Hi. Thank you for joining us this evening. For ultrasound, you can scan.

I will just apologise for me being a little bit in the dark. We've had a bit of trouble with lighting where I am today. I'm Vicky, so I'm head of memberships here at the Webinar bet, and I'm an RVN too, so I'm really looking forward to this one myself.

As always, a huge thank you to many pets for sponsoring this year's Nest programme. We are joined this evening by our guest speaker, Jack Pye. Jack began his career in a first opinion practise where he developed a passion for progression.

After successfully qualifying in 2018, Jack decided to pursue a new challenge at a small old hospital in Norfolk. He worked solely in an emergency and critical care setting out of hours, which is an area he enjoys. He is currently awaiting final assessment for his certificate in emergency and critical care, which is further developing his knowledge in this specific area.

He is also now a full-time local veterinary nurse working in a variety of settings from out of hours emergency work to first opinion practises. He is particularly keen for continuous personal development and professional development, in which he has developed a passion to support other veterinary professionals to grow and enhance their skills their skill set. He has a specialist interest in ultrasonography and currently is an IMV imaging ambassador and vet nurse consultant speaker.

Alongside this, he also provides in-house ultrasound training professionals. He regularly shares his experience in new learnings being engaging with others on his social media platforms, with the hope of encouraging and supporting others' professional development and skills. I will share the tag to, his social media in the chat box so that anyone can give him a little follow if they want to.

And I will also hand over to Jack, but before I do that, can I just remind you to pop all questions in the Q&A box, and we'll come back to those at the end of the session. So, Jack, over to you. Perfect.

Thank you very much for the introduction. And welcome to everyone who's joined us live or watching the, the recording as well. So yeah, this is all about ultrasound for veterinary nurses.

You might have seen me speak beforehand. So, welcome back if you are. There is, a bit of repetition sort of throughout the session, but there was also some new stuff, because things are constantly developing.

And, I also get to know what you guys need to sort of know in terms to be able to carry this out in practise. So, yeah. So we'll get, cracking.

If you see this, cheesy photo of me throughout the, the webinar, then it just means that it's something that I'd consider, a bit of a top tip and something that's probably worth remembering, and trying to sort of just sort of keep in your mind if you are gonna be doing ultrasound scans in practise. So, yeah. Just the, the boring sort of part, just to get out of the way.

It's just that I have a conflict of interest declaration, so I have a relevance sort of financial interest, with IMB Imaging as a brand ambassador and nurse consultant speaker. And also just a quick disclaimer that everything sort of discussed within this webinar should be performed under the instructions of a vet surgeon and in line with the RCBS code of professional conduct for vet nurses as well. So, a quick bit about me, which Vicky has already covered, really nicely.

So, I qualified in 2018, so I haven't been qualified overly long, but it just goes to show that if there's something that you're passionate about, that you can really sort of throw yourself into it and, sort of lead in that area in, in your practises. I'm currently a locum veterinary nurse, sort of throughout Norfolk, mainly, but also travels all around the country. More recently, I've just been lucky enough to be awarded one of the 30 under 30 awards, that are being presented at the London Vet Show.

And, obviously, as I previously mentioned, I'm IMV, imaging brand ambassador and lecturer. And outside of, sort of my working professional life, I own a Daxson, who's in the photo there. Harry, he appears throughout the lecture in, several sort of areas, because he's a bit of a car crash vet nurse's, dog.

So, as you, I'm sure you can imagine. And as previously mentioned, I've found on Facebook and Instagram under Pie_RVN so feel free to give it a follow, and if you want to sort of ask any questions later down the line, then by all means feel free to contact me through that. I'd be more than happy to help.

So, the len now comes for this evening's session, is to be able to understand the basic controls of the ultrasound machine, and, in order to optimise your ultra ultrasound scan image quality. It could be quite a scary thing to look at in, in terms of a, a machine and all the buttons on it, and we can get quite daunt, it's quite daunting, and we just, decide to not bother using it in that case, because we just get worried that we're gonna break something, but, we'll go through which ones are the most important. And, understand when an ultrasound can come in useful under a veterinary nursing job role.

So what we can and can't do, we'll cover and solve some, case-based scenarios as well, involved in that, so that you can take them back to practise and actually sort of get hands-on in that, in that skill set. And then we're gonna recognise different organs and what is a normal appearance or structure when carrying out fast scans of the sort of abdomen and thorax. So, this is packed with sort of quite a lot of photos just to build up your image bank.

And, also how to apply the ultrasound in day to day practise, with the use of scenarios as well. We've got abdomen and thorax included in both of those. So, first up, first up is our machine types.

So, there's 3 sort of 3 main different sort of machine types that we tend to see in practise, and the sort of software is, sort of rapidly evolving, getting sort of better and better in terms of what we can access in practise and the affordability of it. So there really isn't sort of much of an excuse now to not be carrying out, out ultrasound scans in sort of, first opinion practise. So, this is something that we should all, all have, have the access to.

The first one is the sort of laptop style, which is quite common in, in our first opinion practises. They're, they're absolutely fine, the software and the processing in them is, is more than what, more than enough for what you need to be carrying out these sort of, triage scans or sort of, inpatient scans as well. And more recently, we're getting these portable probes, developing, which is in the middle there, which, I'm quite lucky to own one of those.

Sometimes they have two probes, so that's got a linear and a, and a curvilinear probe on it. So, it's got quite a different sort of, a lot of different sort of modalities that it has to it. And the, the quality that's coming through in them is quite amazing, actually, considering they're so sort of compact.

And then we have our big stack sort of type of machines, which are the ones that are probably the most scary of all the different buttons on. So, but they obviously have a lot more processing in them, and, Sort of, sort of more of a, more of a hospital sort of setting and sort of various different probes. So, but whichever one you've got in practise will be, more than sufficient for what we're gonna talk about throughout the presentation.

So, this is, one of my favourite slides, from the, the name. You might have seen it before, pop up. But basically, it's just going through all the different buttons that you kind of need to focus on within the ultrasound sort of scan itself.

So, we're starting with, I tend to refer to our Altar scanners like a pizza slice. So on the right-hand side there is a bit of a, like a pizza slice, going through it. So, if you want a wider sort of image, so if you've got quite a large dog, for instance, then you can increase that width, just so you've got a big, bigger, sort of, image plane, that's going through there.

We've then got, our depth. So, it depends on what, what we're scanning. So, if we've got, a cat or a dog, then we'll increase or decrease that depth, depending on the size of the animal, but also depends on what part of, sort of anatomy we're looking at.

So, if we've got something that's quite peripheral and close to the skin edge, then we'll reduce that depth quite low, because that's gonna help with our image resolution as well. And then our frequency, which can be quite a sort of, sort of scary term, but it's one, if you can remember it, then it's, it will help you in terms of your, your sort of image quality that you get. So, low frequency gives us, good depth.

So, if you've got a big dog, then you want a lower frequency because you want to be able to see more of that abdomen, potentially, just to see sort of Different anatomical structures running throughout. It does compromise your image resolution. So the quality of the image is gonna be compromised the deeper you go.

So, it's trying to find that, a, a bit of a balancing act, just so you can sort of measure up, depends on what, on what you're looking at. And a higher frequency gives you a poor depth. So, if you've got a small cat, for instance, you can increase the frequency, and that's gonna give you a much better resolution in that patient.

So, small cats, you can use sort of quite a high resolution. You're gonna get some really sort of cracking, nice resolution images of things like kidneys and, and other sort of structures running throughout. And then we have our focus point, which is sort of quite a common one.

So, on the image on the left is a little sort of triangular, image just sort of sitting there. That is basically where the best resolution along that image runs along that sort of slice of, of the ultrasound scan there. So, you want to move that depending on what structure you're looking at.

If you're looking at an organ structure, then you can drop that right below, and hopefully, you'll get sort of the best resolution throughout that entire organ structure. The freeze and save buttons are quite important to know where they are, because sometimes you need to click them quite, quite rapidly, if, let's say you don't miss something. But once you sort of get the hang of your Oo scans, you should be able to come backwards and forwards to, to, to different parts of the sort of an topical structure.

But we need to be freezing and saving them images, so we can later on refer to them, because we can't sort of diagnose, we're sort of making observations, and then we've always got a record of, of what's going on, and we can sort of later on, refer to it if we need to. The calliper button, which is also so we can measure organs, measure free free fluid pockets, measure bladder sizes as well. So knowing where that is, is quite handy, and the stuff we're sort of doing serial sort of scanning so we can sort of keep on top of those measurements is quite handy.

And then most machines will have a preset function. So that's where you can select whether you're scanning a large dog abdomen, or whether you're scanning a cat abdomen or a cat thorax. And that will already have the sort of depth and the frequency plugged in, so it's gonna do a lot of the, the work for you before you've even started.

You can then alter them later on, but definitely just use them to your advantage because they will help. Yes. So, this is just a bit about frequency, just hopefully it might help you sort of it from a visual perspective.

So, this is a video that we've got going on here. And as the frequency is increased, you start to lose, you lose that depth. So, the bottom of that image starts to get black, and the top is, is the only place where you've got any resolution.

There is a kidney hiding in there, but just as that in frequency increases, you're just losing that image completely. So. And then knowing which probe to select, depends on what you've got in your practise.

I would say that the middle one is probably the most common probe that we have in practise to use. It's quite a universal probe. So it's that, that is a microconvex probe, or you might have a curvilinear probe, which is similar, but a lot of sort of a, a bigger footprint.

And that footprint is what comes into contact with, with the patient, which, which is touching their skin. So, The one on the left is our linear probe. So, we tend to use that for things like muscles, tendons, ligaments.

If you've got like grass seed foreign bodies, then it's really handy. It gives you quite a sort of a, a poor depth. So it tends to get sort of 89 centimetres.

It gives you quite a wide, sort of field of view. But if you things like kittens or puppies, or you've got something quite as close to sort of the periphery, it gives you really good resolution. So the sort of image quality that it does give you will be, will be really good if you've got quite a sort of a, a shallow, sort of depth of, of patience.

So definitely worth having a go if you've got some small animals, because the images you'll, you'll get from it will be, will be very nice. The, microconvex probe that I previously just spoke about a little while ago, that is, sort of universal, tend to use it mostly for sort of abdomens. It's quite nice to be able to sort of fan throughout the abdomen and, and get some views, through there.

But it's also, able to be used for thorax, sort of point of care ultrasound scans as. Well, the sort of probes have developed and come a long way, so they do tend to fit between the sort of ribs spaces a bit better. It will have limitations if you're sort of looking to do sort of cardiac or heart workups or scans.

But it's worth just having a, a play around if you've got multiple sort of probes in your practise, just to see what sort of suits the patient best. And then the probe on the right-hand side is our phase array cardiac probe. So that's, that obviously has a bit more of a rectangular sort of footprint and fits, sort of square, fits through the ribs spaces really nicely, because they're up on waves, obviously you can't, can't pass through the bone.

So we can get much better views of sort of lung fields, and also our, our cardiac sort of scans as well. All of these probes have, a marker on them. So they'll have like a notch or a light on them.

And that refers to, in the image before here, we've got a little M. So that lines up with the little notch or the light that you may have on, on those probes. It just creates a mirror image of when you're standing so that you actually can, when the hand movements you do then line up to what you're doing on the screen, and it just makes things make much more sense with, with how you're orientating the probe.

So, these are the, the fields of view that I previously mentioned. So, you can see the linear sort of gives you a bit of a, a rectangular shape into the, into the patient, whereas the sort of curvilinear or microconvex is that classic sort of pizza shape view. And then the phase array is a smaller footprint to be able to fit between those rib spaces to get, in between sort of small patients and get, get those cardiac scan views as well.

So, what vet nurses can do, I would say that they can, they can do quite a lot. One of the biggest questions I get asked, which is why I call this, like, sort of, you know, you can scan as veterinary nurses, is that we can't do ultrasound scans because it's surely it's diagnosing. It's not, it's no different for you to be taking bloods or running, X-rays, or any sort of running blood smears and having a look at them and making observations or taking a, a temperature of a patient.

So we can obtain those images of diagnostic quality and work within sort of the vet-led team to create a sort of a, a road map or a plan for that patient. Being able to do those as vet nurses means that we're not waiting for a vet to, to be free to be able to do that, which is gonna benefit patient care at the end of the day. And we're also utilising our skills as veterinary nurses within the profession as well.

We can perform the point of care or sun scans and make observations, not diagnosis, as I previously mentioned. So, a high temperature, for instance, you'd go to your vet and have a clinical discussion. So, this patient's got a high temperature.

Is there anything we can do? That's no different to going to your, your vet and saying, this patient's got what I can see is free fluids. That's not a diagnosis, that's an observation.

If you were to cross the line again, speak to an owner and say, your dog's got a, a hemangiosarcoma, for instance, I think that's crossing the line, and that's going to diagnosis, and that's sort of very sort of dodgy ground. So, having a clinical professional discussion with your vet, is definitely not sort of diagnosing. So being able to do that sort of after, obtaining images is no different to sort of taking an X-ray as well.

We can carry out, triage assessments, which can assist in improved sort of patient outcomes, as I previously mentioned. If nurses are doing these, they may be sort of be able to carry it out quicker because we've, obviously, we're facing a bit of a crisis within the vet profession through nurses and vets not being available. So, if we are available in practise, this is the skill that we can do that is going to benefit our patients by being able to find out what's going wrong with them a lot quicker, and sort of just put all them sort of pieces of the puzzle together, really, and create a plan and a roadmap for them.

We can lead on inpatient care and sort of monitoring scans. So, this is one sort of area that I think if you are wanting to start out, by sort of getting used to it, then this is a, a place that we really can. We tend to spend a lot of time with our hospitalised patients.

So, by scanning them, when they, if they've had any gastrointestinal surgery and they're sort of, in the hospital, then we can scan them, sort of a couple of times a day to make sure that there's, nice peristalsis going on with, with the gastrointestinal tract. Is there any sort of breakdown and dehistance of the wound inside? Is there any free fluid?

We can look at bladder scans and make sure that they're sort of not the recumbent patients who need to intervene in any of this. So, it's definitely an area that we can sort of get on top of and really sort of, take hold of, really. And then ultimately, we can know what normal looks like.

Sometimes we worry about, we don't exactly know what we're looking at on the screen. But if you get into your sort of, into your mind what, the organs look like, as sort of a normal, basis, then anything abnormal is gonna sort of scream out to you like a sore thumb, really. You don't need to know exactly what's going on, if it's abnormal, but just to know that it's abnormal, you can flag that up, and you can sort of fast track that patient through, for further investigations and sort of, you know, put it in front of the vet's eyes, really.

Just a quick note, actually, on that previous slide is, another thing is that, obviously, vet nurses are constantly trying to sort of prove, their worth. A, ballpark figure of sort of ultrasound scans for like a triage scan, sort of a trauma scan is around sort of 125 pounds mark, sort of, as a Sort of, as a rule, sort of around, sort of where I am anyway. So, if we're performing those, then that's another thing we can sort of speak to our, our practise about that.

It's a, a revenue that we're generating. We're also freeing up the vets for them to be able to do things that only they can do that we can't. So it's definitely sort of something that we, we can bring up.

So what we can't do, we can't perform centesis, so we can't enter a body cavity by taking any sort of fluid samples or any FNA's of, any organs. So definitely don't do that if you're asked. I have been asked, before to do it, and, you just need to say, no, it's not worth your qualification.

It's against psychotic conduct. So just to be aware of that if you are asked. We can't give a diagnosis, as I've mentioned quite a few times, and we also can't carry out genography without any consent.

So, in my previous experience, if we were in emergency cases, we didn't have a lot of time to sort of, you know, have that chat about what it involved. So, we had, like, a bit of an information sheet ready, of what the ultrasound scan was involving. So, a clip patch on the abdomen, And why we, why we need to do it, and why we need to do it quickly as well, along with sort of a consent form.

And there would always be someone available, like a receptionist who, could sort of just talk them through it, sort of step by step, just so they were prepared for what was going on. And that disabled, enabled us to sort of carry out that more rapidly so that we could sort of get, treatments on the way if we needed to. So, when can you use it?

A few of these I've already touched on, but post-op inpatient monitoring. So any gastrointestinal surgery, we use to scan as a minimum morning and evening, just to check, again, for those, that peristalsis, do we need to add in any sort of prokinetics? Do we need to look at sort of nutritional requirements and add in sort of assisted feeding?

Is there any dehissant, any free fluid building up? You know, are, are their guts moving ultimately? The sooner we can pick things like that up, the sooner we can get involved, and the better that that patient's outcome is gonna be.

So that patient has a, a breakdown of a wound inside. That, you know, it's not gonna be too long before sort of a septic abdomen starts to occur. So, if we can increase that potentially to 3 or 4 times a day as a scan just to check for free fluid, gut motility in their, in their abdomen after gastrointestinal surgery, then we're gonna have a far better sort of patient outcomes.

Serial scanning. So we can do that as, as repeated scanning. So, for instance, like a recumbent patient, then we can scan their bladder to make sure that it's not getting too big.

Do we need to place a urinary catheter? Do we need to intervene in, in some other, other ways? Also, gut motility checks, things like rabbits, you can do these on the, you, You know, gut, gut stasis in rabbits is quite a common issue, that we see in first opinion practise.

So we can see whether, whether the sort of treatment plan is working. The only thing is that rabbits do contain quite a lot of gas throughout their abdomens, and gas is ultrasounds a bit of, it's a bit of an enemy for ultrasounds, so it can make it a bit tricky. Our triage assessments, as I've mentioned before, so we can do that, sort of thorax scans or abdomen scans, throughout and to sort of see if there's any free fluid or anything that clinical signs may be leading to.

But I've got a few of those, scenarios coming up later on for you as well. And then point of care ultrasound scans for our thorax and abdomen, again, That's exactly what, what, what you want to be looking at. So, if you're concerned about the kidneys, you're gonna scan the kidneys, concerned about the liver, if the sort of bloods are showing that there might be a liver problem, then you, you're gonna sort of focus on that as well.

But I'd always do a thorough abdomen sort of scan, making sure that you're looking at all the, all the organs throughout there, so you've got a systematic approach and that we're not missing anything as well. A few, a couple more uses. So, we've got bladder scans I mentioned before, quite handy, because we can look at things like, the urinary cats in place in, in sort of the correct area.

Is there sort of bladder stones that might be showing up, or is there any sludge? It can be sort of quite nice. I think we all know how painful it is, as sort of veterinary professionals, if we need to sort of burst for a week, and our patients feel that too, and they can sort of, be in quite a lot of discomfort in, in some of those scenarios.

And then our heart scans as well. So, that view that's just down there is sort of our perfect sort of, cardiac view, where we get an aorta and left atrium view. So we can get a ratio from that, and that gives us a hell of a lot of information very quickly on those dysneic patients that come in that, whether it is a cardiac or respiratory cause of, of sort of collapse, potentially.

And that just gives you a, a faster indication of what's going on, resulting in, ultimately, a quicker plan of action, and we can start getting things ready. We can sort of have, have, you know, if, for instance, if it was a, pericardial effusion or pleural effusion, and we've done a sort of thorax scan, then we can start preparing things and getting getting that ready and that patient's, outcome is gonna be, improved because of that. So, a bit about preparation.

I see a lot of people who will go through, ultrasound scans, and they'll just spray a bit of spirit on the fur, and they won't clip the patient. You can do that. Our probes are actually quite robust against spirit.

The worst thing you can do is putting a, a needle through them, by doing a sort of an FNA, which we shouldn't be doing. But just to be aware of that is the worst thing you can do to them. As long as you dry them and clean them afterwards, then they will be OK.

It's a bit of a, a, a misconception sometimes. About spirit depends on what probe you're using. So, but I would always recommend clipping the fur to allow good probe contact.

What the hair does, if you then put gel on top, is you're gonna create a barrier between the fur and the pro contact with, with the skin, and that's gonna result in sort of quite poor images, and you're probably gonna get fed up, like I would, chuck your toys out of your pram and never get back to it ever again. So, just take the time to, to clip your patient and prepare them thoroughly, because the images you get are gonna be a lot better. And that's how I would, clip for a, abdominal ultrasound scan.

You can do that and write that, but we'll talk about that a little bit later. I then degrease the skin with, sort of a skin prep, so, like, diluted prohexidine. That should be just that, that greasy, sort of, oily layer on the skin, and your, gel will then set in better and you'll get better pro types and better images as well.

I'd, get a quiet dark room, as well, just so you can sort of see those sort of finer details on the screen, and just sort of different shades of grey, sedation and restraint if needed. Obviously, if we need to get those images, then we need to consider them sort of being nice and still, so we can see what we, what we need to. And also, just to be aware of, analgesia sort of considerations.

So, if they're not tolerating an, sort of abdominal ultrasound scan, is it because they're in pain. Is there something painful in their abdomen. Someone recently spoke to me, they had free fluid in their abdomen.

As a, as a person, they had an ultrasound, ultrasound scan. They said that was the most painful thing that they had when someone was pushed on their abdomen with, with free fluid in there. Preparation in sort of lateral recurrency is often most popular, but we can do them on their backs.

So, in, in dorsal recumbency, you can then scan both sides of the abdomen, which I will explain why that's quite important. But we can also do them standing, depends on their presentation. Obviously, if we've got a dyneing animal, we're not gonna be one to hold, want, want to be holding them on their side and sort of decompensating them.

And then, yeah, patient preparation, you're gonna get better images obtained at the end of the day. So, this is, just your landmarks where I would, prep our patients for abdominal ultrasound. So, cranially, right up to the ziffy stum.

So I usually sort of use my finger and sort of point right in there and sort of feel that little notch that's there. That's where you are gonna be sort of getting a good view of the, of the liver, initially. And that's where I start my scan.

So, as far up as you can. And then we're going in sort of alongside the sort of, up, up the rib cage towards the, the ventral wardrobe of the sub lumbar muscles, and then cordially, just to the pubis as well, just so we're sort of, covering all of those sort of major organs throughout the, the abdomen. And then you can repeat that on, on the opposite side as well.

So restraint, so we've got lateral recumbency or dorsal recumbency. Lateral recurrency is quite popular, sort of, in the practises that I've been in. And, dorsal recumbency is also, a popular sort of, technique to use.

I didn't think that many of them would tolerate it initially, but they actually do tolerate it quite well, providing they're, they're nice and padded underneath. And obviously, it depends on how, sort of their behaviour and how nervous they are, or, or whether they're comfortable being in, in the practise. But that the enables you to do right and, right and left.

Scans in one go, so it's definitely worth giving a go if, if the patient is tolerating it. And then there's an overview, so clip and prepare your patients. If you sort of fail to prepare, then I would say that you're preparing to fail just because your images aren't gonna be very good, and you're probably just gonna, gonna get a bit upset.

A quiet room, which can be darkened, just so then your patient's gonna be more settled, minimal traffic passing through as well. A nice table as well, nice and stable sort of table. Ideally, if you're doing heart scans, you probably want a cardiac table as well.

Some people don't have them available to them. So cat castles can work quite nicely for sort of small animals and small cats with the little cutout that we have. So this is something to be aware of and and a nice height, and also be comfortable, so for your patients and also for you.

Sometimes the scans can take a little while, so make sure that you, you are sort of set and and nice and comfortable there. So this is just one of my, like, little tips as well, when you're sort of finish your scan. It's never nice when the gel sort of dries on the patient, and the tissue just tends to smear it all around the patient as well and just makes them a bit of a, a messy sort of, ultrasound gel mess.

So, if you've got any tongue depressors in practise, then it, it actually just scrapes the, the excess gel off really nicely at the end of the scan. It's much nicer for the patient and everyone else all around, so they didn't get all, covered in, in the ultrasound gel. So, I would always recommend a systematic approach to your ultrasound scans.

So, when we do the abdomens, we want to make sure that we're scanning sort of the same way each time. So it just helps things to sort of not go unnoticed, essentially. We then get into a routine.

We know it looks normal, and these scans become sort of quicker and quicker as a triage basis. But it's all, it's not necessarily about being quick. We want to be thorough, we want to be making sure that we're looking at everything that we need to on, on the individual organs, so we're not missing anything.

IMB have these, handy checklists, which just sort of show you what you're looking at for each individual, organ. Are we getting the correct views of, of both of them, like cross-sectional, sort of, or, or longitudinal views, which are also very handy. Ultimately, we're we're sort of looking at the sort the size of the organs, the echogenicity, the contents of them.

So, is there any sort of sludge or in the gallbladder? Is there any sort of, sort of, what look like crystals or stones in the bladder? Or is there anything sort of in our heart chambers as well?

And then we can look at things like eco texture. So, that's like the patterns, or whether it's sort of our, our liver or spleens look, whether they're nice and smooth, or whether they look cavitated and sort of a bit, a bit nasty looking. We can look at organ walls, but sort of the thickness of them.

And all of our organs tend to have sort of individual organ traits that we'll go through. And ultimately, we want to be checking whether there's any sort of fluid, sort of around them or sort of, should it be inside them, or, you know. But you'll pick that up as you go along.

And on the left there is just a bit of a, a landmark as to where to expect the different organs throughout the abdomen. So, knowing your normal of abdominal ultrasound is, is the most important thing. So, these are the sort of main, organs that we want to be looking at.

So, we've got spleen at the top left there, kidney at the top right, liver and gallbladder on the bottom left, and bladder on the right-hand side there. We've got 4 windows, that we tend to look through. So, they're diaphragmaticopathic, which is starting sort of right at the, the ziphoid sternum.

And we can see diaphragm and liver through there, and the gallbladder, and we can also sometimes get a bit of a cardiac assessment through the diaphragm as well. It's important to note that, this bottom left image is the liver and the diaphragm. This diaphragm is quite a bright, bright white, hyperchoic line that can sometimes cause reflection, which we'll touch on in a little bit.

We've got a splenorenal view, which we can look at the, the spleen and the kidney, which is our flank side of the patient. And then we've got our systo colic, Window as well. So, bladder and colon, we can look through their mid portal abdomen.

And then we've got a hepatorenal, which is where you go sort of underneath the patient of their own right lateral and sort of poke up just to look at that right kidney. I find it's a lot more comfortable and nicer for them if you don't just turn them into the other lateral, rather than have to sort of put that pressure on them and look through. Ecogenicity, I refer to you quite a bit in terms of sort of describing, our organ structures or, or any sort of thing that we've, any findings that we've got.

So, that it essentially means how other tissues reflect or transmit the ultrasound. Waves that, that we're putting in. So hypo hypoechoic is dark.

So darker tissues, sort of dark grey, that sort of in appearance, as opposed to a hypoechoic is our sort of light grey or sort of bright white, sort of, sort of appearance. So, our diaphragm, which is running alongside the liver there, is our hyper-echoic, Sort of description, really. That can also be due to sort of things like inflammation, potentially, or if it's angry, like our pancreas, for instance, as well.

Isoechoic is equal in echogenicy. So, if you were comparing two different organs next to each other and they had sort of the, the same sort of shading, then we would refer to that as being isoechoic. And then anechoic is black.

So that's where we're sort of not getting any ultrasound, sort of transmission. So, we've got our fluid within our gallbladder, or fluid in, in the bladder as well. And then the basics, so, black, and anechoic is fluid or acoustic shadowing.

So we've got acoustic shadowing on, on the right-hand side there, which is a bit different to the black that you've got, as fluid in the bladder. So, hopefully, you can sort of spot the difference between those two. And then we've got shadowing, which can be gas or dense material.

So, this bottom left image here is, is what we call shadowing. So, like these sort of faeces in the colon, as opposed to a complete blocking of ultrasound waves like bone or, or a foreign body would do. And then grey or white is a, a sort of soft tissue structures that are running throughout the abdomen.

Knowing the difference between our fluid-filled organ structures and, free fluid is really important, especially for our triage scans. They ultimately have very similar characteristics. So, they're both black, in terms of the fluid, that they have.

They're both sort of anechoic. Their sort of appearance is exactly the same, really. The only thing that differs is that if you have free fluid, It doesn't have an organ border.

It doesn't have a surround or sort of an organ wall that's containing that. So, the, free flow tends to have like these jagged edges. It's sort of quite rough.

It's not very sort of smooth as opposed to on this, on this left-hand side. They're all quite smooth walled structures that they're sort of being contained in. So, that's our, our main thing.

But knowing the difference is, is quite vital to know whether the fluid that's there should be there and where it is located. There's a bit of a, a trick one in here. So, this image, sort of on the, on the left-hand side of the screen, at the top, is, fluid, but that's in a uterus.

So, it's obviously not a normal thing, but it's, it's, it's contained within, within the structure. It's not sort of free, free-flowing throughout the abdomen or, or the chest, for instance. If you're not exactly sure where the free fluid is, then if you can find some abdominal structures nearby, then just write those on the screen when you're taking those images.

It can help sort of later on, locate them, which can be quite useful in terms of where it's coming from. And if you do do a scan that is abnormal and has free fluid, don't be alarmed if you can't find your, sort of, anatomical structures like you could do beforehand, because the, the fluid does push everything and sort of distort it throughout the abdomen as well. So, this is where we're gonna go through the different abdominal, organs, just so you can build up an image bank of what looks normal, and roughly where you want to be placing your probe just to, just to be able to find those in the first instance.

So, starting off with our liver, which is where I'd start all my sound scans and work around in the clockwise direction. And, this is situated at the diaphragmatic hepatic window at the Ziffy sternum. Then runs alongside the diaphragm.

So, we've got that big hyperchoic white line, running next to it, which is a really nice sort of anatomical landmarks so that, you know, you're at the liver as opposed to the spleen. That's one of the, the biggest thing sometimes people get mixed up with, is it the liver or is it the spleen? So, if you can see the hyperchoic white line running alongside it, then you know that, that you're at the liver, and that's why you want to be starting your, your ultrasound scan.

As we sort of found the probe alongside the liver as well, you'll get the gallbladder up here that sort of sits between the liver lobes. And, we can also get a vascular appearance. So we've got some sort of vasculature structures coming sort of through there, depends on what orientation we have the probe out.

If you see a gallbladder and a cat and it's got a bit of a line going straight through it, or sort of looks like there's two sort of blobs in there, then they can have biological gallbladders. So don't be alarmed. That's, that's the normal, finding in cats.

So, don't be too alarmed through that. And you can also get a cardiac view, depending on the breed that we have. So, you'll see sort of a cardiac, sort of, scan just sort of popping through that diaphragm, depends on how large the dog is and sort of limitations of your, of your machine.

And, just note that there we've got that little V mark on there, which, is just that that particular machine, but you'll have different markers on other ones depending on, where the, where the notch is on the probe. So, the artefact I mentioned previously is that the diaphragm causes a mirror. So, what we've got here is we've got our diaphragm running alongside the liver.

We've got our gallbladder, which is viewable as well, and we've got a liver here. Also then looks like we've got a liver and gallbladder in the chest, and that's purely because the, ultrasound scan is, is, is so hyperchoic that that diaphragm is just mirroring, the things that are in the abdomen into the chest. That's quite an important thing to remember, because if we are scanning, abdomens that are free fluid, then we, basically can look like the free fluid is in the chest as well.

So, always do a couple of scans to make sure that you know whether it's either in the chest or, or the abdomen, and vice versa. So, next, we then, as we sort of follow up in a clockwise direction, we then come across the stomach, and the gastrointestinal tract. So, our stomach, varies in appearance depends on when the patient last ate.

So it's always, a good idea to ask, ask the owner when, when they last had any food. So if we've got a full stomach and they haven't eaten for a long time, then it can give you a bit more indication as to what might be going on. It's situated sort of cranial abdomen underneath the rib cage.

There. So, and it's mix of appearance depends on the food intake. So, the top left, image is a full stomach, which is full of sort of food.

If they're full of gas, then you might sort of get a similar sort of appearance to that as well. And on the right-hand side, we've got our stomach, which is, more of like a cut or kiwi grapefruit appearance. It just sort of sits between the liver and the spleen that's then starting to come in on that image as well.

It has a structural wall and I say it looks like a bit of a cut kiwi or it looks like a bit of a sort of a grapefruit or something like that, it's been cut in half, you sort of see the stomach falter and it's empty, . And then we sort of can follow that along to sort of our intestines, which you might have heard referred to as coffee beans. And we can look for the peristalsis in them to make sure that our, our sort of our food is sort of moving through as we'd want it to.

And then we've got a sort of a long section of our, of our gastrointestinal tracts running through there. If you were to turn the probe into short axis, that's when it would look like little coffee beans running throughout the abdomen. But as we know, our sort of intestines are looping around in all sorts of different shapes throughout the abdomen.

So it varies entirely on, what we get of those. Our spleen. So situated mid abdomen along, alongside the rib cage, mid-grain echogenicity that we sort of tend to see.

And I tend to refer to it as a slug. It's like, very close to the top of the, the screen on lotsound scan, usually. And then what we can then find.

Is our vasculature structure that's going in and out of the spleen. So, that's our highlus, which is just sort of, situated there as that sort of black, cause we've got blood running through it. And it looks a bit like a whale's tail, is how I referred to it.

So, if you can find that, then, you know, you're, you're at the spleen. And it's just important to know that if you were perhaps looking for that and the spleen's very large, you might struggle to find it if the spleen is, potentially torsed, cause, that would have just cut off the blood supply, and then you, you sort of get that standing megaly that's going on there as well. But we can look for things like cavitated sort of structures, absence of that high list that we've got, any sort of nodules that might be on there, and sort of any, any sort of different textures that we can see as well.

So we can get quite a nice evaluation from the sort of head to the tail of the spleen, sort of by fanning and running along all, all the way through there. Our kidneys, they're located in the hy axial muscle region in the, in the mid abdomen. I used to say that these are really easy to find, but since I've been doing the sort of in-house training with people, they're, they're not the most easiest to find.

They're quite amos or organs, so it does take a bit of practise, but once you've, sort of got it sussed, then, then you can find them relatively quickly. It's important to note that the right kidney is situated a bit more cranial than the left, and they're nice and easily identifiable. They don't look like any of the other organs that we've got going in there, with sort of like the cortex and the medulla.

And they've obviously got that mixed ecogenicity with, with, with their cortex and the dollar due to the structural makeup of the kidneys. So, we can measure them. They're usually a few centimetres, sort of 5 to 6 centimetres.

But they can vary in, in our species and breed, ultimately. And obviously, we mentioned that our right kidney is more cranial than the left, so I always find that easier to flip them over into the other, the other la recumbency and to find the other one. Or if you've got them in dorsal, you'll be able to do that in, within the same stem without having to, to flip them over.

Bladder scans, so, situated where I really expect them to be called labsmen. They have a structural wall unless they're ruptured, filled with anechoic fluid, and they're nice and easily identifiable as well. So, I would always recommend scanning the bladder if you're concerned about a, a bladder problem.

We can X-ray them, but sometimes X-ray doesn't pick up certain bladder stones that might be present. And a lot of sounds is just a bit more sort of, specific and a bit more sensitive to, to what's going on. So if there's sort of any sort of bladder tumours, or we can look at the, the urethra as well and follow that.

It's a bit more sort of, specific, we'll get a bit more information in that. We can also, check urinary catheter placement, make sure that it's, it's far enough in, or it's not too far in, it's hitting sort of the the bladder wall. And we can also look for things like tumours, distention, and also any sort of urethral distention as well, which might indicate sort of a blockage there.

So these are a few, abdominal abnormalities when something's going wrong. So, once we know what normal looks like, so hopefully, the images have built up your sort of image library of what, what's normal, then when something go wrong, it kind of sticks out sort of like a sore thumb, really. And we can then sort of help focus the treatment plans on what's going on, and the diagnostic approach, which can help patient treatment and outcomes, really.

So, first up is our liver and gallbladder abnormalities. So, sort of, quite a common ones would be mixed ecogenicities, abnormal shapes, and uneven edges of that organ. Any free fluid, but that might not necessarily be specific to the liver.

If we've got any distended vasculature, so on that right-hand side there, that liver sort of biliary tree is extremely sort of, distended. So there was a problem going on there. We can also then get gallbladder abnormalities as well, which I've put in with the liver, cause that's sort of under that full sort of liver gallbladder assessment.

So, we've got two abnormalities on the left-hand side there, the top one being a halo appearance of the gallbladder. So it looks quite a sort of edematous. You've got.

A bit of a, a black ring going around it. That can be due to anaphylaxis, potentially, or it can be due to, there might be a pericardial effusion. So, if you ever do see a gallbladder halo, it's worth popping the, the probe on the chest just to check that heart is, is, is all OK.

Down the bottom, we've got, a mucous seal. So, in the gallbladder, that tends to have like a bit of a grapefruit kiwi appearance. Or we can also get sort of sludge like you would in a bladder, bladder as well.

So, if you do see those, then make sure you've got pain relief on board, because they are horrifically painful, apparently. So, definitely get sort of analgesia as a consideration if you are scanning that, if they're, if they're even tolerating it, if they haven't got it on board already. Gastrointestinal abnormalities.

So we've got gas shadowing, acoustic shadowing, which are quite common with foreign bodies. So that top right image is our, As our acoustic shadowing, which is quite, consistent with a foreign body, it's blocking the ultrasound waves down on that entire image. So, that would be quite sort of indicative of, of a foreign body, or an obstruction.

We can get poor gut motility, so, lack of peristalsis, it's quite important, sort of, in terms of, nutritional sort of requirements. Sort of healing, and getting involved in that. We can get intestinal tumours.

So, the top left image we've got is, the dark, sort of hypoechoic part that is around there is, is a sort of soft tissue mass with our lumen of intestine running through the middle. So, you can actually trace that as well when you're, when you're scanning them, you can see the lumen running right through the middle. Of there, .

Of that. So that, that would be quite consistent with the, an, an intestinal tumour. We can get inflamed layering, so we can measure the layers of, of the intestinal tracts, and we can also get things like fluid distention as well.

So, as opposed to that normal sort of peristalsis that we see, we could get quite distended, intestinal tracts with fluid just sloshing backwards and forwards, but I'll speak to you about that a bit more later in one of our case scenarios. And our splenic abnormalities, which I'm sure we're all familiar with. When I use the term sort of cavitated or mottled sort of appearance, that's that top left, sort of splenic abnormality, sort of quite angry looking, quite sort of consistent with sort of things like tumours, agro sarcomas.

We can get enlarged spleens, and we can also get free fluid if they're, if they're bleeding, but it might not necessarily be associated with the spleen. So being able to sort of try and locate. The abnormality where that free fluid might be coming from, it could be heart associated, it could be organ associated, it could be trauma associated, and it's quite important.

So, being able to spot those is, is, is very useful. Kidney abnormalities. So, this has got complete loss of, like, s structural details.

So, believe it or not, it is a kidney. It's got hydrocephalus that's going on there. There's a lot of free fluid sort of surrounding it.

And we've also got what's going on in the middle here is blocking of the ultra sound waves. We're losing sort of the resolution, the image below that. So, quite consistent with sort of kidney stones, because they're, they're blocking the ultrasound waves from, from passing through there.

We can get size differences, so we can get larger or smaller kidneys, depending if there's a blockage going on, tumours associated as well. So sort of abnormal shapes, sort of enlargement. And sort of edoema as well, depending on what's going on.

So, believe it or not, that is, it is a kidney. And then our bladder abnormalities is where my dog comes into play cause he's got, quite a few abnormalities with him. So, this is his bladder at the bottom.

So, if we've got, sediment in the bladder, then it looks a bit like a snow globe, sort of swirling around. We can agitate that and see if it moves. So, sort of sediment, crystal urea.

We can get uroliths, which will block our ultrasound waves. So very similar to how that, kidney looks with sort of, you're losing sort of the image below. If we were to lose below that, that bladder, then it would likely be that there could be a bladderone sitting in there.

We can get things like your abdomen, so loss of a structural wall, which you'll struggle to then find an appearance of a bladder. And we can also get thickened and, and inflamed also. So, and the bottom left there is a bladder, which, has had a cystotomy recently.

So, that is why it's, it's inflamed, so that sort of bladder wall is quite thickened, which we would expect after the surgery that's, that's been had. But you can also get sort of some sort of appearance like that if the bladder is extremely empty as well. So just to be aware of that.

We can get associated tumours as well. So the, the image on sort of the, the middle, sort of at the right, that's the sort of soft tissue mass that's sitting within the bladder. If you wondered whether that was sediment instead, then you can agitate the bladder to see if that sort of moves and swirls around, or you can stand the patient up and see if that moves as well, or whether it's attached to, to that bladder wall.

Top right is a, a, a, quite an interesting case we had. That was, a blocked bladder cat, and we scanned that, and it actually had, like, a diverticulum in its bladder. So it had, like, almost like a bladder within, within a bladder.

So, that's sort of like a sort of more of a soft tissue sort. Structure that's, that's flashing up, sort of within that, causing, causing some problems. And then the top left is just, an area of sludge that's sort of sitting along, along that bladder, bladder wall.

So, if you agitated that, it would then go to how, how this was sort of, swelling around in there. So this, don't get caught up with things like adrenal gland. It's one of my biggest sort of pet hates that people think that they can't do an ultrasound scan because they can't find a, adrenal gland or a pancreas.

But you really don't need to be able to find either of those to be doing pancreas, to be doing ultrasound scans, because your patients are gonna, ultimately be the ones that suffer for it. But this is going to show you how, how far you can take it. We've got a picture of adrenal glands on both of these images, so they tend to look like this little peanut shape that's situated near the kidney.

This image on the left was obtained on a, one of the portable probes. So it just shows you the sort of, how far they're coming in, the fact that they can find adrenal glands on these, on these small probes now. And then on this is, is a laptop sort of style machine that we have, have there.

So, yeah, just sort of shows you how far you can take it, but it's also a nice way to remember sort of how Cushing's is, because, we tend to find the adrenal glands if they're enlarged. So, I always think hyper is sort of a bit more, a bit extra. So, that's sort of an enlarged, adrenal gland, sort of fairly typical of Cushing's.

So these are a few in practise scenarios which are things that will probably happen sort of fairly sort of frequently in firstly in practise, and if they do, hopefully you can take these back and actually get involved. So this is our first patient, you might have seen this one before, crops up quite a lot in my presentations. 9 year old male German Shepherd dog came in tachycardic, hypertensive pale mucus membranes, tachynic and collapsed and lethargic.

This case presented out of hours as an emergency. There wasn't a vet available at the time, because we were quite a busy emergency service. So they were dealing with other cases.

At this stage, the vital parameters were, were of a concern, quite clearly. And I was speaking to the veterinary surgeon, and the owner sort of flitting between the two. We gained.

Consent that we could, perform some initial investigations. So, bloods, and a point of care ultrasound scans or a fast, scan, which just gained us a lot more information of what was going on. We could then make our plan from there, and give the owner a lot more information and, and make, let them make an informed decision as well.

Carried out a, point of er scan, and we found this large cavitated structure, which we were able to follow and locate that it was attached to, to the spleen as well. So, we kind of knew what we were faced with. And we were also faced with a large amount of free fluid, which would explain, the pale mucous membranes.

Obviously, we, we were sort of bleeding into our abdomen. And, you can sort of see the edges of the, of that fluid are, aren't clean. They're not sort of contained within a nice smooth forward structure.

So, once we'd done that, we could speak to the vet. They knew what, what needed to happen. They spoke to the owner.

They wanted, they were very keen to go for surgery and, and, and go from there. So, we could then already start having theatre preps. We could have fluids prepped for, for the patient.

Anything that we needed to do beforehand was then fast-tracked and sped up that we could then sort of You know, focus on this patient, purely from, from this ultrasound scan that we, we did. Obviously, we've done sort of things like chest X-rays before as well, just to make sure there wasn't any sort of spread of, of metastasis. But it's always sort of, you know, very helpful to be able to then start prepping, prepping things and reducing that, that time that patients waiting for, for their treatment.

And then, what we found in the, in surgery was, sort of, you could probably sort of actually line up really with the, with the ultrasound scan that's going on there. It's sort of quite that sort of circular, mass on the edge of the, on, on the edge of the spleen. So, this is quite a positive outcome for the case, because the, the patient was sort of fast tracked the sort of information gathered quite quickly as, as sort of the veterinary nursing team, and feeding that back to the owner, and, feeding it back to the, the vet, sorry, who then spoke to the owners to get informed consent.

And the ultrasound actors is a massive sort of puzzle piece in, in that jigsaw to be able to sort of make a roadmap and a treatment plan, ahead. So, again, faster treatment, better sort of outcome and, and patient sort of, care that we can offer as well. This is case scenario two.

So this is actually two different cases. So, the one on the left and the one on the right. So, a 6 month old cat that came in with a history of chronic vomiting, diarrhoea, had enterectomy surgery for interception, and it was hospitalised post-op.

And, I just wanted to scan it for perisylysis to make sure it was moving, and that we were sort of, on top of its nutritional requirements so that it was hopefully gonna heal and, and do quite well. interception classically looks like a sort of this circle within a circle where the, intestines are sort of, obviously loop in on themselves. And that's what you're seeing on all these ultrasound scan images there.

So, they look a bit different on various ones. These ones have been taken on a, on a, a linear probe, which is why you've got a, a pretty incredible sort of resolution of that. Whereas we've got this on our convex probe, so we're sort of losing a bit of that image resolution.

So, that's what I mean about the, the linear probes, given those, much better sort of, resolution images. Again, enterectomies, enterotomies, anything like that, repeat scans. This is an area that nurses can utilise hugely.

And the benefit of this is we're gonna pick up on any reoccurrence very quickly. If we're doing them regularly, we can check that nutrition, sort of peristalsis is occurring, which is gonna help with, with the healing process. And, you know, if we don't leave them too long, they're not gonna adhese.

So we might just be able to get away with manipulating that intestine away from each other, as opposed to having to do a further enterectomy, which is gonna sort of detriment that patient with how much gut we can take away. And then our third abdominal case scenario, this is one of my favourite patients. This is Mabel.

This case is completely led by the nursing team, working with the vet and relaying the information, which the clinical discussions took place throughout. So, Mabel's an 8 year old female nus greyhound. She came in tachycardic, pyorexic, lethargic, vomiting, dry and dark pink mucus membranes.

And the vet brought her down into the prep room and said, Can you scan her if you, if you get a chance to? And I was like, What's going on with her? Just to get a bit of a history.

And they said, they said the clinical signs as, as mentioned, and any tachycardic greyhounds, I have a bit of a thing about, and I think there's usually something bad going, going wrong with them. So, I absolutely was gonna perform the, the ultrasound scan along with the other sort of, things that were, were requested. We done some investigations, so we've done some bloods.

Sort of there was a bit of dehydration going on, hypovolemia, sort of, and then we sort of continued to do vital parameter mon monitoring and, further imaging as well. So, we sort of had some analgesia, some, fluids as well that were administered under the, the direction of the vet. I know the PCV is, is increased, and, obviously, greyhounds, it can be higher than normal, but this patient was definitely sort of quite dehydrated, very dry, sort of mucous membrane, and tachycardic as well.

Following further imaging, this is what we, what we found on, on ultrasound. So, we've got quite a distended intestinal tract, sort of running throughout. And then we had this sort of fluid that's just regurgitating backwards and forwards, all the way through, followed by this, distended gut running throughout the abdomen.

When I see this, I have a, suspicion of foreign body. So we've got a foreign body hand looking for that acoustic shadowing. But I could not find any whatsoever.

The patient was in right lateral recumbency, tried to scan them and, and just kept finding this, but I couldn't find any blockage in, any blockage of sort of the ultrasound waves at all. So I popped the patient back, carried on fluid, resuscitating. And then decided to re-scan a bit later.

Found exactly the same until we flipped them onto the other side, and, literally into the other lateral recumbency and straight away, found this acoustic shadowing. So, this is being followed all the way along that intestinal tract, and you're just losing that complete image all the way through. So, Quite consistent with the foreign body.

So, we then went to surgery, and what we found was a skewer poking through the intestine tract. And it was quite angry. And I think the only thing that was saving this dog from sort of a lot of free fluid in the abdomen this was this little plug at that moment in time, was stopping anything from leaking through.

But had that been left another few hours, that would start to break, breaking down. You're probably gonna be facing the septic abdomen, sort of contamination. So, Basically, that, you know, time is of the essence in, in some of these things, but also that patient was on left 24 hours just to see how they got on.

We, we, you know, carried out those diagnostic investigations. Post-op care in this, in this case, I repeat scans. So, AMPM as a minimum, we can add them to the hospital sheets.

We can then carry out regular observation and pain scores, looking for free fluid and peristalsis, you know, our nutrition, do we need to intervene? Do we need to assisted feeding and feeding tubes? And ultimately, the nurses can lead the inpatient scan monitoring in this place.

Our foreign body cases. Again, so we've got this sort of very distended stomach, quite typical of sort of foreign body, if there's a blockage that it can't pass through. And then we've got that regurgitating of fluid that's just going round and round in those intestines again, followed by our, blocking of ultrasound waves as well.

So, this is, little Eddie who was a classic for our body, as well as being a chocolate lab. I think you can all expect that this is his intestine poking through as well. So, we've got a corner on the cob that was sitting there that was blocking the, the ultrasound waves with that descended fluid-filled stomach and acoustic shadowing, and also that sort of clinical signs of vomiting and sort of lethargy as well.

And then, just another one, just so you can sort of see that this regurgitation is quite sort of common with foreign body. This is sort of an intestine, which just had a, a lot of, SEI sort of sofa that a, a patient had eaten. So, that was just blocking the, the, sort of fluid and, and food from, from moving through the intestinal tract.

So, yeah, quite common with foreign bodies. And then moving on, to our thoracic point of care ultrasound scan. So, this is a bit quicker because there's not as much that we look at.

So, we're looking at our heart, lung fields, and pleural space within the thorax cavity. Ultimately, we're looking, in laterals or sternal recumbency. There, there's multiple ways that you can do this, depends on the, the patient presentation.

But ultimately, it is there fluids? Is there a soft tissue structure where it shouldn't be? Is there clots in the chambers of the, of the heart, and the size of the, the chambers, and the contractility as well?

Assessment of the lung fields. So, we do that in lateraltern of recumbency. If they've been in lateral for a while, then it's worth just setting them up, just so they could sort of reoxtruate and the lungs aren't sort of being compromised.

But all you need for this is a clip patch between the rib spaces on the most prominent area. So, whichever part of your, your chest sticks out the most, you sort of a clip patch between those two rib spaces. And then we'll get a view like this, where we've got our rib space blocking the ultrasound waves, rib space blocking the ultrasound waves, and we've got our lung here, and, and then we've got bee lines, which I'm gonna talk about a bit more, in depth in a, in a, in a little while.

So we've got A lines and B lines. A lines are absolutely, like, perfectly fine. They're normal.

So, they're horizontal lines that run across, as a long field. So, these are A lines running, running along there. We've got our ribs face again, and then our A lines.

You might hear it referred to as a, as a gaiter sign. It looks a bit like a, a crocodile when people put eyes on them. So, yeah, but that's an absolutely sort of normal indication of lung that we want to be seeing on our, on our sort of thoracic examination.

And then we get bee lines, which are referred to as bad. You might hear them referred to as rockets, flashlights, search lights, anything like that. Basically, they're these bright, hyperechoic lines that, that flow all the way down your ultrasound image.

So, they'll run from the lung all the way down. They won't stop sort of halfway down, and they'll be in between those places as well. Quite indicative of, like, things like aspiration pneumonia, so fluid on the lungs, like wet lungs.

And yeah, that classic sort of searchlight appearance, which is bad, but it's quite a, a important observation to, to know if, if you were to be scanning, some lung fields. And then, the other thing we're looking at when we're monitoring lungs, is the glide sort of sign that we want to see. So, we want to see the sliding motion, of the sort of, of the lung sliding against the chest wall there.

If you've got an absence of that glide sign, it can, be due to things like pneumothorax as well. So, we want to be seeing that glide sign when we do not te fast. But just remember to, to stand your patient up if they've been in a lateral currency for a while, so the lung hasn't been compressed and sort of compromised in that aspect as well.

Again, we can do that in lateral or sonar recumbency, or if the standing up, depends on the, on the patient preparation. Presentation, sorry. Lung abnormalities.

So is there free fluid in the pleural cavity? Have we got beelines and rockets as I previously mentioned? Is there absence of the glide signs, so no pneumothorax or presence of abdominal organs?

Have we got like a diaphragmatic rupture, or is there presence of like soft tissue structures like masses or anything going on? Typical sort of, free fluid in the chest, would appear like this. So that's just free fluid and fibrin, sort of floating around.

So, obviously, if they're in respiratory distress, you're, you're gonna, you're gonna know about it. And that's quite common in sort of the emergency setting. And then, we've also got, some sort of more fluid sitting there within the chest as well, and that heart is sort of struggling to beat, due to this sort of sheer amount of fluid that's sitting there as well.

And we can use the face array probe for these, these views, because they fit between the ribs face is quite nice. But you can also view this sort of through the diaphragm from the abdomen, depending on, on the size of the patient as well, which will be enough to tell you whether there's any sort of fluid in the chest, maybe. And then go from there.

So, our cardiac view, ideally, if you are trying to get a cardiac view, you want to be able to get this aorta with the Mercedes-Benz sign sitting in the middle. That's our sort of perfect view, of our aorta. And then we have a left atrium as well.

That might be flipped, depending on which orientation your machine is at. And then we can get a ratio, which is the left atrium and aortic ratio between the two. And we can measure that an episode of 1.6.

Centimetres, then it's usually indicative of, of a sort of cardiac cause of collapse or, or dyspnea of what's going on. If you can get that view really quickly, then it's gonna give you a lot of information. You're gonna get information on, on the left atrium chamber.

Is there anything in there that shouldn't be like clots or anything like that? Or even sort of pericardial diffusion. So, you're gonna get a hell of a lot of information very rapidly from sort of a non-invasive technique.

And then we can establish what's causing that dyspnea and make a, a treatment plan from there. Cats with large left atriums, just another one that you can sort of then sort of be thinking that the few next steps ahead, can be sort of hyperthyroidism. We can check their T4, as well.

So, quicker patient care and treatment plans, thing, you know, you, you know, your next steps then. And then a few videos of some cardiac abnormalities. So, this one is a, soft tissue mass that's within the pericardium, and we've got a large amount of free fluid, within that pericardium as well.

So, yeah, pericardial effusion that's in there, but that soft tissue mass, we can then start to prep for, We start prepping for pericardiocentesis as a life-saving procedure as well. And then this other one is a large clot that's bouncing around the chamber. So, sort of as opposed to soft tissue masses mass bounced around.

So that would be, you know, quite a concern, on a sort of triage scan as well. And then the bottom one we've got is another pericardial effusion, but that's causing tampanage. So that heart is really sort of struggling to do its job properly because of the amount of fluid that's sitting within that pericardium is, is just not enabling it to.

So this is just a Disney, patient, which is a case example. So this dog, unfortunately, hasn't got a lot going for it, with it being a brachycephalic. This, presented a severe respiratory effort.

We performed a non-invasive ultrasound, which gave us the information a second. He can also perform that whilst they're receiving supplemental oxygen. We had a lot of free fluid that was sloshing around in that patient's chest.

So, immediately we obviously gained consent, after, you know, we got consent for the ultrasound and initial investigations, but we could then start. Setting up for that life-saving procedure, thoracocentesis, which, dramatically, sort of saved that patient. The patient was breathing so much better afterwards.

That fluid was drained sort of rapidly. And the, sort of, the SPA2 of that patient drastically improved as well. So, the patient outcome was, essentially fast tracked straight through and, much more improved as well.

So my top tips are practise as much as possible. So, pre-medicate patients, if it's appropriate, you've got consent to do so, it can be quite nice just to sort of give yourself a time limit to find things like your, your, your liver one time, and the next time you want to be looking for the kidneys and stuff, just so you can build up your image bank and get used to how that probe works as well. But the best thing to do is actually just, just start having a go in the sort of practical aspects.

So, learn what the probe does. So, the small movements, the turning, the angles, the fanning of it. And there's more than one way to hold it and do it.

But just, just have a go. Prepare your patient, and, you'll get sort of better images. Build up your image library as well.

So take photos. Feel free to send them to me if you want to know what's essentially going on, if I can help, I will. And be patient, as you're doing the ultrasound scans and the gel sort of sets in, and your images improve as you go along, and the more you do them, the better you'll get at them as well.

So don't sort of give up and expect it to happen sort of straight away. And if you've got more experienced stenographers, then ask them questions. We're quite prone to sort of carrying out these scans and not really saying what's on the screen.

So, ask questions, and, and you're learning, you'll sort of start to see how, how they got to them and sort of do like a bit of a, tell me, show me sort of thing. But yeah. And ultimately, you don't need to be able to find a pancreas or adrenal gland to start doing an ultrasound scan.

So just have a go, cause your patient's gonna benefit from it, ultimately. So, yeah, thank you very much for, watching. I hope it was informative.

And I've got some practical courses available, with my in-house CPD, so feel free to drop me an email or a message, and I can help with that. And, also, I've got some various, places coming up with IMV imaging as well. We're in Exeter next week if that's of, of any interest to anyone watching.

But yeah, so feel free to get in contact. And thank you very much for watching. Amazing.

Thank you so much, Jack. That was really good, really, really informative and quite unique, I think, for CPD. Yeah.

Yeah. Quite inspiring to think of, you know, all those extra things that you can be doing in practise. So, yeah, thank you very much.

I don't think we've got any questions in the chat box, for now. So if anyone If you have any questions, if you want to pop them either across to Jack, or you can get them to us, and we can send them to Jack and we'll get back to you, that's absolutely fine. And just a huge thank you to many pets for, sponsoring the nest, stuff this year.

And also, again, to Jack, for that brilliant, content there. Really, really enjoyed that. Thank you.

No problem. Thank you very much for having me. No problems.

See you later. Thank you. Bye.