Session 2 – GET THE VIEWS
Goals and Objectives: After active engagement in this session, participants will be better able to:

  • Effectively operate an ultrasound machine in its basic
  • Acquire adequate ultrasound images of the 5 main focused cardiac views (subcostal, apical 4 chamber, parasternal long and short axis, inferior vena cava)
  • Identify key cardiac anatomical structures
  • Apply principles of qualitative/semi-quantitative image interpretation

Active Learning: small group hands-on sessions;

KNOBOLOGY
Model 1 Model 2 Model 3 Model 4 Model 5 Model 6 Model 7
Instructor Pivetta Luksun Darrah 4 De Marchi 5 Perez D’Empaire 6 Kumar 7 Kim / Goffi
 08:30-08:45  Group A  Group B Group C  Group D Group E  Group F Group G
GET THE VIEWS
 Parasternal Apical  Subcostal Parasternal  Apical Subcostal All
Instructor Pivetta Luksun Darrah 4 De Marchi 5 Perez D’Empaire 6 Kumar 7 Kim / Goffi
 08:45-09:15  Group A  Group B Group C  Group D  Group E Group F Group G
09:15-09:45 Group C Group A Group B Group F Group D Group E Group G
09:45-10:15 Group B Group C Group A Group E Group F Group D Group G
10:15-10:30  Coffee Break

Session 3 – LV ASSESSMENT
Goals and Objectives: After active engagement in this session, participants will be better able to:

  • Understand cardiac physiology and anatomy relevant to LV assessment
  • Correctly identify and interpret US signs of LV function (visual estimation of LV ejection fraction; normal LV size; principle of RWMA identification; linear measurement PLAX)

Active Learning: small group hands-on sessions; video analysis / interactive lecture & case-based learning

Class Model 1 Model 2 Model 3 Sim 1 Sim 2 Sim 3
Instructor
Floating: Pivetta & Perez D’Empaire
1 Goffi 2 Kumar 3 De Marchi 4 Kim 5 Persona 6 Luksun 7 Darrah
 10:30-10:50 Groups
1, 2 & 3
Group 4A Group 5A Group 6A Group 4B Group 5B Group 6B
 10:50-11:10 Group 4B Group 5B Group 6B Group 4A Group 5A Group 6A
 11:10-11:30 Groups
4, 5 & 6
Group 1A Group 2A Group 3A Group 1B Group 2B Group 3B
11:30-11:50 Group 1B Group 2B Group 3B Group 1A Group 2A Group 3A
12:00-13:00  Lunch

Session 4 – RV ASSESSMENT & IVC
Goals and Objectives: After active engagement in this session, participants will be better able to:

  • Understand cardiac physiology and anatomy relevant to RV assessment
  • Correctly identify and interpret US signs of RV function (visual estimation of RV function; TAPSE; normal RV size; septal dyskinesia)
  • Correctly identify and interpret IVC signs of fluid responsiveness

Active Learning: small group hands-on sessions; video analysis / interactive lecture & case-based learning

Class Model 1 Model 2 Model 3 Sim 1 Sim 2 Sim 3
Instructor
Floating: Luksun & De Marchi & Goffi
Pivetta Darrah 3 Kumar 4 Kim 5 Persona 6 Perez D’Empaire 7 Duggal
 13:00-13:20 Groups
4, 5 & 6
Group 1B Group 2B Group 3B Group 1A Group 2A Group 3A
13:20-13:40 Group 1A Group 2A Group 3A Group 1B Group 2B Group 3B
 13:40-14:00 Groups
1, 2 & 3
Group 4B Group 5B Group 6B Group 4A Group 5A Group 6A
 14:00-14:20 Group 4A Group 5A Group 6A Group 4B Group 5B Group 6B

Session 5 – PERICARDIAL EFFUSION & TAMPONADE
Goals and Objectives: After active engagement in this session, participants will be better able to:

  • Understand cardiac physiology and anatomy relevant to pericardial effusion and tamponade physiology
  • Correctly identify and interpret US signs of pericardial effusion and tamponade physiology (IVC plethora, RA systolic collapse, RV diastolic collapse, respiratory variations).

Active Learning: video analysis / interactive lecture & case-based learning

Class Model 1 Model 2 Model 3 Sim 1 Sim 2 Sim 3
Instructor
Floating: Persona & Kumar
 1 Darrah 2 Kim 3 Perez D’Empaire 4 Goffi 5 Pivetta 6 Duggal 7 Luksun
 14:30-14:50 Groups
1, 2 & 3
Group 4A Group 5A Group 6A Group 4B Group 5B Group 6B
14:50-15:10 Group 4B Group 5B Group 6B Group 4A Group 5A Group 6A
15:10-15:30 Groups
4, 5 & 6
Group 1A Group 2A Group 3A Group 1B Group 2B Group 3B
 15:30-15:50 Group 1B Group 2B Group 3B Group 1A Group 2A Group 3A
  15:50-16:10 Coffee Break

Session 6 – Lung Ultrasound 101
Goals and Objectives: After active engagement in this session, participants will be better able to:

  • Understand basic lung sonographic findings (A-lines, B-lines, lung sliding, lung pulse, lung point, pleural effusion, consolidation, air bronchograms)
  • Apply principles of ultrasonographic diagnosis of pneumothorax
  • Apply principles of ultrasonographic diagnosis of interstitial syndrome (pulmonary edema of various causes – ARDS vs cardiogenic pulmonary edema)

Active Learning: video analysis / interactive lecture & case-based learning

Class Model 1 Model 2 Model 3
Instructor
Floating: De Marchi
Goffi Persona Luksun 4 Pivetta
16:10-16:40 Groups 4, 5 & 6 Group 1 Group 2 Group 3
 16:40-17:10 Groups 1, 2 & 3 Group 4 Group 5 Group 6

Sunday October 1st, 2017

07:45-08:00 Registration

Session 7 – Lung Ultrasound 201

08:00-08:20 Lung Ultrasound 201
Goals and Objectives: After active engagement in this session, participants will be better able to:

  • Apply principles of ultrasonographic diagnosis of interstitial syndrome (pulmonary edema of various causes – ARDS vs cardiogenic pulmonary edema), atelectasis/consolidation and pleural effusion (simple, complex, loculated)

Active Learning: video analysis / interactive lectures & case-based learning

Goffi

Session 8 – Introduction to Doppler

08:20-08:45 Introduction to Doppler
Goals and Objectives: After active engagement in this session, participants will be better able to:

  • Understand principles of Doppler Imaging
  • Apply common Doppler techniques (CW, PW, Color Doppler) to cardiac and vascular ultrasound

Understand pitfalls and limitations of Doppler

 Goffi / Faundez

Session 9 – APPROACH TO SHOCK & DYSPNEA
Goals and Objectives: After active engagement in this session, participants will be better able to:

  • Apply an integrated ultrasound approach to shock and dyspnea
  • Correctly interpret acquired images, and integrate findings in clinical decision making

Active Learning: video analysis

KNOBOLOGY
08:45-09:15 APPROACH TO SHOCK & DYSPNEA  Luksun

Session 10 – ADVANCED ECHOCARDIOGRAPHY (1)
Goals and Objectives: After active engagement in this session, participants will be better able to:

  • Perform basic valvular assessment & analysis of regional wall motion abnormalities
  • Perform echo-based cardiac output calculation and perform passive leg raising test for fluid responsiveness
  • Assess non invasively RVSP & CVP
  • Perform basic assessment of Diastolic Function

Active Learning: small group hands-on sessions;

Basic valvular assessment & RWMA Cardiac output & PLR  RVSP & CVP estimate  Diastolic function Cardiac output & PLR RVSP & CVP
estimate
Diastolic function
 Class Model 1  Model 2 Model 3 Model 4 Model 5 Model 6 Model 7 Model 8
Instructor
Floating: Perez D’Empaire, Darrah & Kumar
1 Brown 2 Pivetta 3 Luksun 4 Goffi 5 Goffi 6 Duggal 7 Persona 8 Douflé 9 Douflé
09:15-09:45 Groups
1 & 2
Group 3A Group 3B Group 4 Group 4 Group 5A Group 5B Group 6 Group 6
09:45-10:15 Group 3B Group 3A Group 5B Group 5A
10:15-10:30  Coffee Break

Session 11 – ADVANCED ECHOCARDIOGRAPHY (2)

Basic valvular
assessment &
RWMA
Cardiac output
& PLR
 RVSP & CVP
estimate
 Diastolic function Cardiac output &
PLR
RVSP & CVP
estimate
Diastolic function
 Class Model 1  Model 2 Model 3 Model 4 Model 5 Model 6 Model 7 Model 8
Instructor
Floating: Pivetta & Duggal
1 Brown 2 Darrah 3 Luksun 4 Goffi 5 Goffi 6 Kumar 7 Perez D’Empaire 8 Douflé 9 Douflé
10:30-11:00 Groups
5 & 6
Group 4A Group 4B Group 3 Group 3 Group 1B Group 1A Group 2 Group 2
11:00-11:30 Group 4B Group 4A Group 1A Group 1B
11:30-12:00 Groups
3 & 4
Group 6A Group 6B Group 5 Group 5 Group 2A Group 2B Group 1 Group 1
12:00-12:30 Group 6B Group 6A Group 2B Group 2A
12:30-13:30 Lunch

Session 12 – ACUTE CARE ULTRASONOGRAPHY (1)
Goals and Objectives: After active engagement in this session, participants will be better able to:

  • Gastric Ultrasound
    1. Understand basic gastric sonographic scanning technique and landmarks
    2. Recognize patterns of gastric content (empty, clear fluid, thick fluid, solid) and assess gastric volume
    3. Understand implications for aspiration risk assessment and limitations of gastric ultrasound
  • FAST
    1. Understand principles of FAST/eFAST examination
    2. Recognize most common pitfalls in FAST evaluation
    3. Perform a FAST exam in healthy models
  • Vascular Ultrasound
    1. Understand principles of 2D assessment of vascular structures
    2. Perform basic Doppler assessment of venous vessels (flow augmentation/respiratory varations)
    3. Perform a compression ultrasound study of lower extremities
  • Airway Ultrasound
    1. Understand basic airway sonographic scanning technique and airway structures (epiglottis, base of the tongue, anterior neck thickness, lateral pharyngeal wall, vocal cords and their movements, crico-thyroid membrane, tracheal rings, esophagus)
    2. Understand possible use of airway ultrasound for tracheostomy and intubation
    3. Perform a complete neck scanning and identify crico-thyroid membrane.
  • Diaphragmatic Ultrasound
    1. Identify and assess excursion of diaphragm on US
    2. Identify and assess thickening of diaphragm on US
  • US-guided procedures
    1. Understand principles of US-guidance vs assistance
    2. Perform in-plane and out-of-plane cannulation of vascular accesses

Active Learning: small group hands-on sessions;

Gastric US Vascular US Diaphragm US FAST Airway US US-guided procedures
 Model 1  Model 2 Model 3  Model 4 Model 5 Model 6 Model 7  Model 8 Model 9 Model 10 Phantoms Phantoms
 Instructor 1 Bragg 2 Goffi 3 Persona/ Darrah Faundez 5 Vorona 6 Douflé 7 Brown / Perez D’Empaire 8 Pivetta 9 Oliveira 10 Luksun 11 De Marchi 12 Duggal/ Kumar
13:30-14:00 Group 1 Group 2 Group 3 Group 4 Group 5 Group 6
14:00-14:30 Group 6 Group 1 Group 2 Group 3 Group 4 Group 5
14:30-15:00 Group 5 Group 6 Group 1 Group 2 Group 3 Group 4
15:00-15:15  Coffee Break

Session 13 – ACUTE CARE ULTRASONOGRAPHY (2)

Gastric US Vascular US Diaphragm US FAST Airway US US-guided procedures
 Model 1  Model 2 Model 3  Model 4 Model 5 Model 6 Model 7  Model 8 Model 9 Model 10 Phantoms Phantoms
 Instructor 1 Bragg 2 Goffi 3 Persona/ Darrah 4 Faundez 5 Vorona 6 Douflé 7 Brown / Perez D’Empaire 8 Pivetta 9 Oliveira 10 Luksun 11 De Marchi 12 Duggal/ Kumar
15:15-15:45 Group 4 Group 5 Group 6 Group 1 Group 2 Group 3
15:45-16:15 Group 3 Group 4 Group 5 Group 6 Group 1 Group 2
16:15-16:45 Group 2 Group 3 Group 4 Group 5 Group 6 Group 1
16:45-17:00  Adjourn