Hello Sono

I am excited to have my case report on the benefits and best practices of using #pocus to evaluate patients with possible deep venous thrombosis (#dvt) in #urgentcare published in Urgent Caring, the official publication of the College of Urgent Care Medicine (CUCM). Go to page 12 of the September publication linked below. Check out Hello Sono latest blogpost summarizing this case report and featuring a sample evidence-based clinical pathway that incorporates POCUS in the evaluation of a patient with a possible DVT. Here are key TAKEAWAYS: 1.       Risk stratify your patients using Well’s criteria to guide your next steps. 2.       High-sensitive D-dimer are often not available or have a long turn-around times in urgent care; while POCUS takes 2 minutes! 3.       POCUS allows for early diagnosis and treatment of a potentially life-threatening condition. And the best part, the provider can make this decision fully armed with evidence! 4.       There is a learning curve to vascular POCUS and completion of a training program is essential. 5.       Average ED visit is $2K, cost of POCUS is around $120. Do the math! Not only are you practicing better medicine, but you are also generating revenue AND saving healthcare costs. Feel free to share with others and leave comments! #pocus #ultrasound #meded #patientexperience #dvt #urgentcare #patientcare #bedsideultrsound Urgent Caring - September 2024 Publication: https://lnkd.in/eTsZFj4H https://lnkd.in/es-PUwZt

POCUS is essential in improving efficiency and diagnostic accuracy for patients with possible lower extremity DVT (deep venous thrombosis or clot). This is a serious diagnosis that, if not treated, could lead to pulmonary embolism (clot in lungs) and high morbidity and mortality. On the other hand, prophylactically treating patients with blood thinners while awaiting imaging puts them under unnecessary risk of bleeding that could also have devastating outcomes. If you (#urgentcare, #primarycare, #emergencymedicine, #hospital providers) are lucky to work in a place that has high-sensitivity D-dimer results rapidly available, you could get away with skipping POCUS on the low-risk patients. However, if you don’t have D-dimer readily available or if the patient is in higher risk category, POCUS could be HUGE in making informed management decisions. Here are some important questions it can help answer: 1.    Should the patient be started on anticoagulation now? 2.   Should the patient be referred to the emergency department to obtain an ultrasound? 3.    Should the patient be sent for follow-up imaging in 5-7 days as initial scan of proximal leg is negative? Luckily, POCUS for DVT rule-out has been around for a while. A recent metanalysis (link below) showed pooled sensitivity and specific of 95% when POCUS was performed by “specialist” emergency physicians (meaning attendings, not trainees) and a 3-point scan was done (includes femoral vein in addition to traditional views). Another study done on hospitalists showed 100% sensitivity and 95.8% specificity when using formal radiology vascular scan as the gold standard. POCUS is highly sensitivity and could be the first-line imaging in patients presenting with possible DVT. It could potentially be the only imaging in conjunction with risk stratification and D-dimer results. So, what does a normal study look like? There is full compression of deep veins. Full compression mean that the inner walls of the veins are touching when pressure is applied through the transducer. We typically compress in the following regions: 1.    Inguinal region: femoral vein, saphenofemoral junction (junction of femoral and saphenous veins), confluence of deep and superficial femoral veins. 2.   Upper/mid-thigh: femoral vein (addition of this vein, make this a 3-point ultrasound instead of 2-point). 3.    Behind the knee: popliteal vein. What does a positive study look like? You are not able to fully compress the vein! Note, you might not actually “see” the clot.  See the video below. Are you using POCUS for evaluation of DVT? How did POCUS change your management and patient experience? Share in the comments! ED systematic review: https://lnkd.in/ejTRsi5U Hospitalist study: https://lnkd.in/e_djbsAN #pocus #ultrasound #meded #emergencymedicine #urgentcare #primarycare #hospitalmedicine #patientexperience

I was incredibly fortunate to teach #POCUS and reconnect with friends at the Plumas District Hospital's Sierra Nevada Conservation and Wilderness Medicine Conference in Quincy, CA. The theme was Migration and Climate Change. I was blown away by the data that was shared by the participants and all the opportunities that exist for medical providers to get involved. Here are just a few things: 1. Many tribes in Alaska are under threat and require relocation. Their homes are getting destroyed in mudslides and other weather events. They are not able to fish and store their food in traditional ways due to thawing of permafrost and lack of ice cover. The relocation process is complicated and is taking 30 years for some tribes. 2. The incidence of drownings and near-drownings at the Mexico/US border has increased likely due to the increase in the wall height by 13 feet in the last few years. The migrants that choose to jump, instead of taking the water route, suffer devastating high-speed bilateral ankle fractures that required surgeries and long rehab times. 3. Nursing is the most trusted profession in the US, followed by physicians. Go nurses!!! Medical providers are uniquely positioned to educate our patients on the health threats of climate change and advocate on local and national level. 4. I've got to put this in here too... Least trusted professions: Congress representatives, followed by car salesmen, followed by healthcare executives. Wow! This was an off the grid conference in UC Forestry Camp where participants either camped (I did!) or stayed in sweet cabins or dorms. I hope this post will inspire some of you to come and check out this conference next year :). In the group shot below, you can see some key organizers of the conference (Jeff Kepple MD, Tracy Kepple, Karen Story, Jordan Rode), Musa Masala team (Julie Ramirez, Michael McLaughlin, and myself), and our group art! Thank you Julie Ramirez, from Musa Masala for leading an incredible art workshop titled "Creating in Comfort." #wildmed #meded #pocus #wildernessmedicine #climatechange #conservation

To finish up with lung #ultrasound series for now, I wanted to share some important #patientsafety and #healthcarecostsavings metrics for procedural lung ultrasound during thoracentesis (fluid drainage from the thoracic cavity). Some #primarycare docs are performing therapeutic thoracentesis in the office and most definitely in the #hospital. Similarly #hospitalists, #intensivists, and #emergencyphysicians are performing this procedure routinely! Safety & experience analysis: Ultrasound is really a must when performing a thoracentesis! It's been shown to have an absolute reduction of pneumothorax (collapsed lung) of approximately 10%, from 11% in non-ultrasound group to 1% in ultrasound group. That's really impressive. See references below. This is really HUGE in terms of patient outcomes, length of stay (LOS) in the hospital, and overall costs, not to mention #patientexperience and provider experience. Cost analysis: To break this down even further, if the iatrogenic (complication caused by medical provider) pneumothorax requires intervention (i.e. chest tube, pigtail) this increases hospital stay by 4 days and costs on average $18,000/patient (2016 numbers, probably even more now!). If the hospital could avoid 30 iatrogenic pneumothoroces, this could translate into $0.5M in savings! This approximately the number of patients in which pneumothorax was avoided due to ultrasound usage in the Italian study (1st one on the list). Are you currently using #POCUS for guidance during the thoracentesis? Share your experience in comments. If you are not, why not? What are the barriers you are facing? Here are there references I used for this post: 1. Perazzo A, Gatto P, Barlascini C, Ferrari-Bravo M, Nicolini A. Can ultrasound guidance reduce the risk of pneumothorax following thoracentesis? . J Bras Pneumol. 2014;40(1):6-12. doi:10.1590/S1806-37132014000100002 2. Cavanna L, Mordenti P, Bertè R, et al. Ultrasound guidance reduces pneumothorax rate and improves safety of thoracentesis in malignant pleural effusion: report on 445 consecutive patients with advanced cancer. World J Surg Oncol. 2014;12:139. Published 2014 May 2. doi:10.1186/1477-7819-12-139 3. Sperandeo, M., Quarato, C., Squatrito, R., Fuso, P., Dimitri, L., Simeone, A., Notarangelo, S., & Lacedonia, D. (2022). Effectiveness and Safety of Real-Time Transthoracic Ultrasound-Guided Thoracentesis. Diagnostics (Basel, Switzerland), 12(3), 725. https://lnkd.in/eESeyXUr 4. Cantey, E. P., Walter, J. M., Corbridge, T., & Barsuk, J. H. (2016). Complications of thoracentesis: incidence, risk factors, and strategies for prevention. Current opinion in pulmonary medicine, 22(4), 378–385. https://lnkd.in/eVTEUXa8 #pocus #ultrasound #meded #patientsafety #patientexperience #hospitalmedicine #internalmedicine #icu #emergencymedicine #healthcarecosts #pointofcareultrasound #pointofcareultrasound

Continuing with the lung #ultrasound theme, here is another easy and high-yield application for an #urgentcare or #primarycare provider looking to improve #patientcare and #patientexperience by adopting #pocus. Lung #ultrasound is far superior to chest x-ray in diagnosis fluid overload in patients with congestive heart failure (CHF). A 2019 meta-analysis (link below) of 1827 patients found a sensitivity of 88% for lung ultrasound vs. only 73% for chest X-ray. Why are we even bothering with chest x-ray if #pocus is better and is now available and affordable? Ultrasound findings: Instead of A-lines (horizontal lines), you see B-lines (vertical lines). It's quite simple! - A-lines are a reverberation artifact seen in air-filled lung. - B-lines are also reverberation artifact that indicates thickening and/or fluid in the lung interstitium. - The more B-lines, the more severe the symptoms. - B-lines are nonspecific finding in CHF exacerbation. They are also seen in viral pneumonia (COVID!) and other lung pathology. Clinical correlation (as with any imaging) is a MUST. Meta-analysis study in JAMA Network Open: https://lnkd.in/exTFJf9z Are you currently using #pocus to determine if your patient requires diuresis or a visit to the ED? If you are not, share why not in the comments below! As always DM for any POCUS-related questions. Get on our mailing list at hellosono.com. If you like what you see, turn on the 🔔 under my profile header to be informed of a next post. Happy scanning!

Lung #ultrasound is my favorite #pocus application as an #emergencyphysician and #urgentcare provider because it helps me rule out serious conditions very quickly and reliably. Chest X-ray is notorious for missing pneumothorax, CHF (heart failure) exacerbation, and pneumonia (especially if it's a supine film!). The cool thing about lung ultrasound is it's quite easy to learn! Below is an example of what a PNEUMOTHORAX (collapsed lung) looks like. The movement of the pleura is missing, and it's OBVIOUS. Note, if you are going to apply this in a patient, you must clinically correlate. Does their presentation make sense? False positives include: - Pleurodesis or pleural scarring - Subpleural pneumonia - Bleb In the next post I will share the DEFINITIVE sign of pneumothorax on ultrasound. It takes a bit of looking to find. Stay tuned! If this post is useful to you, go ahead and share. 🙏 As always, reach out with any POCUS questions you might have. Hello Sono supports medical practices and residency programs in building high quality and compliant POCUS programs. Contact us at info@hellosono.com for a complimentary consultation. #pocus #ultrasound #lungultrasound #pneumothorax #urgentcare #primarycare #emergencymedicine

I had a blast presenting on Essential POCUS Applications for Primary and Urgent Care Providers during today's webinar hosted by Point-of-Care Ultrasound Certification Academy. The focus was on the beginner user who is looking to adopt POCUS into their practice to improve and expedite patient care. I discussed the "low hanging fruit" applications that are available with "minimal" training and make a huge impact on patient care. Obviously, the more you do them, the better, faster, and more confident you get at those POCUS exams. Here you go! 1. Lung ultrasound for ruling out pneumothorax, pleural effusion, and pulmonary edema. 2. Cardiac ultrasound for screening for systolic dysfunction and pleural effusion. 3. Soft tissue ultrasound for evaluation of abscess and cellulitis as well as localization of foreign bodies. Did you know that you can see glass, plastic, and wood with ultrasound (unlike with X-ray)? 4. Musculoskeletal ultrasound for ruling out fracture, tendon tear, shoulder dislocation, and joint effusion. 5. Lower extremity vascular ultrasound for ruling out proximal leg deep vein thrombosis (DVT). I am not going to go into the impact of these scans on your patients too much as that's a whole other post! However, here is some food for thought: - You might keep a young patient with pleuritic chest pain out of the ED and spare them radiation. - You might also keep an older patient with Congestive Heart Failure (CHF) out of the ED and choose to treat them at home. - You will save time, costs, and nerves for a patient with possible blood clot in their leg. Please share this post with others who might find this interesting. Reach out with any POCUS questions/comments. You will be able to watch the webinar on Point-of-Care Ultrasound Certification Academy site in about 1 week. Hello Sono supports medical practices and residency programs in building high-quality and compliant POCUS programs. DM for more information and/or complimentary consultation. #pocus #ultrasound #urgentcare #primarycare #patientcare

I am excited to be speaking on POCUS Benefits & Implementation at the upcoming webinar hosted by Clarius Mobile Health at 5pm EST | 2pm PST on May 29, 2024. Are you ready to: - take your patient care to the next level, - improve efficiency, and - bring in additional revenue to your practice? I will cover the following: - Use cases in #urgentcare and #primarycare - Benefits to the patient, clinician and practice - Current credentialing guidelines - Best practices for implementation and documentation - ROI Clarius Mobile Health team will be doing a live demo showcasing some of the commonly performed #ultrasound exams in primary care and urgent care settings. Don't miss out! Register at the link provided and share this post with others who you think would benefit from learning why and how to integrate POCUS into their practice. #patientexperience #patientcare #roi #healthcarereimbursement #pocus #ultrasound #urgentcare #primarycare https://lnkd.in/esFsvtQq

Check out Hello Sono's latest blog post on the impact and implementation of #pocus in #ruralhealthcare. By enabling the providers to make more informed clinical decisions, this tool can save your patient a lengthy trip to a radiology center and an expensive transfer to a tertiary care facility. Here are some key takeaways: 1. POCUS significantly improves patient care and resource utilization in rural settings. 2. There are important barriers to implementing an effective POCUS program, such as lack of POCUS leadership and funding, in rural medical facilities. 3. There are multiple strategies to overcome those barriers by utilizing latest technologies such as simulation and AI-powered device protocols. https://lnkd.in/e9kNcfRf #pocus #ulrasound #ruralmedicine #costsaving #patientcare