POCUS Berlin happened last weekend, January 25, 26 and it was amazing! Set in the wonderful backdrop of Berlin, it was the brainchild of Aidan Baron (@Aidan_Baron), Rebecca Lehmann (@rebechaxx) , Robert Buder (@educate_YS) and Aurelia Hubner (@a_hueb). The event was advertised on social media and sold out within days!
This post features some of the key learning messages from the weekend with highlights from Felix Lorang (@acutePOCUS) & Cian McDermott (@cianmcdermott). Check out the weekend on twitter using @BerlinPOCUS and #POCUSBerlin
Find the sister post from DasFOAM.org
The organising team enlisted the help of POCUS educators from around the world (USA, Netherlands, Slovenia, Germany, Poland & Ireland) to teach ultrasound to 70 eager students from all over Europe with different backgrounds: paramedics, young physicians and medical students, even some specialists – the common bond was a desire to learn POCUS!
Some of the organisers had been on the smaccjunior team for DasSMACC in 2017 and had even managed to kept a momento!
Saturday kicked off with a lung ultrasound lecture by Florian Recker. He explained the concept that ultrasound can be used to evaluate parts of the body which are traditionally not considered suitable for ultrasoundFlorian explained how artefacts in lung ultrasound are super useful to distinguish normal lung from lung disease states. A perfect example of this is that B-Lines, atelectasis and signs of pneumonia are easy and reliable to spot on lung ultrasound especially when compared to traditional xray. Read this post for more information
‘Fluidothorax’ and the tricks of the right upper quadrant by Gregor Prosen followed next. Greg is notable for his critical thinking in US and everyone learned a thing or two from his lecture
Greg explained how the FAST exam has evolved from looking at things that are present (free fluid), to now searching for signs that are not present (artefacts in lung US). This represents the evolution of the FAST exam in modern POCUS practice
He also explained the ‘hamburger analogy’ – placing the probe in a plane that ‘slices the body in 2 halves, just like a hamburger bun’. I find this description makes it easier to visualise the anatomical coronal plane and I will definitely use this trick next time when teaching new users
Next Jenn Cotton (@sonomojo), Emergency Physician from Utah, gave a super talk about pelvic ultrasound – she even delivered her lecture barefoot for extra impact! Jenn explained common false positive sonographic findings in the male pelvis and how scanning could (or even should?) ‘get a bit weird’ to get excellent images of the pelvic anatomy. Her learning point is that the probe needs to be right on/ over the pubic symphysis to look inside the peritoneum
Next, Felix Lorang dished out some amazing ultrasound clinical pearls as he explained that ultrasound is nothing more than a machine ‘without a brain’
Our machines do not understand anatomy and the physician user must become expert in interpreting the information that appears on the screen. This is vital for new users to appreciate the limitations of ultrasound. Suspected pathology should be verified from different views and planes
Felix also described how the major advantage of POCUS is it’s immediate availability at the bedside for all sick patients
To close out the day, Aidan Baron and Renkse Wiersema told their individual POCUS stories. Renkse (@r_wiersema) manages to combine her medical studies and a PHD with the Simple Intensive Care Studies group in the Netherlands, thesics.com.
Aidan started medical school in Sydney earlier in January and could not be present in person. Listen to Aidan talk about his ultrasound journey
Cian McDermott (@cianmcdermott) kicked off our lectures on day 2. Here are his top tips for renal ultrasound
- Probe hold – get it right to find the best images. Avoid the ‘smelly sock’ hold, think about holding like lip gloss instead. Find optimal views to make better clinical decisions
- US is a dynamic exam – breathe, move arms, roll patient over to get better images
- Think of hydronephrosis like a tree – secondary sign of obstruction
- Be aware of everything else in the belly! Think aortic pathology & ruptured ectopic pregnancy
The Irish POCUS community was well represented by Rachel Gilmore (@RachelGilmore12) and Cian McDermott. Our small movement feels like it has really grown and achieved in recent months!
The Hertz4veins initiatve was launched at POCUSBerlin. This is fantastic concept to teach medical students about US guided IV placement and provides free online training and educational material at hertz4veins.jimdofree.com. What a superb #FOAMed resource!
Creagh Boulger (@CreaghB) joined the teaching faculty from across the Atlantic. Creagh works as an ER doctor in Ohio State University and she gave 2 superb lectures about cardiac ultrasound. While keeping to the basic principles she brought her talk to life and explained some easily overlooked clinical pearls
- think of the right ventricle as the ‘anterior’ ventricle
- PSAX view is like slicing a loaf of bread
- PLAX is like slicing a hot dog bun open
- ‘1 view is 1 view too few’ so you must perfect your images and gather all the information you can from multiple cardiac views to make better clinical decisions
- To optimnise your AP4CH view, flatten, rotate and slide the probe laterally once you find the point of maximal impulse (PMI)
In the afternoon, Creagh and Jenn ran a high-energy workshop on POCUS phantoms and trainers. This session was a real show-stopper and everyone joined in to scan the low cost but high fidelity models ranging from bowel obstruction to tofu IV trainers and abscess models
While this station was lighthearted and fun, it also carried a heavier educational message – gamification in POCUS education is important so that adult learners can engage and thus allowing learning to ‘stick’. The American duo have definitely mastered this art!
A quote from one of the attendees that I think sums up the vibe of POCUSBerlin weekend workshop
“Course came to an end today but the spark has been lit
I’m excited to get back to work to try all the wonderful things we have learned this weekend”
If you want to learn more about #POCUS, check out these resources and remember happy scannin’!