Serge Chalhoub BSc, DVM, DACVIM (SAIM)
Course Open: March 25-April 30, 2021
Real Time Sessions (RTS): Thursdays, April 1, 8, 15, and 22, 2021; 8:00-10:00 pm ET (USA) World Clock Converter
Total CE Credit: 7
RACE Category: 7 hours Medical Skip to Enrollment Course Information:
This course will cover the key concepts regarding point of care ultrasound (POCUS). POCUS techniques are rapid, easy-to-learn and practical ultrasound skills that ANY practitioner can apply in everyday practice. This co-lecture series by a criticalist and an internist will cover the core principles to understand and interpret sonographic findings of abdominal POCUS including the identification of free fluid, urine production, GI motility, free abdominal air and the gall bladder halo sign. The core principles to understand and interpret sonographic findings of the pleural space and lung. The principles of cardiac anatomy with an emphasis on the key cardiac windows to assess (there are 3 that answer most clinically relevant questions), being able to confidently identify pericardial effusion, cardiac volume status, pulmonary hypertension, and how to differentiate these conditions from common cardiomyopathies will be presented. All clinically relevant questions when asked at the right time, in a binary fashion, based on patient assessment! Covering all things that can be used by general practitioners in everyday practice. If you own an ultrasound machine, there is no excuse to not apply these principles on a daily basis! Learning Objectives:
Upon completion of the course, the participant should be able to
- describe the origins and evolution POCUS.
- describe the key formats that currently comprise POCUS.
- describe when and where POCUS is used in the clinical setting: understanding the 5 T’s of POCUS.
- discuss patient positioning for POCUS and how POCUS differs from consultative ultrasound.
- discuss the value of using clinically relevant binary questions to learn and build POCUS skills.
- perform the abdominal point of care ultrasound.
- describe the key organs and anatomic locations required to perform abdominal point of care ultrasound.
- discuss pitfalls that may result in false negative or false positive abdominal POCUS results.
- describe the formula used to calculate urinary bladder volumes.
- describe the 3 key findings used to diagnose free abdominal air (pneumoperitoneum).
- describe the technique used to sonographically identify post-operative ileus.
- explain the advantages of using both long and short axis window vs. just one window when performing abdominal POCUS.
- describe how the renal pelvis can be assessed to help rule in or rule out ureteral obstruction in patient that presents with azotemia and signs of uremia.
- describe the key anatomic structures that are essential to performing pleural space and lung ultrasound.
- identify the pleural line and determine the presence or absence of a lung sliding (aka the glide sign).
- explain the normal findings of the bat sign, gator sign, A lines, B lines, lung pulse and curtain sign.
- discuss the advantages of using a binary approach to identifying pathology with point of care ultrasound.
- explain the limitations of pleural space and lung point of care ultrasound.
- explain why ultrasound protocols should be modified based on patient positioning and the pathology suspected.
- explain recent modifications to point of care pleural space ultrasound techniques designed to maximize diagnostic accuracy of pneumothorax.
- describe newer approaches to pleural space ultrasound designed to maximize diagnostic sensitivity for pleural effusion.
- explain the advantage of turning the probe parallel to the ribs vs. keeping it perpendicular to the ribs.
- explain the sail sign and ski slope sign in relation to positive and negative findings of pleural effusion.
- describe how to find lung borders to maximize the chances of finding pleural space pathology based on patient positioning.
- explain the difference and be able to identify wet lung vs dry lung using ultrasound.
- describe the pathophysiology of why lung consolidation can be seen with POCUS.
- describe how pleural irregularities can help differentiate causes of wet lung.
- explain how to differentiate partial lung consolidation from trans-lobar consolidation.
- describe the most common types of consolidation and how to differentiate them: shred, trans-lobar hepatization, nodule and thromboembolism.
- explain how the sonographic characteristics of lung consolidation can be interpreted to help differentiate simple atelectasis from pathologic consolidation (static vs. dynamic air bronchograms and fluid bronchograms).
- describe the 3 key cardiac windows when performing cardiac POCUS.
- describe how the left atrial aortic ratio is used in point of care ultrasound.
- describe echocardiographic variables that are used to assess hyper and hypovolemia.
- describe windows used to identify pericardial effusion.
- explain how the pericardial-diaphragmatic window can be used to help differentiate pericardial from pleural effusion.
- explain how left sided and right sided heart conditions, including pulmonary hypertension can be subjectively assessed with cardiac POCUS.
- describe where to assess fluid responsiveness using POCUS.
- explain how the caudal vena cava is used to estimate intravascular volume status.
- describe the difference between in plane and out of plane ultrasound guided vascular access.
- tie together cardiac POCUS, lung ultrasound, and vascular POCUS to estimate and differentiate hypovolemia from volume overload.
RACE Accreditation: This course has been submitted (but not yet approved) for 7 hours of continuing education credit for veterinarians in jurisdictions which recognize RACE approval. Course Agenda: Week 1 (Real Time Session April 1, 2021): Ultrasound definitions, evolution, and the binary approach to learning!
Please note this session is only 1 hour long: 8:00-9:00 pm ET. All other sessions will be 2 hours long: 8:00-10:00 pm ET. This first session will cover POCUS techniques including common definitions and evolution of the field, how POCUS differs from consultative ultrasound exams, the key formats currently used, when and where POCUS should be applied, patient positioning, coupling agents, and the value of using clinically relevant binary questions. Week 2 (Real Time Session April 8, 2021): Abdominal Ultrasound
Ever wonder if the cat that ate lilies is producing urine when it's not possible to pass a urinary catheter? Ever wonder if the dog with an acute abdomen has free abdominal air in the abdomen, or if the post-operative patient that is not eating has ileus? Using a binary approach to ask the right question at the right time makes learning and applying abdominal point of care ultrasound easy! Week 3 (Real Time Session April 15, 2021): Pleural Space and Lung Ultrasound
Ever struggle with determining the cause of dyspnea in a cat that is too unstable to take radiographs or draw blood for ProBNP levels (cardiac, respiratory, pleural effusion)? Ever debate if you should discontinue IV fluids in the patient with mild tachypnea? Have you ever felt frustration at not finding a cause for patients presenting for “ain’t doing right” with no specific clinical signs? Veterinary point of care ultrasound (POCUS) can help you manage these patients! Following a binary approach, the key principles of the bat sign, gator sign, glide sign, A lines, B lines, lung pulse, and curtain sign, dry lung and wet lung will all be covered. Recent veterinary studies have demonstrated the agreement between some veterinary thoracic and lung ultrasound protocols and CT scans are less than ideal when it comes to diagnosing pleural effusion and pneumothorax, and to some extent, lung pathology. This should not be the case! This session will focus on a practical approach to point of care ultrasound that considers clinical findings and challenges current protocols by asking the question; “where will pathology accumulate” and subsequently, “what should we be sonographically looking for to answer binary, relevant, rapid, clinical, and often lifesaving questions”. Don’t simply put the probe on the patient or expect a “one protocol fits all” approach to be applicable to all situations; ask the right question and know how to modify protocols to increase the chance of success with pleural space and lung pathology! Lung ultrasound has significantly evolved over the past two decades and knowing how the identification of artifact at the surface of aerated lung can progress to consolidated lung when the ratio of aerated to non-aerated lung falls below 5-10% is key to identifying lung pathology beyond simple wet lung. Lung consolidation is not difficult to identify and knowing how consolidations differ with regards to their borders and the characteristics seen within lung consolidations, along with history and other clinical findings allows the differential diagnosis to be narrowed. Week 4 (Real Time Session April 22, 2021): Cardiac and Vascular Ultrasound
Ever struggle with deciding if the dyspneic cat or dog should receive furosemide for possible congestive heart failure or wonder if maybe steroid administration for feline asthma would be more appropriate? What about differentiating pericardial effusion from dilated cardiomyopathy on thoracic radiographs, or trying to decide if that fluid seen on ultrasound is pleural or pericardial? What about differentiating pseudohypertrophy and hypovolemia from hypertrophic cardiomyopathy in the cat? This session will build on each prior lecture and continue the binary approach to answering clinically relevant and appropriate questions to ask. The best part of POCUS is that you do not have to be a cardiologist or radiologist to perform these techniques! A patient presents collapsed, it has poor pulses and a prolonged capillary refill time – it is in cardiovascular shock! (The internist runs away). Should an IV fluid bolus be given, and if so, how much and how will the patient likely respond to IV fluid therapy (The criticalist is super excited)? Where and how can you look at the vascular system to estimate intravenous volume status and fluid responsiveness? What is a flat vs. fat vena cava tell you? One last question: have you ever struggled to place an IV catheter in a patient that is dehydrated, has hematomas, thick skin or edema? You guessed it, ultrasound can help, and we will show you how! Successful completion (scoring 80% or better) on the end-of-course test is required to earn a certificate of completion for the course. To learn more about the requirements for earning a CE certificate, please refer to Receiving Your CE Credit and Course Completion Certificate. Course Materials: Course materials will be available in the course library prior to each Real Time Session.
Required Textbook(s): There is no required textbook for this course.
Tuition: Member $161 ($145 early bird special if enrolled by March 11, 2021)
Non-Member $263 ($237 early bird special if enrolled by March 11, 2021)
Prices are listed in US dollars. *To ensure participants are ready and prepared for classes, enrollment will close on April 1, 2021 at 5 pm ET (USA) or when the maximum number of participants is reached. *For more information on how online CE works, see the Participant Resource Center.
- Enrollment qualifications: VIN CE courses are open to VIN member and non-member veterinarians. Veterinarians enrolling in a VSPN CE course must be a VIN member. Veterinary support staff must be a VSPN member to enroll in a VSPN CE or a VIN CE course open to VSPN member enrollment.
- Each enrollee must be able to receive emails from @vspn.org and @vin.com addresses. Email is our major form of communication with participants; personal emails are highly recommended rather than clinic/hospital email addresses.
- For further assistance call 800-846-0028 ext. 797 or email CEonVIN. Please include the course title, your full name, and contact information in your correspondence.
VIN Education Director VIN CE Services: CEonVIN
800-846-0028 or 530-756-4881; ext. 797
or direct line to VIN/VSPN from the United Kingdom: 01 45 222 6154
or direct line to VIN/VSPN from Australia: 02 6145 2357