SonoPearls&Politics: ACEP2012, AAMC2012, AIUM-US First- future of bedside ultrasound

2012 was an amazing year for bedside ultrasound. There were more conferences that included bedside ultrasound in their pre-conferences festivities, but also there were more discussions on what was next for bedside ultrasound, while SUSME and AIUM announced 2013 as the Year of Ultrasound (YOU) – highlighted by AIUM Ultrasound First group, the Life in the Fast Lane bloggers, the Ultrasound Podcast folks, and, of course, little ole’ me on SonoSpot while highlighting the ACEP US Section and the immense amount of social media interest/bloggers/tweets on the topic of bedside ultrasound. There are two conferences I went to, each with it’s own powerful voice with regard to education, medicine, and ultrasound. The excitement I felt was truly unprecedented – I was giddy, I was hopping around, I was all smiles.

The American College of Emergency Physicians (ACEP) meeting had more ultrasound lectures and workshops than ever before with a turnout at the ACEP US Section that was more than any other (although I dont have the exact numbers, the ballroom it was held in was huge, and those who came late had to stand because all the seats were filled). ACEP was amazing. period. From the great lectures/workshops (even the on-site resuscitation of an emergency physician who went into cardiac arrest in the lobby of the convention center (revived by fellow emergency physicians through use of the handy-dandy convention center defibrillator to then have his heart checked for cardiac activity by Dr. Chris Fox with the ultrasound machine he was using during his workshop, which was happening right next to that location) and the Aurora Mass Casualty Response Video, (also seen here), which was one of the most moving videos I’ve seen about emergency response, teamwork, and humanity (I’ve said this many times, but Ill say it again – I LOVE my job – but even better than that, I love those who I do my job with – side-by-side – and what a privilege to be able to feel that way) to everything inbetween and afterwards, ACEP was once again a success.

The Association of American Medical Colleges (AAMC) meeting in San Francisco was equally amazing, particularly with regard to the future of medical education, discussing the concept of the flipped classroom, and the time given to discussing the incorporation of bedside ultrasound into medical education for medical schools – with the first ultrasound workshop being held in its history lead by the “God’s of Ultrasound in MedEd” (that’s my term of choice)  -Drs. Richard Hoppmann (Univ South Carolina), Chris Fox (UC Irvine), and Michael Blaivas (all of whom will be at the World Congress: Ultrasound in Med ED)…. with help from ultrasound educators from Wayne State, Ohio State, and Stanford (yup, little ‘ole me again and my star medical student models). There was even a separate day at Stanford where a 60 minute slot was given to discussing The Stanford 25 (by none other than Stanford’s Dr. Abrahim Verghese himself) and one of it’s aspects, Bedside Ultrasound (by one of our ultrasound team members, Dr. John Kugler, an internal medicine doctor who is starting to incorporate ultrasound into internal medicine residency education – yup, it’s spreading!! – and it’s about time!). No tweets on this conference, but the above should be stated anyway.

The Ultrasound First conference went on with tweets happening every hour! I was unable to attend this one, but so happy that my twitter friends did. It is obvious that 2013 truly is the year of ultrasound. Spreading to medical education, being a multi-disciplinary educational and practical tool, and having a united voice on its value were all discussed – in addition to some pearls on the hot topics including pelvic ultrasound and MSK ultrasound, as well as how ultrasound is becoming an acceptable tool for renal colic and breast masses.

Since I learn from all my Twitter friends, I figured the best way to share is to take out the middle person (yes, Im talking about me). That way you could get it from their own words: Here are only a few posts from #ACEP12  and #US1st that made me go “Hmmmm….” – with a little commentary every now again from me, because I just can’t NOT give my opinion – I know that’s shocking to those of you who know me. Heehee. My tweets are in here as well.


From @USEDCDN : Emergency US management course  “From Blaivas: Starting to see 1st lawsuits for lack of US use in vascular access” – This definitely sparked my attention – lawsuits for LACK of US use?? Wow, well the standard of care is changing, and if a proven tool to minimize complications is right next to you and you dont use it and that complication occurs… there’s a legal risk. Learn it, use it, love it and maximize patient safety.

Also from  “@USEDCDN: EUS MC Resnick: Emergency US is not an extension of physical exam. Big difference. It answers clinical questions.” Ok, this needs mention, but I already posted a rant about this – of course – so will not bother you with another rant… not right now, at least.

From @jeremyfaust  – “Weingart: 4. When is CPR futile? End tidal < 10 after 10 min. Confirm with US #acep12.” Enough said – and honestly, anything that Scott Weingart says, i will believe. period.

“Rice #ACEP12 echo in cardiac arrest- can see if cause PE/tamponade, or if standstill or beating heart. Look or you may waste time/resources” and “echo and IVC in critical patients: LV fxn, IVC collapse, RV size, contractility- will differentiate PE, CHF, hypovolemia, hypervolemia” – you never know what you may find, and what may be an intervention that you didnt think of until you saw your ultrasound (ie. tpa in a dilated RV).

@bedsidesono: lung #ultrasound talk from ACEP at  brush up on A-Lines, B-Lines, lung sliding and more…#FOAMed” – what a giver he is! Stone is one to listen to, hear his opinion, and read his immense amount of publications.

Point of care US dominating new speakers forum so far at #ACEP12! Msk, soft tiss, pleural…”

Congrats @GeriaSonoMD on being new Chair of #ACEP12 US section mtg. Our fellow, Viveta Lobo said you talked her into EM. Awesome. So thx!

Raj Geria – new #ACEP12 US section Chair! Highest priority: pathway to US fellowship accreditation : to ensure safety and quality

Find @SAEMAEUS on twitter and follow to see what’s new with the ACademy

Nova panebianco at #ACEP12 taking about SAEM Academy of Emerg US and SonoGames – also subcommittees they are involved in..

A great resource from the new academy of emerg US : …

Resa Lewis #ACEP12 US section mtg- talking ACGME US milestones and how ACEP can help in achieving them for all residencies

Blaivas #ACEP12 – TEE will show potential causes of hypotension & shock ..Valvular dz..And can be electrically linked :pace & defibrillate. No need to interrupt chest compressions for TTE as can see what’s happening with heart from across rm c TEE. Can use TEE when bad view on TTE or unable to do TTE due to habitus, lung dz, chest compressions. TEE can assess quality of chest compressions too. TTE can tell you if there is standstill, clot in RA, dilated RV, tamponade, and to see a beating heart. TTE (echo) better than checking for pulses for need for chest compressions. AAMC mtg in SF! Spreading to med schools!. WINFOCUS and AIUM EM and crit care goals… Going global!  and  : 2 great online resources for images and education! – plus the test:
@sinaiemus: Rob Blankenship at Ultrasound section meeting: over 56,000 ACEP US tests completed at … #ACEP12
Congrats Vicki Noble and @ultrasoundpod for your well deserved award for your contribution to emerg ultrasound!!
Ultrasound First Forum:
  1. Jason T Nomura MD @Takeokun “To engage the patient groups you need people who are interested in patient advocacy not just the disease state. 
  2. View image on Twitter
  3.  Jason T Nomura MD @Takeokun “Lev demonstrating high res eval of ankle tendons with dynamic scanning for function, something that can’t be done with MRI 
  4. Jason T Nomura MD @Takeokun “Nazarian MRI does not have the resolution to evaluate the fibrillar pattern of the Achilles compared to US. 
  5. Jason T Nomura MD @Takeokun “Hoppmann- if education and integration of US starts in medical school it can change the paradigm. 
  6.  Jason T Nomura MD @Takeokun “Hoppmann has graduated several classes of medical students who had US integrated into their med school curriculum. 
  7. Jason T Nomura MD @Takeokun “Moreau most common imaging modalities for Team USA is X-ray and US, very little CT use.
  8. Mike Stone @bedsidesono “Levon Nazarian at  speaking on MSK imaging. It’s not just more convenient than MRI – higher res, no contraindications, pt’s prefer it”
  9.  Jason T Nomura MD @Takeokun “Nazarian US for sports med is portable to get the technology to the field and locker room, MRI not portable. 
  10. Jason T Nomura MD @Takeokun “Pellikka 2011 joint guidelines from ACC,ASE, ACCP and others about the appropriate times to use echo in the assessment of pts. 
  11.  Jason T Nomura MD @Takeokun “Moore bringing up the ASE and CV Anes guidelines for US guided vasc access. Advocates real time US guidance 
  12. Mike Stone @bedsidesono “Leslie Scoutt from Yale – ACR appropriateness criteria for recurrent renal colic – US & Noncon CT equal ratings 
  13.  Jason T Nomura MD @Takeokun “Scoutt 50% of pts with renal colic will likely have another episode.  that rad exp can build up.”
  14.  Jason T Nomura MD @Takeokun “Scoutt noncon CT is the “gold standard” for renal colic imaging in the US currently.  but there is the rad “risk.
  15. Joshua Copel @jacopel “Lynn Fordham (Pedi Rads) US optimal for pyloric stenosis now. No more need for upper GI or other radiation. 
  16. Jason T Nomura MD @Takeokun “Fordham N/V can be pyloric stenosis, malro, intussusception, and gastroenteritis. US for dx.
  17.  Jason T Nomura MD @Takeokun “IOTA group from Europe with close to 2,000 pts showed very good discrimination of malignant vs benign ovarian mass on US. 
  18. Jason T Nomura MD @Takeokun “IUD placement or misplacement easy to note on US; can present for DUB and pain. t
  19. Jason T Nomura MD @Takeokun “Advances to 3D US allows volumetric imaging that could only be done previously with CT or MRI. But US spares the radiation of CT 
  20. Joshua Copel @jacopel “ Dr. Beryl Benacerraf making case for US over CT, MR in female pelvic imaging at forum. View image on Twitter
  21. Jason T Nomura MD @Takeokun “ is not only about when &where US can be used but education for practitioners and patients per @AIUMPresAlfred
  22. Jason T Nomura MD @Takeokun “@AIUM_Ultrasound represents 9,200 members from 36 specialties with a focus on advancing US use 
  23.  Joshua Copel @jacopel “ opening of US First forum now at Marriott NYC. Over 100 attending from medical profs, industry, payors. Very exciting & energetic”
  24.  Jason T Nomura MD @TakeokunIt does seem to be a who’s who of US at the reception.

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