Hi everyone and welcome to this webinar on a complete introduction to ultrasound for veterinary nurses. Just as we start, I just have a quick conflict of interest declaration, that I have relevant financial interests and arrangement with Vet Solutions as an account manager, brand ambassador, and nurse consultant speaker. And just something too important, that's important to note is that everything we discuss should be performed under the instruction of a veterinary surgeon and in line with the RCVS Code of Professional Conduct for Veterinary nurses as well.
To start with, just a little bit about me. So I qualified in 2018. I'm now an account manager at Vet Solutions, which is formerly IMB Imaging.
I'm a certificate holder in emergency and critical care, as well as being a tutor on the nursing Certificate in Diagnostic Imaging. And I own 3 Daxis now. Harry, who many of you might have sort of seen in sort of various other lectures and on social media, who's pictured on the screen.
And I have Lincoln and Stephen who are brothers, and also over 30 tortoises as well. Harry features quite heavily throughout my, my lectures cos he's often spending quite a lot of time in front of the ultrasound machine, as a typical veterinary nurse's dog from there. I'm also found on Facebook and Instagram under Pie_RVN, so feel free to get in touch if you've got any questions, following this webinar.
So just some learning outcomes for the session. So one is to be able to optimise ultrasound images through machine control adjustments cos it can be quite daunting being sat in front of an ultrasound machine and knowing what controls do what in order to improve your image to get it of a diagnostic quality. Secondly, is to be able to confidently recognise normal organ structures on abdominal and thoracic ultrasound examinations, because once we know what normal looks like, abnormalities will stick out and they will present themselves so that we can then flag them up and then we can then basically alter that patient's journey throughout sort of the the veterinary practise and how that sort of can improve patient outcomes.
Thirdly, is to understand how a veterinary nurse can have a direct impact on patient care with ultrasound. And then fourth is to be able to recognise those basic abnormalities on abdominal and thoracic ultrasound examinations, which are very common ones that will pop up, in first opinion practise or even in referral practise as well. So this is one of my key take homes for the session, and time and time again it comes up.
So you've probably all been in practise and you've heard someone sort of say, oh, I can't do that ultrasound scan because I won't be able to find their pancreas or adrenal gland. Now, that doesn't solve any of our issues by shying away from it. You don't need to be able to find those things in order to start performing your ultrasound scans.
If that patient has an abdomen full of free fluid, if they're sort of bleeding, actively bleeding into their abdomen. The pancreas and adrenal gland are completely irrelevant at that moment in time. So as long as we're sensible if we are taking on ultrasound as like a beginner, and we're not making sort of rash decisions and sort of altering the treatment plan drastically from a snapshot image, and we're being sensible with our observations, then there's no reason why you can't be utilising ultrasound as your imaging modality in practise.
A couple of terminologies that we have that come up within ultrasound as well. So we tend to use these quite interchangeably within the veterinary profession, but they technically do stand for two different things. So our FAST scans are our a focused assessment with sonography for triage, trauma and tracking.
Whereas our poker scans is point of care ultrasound scans. So our FAST scans is where we're primarily focusing on finding an obvious abnormality. It's not an in-depth scan.
Our FAST scan, whether it's AFAAST, which is abdominal, or TFAST, being thoracic, is primarily focusing on is there free fluid in that body cavity? Is there an abnormal mass that I can easily see very quickly, or is there something like a pneumothorax present? That should take no longer than 2.5 minutes to do when you're confident and competent.
Our poker scan ties in nicely with that, that if we found some abnormalities, we're then using the poker scan. To go a little bit more in depth, and we're gonna assess where is that abnormality coming from. So if there's free fluid in the abdomen, is there any signs of a mass associated with the spleen, for instance?
Or if there's a pneumothorax, then that pretty much ticks that off. You know what the abnormality is, and we can then plan on how we're gonna treat that patient going forward from there. So the poker scan really helps to sort of guide that ongoing management, and it'll determine where the issue is coming from.
But is it diagnosing? The age-old question that I used to get asked on a regular basis when I first started doing ultrasound scans. So a vet nurse can absolutely carry out an ultrasound scan under the direction of a veterinary surgeon, and we can make observations.
The same way you do when you're taking heart rates, and if there's an abnormality, if they're tachycardic, bradycardic, arrhythmic, even if they've got a high temperature, low temperature, low blood glucose, all of those things are all observations. If we're using ultrasound to find free fluid in the abdomen, free fluid in the chest, pneumothoraxes, pericardial effusions, they're all observations as well. There's no diagnosis or disease process that you are diagnosing in that moment in time.
We can also have clinical discussions within our veterinary team, which can assist in those improved patient care and outcomes. But observations and findings on ultrasound are not a diagnosis. So if we found free fluid in the abdomen and suspicious looking mass on the spleen, you could say to your vet, I've scanned the patient, they've got free fluid present and it looks like there's a sus suspicious mass on the spleen.
There's no diagnosis there. If you were saying that the patient has a hemangiosarcoma, then obviously that is breaching into diagnosis territory. So just be sensible in terms of how you're reporting on these, but also having clinical discussions with your veterinary team rather than going and speaking to the owner about your findings from there.
And then what vet nurses can't do with ultrasound, this is definitely one to be aware of, cos not everyone you will work with will be aware of what can be delegated or what can't be delegated. And you may be put in a position sometimes where you're asked to do something that they think is OK for you to do, but you actually can't. So we can't perform centesis cos that would be entering a body cavity, whether that's abdominal or thoracic.
We can't diagnose, as we've just discussed, but we can make observations. And we can't carry out ultrasound without consent from the owner. So make sure you have got consent.
Mainly the point from that is that you're going to deliver their patient back to them with a largely sort of clipped abdomen or chest potentially. And that's gonna be the thing that they notice first, despite all the good work that you might have done. So just make sure that they are aware of why we're clipping and why we're doing the ultrasound in the first place.
Make sure that they have got informed consent. And then moving on to what, what vet nurses can do, because I would say there's a hell of a lot more that we can do than what we can't. So we can obtain those images of a diagnostic quality and work within the veterinary team.
We can perform the point of care ultrasound scans and our AFAST and TFAST scans. We can make those observations which can assist in those assessments and discussions and that patient's journey then through their treatment plan. If we can pick up on things a lot quicker, we can actually action them quicker, which is gonna improve the patient outcome and the patient care that we can offer.
We can also lead in inpatient care and monitoring scans, which I'll touch on on the next slide in terms of what that looks like and how you can start to implement that in your practise. And above all, we can know what normal looks like. Because if you know what normal looks like, it then turns into like pattern recognition.
Once you've then honed your skills into utilising the ultrasound and actually how to manoeuvre the probe across the abdomen and the chest, you'll then know what normal looks like so that you can actually flag up those abnormalities. And as time goes on, you can then develop that even further into finding those smaller sort of details. And then when we can use ultrasound, some people think that maybe it's not really utilised a whole, sort of a large amount.
But I would say that practises and hospitals that are utilising it well will pretty much have their ultrasound on most of the day. And patients will be going to and from that all the time from there. One of the biggest things that you could implement as a veterinary nurse in practise is post-op inpatient monitoring scans.
So when I used to work in a small is hospital, we used to do this morning and afternoon as a minimum on any post-op patients that had the indication to do so. So enterectomies, gastrontomies, X labs, we would serial scan these patients to track how they were doing. So.
We would want to get a baseline post-surgery. So if they had an enterectomy and they have their abdomen flushed because there was sort of a septic risk or they had free fluid and things like that, then we would get a baseline scan, first of all to see what free fluid is remaining, cos even with the, the best one in the world, you're never gonna suction all that fluid out. So we've got a baseline of fluid, we can see what sort of the intestines then look like.
And then when we come to scan them again, sort of in maybe sort of 4 to 6 hours later, we can make sure that that fluid looks like it's getting smaller rather than increasing. We can also look to see whether the intestinal tract is then peristalsing. So is the nutrition that we're gonna be giving them actually moving through that gastrointestinal tract so that they can absorb it to actually heal adequately as well.
What then that turns into is if you're doing that on a regular basis and doing it twice daily or 3 times daily even, again, this is taking no longer than 2.5 minutes to do so when you're confident and competent to do so. Then if you start to notice minor changes, so maybe the free fluid is increasing in size, the guts aren't peristalsing as well as I would expect them to, and maybe the patient's status has deteriorated as well.
You're probably gonna pick up on the first two things a lot sooner than that patient actually displaying that. So if their abdomen is starting to fill up with fluid, is that surgical site dehissing? Do we need to actually go back and do revision surgery to prevent that patient sort of getting more and more into a septic state?
If you can implement that, then your patient care and outcomes are gonna be far sort of improved, from that point. Bladder assessments we can utilise it in, so if you've got blocked bladder cats that are in, we can use ultrasound to see if the, obviously if the urinary catheter is draining as you'd expect it to, that's fine, but if it's not, pop the probe on, why isn't it draining as we'd expect it to? Is there a buildup of sediment that's potentially blocking the catheter?
Is the catheter hitting the bladder wall? Is there anything obvious that you can see that may be causing, an abnormality with that? Also, if you've got recumbent patients on fluid therapy, then we can utilise ultrasound to sort of measure their bladder.
Do we need to take them out for more frequent toilet breaks? If they're recumbent, maybe do we need to place a urinary catheter in that case. And we can then sort of measure like ins and outs as well.
We can also utilise it with cardiac scans, which everyone gets a bit scared about because cardiac scans can be quite difficult to sort of master. But from a vet nurse perspective, then we're mainly looking for pericardial effusions. Is there any sort of contractility issues or obvious sort of abnormalities?
Is there anything bouncing around in the chambers? Is there maybe a smokescreen that's secured in the heart that maybe looks like the blood is very viscous and maybe it's a thrombus risk as well. There's a lot we can see by purely palpating the heart on the side and popping the probe on between those rib spaces.
So we don't need to get a full echocardiogram. I'm imaged from that Then we can move on to our pocus AFAS TFAST scans, which you've already touched on. And then also gut motility checks, which can also extend to sort of your, your exotics, such as like rabbits, for instance.
And if they've got gut stasis, it's just worth, weighing up whether that would increase the stress of the patient and whether it's worth it for the benefits that you're gonna get from it. And more and more people are now starting to carry out ultrasound guided local anaesthesia, to place nerve blocks, which is, again, something that vet nurses can do with correct sort of training. And also ultrasound guided vascular access as well.
So utilising ultrasound to visualise the vein and actually place a, a intravenous catheter into that if you've got a, an incredibly sort of collapsed patient that you're struggling to get vascular access to. In human, this is very, . Normal, so if they fail a certain amount of times to place an intravenous cannula into a, a human patient, then they would actually reach for the ultrasound to actually use ultrasound to guide that in.
And it's a very useful tool to have, especially in sort of the emergency and sort of critical care environment. So moving on to the benefits of ultrasound. So we can see inside an animal's body cavity in a very non-invasive way.
There's no radiation exposure, so it's nice and safe for the patient, but also for the staff that's carrying it out. We can also examine the structure of organs in real time. The images that you're seeing on an ultrasound are that split-second view of what is actually going on there and then.
It's also really nice and mobile now, so we've got various different machines that are out there, so you've got handheld probes that connect to phones and laptops, you've got your laptop systems, and then you've got your car-based systems as well. So we can actually take these ultrasounds to the patients and do a bed or kennel side if we need to. And we can also use it to give us rapid answers to focus our treatment plans.
If you've got collapse and emergency patients coming in and you know how to use ultrasound in those moments, the answers you're gonna get from it, again, are within that split second. You can work around those patients, especially if they're compromised. So if you've got dyspneic patients, you can work around them.
They don't need to be laying in right lateral, nice and still for an X-ray, for instance, with ultrasound. You can do it exactly how they, how they present, essentially. So moving on to the ultrasound machine.
So the settings on an ultrasound machine can be quite daunting. So if you were faced with a machine like you've got on the left hand side, that can be quite terrifying if you're asked to do an ultrasound scan and you haven't seen it before. But there's very few buttons on there that you actually need to be able to, 1, locate, and 2, know what they do in order to get your image of a diagnostic quality.
So 1 is width. So that does exactly as it says on the tin, so you can increase your field of view of that image to see a bigger overall picture of that organ. Second is depth.
So that is your depth of penetration, so how far. Are those ultrasound waves reaching into that patient. So if you've got a really large Newfoundland, for instance, you're gonna need a greater depth, whereas if you've got sort of a small puppy or a cat, you're gonna need less of a depth of penetration to sort of see those overall organs.
Depth then ties in with frequency, so I would definitely locate where your frequency, sort of adjustment is on your machine. A higher frequency will give you a lower depth of penetration into your patient, but the image resolution that it gives is far superior. So it will give you much better image resolution using a higher frequency.
Whereas a lower frequency will give you a better depth of penetration. So for your larger patients or really sort of deep organs. But it will hinder your image resolution.
So at any point you want to be trying to use the highest possible frequency to give you the best image resolution without jeopardising the depth into your patient. Next is your focus point. So on your machines, if you've got a specific aged machine, then they usually will have a, focus point which will present as like a little marker down the side.
This particular marker basically focuses the ultrasound waves across that specific area and above. And then below that point, they will start to sort of diverge out where they'll sort of scatter, and then the returning signal isn't as strong. So your image quality below that point isn't going to be as crisp.
Then your freeze and save buttons are quite important because sometimes you need to freeze quite quickly and you'll need to know where they are. Mainly because when we're using those, we need to capture those images in cine loops so that we can later on refer to them if we need to. And then our calliper or measuring buttons are used for measuring organs or measuring free fluid pocket sizes.
And that's quite important, especially if you're doing serial scanning, to then get a rough idea of whether that is increasing or decreasing in size. And then our presets, which everyone tends to forget about, and you might have got people in practise who have said, don't touch the machine, don't mess with the settings, they're my settings, and I don't want anyone to, to fiddle with them. But if you've got presets on your system, it essentially should be set up so you can take, set it up for cat abdomen, large dog abdomen, cat thorax, large dog cardiac, and all those sort of different things.
That should give you a really nice starting point of depth and frequency. And it should be to the point that when you put the probe on, if your patient has been adequately prepared, that your image is pretty good from the offset. So absolutely utilise them if you've got them.
Also, if you fiddle with anything for your stand and your image quality isn't as good as when you started, just go back and reselect that preset and it'll take you back to that starting point. The next thing just to be aware of is on all of your probes, you'll have this little marker of some sort. Sometimes it's a light, sometimes it's a little bump.
That basically correlates to this marker on the top of your ultrasound image. That will vary in appearance, depending on the manufacturer of the ultrasound machine, but they basically correlate to each other. So if you had your ultrasound machine to the left with your patient in right lateral recumbency with their legs towards you.
And you had your marker pointing towards their head, you then know that this side of the image is cranial and the other side is caudal. It just helps in terms of how you're orientating yourself and how to bring things into the centre of the image and which way you need to move in order to do so. So moving on just to touch on that frequency point again, so low frequency gives you good depth of penetration, but poorer resolution, whereas that higher frequency gives you poor depth, but better resolution.
When I play this video, there is a kidney situated in this area just here. Now there's a few things that we could do to optimise this image already. Currently we've got from this point below as complete dead space.
We're not really interested in this, this area if we're focusing on the kidney. We want that kidney taking up a good 2/3 of that ultrasound image, so sort of reducing your depth quite significantly. Subsequently to that, you could then move your focus point actually more in line with your kidney as well to get the best resolution across that area of the image.
What we're gonna do when I play this is we're going to increase the frequency. We're not going to change the depth or anything, but you'll see as we increase the frequency, the resolution of the kidney improves ever so slightly to the point that actually we increase it too high and all we're left with is these first couple of centimetres of the scan image. So here we can increase the frequency, we can see we're we're losing a bit of depth, but we've got a bit better resolution over the kidney.
And then we increase it again and we kind of overcook the frequency and we're not left with really an image of a diagnostic quality from there. If you left the frequency at that point and then reduce your depth, you'll find that actually you could see the kidney pretty sort of well within that area. And then moving on to which probe to pick.
So depending on what you're scanning and the situation will depend on what probe you need to reach for. I would say most practises probably have these three probes available to them. And they will all be used for, for different things, essentially.
So starting from left to right, we've got our linear probe here. I never personally used to use a linear probe because I wasn't too interested in scanning sort of eyes and sort of muscles, tendons and ligaments. However, if you have got one in practise and you've got any, small patients, so probably anything sort of under 10 kg or any cats, this is your probe that I probably would reach for a lot of the time if you're doing sort of, general scanning.
So if you're scanning their abdomen, this will give you really lovely images. So you'll get high frequency probes with your linear probes. But you'll have a, a depth limitation.
So usually around 8 to 10 centimetres. Some of them will go a bit deeper, sort of 12 centimetres. So they're more for our shallow structures.
You'll get a more rectangular field of view, so depending on the size of the patient, it can be quite tricky to sort of orientate it over them and get underneath sort of like the little spaces. But the image quality that it will give you will far outweigh any of these other probes that you see on the screen at the moment. Moving on to our microconvex probe in the centre here.
This is like our universal probe. So this is what I would reach for in an emergency situation if I needed to do an AFAST and a TFAST scan. This will do your whole abdomen, even sort of on your larger patients and your small patients.
But it will also fit between the rib spaces as well in order to see if there's things like pneumothoraxes or pleural effusion or pericardial effusion and the like as well. The depth of this one will go up to about 20 centimetres, some of them will go a bit deeper as well. And it's got sort of a mid-range frequency and it'll, it'll work between like a lower and a higher frequency as well, just to sort of ensure that you can capture all of those different patients if you need to.
And then on the right-hand side, we've got our cardiac probe, which has got a nice square footprint to fit between those rib spaces quite nicely. But one of the other things that it will do will support various other Doppler modes, such as like continuous wave Doppler. But it will also keep up with frame rates as well.
So when you're obtaining an ultrasound, it will work in frames per second. So your linear probe, because it's doing sort of more small and superficial structures, will probably work at a frame rate of, like, say, 15 frames per second. Well, if you're using a linear probe scanner, cat's heart is gonna look like it's got bad internet connection and it's like not keeping up with the heart rate, which is why we use cardiac probes, cos when we're looking at sort of moving structures such as the heart to make sure that we can look at those valves and really capture all the sort of detail and, and, information from there as well.
So moving on to the basic steps of ultrasound. So if we see things that appear black, like on the left hand side here, this is fluid. So this is a bladder that is full, filled with fluid.
And then if we go on to other types of black, so we've also got black here, black here, and there's also a bit of black in this area too. So this is where Alan gets a little bit confusing. We need to use our own judgement and our own skills to know what we are looking at in order to identify it properly.
This black here is more of a shadow, as opposed to the fluid here, we can still see the image underneath. And this is contained within the smooth walled structure, so we know that that is a, a organ basically full of fluid. So that is our bladder.
Next to that we've got this shadow here, which is actually removing the image underneath and giving us this sort of grainy appearance. So this can be things like gas, but it can also be something like dense material. So here we have got the colon.
So this is the layering of the colon, and then we've got faeces within that colon that's giving you that shadow shadowing. Mainly that's because the material is so dense that the ultrasound waves can't pass through it and bounce back to give you an image. It's basically being blocked from, from this point here, which is then giving you this highly reflective surface at the top.
This other type of shadowing here is like acoustic shadowing. So again, this is our dense material. You'll commonly see this sort of acoustic shadowing within the chest if you're scanning between rib spaces, because bone is ever so dense that ultrasound can't pass through it.
So again, it gets reflected back, and then you get this shadow being cast. This particular image is actually of the small intestinal tract, and there's something dense sitting in there that is causing this to shadow sort of beyond as well. But we'll come onto that with a, with a case scenario a bit later on.
And then our grey and white structures throughout the abdomen and throughout the chest are our soft tissue as well. This particular bit of black here is just a blood vessel that's, within sort of the liver lobes as well. And then moving on to echogenicity, this is a term that you would use if you are sort of reporting on your ultrasound or if you're describing them to sort of other sort of veterinary professionals that you're working with.
And this is all to do with how well the tissues reflect or transmit the ultrasound waves, essentially. So if something is hypoechoic, it's usually dark or darker grey. So it'll present as like darker tissues.
If something is hypoechoic, then that will be lighter grey. It can also indicate things like inflammation. But I would usually refer to the diaphragm just here as a hyperchoic bright white line that runs alongside the, the liver as well, from that one.
Isoechoic would be something that is equal in echogenicity, so equal in its, grey scale, so similar sort of, of like two tissues that look very similar. And then anechoic is black. So here we've got a gallbladder full of fluid, which is anechoic.
And then here we've got our urinary bladder, which has got urine, obviously in it, which is presenting anechoic as well. Basically, that's because there's no echoes, so there's nothing for it to bounce, bounce off and also send back as, as a signal, from there. So that's why fluid doesn't sort of give you an image as such, it'll just give you this sort of void and then you can see beyond it from there.
And then having some anatomical knowledge can be really helpful. Because we also need to tell the difference between fluid-filled organ structures or free fluids. Because they're both fluid, they both appear as anechoic and black.
The main difference is that fluid-filled organ structures are contained within a smooth wall structure. But having some anatomical knowledge can help because you can think at the time, where is my probe? What am I expecting to see within that area, and is it normal or abnormal.
So on the screen currently, we've got a urinary bladder here, absolutely normal, you can see it's smooth walled and contained. Here we've got our gallbladder, as we've discussed already. Again, smooth walled and contained.
Here we've got these sort of multiple, sort of, circular, fluid-filled areas. Now this isn't particularly normal, but we know that the fluid is contained. So in that particular image, that is a uterus that is fluid-filled, so very commonly, known as like pymeters or hydrometers in practise.
Again, if you were concerned then of breaching into diagnosis territory, you could say that there was a fluid-filled uterus on ultrasound examination. There's no diagnosis there, it's purely a observation. Moving on to free fluid, the main difference is, is that we've got this pointy and sort of irregular, outline of this fluid.
It's not contained, there will be things suspended in it. So here we've got a loop of intestine that's actually suspended within that free fluid. Here, a large amount of free fluid, and then again we've got a little pocket of free fluid just next to the bladder.
So it's worth measuring those pockets to make sure if we measure them again, are they increasing in size or reducing from there. I wouldn't take the measurements as absolute sort of gospel from there because you might find that if you scan them in a couple of hours, because you're. Scanning your body cavity, those areas are gonna move, and those sizes of free fluid pockets are gonna change as well.
But if you've got drastic changes, then I would obviously then take that as a bit more of a, of a sign that maybe something's changing, whether it's increasing or decreasing. So moving on to patient preparation, which is a step that I definitely would make sure that you spend the time to do, because if you prepare your patient adequately, then your images are gonna be far better as a result of that. So first off, I would click the to allow really good pro contact.
So Harry here is . Just demonstrating how he would like to be clipped. So a nice surgical grade skin prep here, because we want to remove the coat, because if you leave any any fur or hair on that patient, the moment you put gel on, you will trap air between the hair follicles of that patient.
And air and ultrasound aren't very good friends, and it's essentially going to hinder your ultrasound waves being able to sort of, contact sort of the patient and actually the tissues. I would then degrease the skin with skin prep, so something like diluted chlorhexidine can work really well. That just means that you get rid of that greasy, oily barrier that sits on the skin.
And then the ultrasound gel can set in a lot better and your images are gonna be a lot better as a result as well. People often think that maybe a sphinx cat would be an ultra stenographer's dream. However, they are very greasy and oily.
So if you were to not sort of scrub them and just pop the gel on, you'd find that it actually probably just falls straight off. So definitely give them a good scrub, you'll find that your images are a lot better as a result. And then there's the age-old question of spirit, as whether we can use it or not.
So. There is a difference between spirit and isopropyl alcohol. Isopropyl alcohol doesn't contain castor oil, and it's castor oil that is believed to degrade probes over time of constant use with ultrasound probes.
However, if you're using it in an emergency situation, you're using it very quicker. Then if you're using it sort of for a short period of time essentially what you can do is just make sure you clean your probes afterwards. It's they're not being left in contact with the probes and it's unlikely to cause any sort of degeneration of those.
The reason for using it is if you haven't got time to clip, or if you want it to be more of a sterile procedure. That then dampens down the fur, gets rid of those air bubbles that potentially get locked in between the hair follicles, resulting in better contact between your probe and your patient, and better images as, as a result from there as well. If you are really worried about using it, then I would just use like stuff like cling film or a sterile glove over the top of your ultrasound probe just to give yourself a barrier between them.
But if you are cleaning your probes after using them, there's no reason why it would cause any damage in the long term. The only way I wouldn't use it is if you've got any needle stick injuries to the top of your probe, because then it can ingress and cause that to sort of dry out on that rubber sort of footprint from there. I would also have a quiet and dark room just so you can adjust your eyes to the scales of grey on the screen and sort of those minor details and also consider sedation and restraint if it's needed as well.
If the patient's not tolerating the ultrasound, I would ask why? Is it because they're painful? 9 times out of 10, if we're scanning them for an emergency reason or a reason that they've had like an ongoing condition, there might be an element of pain associated with that.
So make sure they've got either sedation or analgesia on board when we're doing this, because it can be quite uncomfortable. Lateral recumbency is often most popular, but we can do them on their backs, or we can do them standing. So the nice thing with ultrasound is we can work around them.
So however they're most comfortable being scanned, if they're dyspneic, we're not gonna necessarily want to lay them on their side and further decompensate them. But patient preparation will give you better images, so please take the time to do so. Now we're gonna go through an abdominal scan, from start to finish, and this is just the routine that I do it in and show you the normalities that you can expect to see, followed by the abnormalities as well.
So when I start my abdominal scans, I will do it in exactly the same way every single time. Because having a systematic approach to it means that you know what you're expecting to come across next each time. And if you don't see that next or you see something in between, you can then start to question that is this actually completely normal.
So here's just a rough situation of where things are based. Obviously it's going to vary because you've got things all in between as well, such as the intestinal tract, the stomach. And then you've got other sort of minor organs like lymph nodes, pancreases, adrenal glands, and the like as well.
Obviously bear in mind, things are gonna move into different places. So if you've got a stomach that's really full, that's obviously gonna be distended and that's going to move things from there as well. You'll also get to the point where you become really confident doing an abdomen scan, and then you'll come across 11 day that will be full of free fluid and everything will be in different places and it doesn't look how you would expect it to.
But being able to identify that. Is a massive benefit to the patient care and outcome that we can offer as well. So first of all, I start all of my scans at the diaphragmatic hepatic site at the zippy sternum.
So some people prefer to start at the bladder cos you don't have to put as much pressure on the probe to the patient, and sometimes they then start to tolerate the ultrasound scan a little bit better from there. Here, it depends on the patient's size, sometimes you will have to put a little bit of pressure in order to get the images that are on the screen currently. So the liver runs alongside the diaphragm, which is this hyperchoic bright white line that runs alongside it.
So you can see this on all of the images. It's vascular in appearance depending on what view we have. So if we're in sort of transverse or sagittal plane, you'll get various different sort of blood vessel structures come in and out of view.
The gallbladder will be viewable. So this is our gallbladder. If we were pointing towards the chest as Harry's laying there and fanned down towards the table, our gallbladder will usually come into view.
And the size of that will depend on when they last ate. So if they've eaten recently, then that gallbladder will be a bit smaller because it'll have emptied for that digestive process. Our cardiac view sometimes will be visible depending on the breeds and the capabilities of your machine, but essentially what should happen is as you point through to the diaphragm and increase your depth and probably reduce your frequency, you should be able to see the heart beating within the chest from there.
The other thing just to bear in mind is, is that because the diaphragm is so hyperchoic and bright white, it actually acts as a mirror, so it can mirror the liver and gallbladder into the chest from there as well. And as you change the angle of incidence, you'll see then the heart comes into view as well from there. The reason I mention that is because if you have free fluid sitting between the diaphragm and the liver, it can reflect that to look like it's in the chest.
So it can make an abdominal effusion look like a pleural effusion from there, which is obviously a very different case to manage and a treatment plan on going from there. So just make sure you've considered that. The reason I start my scan at this point is because I tick off a lot of things in an emergency situation.
I can already see the diaphragm's intact. I can see there's no free fluid within sort of between the liver and the diaphragm. I can also see into the chest to check there's no pleural effusion.
And I can also see that the heart looks as if it's doing a relatively good job from there. I can also see the gallbladder as well to make sure there's no signs of any abnormalities as well. So you've seen a lot of information within probably 30 to 45 seconds of scanning your patient, which in the ECC is going to be quite sort of critical.
Then moving on to our liver and gallbladder abnormalities, so we can get things like mixed echogenicity, which we would, describe as being heterogeneous, which I'll, I'll show you an image of a little bit later on a different organ. Abnormal shapes and uneven edges, so if they weren't sort of sitting nice and, sort of smoothly against the diaphragm, you might sort of be questioning, is there a mass potentially that's sort of displacing things. Free fluid, again, that might not necessarily be associated with that organ, but it's worth flagging up where roughly it is.
Because if it is sort of bleeding, then it's probably gonna be bleeding obviously from that area of interest, but bear in mind there's a cavity and it's free, free moving around there. Distended vasculature as well, and then also moving on to our gallbladder abnormalities such as like sludge or halo appearances, and also mucoceles as well. So the abnormalities on the screen, we've got a really distended sort of biliary tree, on this case, this was actually a gallbladder blockage that was an extremely painful patient to scan.
So just bear that in mind, if they haven't got any analgesia on board when you come across any of these, please get it on board ASAP. This one here is a halo sign which has got this edematous ring surrounding the gallbladder. If you were to come across this, it could be due to things like anaphylaxis, but it's always worth then scanning the heart because it can have a link to having a pericardial effusion at the same time.
So just make sure that you're ruling that out if you come across this. This gallbladder in particular was Harry's when he decided to play with a wasp in the garden and showed signs of anaphylaxis, so he ticked that one off his, his medical checklist. And then the bottom left here is a, a classic sign of a mucocele, so it's like this segmented appearance, or grapefruit kiwi appearance, however you want to refer to it.
And then moving on to our stomach and GI tract, so. Our is situated in the cranial abdomen underneath the rib cage. There's a mixed appearance of this, dependent on the food sort of intake.
So if they're coming in for a planned ultrasound scan, I would always advise that they are starved. And then hopefully their stomach will look like this collapsed appearance where you can see the rugal folds. Whereas if they've eaten recently, they're gonna have this full stomach and this sort of shadowing coming from there as well, which is gonna hinder being able to see some structures and some sort of minor details as well.
If they're coming in for an unplanned ultrasound examination, I would always ask them when did they last eat? Because if there's abnormalities being displayed, and they say, oh, they haven't eaten for 3 days, and you scan them and see a stomach like this or a fluid-filled stomach, then you might have a bit more of an indication of what potentially is going wrong. There's a structural wall to it, and then it's located between the liver and the spleen.
And then the intestines tend to look like coffee beans as you can trace the gastrointestinal tract from there. So here we've got a bit of intestine in small axis short axis, here and here. And then this is a long axis piece of intestinal tract from there.
Short axes tend to look like coffee beans, and obviously sadly the intestines don't run all completely in a straight line. So you will have to orientate your probe as you sort of follow through, on those intestinal tract, journeys. This here I purely took because it looks like a little smiley face, but it does show you a very clear differentiation between short axis intestine and then long axis from there.
And then again another long axis piece of intestine sitting just beneath the spleen. And then moving on to our gastrointestinal abnormalities. So we've got gas shadowing.
Acoustic shadowing is very common with our sort of foreign bodies. So this is very sort of common from there. Pork gut motility, so if you've got lack of peristalsis, this is obviously really important in those post-op patients, especially if you've got post-op enterectomies, gasttrotomies, ex-lapse, enterotomies, all of that sort of stuff that you want that nutrition to be moving through the gastrointestinal tract so they can absorb it and actually heal adequately.
Intestinal tumours, which will usually appear hypoechoic to the surrounding tissues. So here we've got a hypoechoic mass that is actually surrounding the lumen of the intestine. And as we play the video, you can actually trace that lumen right the way through that mass.
That was almost compressing the lumen of the intestine was acting a bit like a foreign body. And then moving on we've got inflamed layering as well, so IBD and then we can get fluid distention as well. So on this particular video here we've got a large amount of fluid in the stomach, and then we get this shadow that comes from it as well.
And this was a case, that came on an ultrasound CPD day, and was a practical, demo patient, and it had eaten a sock that morning. So that shadow that you can see being cast now, is said sock swirling around within the stomach. So the sock comes in just about there.
And then some further gastrointestinal abnormalities, so here we've got a bit of distended gastrointestinal tract, so small intestine. And then on the same image or same scan, we've got a normal piece of intestine that's peristalsing as we would expect it to. So if I was to see something like this, I would, it would instantly raise suspicion of something like a gastrointestinal foreign body.
Because think of it as you're on a narrow country lane and there's a car that's broken down up ahead. That's the obstruction. Behind that you've got cars building up and traffic building up where it can't continue its normal journey.
So that is what we can see on the left hand side. So that's all your traffic building up, and then beyond that obstruction, you've got normal moving traffic. So somewhere in between, you've got that, that area of concern, which is likely going to be a foreign body.
So then you need to go on that hunt looking for that acoustic shadow. That particular, intestinal tract was Harry's, when he decided to eat a corn on the cob and have a foreign body. Moving on to the spleen, situated mid abdomen along the rib cage, mid-gray in echogenicity, and has a bit of like a slug-like sort of shape.
So it sits quite close to the peripheral sort of skin edge and quite close to the top of your scan. There's a vascular supply, which bifurcates off like this just, and it looks like a bit like a whale's tail. And then also we use the term, for Doppler, which is BART, which is blue away and red towards.
So if you were to put colour Doppler on the splenichylus and you saw it blue, it just means that it's moving away from the probe, and red means it's moving towards. Sadly, it can't differentiate whether it is, oxygenated or deoxyated from there, but you can put that on and see that splenichylus bifurcate off in those instances. And then some stoic abnormalities, we can get mixed echogenicity, which is that mottled cavitated, heterogeneous appearance, which this is pretty classic of that description.
We can get enlarged sort of splenomegaly or splenic torsion, tumours like hemangiosarcoma associated with the spleens and free fluid as well, which might not necessarily be associated with the spleen, but it's worth noting and really thoroughly checking the spleen if you have got free fluid to make sure that's not where it's coming from. So here we've got a large amount of free fluid that's actually displacing the spleen off the body wall. And then here we've got a little nodule, on the spleen as well.
So you can see that's quite small from there. And as we fan through the spleen, that becomes visible, and as you're fanning through still, it then, you lose it. So it's quite easy to miss very minor details because we're over the same part of the spleen, but we're fanning through it.
So make sure you're thoroughly assessing your organs. And then moving through a spleen scan here, so we can see a really large piece of small intestines below, and then we've got our spleen just above. Here we're using a linear probe.
So again, that's that higher frequency probe, poorer depth. We're only at about 4 centimetres. But it gives us much better image resolution.
So as we fan through, we can see the splenichylus coming in here. We've got bits of small intestine just below. And then we fan through still, and then we've got this nodule that becomes apparent just in the middle there.
And then we can measure that, so we can keep an eye on it, make sure it's not growing, getting smaller, is it changing in appearance. So you can really use ultrasound to monitor these patients as well. That, scan in particular is Harry's spleen, that he's got a little nodule on it, which is nodular hyperplasia, so it's nothing to worry about at the moment.
And then moving on to our kidney as we continue our journey around our abdomen. So this is located in the hypaxial muscle region, mid abdomen. The right kidney's situated more cranial than the left.
They're really nice and easy identifiable because this is probably one of the, one of the only organs that looks as you would expect it to look on ultrasound. It literally looks like a kidney, which is quite nice. It's obviously got a mixed echogenicity due to its structural makeup.
And as you fan through it, you'll see different parts of sort of the, the renal artery going in, the cortex and the medulla. Kidney abnormalities, we can get things like loss of structural detail, we can get size differences, so small and large kidneys, associated tumours and irregular shapes, blockages and kidney stones, and edematous kidneys and echogenic changes as well. So this kidney is pretty much trying to tick off everything it possibly can.
So we've got some free. Fluid surrounding it just here. We've got a bit of hydronephrosis going on.
There's also this really hyperchoic area in the middle, followed by these acoustic shadows just below. So that's likely to be some sort of like calcifications or kidney stones sitting within there that's causing those shadows from there. And it's loss of structural detail.
It's not really wanting to be a kidney anymore. I'm very pleased to report that isn't Harry's kidney though. And then moving on to our bladder situated in the crane, the caudal abdomen, there's a structural wall to it unless it's ruptured and it's filled with anechoic fluid and nice and easy identifiable.
One thing to remember here is if you're moving from your kidney where you might be having to apply a bit of pressure, as you move around to your bladder, you might just need to. Reduce that pressure from the patient a little bit, cos sometimes we can compress the bladder and push it out of the way. Or if it's quite small and not very full, we can actually, like, literally squash it so you can't see any urine in there.
So just reduce the pressure on the probe onto that patient, it should then sort of reveal itself as well. This particular bladder here isn't normal, so it's actually acting a bit like a pendulum, and it's got all this sort of sediment that's situated in it as well. So if you were to agitate that, you'd see that sort of snow globe effect with all that sort of crystals, flowing around.
That one is Harry's bladder. And then some abnormalities, we've got oliths, so blocking of sound waves, sediment and crystal urea. Your abdomen, if you've got a loss of structural wall in those trauma patients, thickened and inflamed walls, tumours, and also distention.
So here we've got a, this is a bit of a weird case of the diverticulum, almost have like a bladder within a bladder. Here was a bladder post cystoomy, so it's got this thickened wall from here to here. You can use ultrasound in this case to monitor that patient, make sure that inflammation is coming down, but also that there's no free fluid leaking from there as well.
Like, is that site actually healing as we would expect it to. And you can also then keep an eye on that inflammation, see if it's reducing over time. And then we've got some sediment on this patient, so you can sort of see that it is sort of suspended within there.
This particular one isn't the best image, but we've got an actual bladder mass that was associated with the wall, of that bladder in this case. And here we've got this hyperchoic area within the bladder, followed by the shadow and loss of, image below. So this was a case of bladder stones within a patient.
And then here, I've actually labelled him, on this case. So this is Harry's bladder, which is a bit small, and it's got a bit of a thickened wall here. But again, we're only at about sort of 2 centimetres depth, so it's really tiny.
Here was when it then filled up a little bit, so you can see the wall looks less thickened, because it's like a balloon. If you blow the balloon up, the wall of the balloon is then begun, going to become thinner. It's exactly the same with the bladder.
So if you see a thickened wall, don't automatically think that it's inflammation, it could just be because it's really empty. In Harry's case, it probably was a little bit inflamed because he does have a habit of, having rather, a large amount of sediment throughout as well. And now we'll go through some in practise scenarios, so this is when it really comes in useful.
These are all being led by, myself and, the nursing team. So this is Buddy, who is our first abdominal case scenario. He presented as a nine year old male German Shepherd dog, tachycardic, hypertensive pal mucous membranes, tachypic collapsed and lethargic.
There wasn't any vets available. This is when I was in a small animal hospital. It was quite busy, so we had consent working, sort of speaking to the vets and conversing with them and speaking with the owner to, to do sort of initial investigations.
So we carried out our AFAS scan, which showed us this very large amount of, sort of free fluid. And then followed with our poker scan to find out where is that fluid coming from. And this is what we saw.
So you've seen this image already. So this was our splenic mass, that was associated at the tail of the spleen. And also with that large amount of free fluid.
So it was quite obvious what was going on with Buddy. We can then turn those findings into being proactive. We can set up X-ray and we can take chest radiographs if we've got consent to do so.
We can place IVs and get fluids going in. We can take bloods and run those, we can have theatres set up. All of those things are then ready to go, rather than waiting 30, 45 minutes to an hour for someone to become available to scan Buddy.
And all that time is then further deteriorating. So you've got a much more stable patient going into theatre rather than someone that's decompensated and then has a poorer sort of prognosis and outcome. Buddy went to surgery and we removed his spleen along with the, the tumour, so you can see that this is that heterogeneous appearance on that ultrasound scan.
But what I would advise you to do is if you scan something and it goes to surgery, go and have a look at it because you can start to build up that pattern recog recognition of what you're seeing on the scan and what's actually going on internally as well. So with Buddy, Ulsan gave us really rapid answers in his case, so he was in the hospital for sort of less than 20 minutes and we knew exactly what was going on and we can then effectively triage him through the hospital in terms of what needs to be done as next steps. It was carried out in a compromised patient.
We've got a really rapid formulation of treatment plan and a proactive instead of reactive approach, and that was all carried out by the nursing team. Abdominal case scenario tubes, this is Lola. Lola had a suspicious mass on abdominal palpation, also had vomit and diarrhoea, and she was going in to have enterectomy surgery, but we popped the probe on beforehand to find out what was going on.
And we were presented with this classic bull's eye appearance sort of sign. So this is classic for interception. So we've got a bit of intestine inside and another bit of intestine, and a bit of momentum that's been dragged through as well.
So she had enterectomy surgery, she then had post-op scans, morning and afternoon to make sure, again, no dehiscant, it was peristalsing, and the nutrition we were giving through, was actually being absorbed adequately as well. If you then sort of saw free fluid building up, then you might be like, oh, has this broken down? Do we need to go back in, rather than waiting for her to clinically present as a deterioration and then jumping in, on a more sort of compromised patient.
Abdominal case scenario 3 was a 6 month old cat that had a history of chronic vomiting and diarrhoea. It had enterectomy surgery for interception the day before, and it was hospitalised post-op. So we then opted to do a repeat scan, looking for free fluid and peristalsis.
And sadly, this patient had re-intercepted less than 24 hours, after its initial, initial surgery. So I'd always recommend that you're doing post-op scans for your gastrointestinal surgical cases because the benefit they can have. Means that you might be able to intervene a lot sooner rather than then being faced with a critical patient or something that's really compromised and then has to be put to sleep.
So sadly this case did need to be put to sleep because of the amount of gastrointestinal tract that was removed the day before. Abdominal case scenario 4 was Fern. So, Fern was an 8 year old female neutered greyhound.
She presented tachycardic, p pyrexic, lethargic, vomiting, and had dry and dark pink mucous membranes, and Fern was, presented to the nursing team to, perform a scan. So what we could see on Fern when we started scanning her was she had a lot of dilated intestines, as we've already discussed. So dilated and this regurgitant sort of fluid going backwards and forwards.
So at that point we were then looking for the shadow. So where is the acoustic shadow that is causing this regurgitant, fluid going backwards and forwards? Because the giveaway was this little bit of normal intestine at the top here that was peristalsing normally, and also a hyperchoic pancreas just beneath it as well.
So this is slightly duodenum with pancreas just, just beneath. We then put fern into the other lateral and within seconds, found the culprit. So here is the acoustic shadow.
I would always recommend that you scan both sides of the abdomen. If you have any inkling of, of an abnormality, like, don't be caught out by just scanning the right-hand side of the patient or the left hand side of the patient if they're in right lateral, because you can often see structures, certain structures a lot better by scanning them in, in the other lateral, such as like the duodenum, for instance, and sort of the pancreas. So we spotted this shadowing coming from her small intestine, at which point it was then, confirmed and then recommended to go to surgery.
So Fern went to surgery, and this is what we were presented with. So she had this wooden skewer that was perforating through her small intestine. So there was actually no free fluid at that point, so I think it was very early on into the perforation.
But you can see how angry that gastrointestinal tract is as it's worked its way through. So. Fern had an enterotomy and that was removed, and she had repeat scans morning and afternoon as a minimum.
Regular observations of pain scores. Again, we were looking for free fluid and peristalsis. Nutrition was a vital role in her recovery in order to make sure that she healed adequately.
If you need to place a feeding tube, absolutely do. And this was all again delegated to veterinary nurses. So absolutely something we can be utilising.
Now moving on to thoracic ultrasound, there's far less that we can look at in the thorax. So we've got the heart, the lung fields, and the pleural space. And the indications for thoracic ultrasound are dyspneic presentations, dull cardiac sounds on auscultation, pulse abnormalities, and triage assessments.
Ultrasound is super useful in dyspneic cases because again, they don't have to lay for a radiograph, the results you're getting it are instant. So if you've got dyspneic presentation, it can give you a hell of a lot of information and really guide your treatment plan in these cases. Starting off with our lung field assessment, so we can do this in lateral sternal recumbcy again, as I've mentioned, and all we need for this is a clip patch between the rib spaces on the most appropriate.
And you're literally popping your probe directly through that lung. So you're pointing it straight through the patient, and then you want to see acoustic shadow on each side. So this is your rib, which is causing that shadow, and we're looking at the area in between.
Normal appearance will have A lines, which is this horizontal lines that run sort of throughout the lung field. And you have the, obviously the rib spaces, sort of blocking those. So actually, some people will say it's a bit of a gator sign, so you can see it looks like a like a crocodile poking size above the water.
And we're interested in this area in between. We want to see that sliding backwards and forwards as the patient breathes in and out. So this is your lung sliding against the chest wall within that area.
This is not what we want to be seeing. So this is an abnormal sort of sign. So beelines, or you might have heard them referred to as rockets, flashlights, searchlights, fireworks, whatever you want to call them, they're still abnormal.
So they can be indicated for things like aspiration pneumonia, fluid on the lungs, pulmonary edoema, and they extend right the way through the image. So you can see here, as that depth is increased. They still continue.
They don't just stop. So this is hyperchoic bright white lines between your rib spaces, that is indicative of B lines. So definitely worth flagging up.
If you saw the odd one, then maybe it won't be sort of too much of a concern. But if you saw an image like either of the ones on the screen, I suspect you're gonna have a dyspne patient in front of you. And then this is, the glide sign, which is what we want to be seeing again.
This is a positive glide sign. So this is more of a curtain sign, so it's actually a lot more obvious. So this is when you're more caudal on your patient within the lung fields.
As they breathe in, the lung obviously inflates and extends past where it wasn't before, so it's a lot more obvious as it pushes, onto the diaphragm, sort of from there. If you've got absence of a glidesone, it can be due to pneu pneumothorax, where you've got a barrier of air sitting between that lung field and this ability to then slide quite naturally against the, the chest wall. So if you haven't got that, again, flag it up.
Has it got a pneumothorax? Is it dyspneic? Use the ultrasound as part of your jigsaw puzzle as to what is going on with your patient.
This is an example of a pneumothoraxis. There is a patient that came in after being involved in an RTA and its white line is actually way down here rather than being up here, and it was bouncing. Plus, we had quite a dysique patient on our hands in this case as well, from there.
At the moment, there's a lines. There was a bit of a B line coming in a little while ago. But we performed a radiograph, and you can see there's all this air sitting within the chest that shouldn't be there, and it's actually lifting the heart off that sternum area as well.
. Then what we've done is we drained the patient's chest. We removed, I think it was about 800 mL of air, or it might have been a bit more actually in this case. So we removed that air, you can then see the chest looks a lot better.
And then we actually, that's not playing for some reason. But essentially that line is now up here, rather than down here. And it was then sliding backwards and forwards.
There is a bit of a beeline coming in, which would be expected with like the inflammation and sort of the trauma, sort of from there as well. And then moving on to cardiac abnormalities. So these are all cases where there was some sort of abnormality displaying, we've palpated the heart and we've popped the probe on.
We're not doing a full on sort of echo exam and doing sort of standardised views. It's initially just looking for any obvious abnormalities. So starting on the left hand side, this is a case where you've got a large amount of pericardial effusion, which is actually restricting the heart from doing its job properly.
And it's also highlighting a mass just to the side there because you've got the contrast between fluid and tissue. And then on this one, again, you've got a very large, a, a large amount of fluid surrounding the heart. Acting, and it's also causing like tamponade cos that heart is so restricted that it's on in like this sack of fluid that it can't really do its job.
You're also gonna really struggle to get standardised views from that sort of presentation as well because it's just so collapsed. And then this patient, was a cat that had a clot that had formed within the chamber. And you can actually see it, bouncing around in the chamber.
And also the conductility of that patient is really poor as well. So you can see that's quite an alarming case, to be presented with. And then on the other video, just over here, this is a.
Dog and you've got a really large thrombus that has formed within one of the chambers. Again, the contractility is quite poor. And if that was to escape, it's obviously gonna cause quite a lot of suffering, with both of these from here.
These particular cases then will probably need pretty urgent pericardial drainage, so you can then set up for that, to sort of help in terms of like a therapeutic, stabilisation of the patient as well. Now moving on, this is another abnormality, so this is a really enlarged left atrium. So this is a left atrium aortic ratio.
So you would take a measurement from here, which is your aorta with the Mercedes-Benz sign that's in the middle. And then you would measure across your left atrium as well and divide them. If you can get this view, this gives you a lot of information as to whether if you've got a collapsed patient, is it a cardiac cause of collapse or is it another reason from there.
So if you can nail any view, this is probably one of them. And you can see the pericardium is this bright hyperchoic part around the outside. And then on the other side we've got a smokescreen, which has got this really viscous thick blood within the heart chambers from there, so that's probably imminently going to throw a clot or a thrombus from there.
And that's just an overview of that right parasternal shortis view, which is our left atrium here and our aorta. Usually it's flipped the other way, it just depends which way your marker is at the top. But again, if you can nail that one, it gives you a lot of information from there.
So anything over 1.6, is an enlarged left atrium, from there, and it can be a cardiac cause of sort of collapse, essentially. And then the dyspneic patients, this was a patient that came in, to us, and within sort of 10 minutes again of it being on site, we'd popped the probe on, it was receiving supplemental oxygen, and this is what we found.
So it had an extremely large amount of free fluid present in its chest. Very dyspneic. Again, from there, you can then set up for, .
Drainage of its pleural effusion, that will then in turn stabilise the patient. You've also then got a sample of that fluid from that chest. Again, not something that we can do as nurses in terms of the drainage, but you can certainly identify it with the ultrasound scan from there.
And then set up sort of proactively for that sort of drainage of the pleural effusion. So my top tips for ultrasound, that obviously this is a whistle stop tour going through quite rapidly, abdominal and thoracic, and also how to optimise your images. But practise as much as possible, pre-op patients, if you've got sort of bitch stays that are going to be clipped, if you've got consent to do so, they can be quite good ones to sort of practise on.
Obviously, just make sure that you're not spending too long and just sort of maybe try and, focus on particular organs each time. Learn what the probe does as well, it's quite a practical technique in order how to hold it, how to move it. There's more than one way to do it, if you like to hold like a pencil or hold it differently, but it's definitely a very practical skill to learn.
Prepare your patient as well cos your images will benefit massively from it. Build up your image library. Again, it's that pattern recognition, what does them organs look like routinely, and as soon as they don't, you can then flag it up and save it.
Be patient as well, it doesn't just happen straight away, it can take a little while to get sort of confident and competent in doing so. If you've got more experienced stenographers in practise, then ask and see if they'll work with you and sort of tutor you and ask some questions in terms of what's going on on the screen. If you're in the room and you don't know what's going on on the screen, it's a very boring place to be.
I used to run and hide to get away from the ultrasound machine. Now I absolutely love it. But ultimately have a go as well.
As long as you're aware of your limitations and you're not making snap decisions and snap observations that you're not sure on, then there isn't really any damage you can do. Find a practical course as well, because that can really help in terms of applying your theoretical knowledge into practical base as well. And ultimately you just don't need to be able to find those pancreas or adrenal glands to start doing an ultrasound scan cos that's only gonna be to the detriment of your patients.
So please utilise it in practise cos it will benefit your patient care and outcomes no end. Thank you very much for watching and thank you to the webinar vet for having me. If there's any questions after watching this then feel free to get in touch on email or via social media and I'll be more than happy to help.
Thank you very much.
