bedside ultrasound in the Southwest

In the Hopi Emergency Department, and many emergency departments across the country, when it is outside of business hours, our laboratory and radiology technicians (the people that can run the blood tests and take the x-rays or CT scans) are on call and 40-minutes away.

What if there was a tool that would allow us as providers to look inside your body right there in the room with you, 'at the bedside', and find out what is wrong without calling anyone in from home and without exposing you to any radiation?

We are realizing more and more that we already have this tool -- ultrasound -- and if we learn how to use it properly it can be incredibly powerful. Ultrasound uses sound waves to look inside the body. Most people are familiar with the use of ultrasound for pregnant women to look at their babies and how they are developing, but it has many many other uses.

I was fortunate to have had some amazing mentors in my residency program who trained us all in bedside ultrasound right at the beginning of our 3-year residency program and allowed interested residents, myself included, to do an elective in our third year to get much more hands-on experience with ultrasound. 

I love ultrasound for many reasons. First, it is quality time spent with a patient. I love to show someone their kidney, or gallbladder, or liver, or pregnancy, or veins, and either reassure them that they are OK or show them what is causing their problem, and patients to look at the pictures with me. Second, it is very cost effective. Ultrasound machines are a bit pricey, but once you have the machine it can be used over and over, so in the end it is cheap, easy, portable, and sometimes saves unnecessary expensive tests, radiation, or transfers to another hospital.  Third, it s so fun to teach. I have had the opportunity to help teach courses at my own residency, at a Global Health conference for family physicians, and most recently at a nearby Indian Health Service facility at Zuni.

This last weekend, after running in the middle of the night and again early morning in the Ragnar race in Phoenix, I drove out to Zuni, New Mexico and had a wonderful Contra Costa Family Medicine reunion with a couple of former co-residents and a couple of our ultrasound mentors in the setting of a two day course they were putting on for bedside ultrasound for Indian Health Service providers.

IHS-Contra Costa bedside ultrasound champions

I had been doing quite a bit of bedside ultrasound before, but after these recent courses my excitement and awe of the potential of ultrasound has been elevated even more, and I'm working on mentoring other providers at Hopi to be able to answer some simple questions with a bedside ultrasound: Is your leg swelling from a blood clot in your veins? Is your stomach pain coming from your gallbladder? Has a pocket of pus formed in your skin infection that I need to drain?

Sometimes, the answer to one of these questions can make all the difference for a patient's care.