SonoGlobalHealth – Ultrasound in Global Health resources available @AIUM_Ultrasound

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For those of us who travel, teach, and spread the gospel of ‘sound – we look for resources that may help in knowing the conversation for this topic. AIUM has a page that could help in your needs, as well as see photos of trips that their physicians have undertaken for ultrasound teaching and advancement.

Ive posted on other groups that have gone all over the world, in addition to my own experiences – including TO-theWorld who enhanced maternal education and minimizing MTFT of HIV.

For other resources, that are free for ultrasound in global health:

Partners in Health

World Health organization

Here’e a video that discusses ultrasound in global health, with a cameo photo of our own Dr. Jessica Ngo using it during Stanford’s emergency response to Haiti after the disaster with our SEMPER team.

SonoGlobalHealth: What Ultrasound does in Uganda to prevent MTCT of HIV #FOAMed #FOAMus

A friend of mine, William Cherniak – a family medicine resident in Canada at the University of Toronto-  has been working on a project. Not just any project, but a global impact project with the help of KIHEFO (Kigezi Healthcare Foundation) and his own group that he created called TO-the World. What is this project, you ask? Well, it was to show how minimizing maternal to child transmission (MTCT) of HIV can be helped by simply having and letting the women know in the region that a portable ultrasound has arrived. This project will be presented at Global Health 2013

Screen Shot 2013-08-29 at 5.50.19 PM

The project in brief: “In
 alignment
 with 
the 
WHO 2010 
guidelines 
for
 MTCT elimination and 
the
 Ugandan 
government’s
 adoption
 of plan
B+; KIHEFO,
 in
 collaboration 
with
 TO
– the
WORLD,
 designed
 a structured maternal
 health
camp [sMHC]
 centered on providing
 expectant
 mothers in
 rural
 Uganda with a 
free
 obstetric
ultrasound [OBU]. The
 four‐pronged
 approach
 of
 MTCT
 elimination 
was
 followed 
in
 the
 design
 of 
the 
sMHC. In 
one 
day, 
45 
women rotated 
through
 registration, 
pre‐test
 counseling, 
testing
 for 
HIV 
and 
Syphilis, 
family
 planning,
 obstetric
 ultrasound 
and, 
for
the 
women 
identified 
as
 being 
high 
risk
 by 
triage, 
dental 
and/or 
medical 
services. 
Each
 woman
 received 
fansidar, 
multivitamins,
 folic
acid
 and
 filled 
in 
a 
pre‐ designed
questionnaire.
 In 
total,
10 women
 identified 
themselves 
as 
being 
HIV+
 at 
registration, surprisingly 
only 
half 
were currently being 
treated 
with 
ARVs. 

An 
additional 
two 
women
 were 
diagnosed 
as 
being 
HIV+ 
during 
the 
health
camp.

 All
 women 
received 
counseling
 and
 were
 started
 on
 ARVs for 
life. Only 
7 
women 
had 
ever 
previously 
had 
an 
OBU, 
and
all
 45 
women 
verbally 
identified 
that 
the 
reason 
for
 attending 
the 
antenatal 
health
camp 
was 
to 
receive 
a 
free 
OBU.” – Now that is just amazing. The power of what a portable ultrasound can have on a community in fighting MTCT of HIV. Bring the ultrasound, and they will come – that is your way to start the healthcare and assessment they need.

They continue to state how they hope to solve the problem of high maternal death and high infant death rates: ” Solving
 the 
Problem
– Ultrasound
 and 
Outreach 
to 
Reduce
 Maternal 
Mortality. As
 stated 
above, 
the 
leading 
causes
 of 
maternal
 mortality 
include  hemorrhage, 
eclampsia, 
obstructed 
labor,
 infections,
 and
 birth 
defects. 

Studies 
have 
shown 
that 
obstetric 
ultrasound
 imaging 
can 
prevent 
most outcomes
 by 
providing 
early 
diagnosis 
and 
intervention. 

By 
providing useful 
information 
such 
as 
whether 
or 
not 
the 
mother 
is 
carrying 
twins, 
has 
an 
ectopic 
pregnancy 
or 
otherwise a 
mother 
and
her
 partner 
can
 make
 an 
informed 
decision 
about 
whether 
or 
not 
to 
deliver 
at 
home 
with 
untrained
 professionals, or 
a
 health
center where 
they 
can receive 
life‐saving
 treatment. Furthermore, 
the 
World 
Health 
Organization
 (2003)
 recognizes 
ultrasound 
technology 
as 
ideally 
suited
 to 
low
 and 
middle 
income countries, 
as 
it 
is
 relatively 
low‐cost, 
low
 input, 
and
 easily 
maintained
 and 
transported. 

Additionally, 
studies
 conducted
 on
 the 
use 
of 
ultrasound 
technology 
in 
two 
rural 
hospitals 
in 
Rwanda
 have 
indicated 
that 
after 
an 
initial
 training 
period,
 an 
ultrasound
 program 
led 
by 
local 
health 
care 
providers 
can 
be 
sustainable
 and 
lead 
to
 accurate 
diagnoses. Ultrasound 
imaging 
is 
beneficial 
to 
rural 
populations 
as 
it 
is 
a
 simple 
a
nd non‐invasive
 procedure. This
 helps 
to 
reduce levels 
of 
fear 
from 
women 
who 
have previously maintained 
their 
cultural
 preferences 
for 
receiving 
treatment 
and
 giving 
birth 
with 
untrained 
birth 
attendants 
in 
their 
local
 villages.

Sustainability: Various
 studies 
on
 obstetric 
ultrasound 
imaging 
as 
a 
sustainable 
and 
appropriate 
technology 
to 
developing
 nations, 
and 
its 
capacity 
to 
reduce 
rates 
of 
maternal 
mortality, 
have 
been 
conducted 
in 
rural
 regions
 of 
Rwanda, 
Botswana
 and 
Tanzania. 
In 
northern 
Tanzania, 
a 
study 
conducted 
amongst
 women
 who
 were
receiving 
ultrasound 
imaging
 for 
the 
first 
time 
indicated 
that 
the 
majority 
of 
women 
were 
satisfied 
with the 
information 
provided 
from 
the 
procedure, 
despite 
not 
initially  understanding 
its 
purpose. 
The 
ultrasound
 procedure
 provided 
women 
with 
the 
ability 
to 
see 
fetal 
positioning,
 fetal 
sex, 
and
 to 
recognize 
any 
potential
 pregnancy
complications. 
Information,
 particularly 
the 
latter, 
resulted 
in 
guiding
 treatment
 for 
the
woman’s
 particular birth
– helping 
her
 make
 an
 informed
 decision
 as 
to 
where
 and
 how 
she 
would
 deliver.
 This
 particular 
study
 in
 Tanzania 
concluded
 that
 the 
ultrasound 
imaging 
was 
useful
 in 
reducing 
the 
risk 
of
 maternal
 mortality, 
although
 the 
treatment 
should 
be 
accompanied 
by 
a 
thorough
 education 
campaign 
and 
consent program.”

The future? “Currently,
 TO
– the
WORLD 
is 
in 
the 
process 
of 
raising 
funds 
to 
purchase 
two 
portable 
ultrasound 
machines.  

These 
machines 
will 
be 
purchased 
locally 
in 
Uganda 
to 
ensure 
sustainability 
in 
maintenance 
and 
economic 
stimulus for 
the 
communities 
in 
which 
they 
serve. Multiple 
outreach 
camps
 will 
be 
conducted 
in 
2014 
with 
the 
previously 
designed 
model 
based 
on 
the 
WHO 
four‐pronged 
approach 
to 
MTCT 
elimination 
of 
HIV.

The WSJ actually spoke of what happens when an US machine is taken to a developing country – more antenatal visits!

Here is the video William made to support his cause:

1. Report
of
a
WHO
Technical
Consultation.
Towards
the
elimination
of
mother‐to‐child
transmission
of
HIV.

Accessed
March,
2013
at

http://www.who.int/hiv/pub/mtct/elimination_report/en/index.html

2. IRIN
Humanitarian
News
and
Analysis
–A
service
of
the
UN
office
for
the
coordination
of
human
affairs.

Accessed
March,
2013
at
http://www.irinnews.org/Report/96308/UGANDA‐Government‐
adopts‐new‐PMTCT‐strategy
3. WHO
Executive
Summary,
April 2012.
Use
of
Antiretroviral
Drugs
for
Treating
Pregnant
Women
and
Preventing
HIV
Infections
in
Infants.

Accessed
March,
2013
at

http://www.who.int/hiv/PMTCT_update.pdf

4. World
Health
Organization. Statistics
on
Maternal
Mortality
in
Uganda,
accessed
March,
2013
at

http://www.who.int/healthinfo/statistics/indmaternalmortality/en/index.html

5. Kigezi
Healthcare
Foundation
website,
accessed
March,
2012
at
www.kihefo.org
6. Maternal
Health:
Investing
in
the
Lifeline
of
Healthy
Societies
and
Economies.
Africa
Progress
Panel
Position
Piece.
September
2010.
7. Yaw
A.W.,
Alexander
T.O.,
and
Edward
T.D.
The
Role
of
Obstetric
Ultrasound
in
Reducing
Maternal
and
Perinatal
Mortality,
Ultrasound
Imaging
‐ Medical
Applications,
InTech,
Accessed
March,
2013.
Available
from:
http://www.intechopen.com/books/ultrasound‐imagingmedical‐applications/the‐
role‐of‐obstetric‐ultrasound‐in‐reducing‐maternal‐and‐perinatal‐mortality.
8. Shah
S.P.,
Epino
H.,
Bukhman
G.,
Umulisa
I.,
Dushimiyimana
J.M.,
Reichman
A.,
Noble
V.E.
Impact
of
the
introduction
of
ultrasound
services
in
a
limited resource
setting:
rural
Rwanda.
BMC
InternationalHealth
Human
Rights.
2009;27:9‐4
9. Firth
E.R.,
Mlay
P.,Walker
R.,
Sill
P.R.
Pregnant
women’s
beliefs,
expectations
and
experiences
of
antenatal
ultrasound
in
Northern
Tanzania.African
Journal
of
Reproductive
Health.
2011;
15(2):91‐
107

Sono-iBook: Intro to Bedside Ultrasound – great chapters/images/videos – Volume 1& 2 in iTunes! #FOAMed

LLLLLLLLet’s get ready to UltraSoooooooouuuuuuuuund!!!! It’s what we have all been waiting for! It’s finally here! Weighing at a meager zero pounds (since it’s on the iPAD, oh yeah!), another amazing product of Drs. Mike Mallin and Matt Dawson of ultrasoundpodcast fame, and authors including experts in bedside ultrasound from around the world (and little ole’ me too). I’d like to present the SECOND volume of the Introduction of Bedside Ultrasound ! And, as Mike and Matt say it best, “If you already own Volume 1….” (which include topics in basic ultrasound applications & more filled with visual image and video clip tutorials – unlike any other “text”book that you have ever owned!) “…..this is much better.  If you don’t yet own Volume 1….they’re equal…..get them both.” – Yes, trust me, you will not be disappointed. You can also get Volume 1 on inkling chapter by chapter purchasing ability where you can read it on your iPHONE too!)Take your iPAD to the bedside, place it on the ultrasound machine, or both to help guide your ultrasound education and that of others! Volume One pics:

Screen Shot 2013-05-17 at 12.03.13 PMScreen Shot 2013-05-17 at 12.03.21 PM

Volume Two involves topics on TEE (which is an up and coming application of bedside ultrasound in cardiac arrest), MSK, Right Heart, EMS, Medical Education, Gallbladder, more Nerve Blocks (that’s where I come in..heehee :), PIV, Soft Tissue, DVT, Appy, Peds, Diastology, and much more!  364 pages of interactive content, with HOURS of video demonstrations and tutorials. – doesn’t that make you drool!?! In volume two picture: …do you know what technique that is? you will…

Screen Shot 2013-05-17 at 12.03.33 PM

To hear them speak on it, and to get a taste of perfection, go here.

Screen Shot 2013-05-17 at 12.03.24 PM and Screen Shot 2013-05-17 at 12.03.28 PM

SonoEvents: SonoGames, Castlefest2013, and the FREE Intro to Bedside Ultrasound iBook #FOAMed

This SonoGift is amazing! I could have sworn that I sent this earlier (and I think i did on Twitter and Facebook), but for whatever reason, it is in my blog’s draft folder, and I was shocked! – How dare I keep this away from everyone who follows SonoSpot?!!!! So, I apologize… from the bottom of my subxiphoid window (…ha! yes i know, I have many of them). If you’re getting this for the second time, then take it as a friendly reminder of how awesome the UltrasoundPodcast guys are to provide this amazing gift to everyone to learn the up-to-date info on bedside ultrasound applications… for free. Now, if you are getting this for the first time, you are going to LOVE it….. Why? Well, first off, it’s free (did I say that already?). And, if that wasnt enough, it’s the pdf version of the AWESOME iPAD download-able iBook (also found here chapter by chapter purchasing on inkling that can also been read on iPHONE) of Introduction to Bedside Ultrasound from the UltrasoundPodcast crew, with chapters written by so many of my friends. If you purchase the iPAD version (for pretty cheap, if you ask me) (including the iPAD mini and retina display), you can view all the clips and videos placed by the authors/experts in bedside ultrasound – which truly makes it the best “book” on bedside ultrasound that I know. It’s worth it.

You know what else Im excited about? SonoGames Part Deux at SAEM - this time, our crew is going to make it after the first round!!! You all better watch out! A sneak peak at SonoGames last year by the serious yet humorous, heavy yet light, good yet talented UltrasoundPodcast and their hilarious interviews:

Oh, and did I mention Castlefest2013????!! Im so excited to join them at CastleFest2013 – ultrasound, castles, wine, and festivities?—what more could a Sonogirl ask for?! You can even be there virtually! Yes, they did think of everything.

SonoEquipment: How to make your own Ultrasound Gel – Guar gum, salt, and water #FOAMed

I saw an interesting blog post, sent to me by my ultrasound uncle, Dr. Chris Fox, that was on the: “Why Is American Healthcare so Expensive?” site entitled “How to Make Ultrasound gel: which is also sterile and edible and environmentally friendly” by Dr.Janice Boughton. Not only did the title catch my eye, but the content drew me even closer. If you are in need of gel – whether that’s because you are doing global health, disaster relief, or healthcare at any resource-limited area – there are ways to make it. Ive heard of a couple alternatives – and here is a way to make your own – that is also sterile, edible, and environmentally friendly. :)

As the blog post states: “Ultrasound requires an aqueous interface between the transducer and the skin or else all you see is black. Ultrasound gel is a clear goo, looks like hair gel or aloe vera, and is made by several companies out of various combinations of propylene glycol, glycerine, perfume, dyes, phenoxyethanol or carbapol R 940 polymer along with lots of water.” – not easy to find, and ot so cheap either. So, she set out and tried six different recipes – yup, that’s right – SIX! …and made the below gel (see pic) from guar gum (found in the flour section of stores), salt and water:

IMG_0075

“Guar gum is available in the flour section of many grocery stores and costs about $10 for a 220 gram bag. It is purported to be good for diarrhea, constipation, diabetes and lowering cholesterol.” – how cool is that?!

1. Mix 2 teaspoons of guar gum with 1-2 teaspoons of salt. (The amount of salt isn’t vitally important since it is just added to keep the guar gum from clumping. Using slightly less than a teaspoon of salt per 2 cups makes a gel with which is isotonic, which would be ideal for use near eyes or other mucus membranes or on open wounds).

2. Boil two cups of water.

3. Slowly sprinkle the guar gum/salt mixture into the boiling water while stirring vigorously with a fork or whisk.

4. Boil for about 1-2 minutes until thick and well mixed.

5. Cool before using. Save lives.

To read more about her plight – click here. Thanks Janice!

Below is a video on how to do it made by her too:

SonoResource: The Utility of Ultrasound in Global Health – from my trips and others’ experiences

World Humanitarian Day is August 19th. Travelling to a third world country is what all healthcare providers should experience, as it will make a difference (to either your perspective on life and happiness or to the people who you treat). I have met some amazing people along the way, none who affect me more than those who live there (and the great way they define happiness) and those who go around the world to try to make it a better place. I have travelled to the Middle East, India, Guatemala, Honduras, Mexico, and Nepal with groups of people who have done far more than I could ever do, and the inspiration I get from them is amazing (Stanford International EM facebook page and the Rwanda PURE initiative). The stories I’ve heard, the experiences I went through, and the humbling that comes from it all are what keep me going. But, Ive realized something: there are two ways of thinking about global health and our aid efforts: Continue reading

SonoTexts: JAMA review on ultrasound texts – and a list of some of the best

I was flipping through the most recent issue of JAMA and noticed 2 book reviews in the end, both of which had to do with point-of-care ultrasound – yes! Its probably the only thing that would stop me in mid-bite of my midnight snack. One of the books highlighted is by Hadzic, a regional anesthesia book which recently added a section on US-guided nerve blocks – hot topic these days as has been well studied and taught by Mike Stone, Arun Nagdev, and others. Of course, the review done by Chris Moore about Chris Fox’s book, Atlas of Emergency Ultrasound was what got my attention: quite matter of fact about point-of-care ultrasound, which I appreciate. I loved that Chris Fox’s book is highlighted in JAMA. Period. Disclaimer: I am biased as he is the one who made me into an US believer during my residency at UC Irvine, and was the first SonoFiler I wrote about – great guy and good friend.

My favorite part of the review:

Continue reading

SonoLinks: new links to awesome US educational sites/texts/apps

Since the last installment of SonoLinks, there have been several more awesome US related websites/links that 1) I have found in my search for more, 2) are new ones that just came on to the horizon or 3) I totally forgot to add before – - –  They are all free! They are all listed on our Blogroll (scroll down, on the right of the screen) that we keep updated. If anyone knows of any other great sites, send them on over!

SonoCloud – a new and excellent website for free and easy visualization, downloading, uploading, and learning of US clips and images – by Matt & Mike (of Ultrasound Podcast) and Mike Stone (current ACEP US Section President). Can you say A-W-E-S-O-M-E! You can help fill up their library of clips by downloading your own on there too.

WikiSpaces to De-identify/Crop/Edit your image/Clip – thanks to Ben Smith for creating and sharing! A great way to post/share your stills and clips without violating HIPAA by cropping out the MRN/patient name. A simple way to keep you out of HIPAA jail.

EchoBasics – Mereles, a cardiologist from Paraguay, has an excellent website of all things cardiac echo, from basic to advanced evaluations, including explanations and clips, and even 3D and 4D clips! very cool.

ICU Sonography – along the same lines as above, there are a couple sites that are worth mentioning for ICU Sonography: Beth Israel’s website and Stanford’s website. Great review/images of critical care US and echo/IVC.

Yale’s Atlas of Echo – a complete site of everything you need to know about cardiac echo

Neuraxiom – A great website for US guided regional nerve blocks!

Sonic Nerve Blocks – another excellent website by Sanjay Sinha, an anesthesiologist at the University of Connecticut, to review all US guided nerve blocks

EFSUMB – free US textbook reviewing US applications (and includes resource limited US utilization and HIV related views)

Partners in Health book – an excellent manual for US use in resource poor/limited settings by Sachita Shah et al.

SonoWorld – an all-inclusive website that has cases, lectures, images, and articles

Ultrasound Village - another all-inclusive site with from our colleagues in Australia filled with lectures, images, and quizzes!

Qstream – a great free way to test your US skills through email question and answers by Sam Ko.

Other organizations that deserve mention in addition to ACEP include:  SAEM (who have narrated lectures),  AIUM (which is an organizer of the UltrasoundFirst project), WFUMB, and WINFOCUS

Emergency US Fellowships – in the time of application review, I thought I would send out the link for those interested in applying for emergency US fellowships

Emergency US Research articles – Chip Schmier does a GREAT job in sending out the new US related research articles every month; allows us to feel “in the know” when our colleagues ask us questions about it.

And… a website for free medical education testing and media sharing using a social networking and incentive paradigm: GMEP  – Global Medical Education Project – as you can see SonoSpot has already created a folder and adding to it with US images of all applications.

SonoLinks: The websites, smartphone apps you need to know for Bedside US

A list of awesome sites and apps for bedside US: whether that be for viewing lectures, US videos/images of normal/abnormal pathology, learning the technique for each application, or to get all that you need to know on your smartphone – you’ll love these! This is not a complete list, but ones that I have found to be great! If you know of any others, feel free to list in the comments.

ACEP US Section – for all the needs of emergency physicians who perform US, credential others, direct US programs and much more!

SAEM US Academy - is a community within the Society of Academic Emergency Medicine. AEUS provides an international forum bringing together bedside clinician sonologists with the common goal of advancing patient care

Bedside US and the Stanford 25 – The Stanford 25 is a list of 25 dependent physical diagnosis maneuvers to help with the physical exam and medical education, one of which is bedside US

Society of US in Medical Education – this link takes you to the learning modules, but if you press “Home” you will see how amazing this society is for enhancing US education.

Emergency Ultrasonography – this site is a great go-to for providing the foundation for a basic understanding of Emergency Ultrasound through lectures, modules, testing

EMSono – a great site which is a comprehensive emergency ultrasound education website that also provides you with free teaching modules through the SonoBridge. It also provides the ACEP test for bedside US.

SonoGuide – An excellent free online site to learn all that there is to know with regard to bedside US

SoundBytes – a great CME download and set of lectures !

Ultrasound Podcast – a very fun and cool way to learn bedside US through two very funny guys! They also bring you the iPhone app: 1-Minute Ultrasound

Ultrasound SHARE – a great site for a library for all the US videos/images you ever want to see!

US Guided Nerve Blocks – a complete source for all you want to knwo in regard to US guided Nerve blocks.

ViewSono – great video tutorials are short format case based reviews of core ultrasound procedures in emergency medicine, critical care and regional anesthesia

Vimeo US images and videos – an awesome site to see every US related video you’ll ever want to see!

There are quite a few smart phone apps and iTunes videos that can help while you are on the run, train, plane, or riding in the back of a harley:

1-Minute Ultrasound

Emergency Medicine Ultrasound

Dr. Chris Fox’s Emergency US lectures

Pocket Atlas of Emergency Ultrasound

SonoAccess