Free EM Ultrasound

This is a free u/s "course."  It is a guide to help you navigate through available electronic resources in order to teach yourself not only how to ultrasound in the ED, but also why you ultrasound in the ED.
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The second goal of this course, is to have it continually evolve and improve.  I am not an expert in ultrasound, and I can't possibly be aware of every free or inexpensive electronic resource available.  Therefore, I am asking for your help.  Do you know of a good app, link, video series, or other resource that we could all benefit from?  If so, please post your contributions in the comments section.  Any feedback is appreciated.
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The information below is meant to be the passive section of the "course."  Ultrasound is a hand-on activity, and so the active part of the "course" is on you to get in the ED and practice.  If you feel like you need to do some background reading, try out http://www.sonoguide.com/.  It’s pretty much a free text book with good pictures and some short clips written by Beatrice Hoffman, MD who is part of the ACEP u/s section.

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Each lesson is meant to be about 1 to 2 hours.  Additional resources are posted if you want even more studying materials.
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HOW TO GET STARTED: Collect your tools: this is designed to be as free as possible.  Some of your institutions have subscriptions to the paid services and if they don’t, there’s no harm in asking.

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I. Websites:  First things first, go to your internet browser and create a folder in your bookmarks called “ultrasound.”  You will use this folder to bookmark every pertinent website you need for the course.

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II. Passwords: Do you save your passwords in a file somewhere?  I’m not talking about your bank account passwords, but you not-so-important passwords should be kept in a .docx file.  If you don’t already have a virtual flash-drive service, create a DropBox account (www.dropbox.com).  This will allow you to save your passwords file in a virtual-flash drive in which you will be able to access the file anywhere on any of your devices.  Download it on all your devices – now!

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III. Sign up for these sites:

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FREE:

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1. www.academiclifeinem.blogspot.com ; join the site. Bookmark it.

2. www.vimeo.com ; go to the “Explore” toggle in the header menu.  Pull down to “Groups.” Go to search box and put in “ultrasound.” Join the “ultrasound in emergency medicine & critical care” group. Bookmark it.

3.  http://www.emsono.com/acep/exam.html ; bookmark it

4. http://www.slredultrasound.com/index.html ; bookmark it

5. http://www.sonoguide.com/introduction.html; bookmark it

6. http://freeemergencytalks.net/wp-login.php?action=register ; register

7. http://www.sonoguide.com/ ; bookmark it

8. http://www.hqmeded.com/allus?page=1 ; bookmark it

9. https://cmedownload.com/ ; type in ultrasound in the search bar and create a bookmark for that page and save it in your “ultrasound” folder.  There are a bunch of free videos, but signing up for the site gives you access to a whole course.  It’s expensive though.

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NOT FREE:

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1.  www.emrap.org ; your program should have a subscription to this through EMRA (www.emra.org) .  If they don’t, you have to ask them.  This is essential for EM learning.

2. www.uscessentials.com ; ask your program to get this too.  These lectures are awesome.  Same people as the emrap people.

3.  www.emcorecontent.com ; bookmark it

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IV: Get these apps on your phone and/or tablet. 

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FREE:

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1. Medscape

2. SonoAccess (or you can download most of these videos as free podcasts)

3. Geniuscan – for taking pix of the u/s screen

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NOT FREE:

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1. Emergency Medicine Ultrasound – by EM Apps, LLC and written by the Yale folks; ~ $5. 

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V: Subscribe to the iTunes U files:

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1. “UCIMC Ultrasound Education,” by J. Christian Fox, MD and company @ UC - Irvine: http://itunes.apple.com/us/itunes-u/ucimc-ultrasound-education/id452550953

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LESSON 1: BASIC CARDIAC U/S

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STEP 1.PRETEST:  http://www.emsono.com/acep/ACEP_EUS_Exam.html ; take the 10 question cardiac quiz as a pre-test to see where your current level of knowledge is and how much you think you need to study.

STEP 2. Get set up: While watching lectures, it’s easy to get lost and not understand what you’re looking at on the screen.  I found it helpful to keep the EM Ultrasound app open for reference.  Open up http://www.slredultrasound.com/ImageBank/Cardiac.html for great pictures of 3 of the 4 cardiac views.  You’ll also need your SonoAccess app and your iTunes U subscription to “UCIMC Ultrasound.”  This lesson will take approximately 2 hours total. 

STEP 3. Learn HOW and WHY you do the ultrasound exam

1. Use the SonoAccess app.  Go to the “Coach” toggle on bottom of app.  Take a look at the 3 quick instructional videos on how to do the focused cardiac exam called “Scanning Techniques – Focused Echo: Parasternal Long View,” and  “Apical View,” and “Subcostal View.”  These are quick videos to get you oriented.  Fastforward through the intro (first 20 seconds of each video).

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2.  Go to iTunes U and find your “UCIMC Ultrasound Education,” subscription.  Use the “Cardiac Ultrasound,” lecture by Dr. Fox @ UC – Irvine.  Fast forward to 4:52  seconds and watch the whole thing to 41:28 [~36 mins total].  If you do nothing else, WATCH THIS VIDEO! It’s a good intro to the EM cardiac u/s exam w/ practical tips.  Pretty good lecturer; very practical.  Great pictures/videos. Good review of some of the basics of cardiac EM pathology.   Great discussion about kinesis.

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3.  Go to the SonoAccess app.  Click on the “Cases” toggle on bottom of app.  Watch the 4 videos “Parasternal Long Axis, Part 1,” “Parasternal Long Axis, Part 2,” “Subxiphoid View,” and “Parasternal Short.”  5-min videos (skip the first 15 secs of each).   This is a nice way of going back to how to do the 4 views and they do a lot of labeling of the relevant anatomy on the ultrasound images.

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4. Go to iTunes U and find your “UCIMC Ultrasound Education,” subscription. Watch the first 13:55 mins of “Cardiovascular Ultrasound.”  It’s a f/u lecture by Fox again.  Plays a game if the heart needs fluids vs. inotropes (discussion of kinesis).

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STEP 4: NOW GO GET YOUR HANDS DIRTY - I've found the app called Emergency Medicine Ultrasound – by EM Apps, LLC, to be very helpful to have available when scanning in the department.

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OTHER FREE RESOURCES IF YOU WANT TO LEARN MORE ABOUT BASIC CARDIAC U/S:

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1.http://www.emcorecontent.com/index.php?option=com_content&view=article&id=9695:AllLAConference_20100902_Cardiac_Ultrasound_Pardita ; 35 mins

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2. iTunes UCIMC Ultrasound Education, “Ultrasound – Pericardial Effusions and Tamponade.”

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3. Go to http://vimeo.com/groups/ultrasound/videos/16908494 and watch the 5 min video by Rob Reardon, MD at Hennepin for discussion of cardiac u/s in PE.

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4. Some other cases by Dr. Reardon: http://vimeo.com/groups/ultrasound/videos/16646777 ; http://vimeo.com/groups/ultrasound/videos/16646666 ; http://vimeo.com/groups/ultrasound/videos/16258315 .

5. http://www.hqmeded.com/node/13 - an introductory lecture on echo from Hennepin
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6. http://www.erpocketbooks.com/er-ultrasounds/cardiac-echo-for-the-ed/ ; a text and picture based HOW to do ED ultrasounds

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Lesson 2: AORTA

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STEP 1.PRETEST:  http://www.emsono.com/acep/ACEP_EUS_Exam.html ; take the 10 question aorta quiz as a pre-test to see where your current level of knowledge is and how much you think you need to study.

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STEP 2. Get set up: It’s good to have some static labeled pictures to reference if you ever get lost during a lecture.  Open up http://www.slredultrasound.com/ImageBank/Aorta.html. You’ll also need your SonoAccess app and your iTunes U subscription to “UCIMC Ultrasound.”  This lesson will take approximately 1 hour. 

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STEP 3. Learn HOW and WHY you do the ultrasound exam

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1. Use the SonoAccess app.  Go to the “Coach” toggle on bottom of app.  Take a look at the 2 quick instructional videos on how to do the aortic exam called “Techniques – Abdominal Aorta,” and “Technique – Abdominal Aorta Measurements.” These are quick videos to get you oriented.  Fastforward through the intro (first 20 seconds of each video).

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2.  Go to iTunes U and find your “UCIMC Ultrasound Education,” subscription.  Go to “Abdominal Aorta, Vena Cava, and DVT.”  Watch from 17:55 to 39:40.

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3. Again on UCIMC Ultrasound Education and use the “10 Ultrasounds everyone should know,” lecture by Dr. Fox @ UC – Irvine.  Watch from the 11:28 to 13:28.  This whole video is pretty awesome; but AAA is reviewed here.

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4.  Go to the SonoAccess app.  Click on the “Cases” toggle on bottom of app.  Watch the 2 videos “Aorta Ultrasound – Introduction (Part 1)” and “Aorta Ultrasound – Aneurysms.” 

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STEP 4: GO GET YOUR HANDS DIRTY AND SCAN

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OTHER FREE RESOURCES IF YOU WANT TO LEARN MORE ABOUT BASIC AORTIC U/S:

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1. http://freeemergencytalks.net/wp-content/uploads/2010/04/Stephen-Gletsu-Aortic-Ultrasound.mp3 - from 2011 Mediterranean conference in Greece; listen to this on your way to work.

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2. Also on freeemergencytalks.net: Stephen Gletsu (Saudi Arabia): Ultrasound in Chest Pain - Focus on Aortic Syndromes.

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3. And again from freeemergencytalks.net: Tom Costantino: AAA and SAFE ICU Ultrasound

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4. http://www.hqmeded.com/node/18 ; intro AAA exam video from Hennepin

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5. http://www.erpocketbooks.com/er-ultrasounds/aortic-ed-ultrasounds/ ; a text and picture based HOW to do ED ultrasounds
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LESSON 3: GALLBLADDER/RUQ

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STEP 1.PRETEST:  http://www.emsono.com/acep/ACEP_EUS_Exam.html ; take the 10 question biliary quiz as a pre-test to see where your current level of knowledge is and how much you think you need to study.

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STEP 2. Get set up: You’ll need your SonoAccess app and your iTunes U subscription to “UCIMC Ultrasound.” Open up your Vimeo account.  Sign on to USC Essentials if you have an account.  This lesson will take approximately 1.5 - 2 hours. 

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STEP 3. Learn HOW and WHY you do the ultrasound exam

1. Use the SonoAccess app.  Go to the “Coach” toggle on bottom of app.  Take a look at the 3 quick instructional videos on how to do biliary/RUQ views called “Techniques –GB Exam,” and “Technique – CBD Measurements,” and “Techniques – FAST – RUQ.”  These are quick videos to get you oriented.  Fastforward through the intro (first 20 seconds of each video).

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2.  Sign on to USC essentials and find the lecture “Belly Badness Part 1 of 2.” [NOTE: This is NOT free – but I recommend it!].  It’s a lecture given by Tarlan Hedayati from USC in 2008 and runs 16:15 (skip the first 1:30).  It’s a succinct, well done talk that goes through WHY we use u/s for RUQ pain.

2a. If you can’t get onto USC essentials due to cost, take a look at http://academiclifeinem.blogspot.com/2011/03/paucis-verbis-strength-of-diagnostic.html.  This is Michelle Lin’s blog from UCSF.  It succinctly makes many of the same points that the Hedayati lecture does – but no video.

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3.  3.  Go to the SonoAccess app.  Click on the “Cases” toggle on bottom of app.  Watch the 4 videos “Gallbladder Ultrasound – Introduction (PART 1),” “Gallbladder Ultrasound – Gallstone (PART 2)“ and “Gallbladder Ultrasound – Acute Cholecystitis (PART 3),” “FAST RUQ – Normal,” and “FAST RUQ – Hemorrhage.”  About 5 – 10 mins per video.  Skip the first 20 secs of each.   Given by the u/s director at Columbia Presby, Phil Perrera, MD.

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4.  Go to iTunes U and find your “UCIMC Ultrasound Education,” subscription.  Open the “Abdomnial and Renal Ultrasound,” lecture by Dr. Fox @ UC – Irvine.  Watch from 33:20 to 39:30.  Quick review of what you’ve already learned given by a very good lecturer. 

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5. Go to http://vimeo.com/groups/ultrasound/videos/16450783 to watch a case presented by Scott Joing, MD at Hennepin.  Quickly reviews some abdominal aorta images and GB.

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STEP 4: GET INTO YOUR ED AND SCAN

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OTHER FREE RESOURCES IF YOU WANT TO LEARN MORE ABOUT BASIC GB/RUQ U/S:

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1. http://www.hqmeded.com/node/19 ; intro video by Hennepin
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2. http://www.erpocketbooks.com/er-ultrasounds/right-upper-quadrant-ruq-ultrasounds/; text and pictures on HOW to do ED u/s
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LESSON 4: KIDNEY/URETER/BLADDER
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STEP 1.PRETEST:  http://www.emsono.com/acep/ACEP_EUS_Exam.html  ; take the 10 question GU/Scrotal quiz as a pre-test to see where your current level of knowledge is and how much you think you need to study.
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STEP 2. Get set up: You’ll need your SonoAccess app and your iTunes U subscription to “UCIMC Ultrasound.” Open up your Vimeo account.  Sign on to USC Essentials if you have an account.  This lesson will take approximately 1.5 - 2 hours. 
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STEP 3. Learn HOW and WHY you do the ultrasound exam
1. Use the SonoAccess app.  Go to the “Coach” toggle on bottom of app.  Take a look at the 6 quick instructional videos on how to do Kidney/GU views called “Scanning Techniques – Kidney,” “Scanning Technique FAST Exam: LUQ,” “Scanning Technique FAST – Male Pelvis,” “Scanning Technique FAST: Female Pelvis,” and “Scanning Technique, Female Pelvis: Transabdominal.”  These are quick videos to get you oriented.  Fastforward through the intro (first 20 seconds of each video).
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2. 4a. Go to iTunes U and find your “UCIMC Ultrasound Education,” subscription.  Open the “Abdomnial and Renal Ultrasound,” (also called “GI GU)” lecture by Dr. Fox @ UC – Irvine.  Watch the first 13:45.  A very good lecturer speaking to medical students.   
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3.  Go to the SonoAccess app.  Click on the “Cases” toggle on bottom of app.  Watch the 3 videos “FAST Exam – Suprapubic Views,” “Renal Ultrasound – Hydronephrosis,” “Trauma FAST Exam – LUQ Exam,”   About 5 – 10 mins per video.  Skip the first 20 secs of each.   Given by the u/s director at Columbia Presby, Phil Perrera, MD.
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4: “Kidney and Bladder,” episode.  Start at 15 mins and watch to the end (32:21) to learn about bladder u/s.  This lecture is for medical students, but it’s a nice review of anatomy and does a great job of correlating u/s images to anatomy.  Also speaks about suprapubic bladder catheterization.
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STEP 4: GET INTO YOUR ED AND SCAN
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OTHER FREE RESOURCES IF YOU WANT TO LEARN MORE ABOUT BASIC KIDNEY/BLADDER U/S:
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1. SonoAccess app.  Go to the “Coach” toggle on bottom of app and watch “3D Animation: eFAST LUQ.” And “3D Animation: eFAST Pelvis.”

2. iTunes U, “UCIMC Ultrasound Education,” subscription.  “Bladder Ultrasound,” is a repeat of what you learned above, but in a different format and not directed entirely toward medical students.  I think Dr. Fox is a better lecturer when he’s in front of crowd than when narrating a tutorial.  Most are (including myself!).
3.  Reading: http://www.sonoguide.com/renal.html  

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LESSON 5: REVIEW FOR LESSON  1 – 4

https://www.essentialsofem.com/account/course/essentials/2007/lecture/advanced1