The 6th World Congress in Sports and Exercise Medicine (WCSEM) was held in the Alex Hotel in Dublin on November 3rd and 4th. This was a fantastic meeting bringing together Sports Medicine specialists from around the globe and some of the Irish Emergency Medicine folk were honoured to be involved
The course organisers ordered POCUS on the menu and Victoria Mehigan, Rachel Liu, Evan Peck and I were delighted to deliver a Sports Medicine-tailored ultrasound workshop, kindly supported by SonoSite and Mindray ultrasound systems
Victoria and I are Emergency Medicine consultants (with a special interest in ultrasound) in Ireland. Rachel Liu is an Associate Professor of Emergency Medicine and Director of Point of Care Ultrasound Education at Yale School of Medicine, US while Evan Peck specialises in Diagnostic and Interventional Musculoskeletal ultrasound in the Cleveland Clinic Florida, US
Most of the workshop attendees were general practitioners and physiotherapists so we decided on topics relevant to their practice – I find that it’s a good idea to poll your audience to meet their learning needs. For this workshop we taught the basic principles of musculoskeletal shoulder, EFAST, and ECHO skills
Evan reminded our learners that a focussed shoulder US exam performs as well as MRI in the diagnosis of a full thickness rotator cuff tear making this test ideal for evaluating these injuries. POCUS can also be used to confirm a shoulder dislocation and relocation prior to x-ray. To perform shoulder US, sit your patient up and start with the hand supine and look for the biceps tendon in long axis and short axis. Next get your patient to internally rotate the shoulder in the modified Crass position. Watch this fantastic lecture by Mark Goodman on how to start using POCUS for shoulder injuries in the ED
Next up Rachel Liu showed us how to evaluate left ventricular function using a quick point of care technique. Pick a point in the centre of the left ventricle and watch to see how well and how close that the ventricle walls converge on this point. Using this simple qualitative concept you can look for a changes in LV function for example if your patient is dehydrated and hyperdynamic following a long endurance event
Rachel is an ultrasound education specialist – notice how she is scanning the heart with her non-dominant hand, upside down and kneeling down while facing the audience to allow everyone to see how to get the best view!
At my scan station, I encouraged new users to hold the probe as comfortably and deftly as possible. There is no absolute ‘best’ way to hold the ultrasound transducer but I ask learners to try to hold it as if they are ‘putting on lip gloss’ to allow maximum range of movements and to avoid fatigue
At our workshop, we made sure to feature an ultrasound application for everyone to take home. Some learners practised needle guidance skills using tofu models to simulate a foreign body removal. Using ultrasound and a water bath greatly improves visualisation of finger flexor tendon movement. Finally we looked at rib and clavicle fractures using ultrasound as well as imaging the achilles tendon
Teaching ultrasound to a diverse group is a fantastic fun way to break down silos and build collaborative relationships between specialities. At the end of the day, your patient will benefit from your new skills. I’m really looking forward to WCSEM in 2019 to be held in Bath in England!