POCUS

A training day in London……

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A couple of weeks ago I went up to London to attend an ultrasound workshop. It was at Canada Water, not too far from The Shard, an amazing building! The course was run by The British Medical Ultrasound Society and was about Point Of Care UltraSound (POCUS), which is where ultrasound is performed by the clinician seeing the patient, rather than by a sonographer somewhere else in the building. Although this type of course is aimed primarily at hospital doctors, and they made up most of the audience, there was a GP there, as well as me, the only chiropractor/sonographer. My use of ultrasound is POCUS, of course, because I am the clinician, as well as being the sonographer, when I use abdominal ultrasound here in the clinic to help work out what is causing a patient’s back pain.

The first presentation was about the FAST examination (Focused Assessment with Sonography for Trauma), used in A+E departments, mainly to look for free fluid (bleeding) in patients who have had trauma. Five views are taken, looking for fluid. In this example, you can see blood in the peritoneum. Interestingly, a bleed will often form sharp triangles, which helps to differentiate it from a cyst, which doesn’t. I don’t use the FAST protocol in my patient assessment, but it was a good reminder about some of the practical aspects of an abdominal ultrasound examination (which is what I do every day).

The next presentation was about abdominal aortic aneurysms (AAAs), where there is a bulge in the main artery carrying blood to the lower body. These are most common in older men who smoke, or have smoked in the past. We are looking for an increase in the internal diameter of the artery, above 3cm, as they can rupture, with fatal results. AAAs can cause back pain, so this is certainly of interest to clinicians like chiropractors.

We then had a presentation and a practical session about the use of ultrasound scanning to detect deep venous thrombus (DVT). Veins are normally easily squashed by pressure, so the aim with ultrasound scanning is to see if the vein can be squashed. If it can’t be squashed, then there may be a DVT. I haven’t done DVT scanning in the past, and it obviously takes quite a bit of practice to develop the confidence in your interpretation to use it clinically. I can see the merits of being able to do this and being able to differentiate a DVT from a muscle tear in the calf, which is often difficult to do. This area is something that I need to do more training in and get a lot more practice!

Next up was vascular access scanning, where ultrasound is used to guide the insertion of a canula into a vein for drug administration.  Not something that I will be doing clinically, but interesting to learn about, and to practice with the help of some models. I found it quite difficult, so hats off to those clinicians doing this with ease in hospital!

We then moved on to ultrasound of the lung, looking at a variety of things for which ultrasound is helpful, including pneumothorax. Normally you should see the pleura slide over each other like in this video. In this case there is shimmering of the pleura, and comet tails, so this excludes a pneumothorax . There was lots more, of course, some of it relating to the use of ultrasound in assessing the lungs of patients who have Covid-19. Not something that I am planning on doing!

The last section was echocardiology: using ultrasound to image the chambers of the heart. Although this was really interesting, it’s not something that I shall be using in practice. It’s a challenging subject not least because most of the images of the heart are from underneath, so I found working out what was what extremely difficult!

Although, like all seminars and workshops, much of what we were covering was not applicable to me, it made me think, and also made be reflect on what areas I should do more CPD in the future. I think being able to do DVT scanning proficiently is my next aim. I was pretty exhausted by the end of the day, when I had to get the underground back across London and then catch the train home, but it was worth it! Thanks to BMUS for a great training day.

#BMUS, #ultrasound, #POCUS, #FASTscan, #AAAscan, #DVT, #lungultrasound, #echocardiography

Have you seen my shoes, Dad?

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I don’t know about you, but my kids could never find things…. ‘Where are my shoes, Dad’? They would yell, as they stormed around slamming doors. ‘Wherever you left them’ was my standard answer, of course! (They were always under the sofa, btw….)

When I was doing my diagnostic ultrasound training, I would sometimes struggle to find one of the kidneys with the ultrasound scanner, but sometimes a kidney really isn’t there, because the patient only has one kidney. One of the problems with this is that the single kidney that is present is often a bit quirky: large, situated somewhere weird, and imperfectly constructed. This single kidney may be more prone to infection, and an infection of the kidney will often create low back pain, which is sometimes what brought the patient in to see us in the first place!

Patients with only one kidney are more prone to developing high blood pressure, so this will need to be monitored. Your kidneys are very important, so sometimes patients with one kidney are told to avoid contact sports, in case they damage their one kidney.

Statistically, Abingdon will have about 31 people who only have one kidney!

An uncommon cause of low back pain in an older man

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I had to scan one of the family guinea-pigs (Jill) the other day (my girlfriend is a vet). This poor little pig was weeing a lot, and there was blood in her urine. It seems that she was in pain too, as she didn’t like to be handled too much. My girlfriend suspected that Jill had a bladder stone, and indeed, we could see a bladder stone on her ultrasound scan (you can see it in the video).

Bladder stones do occur in humans, more commonly when we are dehydrated, or if a stone migrates down into the bladder from the kidney. Bladder stones can also form if the bladder does not empty very well, something that happens in older men, as their prostate enlarges. Bladder stones can cause low back pain. Low back pain has many different causes, of which this is only one, and is probably the most common reason for patients to consult a chiropractor. Low back pain that has a mechanical origin will often respond well to physical treatments. Back pain that is caused by a bladder stone is likely to be persistent, however.

In this video there are a couple of tips that you might find helpful in preventing bladder stones from forming. ‘Point of care ultrasound scanning’ (POCUS) is really helpful in picking up this type of condition.

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