well here at MedCram and today's question is what is clinical
ultrasound and how are clinicians using it today and for that I'm gonna go to
dr. Joshua JK who's the ER physician and ultrasound expert Joshua tell us a
little bit about yourself and about our question today well first and foremost
I'm an emergency physician so the whole reason why I got into clinical bedside
ultrasound was to take care of patients after I finished emergency medicine
residency and became board-certified in emergency medicine then I did additional
ultrasound training and subsequently became the ultrasound director at
Cleveland Clinic ekor general tell us why it's important for our make Ram
subscribers to know about ultrasound and how is that going to fit into their
practice well I encounter situations in emergency
medicine all the time where I wish I had a way to gather more information at the
point of care right when I'm taking care of the patients at the bedside and
history has limited physical exams limited I may not be able to get
diagnostic testing but in comes bedside ultrasound and I feel like with bedside
ultrasound I'm almost cheating in a way because I'm able to look inside the
patient in real-time and narrow my differential diagnosis find out more
what's going on and so I found it of amazing utility in the emergency room to
take care of patients so Josh what exactly is clinical ultrasound and who
needs to be concerned about it who needs to know how to do it or use it that's a
great question clinical ultrasound really is just
ultrasound that is being used by the clinician caring for the patient whoever
that clinician is and it's used at the point of care so in the time when the
patient is being cared for and it's used at the bedside so there's a lot of terms
out there bedside ultrasound clinical ultrasound point of care ultrasound and
really clinical ultrasound encompass is any ultrasound that's being performed by
the clinician to care for the patient so the people that
to know our clinicians of all levels so we have physicians we have nurse
practitioners physician assistants we have medical students paramedics
respiratory technicians you name it echo techs ultrasound Tech's anybody
that's part of the care of the patient falls within clinical ultrasound in my
practice I see people using it from all specialties cardiologists internal
medicine physician nephrologists surgeons emergency physicians
intensivist you name it and what I love about it is also it's kind of creating a
common language amongst physicians that we can speak when we're caring for the
patient Joshua you are such a great professor and teacher and I know this
personally because I knew you that ultrasound was important for me to know
as a critical care physician and I specifically went to your meeting out
there in in Ohio in Columbus and I thought you were such a great instructor
you explained things the way we like to explain things on my cram comm and we've
invited you to to speak for us on mccrane calm about ultrasound among
other things as well tell us about the course that you've got set up for us
well we titled it clinical ultrasound because we want clinicians to understand
this courses for them we want them to be able to incorporate bedside ultrasound
into their practice whether they've ever touched an ultrasound machine before or
they've been using it for years and so the course really starts from the core
foundations of physics and instrumentation and we'll be adding
additional courses to rapidly get into the clinical applications and so I
really believe that this course is going to be useful to any level of clinician
out there and I look forward to continuing adding content what's been
fun for me as an instructor is more and more people come up to me at my
institution and say hey can you teach me this hey can you teach me that because
as they see the utility of it then they want to learn it and I believe that'll
happen to our subscribers in the course as they see the utility for it they're
just going to want to learn and I was surprised when I learned at
your course just how much more accurate and how much quicker ultrasound is than
a regular chest x-ray in diagnosing for instance a pneumothorax yeah I think
we're finding out in the literature more and more that ultrasound is way more
accurate than our physical exam alone and it can even rival imaging modalities
such as CT and MRI but it does it with less cost less radiation and much more
rapidly in the clinical correlation happens automatically because the
clinicians that are taking care of the patients are the ones performing the
ultrasound right so you get that that loop comes
right back much more quickly now what do you have to say to those people watching
that say you know I've seen ultrasound images and it looks like a roar stat
test to me I mean I don't know what I'm looking at are you gonna be able to step
them through and by the time they get done with your course they're gonna be
seeing the right stuff all I can say is I'm testimony of that the thing that got
me into ultrasound partly was because I I was frustrated I started bedside
ultrasound in my residency program and I thought I don't know what I'm looking at
I don't know how this physician who's teaching me can say they see anything
looks like black white and gray fuzz to me but yet I saw its utility so it was a
challenge to learn more and I can tell you from experience you know me who used
to look at that and say yeah this is all fuzz is now is now being called an
expert with time and dedication you definitely definitely can learn this
modality so if I can do and I think anybody can do it tell us about where
the technology is taking us now is it is it unrealistic to think that we'll have
an app or a little device that we can just plug into our iPhone as we're doing
rounds in the morning well what's fun is that the technology
is already there and we just haven't come around to utilizing it in a way
that the technology is available yet but I believe we will so historically yeah
you had those big clunky ultrasound machines and don't get me wrong they
have a lot of features and there's a lot of utility too
an image quality is great but over time the technology has become smaller and
smaller and smaller all the while trying to maintain the image quality the
functionality and we've just had that technology even get into nano chip
technology where you can have a probe plug it into your phone and use a single
probe system for the entire body and so I'm excited to see how that will change
the face of medicine yeah and exactly my next question how much of a paradigm
shift or game changer is this technology when used in the appropriate hands at
the bedside well I think you hear people talking about how we've lost our
physical exam skills over time because we've been utilizing too much diagnostic
testing and why I think there's some level of truth to that I I foresee the
clinician that maintains those physical exam skills but recognizes the
limitations of them in augments those physical exam and clinical skills with
bedside ultrasound because it's a way that you can look into the body or look
at the cause of what you're hearing or seeing on physical exam for example you
know remember in medical school Roger of having to learn all of the you know s1
s2 s3 the different clicks rubs gallops and murmurs and then try to distinguish
what pathology was there well what if you could just take the ultrasound out
of your pocket and put it on the patient and then instead of hearing the Austin
Flint murmur you could see that regurgitation and that's what we're
seeing with bedside ultrasound and it helps us take care of our patients
better we have literature that that confirms
this patient satisfaction scores increase clinician satisfaction scores
increase the length in time to diagnosis improves disposition decisions and
proves and so this has already been impactful in the field of medicine and I
only see it increased well thanks very much dr. Joshua JK and
welcome to MIT cram and I encourage all of our make ramp subscribers those
watching to go over to make cram calm to check out this amazing course thanks for
joining us