Make waves by using ultrasounds in day-to-day practice

Keynote speaker Dr Mariana Pardo (left) all smiles before her presentation with dvm360® chief veterinary officer Dr Adam Christman (right).

According to Mariana Pardo, BVSc, MV, DACVECC, it’s a recurring theme in history for people to be hesitant to implement new technology in medicine because they find it cumbersome. She began her keynote presentation¹ on the final day of the Fetch dvm360® conference in San Diego, California, by quoting John Forbes in the 1800s and his thoughts on the stethoscope at the time: “That it will ever come into general use, notwithstanding its value, is extremely doubtful; because its beneficial application requires much time and gives a good bit of trouble both to the patient and the practitioner.” Now the stethoscope is universally used for each visit in both human and veterinary medicine, and Pardo aims for the same to be done with the ultrasound.

Therefore, she outlined the basics and practical skills for incorporating point of care ultrasounds in daily practice to bolster patient care. “There’s so much information that you can get from using ultrasounds on your day-to-day basis and it might seem that it requires a lot of knowledge, but I’m going to try to simplify it for you and show you how much information you can garnish that will just become complementary to what we are doing,” Pardo said.

Know your knobology

Select the proper ultrasound probe

Pardo recommended to first choose the appropriate ultrasound probe based on the application:

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

Steps when performing ultrasounds

There are 4 main movements when performing ultrasounds including to slide, tilt, rotate, or rock it back and forth.

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

The steps of the process include:

• Step 1: After turning on the ultrasound machine, select the correct ultrasound transducer you will need.
• Step 2: Select the correct application preset for that transducer.
• Step 3: Adjust the depth, meaning how deep 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, meaning how bright or dark you want the image to appear. This increases or decreases the strength of the returning ultrasound signals that you visualize on the screen.

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

Takeaways

To conclude, Pardo summarized that using point of care ultrasounds requires an understanding of it and how to use all the knobs and settings. Not to mention, practice makes perfect when it comes to identifying normal versus abnormal structures to offer patients the most high-quality care.

Reference

Pardo M. Hocus Pocus! Integrating ultrasound in your day-to-day practice. Presented at: Fetch dvm360® Conference; San Diego, California. December 2-4, 2022.