SCGH ED ultrasound service

1. James Wheeler

2. The Team
4 ED Consultants with DDU:
Diploma of Diagnostic Ultrasound (General) – 2 yrs supervised scanning, Primary and Secondary exams
Can write formal reports – can bill medicare for their imaging!!!! (but we don’t)
○ Rippey
○ Hay
○ Wheeler
○ Gawthrope
1 US Fellow
Currently undergoing DDU training
○ Phillips
1 US Registrar
○ Anu Mascarenhas……..?You
Currently trying to complete ED requirements for ACEM competency in: EFAST / AAA scanning
Practicing the art of:
○ Procedural ultrasound
○ Basic bedside diagnostic sonography
As in all facets of medicine we are all still constantly learning and have different experience levels in
different facets of sonography

3. The Service
A dedicated US competent ED Physician +/-
fellow +/- reg rostered for ED sonography:
0800-1800 Mon-Fri
A limited service may be available afterhours
dependent on our rostering and the
departmental load
This is a very unique service in Australia /
Internationally

4. Why have we chosen to do
EDUS?
We are impatient!
We really believe it assists in timely and
appropriate patient management

5. How do we use US!
As a formal investigative imaging test
ie. full abdomino-pelvic ultrasound
As an extension of our bedside physical
examination to answer specific clinical
questions to assist in Dx / Mx and disposition
of our patients:
ie. Focused ultrasound study for Ix of Sepsis / SOB
To safely and quickly guide bedside
procedures

6. ED Sonography – What we do!
Full protocol diagnostic sonography
Renal Tract
Hepatobilary
Gynaecological / Pelvic
Early Pregnancy
DVT
Achilles
Ocular
Neck masses / Soft tissue masses – to the limit of our experience
Focused (bedside) diagnostic sonography:
EFAST
AAA
SHOCK / SOB / SEPSIS Assessement
Echocardiography
○ PE / AMI / Arrest / Effusion / Tamponade
Lung Ultrasound
○ PTX / Effussion / HTX / Pneumonia / Collapse / Oedema
?Superficial Abscess
Anything we think appropriate
Procedural
CVC / IVC / PICC insertion
FNB / FNC
Pericardiocentesis / Paracentesis / Thoracocentesis
Abscess I & D
FB removal
…….

7. ED Sonography – What we DON’T
do!
Full protocol diagnostic scans in some specialty areas or outside of our
personal experience ie:
Musculoskeletal
○ apart from Achilles
○ Often need private referral – only one sonographer at SCGH that does this
Vascular Studies:
○ Carotids / ABI’s / Flow studies
Transplants
○ Renal / Liver
Morphological 2nd & 3rd Trimester Pregnancy Scans
US studies that are not the correct imaging study for that patient!
US studies that will not affect the ED Mx of the patient - when there are
other demands on our time!

8. What are the advantages of
using ED sonographers?
You know us!
We are nice people!
We are usually easily accessible & can give you timely
answers!
We are clinicains
We will usually re-examine patient and Hx
We will form our own DDx & tailor our US study to answer both our Q’s
We are happy to assist with:
○ patient management (including procedures)
○ liasing with inpatient specialties / radiology / other hospitals
We are keen to teach bedside ultrasound and basic anatomy

9. What we need from you!
Appropriate patient assessment & consultation:
Hx, Ex, Ix (both recent and any old relevant studies)
An appropriate clinical question/s based on that assessment
Not: I want an US.
Not: I want an US to find the cause for this patients pain.
But: I want an US to rule out / in…. or differentiate….
Appropriate preparation of the patient (as far as possible)
Analgesia (to allow probing!)
Bladder volume (fullish - pelvic & renal tract scans)
Fasting (Abdo scans)
Inform patient / nursing staff
○ TV scans for ovaries & early pregnancy
○ What examining for…
If performing bedside ultrasound and not credentialed – please inform
patient and nursing staff that this is a training study (we are happy to
review and formalise the study)

10. What we want from you!
Interest in learning US:
Vascular access
EFAST
AAA scanning

11. Feedback?