FUSIC Links & FAQs

Physics and instrumentation

• Properties of sound waves: amplitude, frequency, wavelength, propagation velocity
• Ultrasound in the body:
  • Propagation velocity in different media
  • Frequency and attenuation
  • Sound and interfaces – transmission, reflection (specular, scatter), refraction, acoustic impedance
  • Biological effects – heat generation and safety
• Sound generation:
  • Piezo-electric effect
  • Basic transducer design
  • Types of transducers
  • B mode and M mode
• Image quality
  • Frame rate, temporal resolution, spatial resolution, axial resolution, lateral resolution and how these relate to frequency, depth and width
  • Gain
  • Focus points
  • Artefacts and their generation
• Doppler
  • Colour, Power, Spectral (PW, CW)
• Ultrasound systems
  • Basic components and controls
  • ECG
• Descriptive terms
  • Hyperechoic, hypoechoic and anechoic and how they relate to structures
  • Sonographic appearance of tissues, muscle, blood vessels, nerves, bone, tendons etc

Ultrasound techniques

• Patient information and preparation
• Indications and limitations of focused examinations
• Relevance of other imaging modalities to ultrasound
• Influence of ultrasound results on the need for other imaging
• Selection of appropriate transducer and exam type
• Use of conductive gel
• Correct probe placement and orientation for standard views • Correct adjustment of ultrasound controls (depth, gain, width and focus)
• Probe manipulation and nomenclature – e.g. pressure, sliding, fanning, rocking, rotating
• Scanning techniques – 2D, M-mode, and colour Doppler
• Identification of relevant anatomy
• Identification of common artefacts

Administration and governance

• Image recording, reporting and storage
• Indications for immediate expert assistance, subsequent comprehensive scan by accredited practitioner or need for alternative investigation
• Medico-legal aspects – outlining the responsibility to practice within specific levels of competence and the requirements for training
• Need to quality assure reports
• Relevance of data protection act to image storage
• Consent
• Understanding sterility, infection control and machine cleaning
• The value and role of departmental protocols
• The resource implications of ultrasound use

Knowledge

• Indications and limitations of focused echo
• Relationship between conduct of peri-arrest echo and the ALS algorithm
• Format of standard echo report

Performance of systematic examination of the heart

• Scanning the heart from the PLAX, PSAX, A4C and subcostal windows

Recognition of normal anatomy

• Pericardium, walls, chambers, valves, great vessels, lung, ribs, sternum

Recognition of pathology including:

• LV dilatation – end diastolic internal diameter >6.5cm
• RV dilatation – RV area >2/3 the size of the LV
• Ventricular dysfunction – reduction in wall thickening and motion, TAPSE, MAPSE
• Regional wall motion abnormalities – regional reduction in wall motion and thickening
• RV dilatation, D shaped septum, paradoxical septal motion
• Features of low venous return (vasodilatation, hypovolaemia) – small, collapsing IVC, small, hyperdynamic LV and RV, papillary apposition in systole
• Pericardial collection – distinguish from pleural collection •
• Pleural collection – distinguish from pericardial collection

Clinical integration and conclusions:

• Is the left ventricle significantly dilated or impaired?
• Is the right ventricle significantly dilated or impaired?
• Are there features of low venous return?
• Is there a pericardial effusion?
• Is there a pleural effusion?

Performance of systematic examination of lung and pleura

• Scanning each lung in 3 zones (upper, lower and postero-lateral regions

Recognition of normal thoracic structures and adjacent organs

• Ribs, subcutaneous tissues, pleura and diaphragm
• Heart, liver, spleen and kidneys

Identification of ultrasound appearances of normal aerated lung including:

• Diaphragmatic movement
• Pleural line and sliding sign (in 2D and M mode)
• Normal aerated lung (including A-line and B line artefacts)

Recognition of pleural fluid

• Ultrasound appearances of pleural fluid and pleural thickeninG
• Appearances suggesting transudate, exudate and loculation
• Assessment of size of effusion
• Distinguishing between pleural thickening and effusion
• Demonstration of sinusoid sign on M mode
• Distinguishing between pleural and abdominal fluid collection

Recognition of consolidation/atelectasis

• Ultrasound appearances of consolidated/atelectatic lung
• Ultrasound appearances of air and fluid bronchograms

Recognition of interstitial syndrome

• Differentiating between normal and pathological B-lines

Use of ultrasound to exclude pneumothorax

• Recognition of signs of pneumothorax (B mode and M mode)
• Absence of lung sliding, B lines and lung pulse
• Presence of lung point

Doctors (or AHPs for whom this is part of their practice) –Performance of ultrasound guided thoracocentesis and knowledge of the pros and cons of direct vs indirect approach

Allied Healthcare Professionals (when this is not part of their practice) – Description of ultrasound guided thoracocentesis

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