GSACEP Lecture Series: Creating a POCUS Curriculum for SOF Medics Wells Weymouth, MD

Point of Care ultrasound is moving from the radiology suite to the battlefield.  Dr. Weymouth discusses creation of a medic centered point of care ultrasound curriculum and some brief case discussions.

CME is no longer available for this lecture.  However, GSACEP members can access the full presentation and slides at https://gsacep.tradewing.com/event/fC7PFy6FJd2brZRaf.  

Join us for Government Services Symposium 2022 April 8-12 in Orlando!  Click here to register. https://gsacep.org/aws/GSACE/pt/sp/conference_home_page

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Episode Transcript

Wells Weymouth (01:01):
My name is wells Weymouth. And I'll be giving
this talk in conjunction andwith a lot of help from Kim and
Baines for the GSS 2021 shortlecture series for the point of
care ultrasound mediccurriculum. And normally, we
would be asking the governmentto come pay for us to get some

(01:23):
exciting and stimulating lecturetalks. And while networking and
seeing some old friends andmeeting some new ones, I think
it is very unfortunate that thisis now virtual, but I will say
big thanks to Dr. Tyler Davisfor setting it up, and still

(01:44):
allowing us to get all theeducational benefit of this even
though it's not in person. Sofor our talk, we have no
disclosures. A little bit ofbackground. So there is an intro
to ultrasound curriculum builtinto the SOCCOM Special
Operations comic medic pipelinetakes about five to six hours
and it spread over a couple coremodules from AWHONN trauma to

(02:09):
ultrasound Familiarity is basedafter that on individual
experience. So if they're notlearning it back at their
respective units, they aresimply not learning it. And
there are no formal educationcourses readily available that
are utilized by medics.
Typically, if they do, it's avery expeditious, Medicare

(02:29):
ambitious one, those aretypically geared towards the
providers. And then as we know,medics operate with relative
autonomy, and extremely austerelocations where ultrasound would
be perfect. So what we thoughtis how can we provide an
ultrasound curriculum for medicswho are chilling on their bed on

(02:51):
ployment, or on the back of abird while they are waiting for
something else to happen? So wedid is we did didactic and hands
on sessions, we introduced theseon a weekly basis to our medics
and showed them, hey, this isthe cool stuff that you can do

(03:11):
with ultrasound, neuro wwoxLooking vessels, and then we
said, hey, I think you shouldlearn more about this. And if
you're interested, we would likeyou to join our Google classroom
or Blackboard. You know, we useda couple different ways. And we

(03:31):
placed these modules into there.
And all of these modules werethen followed by a short quiz.
And then an end of Module test,students were required to score
7% on the test to receive amodule complete checkmark, all
of this information and all thismaterial was relatively easy to

(03:53):
find online. We basicallycollated it and then added some
key learning points. So afterthis, we sent our medics are
continued to send our medicsinto their respective austere
locations. And they startedcoming back with some cases. So

(04:13):
we'll start with the mostextreme case, in my view, to 43
year old male contractors withhistory of hypertension, who
presented with fatigue for threeweeks and mild intermittent
central chest pain for two days.
The vital signs show that he'smildly hypertensive, which he
says is not completely abnormalfor him. As physical exam is
normal EKG is read as normal,there's another provider present

(04:37):
during this encounter, he saysEKG is normal. And then they get
an eye stat, which is normalexcept for granted in a 311,
which is abnormal for thisgentleman. So they're thinking
maybe he's a little dehydrated.
But let's just go ahead and getthe ultrasound and we're going

(04:57):
to do is we're going to do anecho. And we're going to do a
renal ultrasound, and inparticular, on the renal
ultrasound, they end upcapturing this image, which is
highly concerning, and they sendhim immediately to the URL to
your facility. And it turns out,he has a massive type B aortic
dissection. So amazing pickup bythe ultrasound truly, I'm not

(05:21):
sure if it would have happenedthat fast. And I think this man
has ultrasound skills to thankfor his expeditious care. Moving
on to the next case, there was a52 year old male pilot with
sudden onset left leg pain whileplaying basketball, vital signs
normal and then he's got painwith any movement of the left

(05:43):
foot.

Unknown (05:44):
So we were able to obtained an x ray because there
was a rudimentary extra machineavailable, which really shows
nothing he's got maybe in a puffseal injury from long ago maybe
a little bit of tissue edema.
Good The exam is extremelydifficult because of this
gentleman's pain. So we wereable to obtain an ultrasound

(06:05):
which shows just complete tearof the Achilles tendon and then
some surrounding fluid andedema, and he gets a appropriate
splint and then gets evacuated.
So, great case for ultrasoundwhere the exam was difficult to
kind of clinch the diagnosis forus. Then we saw another night, a

(06:31):
27 year old female contractorwho presented with vaginal
bleeding and pelvic pain. Sothis is every, at least for my
medics, every medics worstnightmare, sort of vital signs
normal and then the urine HCG ispositive. So there's initial
concern is this topic is thisreally is this ectopic, that

(06:52):
torsion was very low on thedifferential appendicitis
extremely low. And were able toobtain this beautiful
ultrasound, which shows veryclearly a high up. And while
this person was eventuallyevacuated from theater, it was
not nearly as expeditious as theoriginal idea was, and therefore

(07:21):
we were able to save some airassets and a lot of heartache
from several commanders. We hadanother 31 year old female with
left breast pain, vital normal,well, she had a left breathless,
induration and erythema in thesort of the anterior and

(07:41):
superior region. And the medicwas saying, well, Doc, I think
we could just do antibiotics inreturn, I said, oh, let's just
put a probe on there and seewhat you got. And lo and behold,
a large fluid pocket, whichobviously requires drainage. So
he was able to, in fact, drainthe abscess, and she came back

(08:01):
the next day, and it wasdraining very well and then
follow up later that week,everything went really well. So
potential delay of care withjust using antibiotics. But
again, ultrasound comes in savesthe day. So next case, we have a
23 year old male whose left footwas rendered by razor, they're

(08:23):
the kind of utility vehiclesthat are just from personal
experience, incredibly fun todrive around. So he's got pain
with range of motion, he's got alaceration president, there is
some concern for fracture, giventhe amount of pain he's in. But
the medic of the time says,Well, we could just suture

(08:47):
advantage it and then have himseen by our experts, because
he's in a different countrywhere the medical care may not
be as good. And the idea isfloated. But we really say now
we think you need some X raysfirst, and then if, if you can

(09:08):
just go ahead and get anultrasound. So the X rays were
pretty obvious for a fracture,the ultrasound also showed a
fracture. So I don't think theultrasound necessarily changed
this person's course. But it wasan easy, quick and effective

(09:30):
test to get pre hospital. Lastcase, so we had a 35 year old US
citizen contractor complained ofchest pain and vomiting. This
was his EKG, again, really readas a normally Hedgy by provider
at the time. And then there wasan ER doc there and the

(09:51):
ultrasound was read as absenceof beelines Sliding long, and a
normal echo, really notconcerning for much of anything.
So he was sent home with somePPIs and really treated for
GERD. Now, later on, it wasdiscovered that this chest pain

(10:15):
really was likely due toesophageal stricture, and
possible Achalasia. But what wedidn't have to do is spin up a
bunch of assets in order to gethim seen by a cardiologist
immediately, right, so that'salways a nice thing when you
have a little time and that'sreally what the ultrasound

(10:36):
bought us in this case.
So, really, in conclusion, pointof care ultrasound we believe
can be effectively integratedinto existing medical
curriculums, or non existingmedical exams. And then it
really does need to be coveredby some small group hands on
sessions when you can write sothey can get the basic block of

(10:59):
instructions through the app. orwhatnot, and then get the hands
on part later on. Medicsperceived Ultrasound Training as
just incredibly valuable andunderstanding human anatomy and
diagnosis critical disease. Soit was not just a clinical tool,
it was an educational tool. Theultrasound training was

(11:20):
downloaded for offline usereference during patient
encounters, which is exactlywhat you want. And then our
future goals include expandingon this work to incorporate
expanded modules because therereally is no limit to what you
can put on these new iPhones orAndroid. So thank you so much
for having us here today. Reallyappreciate it. I can be reached

(11:44):
by email. And thanks again toDr. Davis and all the people who
put this on and I look forwardto seeing everyone in person
some of the time