Making waves using ultrasound in daily practice

According to Mariana Pardo, BVSc, MV, DACVECC, it’s a recurring theme in history that people are reluctant to implement new technology in medicine because they find it cumbersome. She started her main presentation¹ on the final day of the Fetch dvm360® conference in San Diego, California, quoting John Forbes in the 1800s and his thoughts on the stethoscope at the time: “Whether it will ever be generalized, despite its value, is extremely doubtful ; because its beneficial application requires a lot of time and gives a lot of trouble to the patient as well as to the practitioner. Today, the stethoscope is universally used for every visit in human and veterinary medicine, and Pardo aims to make it the same with ultrasound.

Therefore, she described the basics and practical skills to incorporate point-of-care ultrasound into daily practice to enhance patient care. “There is so much information you can get from everyday ultrasound use and it may seem like it takes a lot of knowledge, but I’ll try to simplify it for you and show you how much information you can garnishing it will just become complementary to what we do,” Pardo said.

Know your potentiometer

Select the right ultrasound probe

Pardo recommended to first choose the appropriate ultrasonic probe depending on the application:

• Linearapplications: soft tissue, musculoskeletal, pediatric, ocular, thyroid, thoracic, most procedures, DVT, appendicitis, testicular
  • Features include: high frequency transducer, best resolution of any probe, shallow structures and rectangular field
• curvilinear: applications for general abdomen (ig, gallbladder, liver, etc.), eFAST, renal, aorta, IVC, bladder, intestine, OB/Gyn
  • Features include: low frequency transducer, large/wide footprint (better lateral resolution), curved field, deep structures
• Phased network (also called “cardiac probe”): cardiac, abdominal, eFAST, renal, bladder, intestinal, IVC applications
  • Features include: low frequency transducer, small and flat footprint (easier to pass between ribs) and deep structures

Steps when performing ultrasounds

There are 4 main movements when performing ultrasound including sliding, tilting, rotating or rocking back and forth.

“Start getting used to using your hands with ultrasound, practice on every patient. If you don’t recognize normal structures, how are you going to recognize a patient that’s not well? So honestly for me, my ultrasound exam is part of my complete physical examination.

The steps in the process include:

• Step 1: After turning on the ultrasound device, select the ultrasound transducer you will need.
• 2nd step: Select the correct application preset for this transducer.
• Step 3: Adjust the depth, i.e. the depth at which you want to be able to scan. The right side of the screen will have dots or lines that correspond to the depth in centimeters.
• Step 4: Adjust your gain, i.e. how bright or dark the image is. This increases or decreases the strength of the returning ultrasound signals you see on the screen.

“You want to try to have the place of interest you’re looking at in the center of the screen,” Pardo advised. “Once you get that image where you want it, you’re going to keep that depth at that point and normally you can just scroll up and down and it’s going to show you measurements of how deep you are.”

Take away food

To conclude, Pardo summarized that using ultrasound at the point of care requires an understanding of it and how to use all the buttons and settings. Not to mention practice makes perfect when it comes to identifying normal versus abnormal structures to provide patients with the highest quality care.

Reference

Pardo Mr. Hocus Pocus! Integrate ultrasound into your daily practice. Presented at: Fetch dvm360® Conference; San Diego, California. December 2-4, 2022.