SCCM Pod-481: Everything You Need to Know About Critical Care Ultrasound

---

For more than 10 years, the Society of Critical Care Medicine has offered an in-person critical care ultrasound course that spanned two days, interspersing lectures with interactive training. This format has now been replaced by a hybrid format, allowing more countries to host the course, virtually or in person, to ensure that healthcare professionals continue to receive optimized ultrasound training and education. Diane C. McLaughlin, DNP, AGACNP-BC, CCRN, FCCM, was joined by Sarah E. Bain, MD, at the 2023 Critical Care Congress to discuss the critical care ultrasound course, how it has evolved, and how it is expanding around the world. Sarah E. Bain, MD, is division head of cardiovascular thoracic and structural heart anesthesiology at Virginia Mason Hospital in Seattle Washington, USA. This podcast is sponsored by Echonous.

*If you are unable to play the podcast please click here to download the file.

Transcript:

This podcast is sponsored by Echonous, maker of the Cosmos Handheld Ultrasound. Cosmos is redefining point-of-care ultrasound by bringing the power of AI and advanced features like CW, PW, and auto VTI trace to a handheld device. Critical care practitioners can now do more with the handheld system than ever before. Cosmos uses trusted technology and works on compatible iOS and Android tablets. Learn more about Cosmos by visiting echonous.com/podcast.

Dr. McLaughlin: Hello and welcome to the 2023 Critical Care Congress edition of the Society of Critical Care Medicine Podcast. I’m your host, Diane McLaughlin. Today I’m joined by Sarah Bain to discuss critical care ultrasound expanding throughout the world. Dr. Bain is division head of cardiovascular, thoracic, and structural heart anesthesiology at Virginia Mason Franciscan Health in Seattle, Washington. Welcome, Dr. Bain.

Dr. Bain: Thank you. I’m really excited to be here.

Dr. McLaughlin: Do you have any disclosures before we get started?

Dr. Bain: I have no disclosures.

Dr. McLaughlin: I’ll disclose that I have taught at this course and I’m very excited to be talking to you about it. I think it’s really a great course and it’s changed a lot over the last couple years, so I think that’s a great place to start. What in the world is a smart course?

Dr. Bain: Well, just to tell people what our course used to be like, we’ve been running this course for over 10 years and, pre-COVID, we would do everything in person. It started just at Congress and it was a two-day course. If you were an attendee, you would be there for two full days with us, and it was getting lectures in person from expert faculty and then interspersing that with hands-on training at the bedside with live models. Then COVID hit and we had to shut down everything, like the rest of the world. In order to continue to optimize ultrasound training and spread it, we recorded all our lectures and offered a virtual course without the hands-on. Then, just last August, we came back in person and decided to continue with the lectures virtually, so the attendees would have access to the lectures prior to the course to review and study and then come in and we would have a really intense nine-and-a-half hours of hands-on training with the faculty.

Dr. McLaughlin: Oh, wow. They have access to those lectures for more than just before the course, right?

Dr. Bain: Yeah. They get access to the lectures a few months beforehand, in fact, as soon as they sign up, and then they’ve got it for two years after the course to review. So it’s an incredible opportunity to have this kind of data at their fingertips.

Dr. McLaughlin: Yeah, and they have that jam-packed day where they really get hands on the probe and then they can review it with the lectures that are recorded.

Dr. Bain: Absolutely. We also offer them free access to the eBook that we created with the Ultrasound Committee; it’s the Comprehensive Critical Care Ultrasound book. We’re on our second edition, and they get free access to the eBook. We also offer a physical hard copy if you wanted that in your ICU to reference. Between that and the lectures, and, I think, over nine hours of lecture material and then the full day of hands-on with our faculty, that’s what we’re considering our smart course now.

Dr. McLaughlin: Who are the faculty?

Dr. Bain: We have the best faculty, as you know. I will say this, I have never worked with a group of people like this ever in medicine or non-medicine. It is the most dynamic, passionate group of our faculty that come together, and it’s just a breadth of knowledge, experience in different specialties. We have a number of advanced practice practitioners. We have a number of physicians spread through the specialties of internal medicine, emergency medicine, infectious disease, cardiac, anesthesiology, pulmonary medicine, critical care medicine—of course, we’re all critical care providers—and neurocritical care as well. Everybody brings something special to the table. It’s a really fantastic group of people.

Dr. McLaughlin: I know the Ultrasound Committee put in a process to select faculty so that it was fair and transparent and to make sure that all these groups were represented.

Dr. Bain: Yeah. All faculty are vetted. Either they’ve been recommended by current or previous faculty, they’ve been trained by current or previous faculty. We then bring in new faculty as mentees now. They get to come into the course and they teach, but we’re mentoring them during the teaching sessions. Then they come back for the next course that we offer as full faculty.

Dr. McLaughlin: That’s a pretty cool addition over the last two courses that I’ve seen, is a way to bring people on board and see what’s already been so successful and still add their knowledge and expertise.

Dr. Bain: Yeah, I think it’s working really well. It is fairly new too. I don’t remember that when I first started the course, maybe five years ago. I think it’s been fun and it takes a little pressure off new faculty because they get a chance to see how we do it and pair them with much more seasoned faculty as well. I think it’s worked well. Then, the attendees at that station get a two-for-one and they get a different perspective coming from each of those providers.

Dr. McLaughlin: When walking around, we just had the course the last two days, station to station. This is the first time I’ve shadowed on some of my off-time. Everybody does add their own flavor while still everybody gives the same fundamental skills with their little tips or knowledge or experience. It’s really neat.

Dr. Bain: It is really neat. I think, again, it goes to who our faculty is, not just where they’re coming from in terms of institution and specialty and background, but we’re also getting some of the top-level providers in critical care medicine across the country. We have chairs of the department, we have division heads of departments, we have program directors, associate program directors. These people are really involved in education and teaching and the next generation, and they’re there because they love ultrasound, right? I mean, every single person there that’s teaching just loves ultrasound. They could talk about ultrasound all day. I think it’s really fun.

Dr. McLaughlin: They really are the people who are leading ultrasound worldwide. It’s like being in the room with all of your idols, right?

Dr. Bain: All the people who are listed on the book cover are there and they have just this breadth of information, and we can go as superficial or as deep as necessary, depending on the attendees’ backgrounds, and really try to give them the best experience we can in a short amount of time. Beyond coming to your institution and spending months with you scanning, this is what we can do.

Dr. McLaughlin: Yeah. Even as faculty, I learn something new every single year.

Dr. Bain: Me too, every single year. And I rewatch the lectures all the time on my own and feel like I pick things up all the time.

Dr. McLaughlin: Let’s talk a little bit about who’s attending the course.

Dr. Bain: Yes.

Dr. McLaughlin: Because I’ve seen that change over the last couple years. Who is the course really designed for?

Dr. Bain: I was thinking about this because we’re trying to target the right audiences. But really, if you have an interest in adding ultrasound skills to your clinical work at the bedside, this course can be for you. I think that we are currently calling it the fundamentals course, and we do offer an advanced course, and I can talk about that in a little bit. We are adding an introductory to ultrasound course, and this is going to be starting at Congress 2024.

I feel like, with these levels of courses, we can basically target any level of experience. So if you’ve never held a probe in your hand, we can make this course worth your while if you do some prework. If you’ve been scanning on your own and maybe got a little experience in training but not that much before ultrasound really took hold, we can also make this worth your while because just teaching you a little bit more, all those tips, all those pearls about how to optimize your images and what to do with those images. Then, for those who were coming out of training maybe a little bit more recently, who do have some ultrasound experience, who are familiar with the machines, then the advanced course can really target and push them to next level in echocardiography.

Dr. McLaughlin: This was the first time that I actually saw a bedside nurse attend. She said that she was attending because she wanted to bring ultrasound to the rapid response team. It blew my mind.

Dr. Bain: I love it. We’re starting to see that. We definitely have a lot of advanced practice practitioners. We’ve got attendings. We do get some fellows and residents. I haven’t seen a lot of medical students yet, but I think they’re getting it in their training already. But like I said, if you want to incorporate ultrasound into your daily work, this is a great course, no matter who you are.

Dr. McLaughlin: What really is the difference between these courses if we were to narrow down on that a little bit?

Dr. Bain: We are designing this introduction to ultrasound course, again, that we’re going to be rolling out next year. I think that is going to be focused on people who have never held a probe, whom this is really, really new to, and that we can walk you through from very, very beginning, basic aspects of the machines, knobology, what these views are, and how to get your windows and go through there. That’ll be a half-day course, likely, with three to six stations. Then the fundamentals course, I think we can maybe look at a little bit more as an intermediate course where you’ve got a little understanding of what things we’re supposed to look at, but let’s really perfect your imaging quality, what you’re seeing on the screen, and giving your eye a better understanding of normal, abnormal pathology, etc. and then getting you through those. We’re talking echocardiography, lung, and FAST.

Dr. McLaughlin: There’s some actual advanced-type measurements, even in the fundamentals course that you get.

Dr. Bain: We are doing that, and I think that that’s why I was referring to it as an intermediate course. I think that attendees will get what they want from the course based on their level, and then they always have the lectures to go back to and reference. We are doing Doppler in our intermediate course. We’re looking at things like cardiac output. We’re looking at volume status, utilizing Doppler and measurements, and I think that’s something that likely sets us aside a little bit from other introduction to ultrasound courses. If you get really interested in that and want more of it, I think our advanced course is then the next step to go to. I would think having a little time between those courses that we can talk about. But the advanced course is going to focus on primarily more complex pathology and assessment of cardiac dynamic changes and hemodynamics and valvular assessment and diastology, a lot more on the echocardiography aspect.

Dr. McLaughlin: That’s a question I get all the time. People say, Okay, I’m here, I’m at Congress, I signed up for the fundamentals course. Can I come tomorrow and do the advanced?

Dr. Bain: We’ve done that the last two sessions because, again, just coming back from COVID, we’re back in person. But I’m finding that, while it’s convenient because you’re physically there and can do both hands-on, you’re probably not getting what you want to get out of it than if you gave it some time between the courses. I think now we’re looking at that six months or even a year between taking the fundamentals course and then taking the advanced-level course. I think what we are really wanting to emphasize to attendees is that they take our first course and then they go home, and they need to start scanning at their institution. They’ve just got to get a probe in their hands as soon as possible and keep the probe there.

We are wanting to facilitate maybe a pathway for them to go home with, to say, Hey, in your first week home, focus on this; in your second week home, focus on this. Then walk through maybe a six-month program because otherwise it’s pretty overwhelming. There’s so much to know about ultrasound and where do you even start and how do you start perfecting this huge body of data that we just gave to you in nine hours. I think then going through that and then coming back to the advanced, it would make so much more sense, and then you’d really be able to take the skills that you would learn and actually put them to work.

Dr. McLaughlin: It’s funny because we did not talk about this beforehand, but that’s a message that I kept hearing everybody say is, You take this course, you listen to these lectures, but you have to go home and scan people.

Dr. Bain: You’ve gotta scan because it’s like, And then what? I think it can be a little overwhelming. I really like the idea of the smart course actually. I’m really wanting for our future attendees, to really drive this home, is to take your time watching the lectures. Don’t try to cram them into the 24 to 48 hours or on the plane ride to us, take a few months to look at them, maybe just a lecture or two a week and just start at the beginning and work your way through in the path of the lectures that we give you, and let it sink in a little bit. Then you come and do the course, and then you rewatch the lectures afterward as you’re scanning at home. But again, ultrasound is all about scanning. It’s all about getting that probe in your hands. You just can’t learn it if you’re not doing that, it’s not something that you can learn from watching lectures. It’s not something that you can learn from reading a book. You’ve just gotta get the probe in your hands.

Dr. McLaughlin: I think that message has been well delivered throughout the session where it’s ringing a bell in my ear.

Dr. Bain: I know. It reminds us all to do it, like we should be scanning every patient if you have the ability and the machines at your institution. But if you can and you’re rounding, take the ultrasound with you on rounds. If you’re an anesthesiologist in the OR, scan your patient on the table or in preop or in PACU and just start seeing all the examples of normal and abnormal.

Dr. McLaughlin: Our models actually have pathology at times, right?

Dr. Bain: They did, yeah, because they’re human. They’re really a good representation of the patient population. All different sizes and coming with all different comorbidities. So yeah, we did see some interesting stuff this time.

Dr. McLaughlin: We sure did. How many courses are there that people can sign up for? It’s typically twice a year, is that right?

Dr. Bain: We’ve got the courses that we just gave at Congress. Every year at Congress, these are now precourses, usually the two days before Congress starts, and these are two separate courses. One day is a full day of one set of attendees, and then we can do a second day, which is exactly the same for a new group of attendees. There are technically two fundamental ultrasound courses at every Congress. Then in August, it’s usually the second or third week of August that we offer the same courses, the fundamental courses in Chicago.

We have a home base in Chicago with SCCM, and every year we offer these fundamental courses. We were offering the advanced courses along with these fundamental. Like I said, we’re going to change the structure, I think, in the next year to two years and have the advanced course maybe paired with our echo course. We are working with the ASE and NBE to do a three-day course of intense lectures to get people ready for the critical care ultrasound exam that usually is held in January. I think that is the best time, I’m pretty sure, that we’ll find the advanced course could be utilized. It’s not totally set yet, but we’re working on the details.

Dr. McLaughlin: The Society of Critical Care Medicine is an international organization, but we have opportunities everywhere if somebody wants to learn ultrasound. Can you tell me about some of the places that we’re actually teaching?

Dr. Bain: We really are a global organization now. We have a number of countries that we’ve held courses in. I know we’ve held in-person, probably in the last five to seven years, we’ve sent faculty to various places to teach and also to lecture, and that includes Abu Dhabi and Colombia. We actually have a group of 10 people going to Ukraine in March. They’ll be teaching ultrasound for, I believe, two and a half weeks. It’s really exciting. We also have virtual courses that we’re doing in China and Singapore right now, and I think there are a few more countries that we’re readying to roll this out in as well. We haven’t been able to send anybody in person yet to China or Singapore, and I think we had been ready to do that right before COVID in 2019. But we’re doing a train-the-trainer instead where we’re able to train their attendings and then they’re going to turn around and be able to train likely hundreds of people, which is really exciting. And it’s all starting with SCCM.

Dr. McLaughlin: They send their top guys over here and then they get to bootcamp with our awesome faculty.

Dr. Bain: Yeah, and we do a lot of this virtually. Zoom and COVID really changed the world and how we can interact internationally. So we are on the phone and we’re doing things online and I’ve been part of their Zoom Congress in China.

Dr. McLaughlin: If there’s one thing that you would want people to know about the course, what would it be?

Dr. Bain: Maybe a couple things I would say. I think what sets us apart as the SCCM ultrasound course, and has for many years is, one, we’ve been doing this a long time, but it really is the faculty. The people who come to teach you at these courses love ultrasound and they love critical care and they love taking care of patients. There is such a deep level of passion for this, and it’s infectious. Not to sound a little corny, but the energy I feel when I’m with these people, it energizes me for the next year when I go home and I’m taking care of patients. It just is a great reminder of why we all went into medicine. I think it’s really exciting for everybody to be together. I get it too from our attendees. It’s just an incredible burst of energy and how to go back, especially in this world of burnout and fatigue. I think that’s a huge part of this, that there’s so much love for this, and ultrasound can change your practice. It really can if you do it in a safe, responsible way, and that’s what we can help with. We can teach that and facilitate that for you when you go back to your institution and the quality of patient care improves. So many aspects are so positive.

Dr. McLaughlin: Can I make one comment on that?

Dr. Bain: Yeah.

Dr. McLaughlin: I was trying to explain that feeling to somebody, and I said it feels like you’re in a room full of superheroes and they’re sharing their superpower with you.

Dr. Bain: That’s such a good way of putting it.

Dr. McLaughlin: Like x-ray vision.

Dr. Bain: It is.

Dr. McLaughlin: But it really is that feeling because everybody there is just at the very top level that you could possibly be at and saving the world. It is corny. It is, it’s like a superpower.

Dr. Bain: Yeah, but it feels that way and reminds you, and you get in the bog sometimes when you’re working so hard. We all work so hard and I think these are the moments that we come together and we remind each other that it’s so worth it. But ultrasound is power and, like they say, with power comes responsibility. So we have to do it in a responsible way. This is the great way to do it.

Dr. McLaughlin: What are the other things? I cut you off on that one because I was excited to share my superhero analogy.

Dr. Bain: When you had asked me what are the things I’d want people to know about the course, I think that if you’re going to come to the course, the best thing you can do is to prepare, to watch the lectures, spend time absorbing them, let it marinate. It’s so much information, it is overwhelming. We cover so much in this course. There’s so much that we can do with ultrasound that is evidence-based now, and there’s so much that’s coming out. We just curate it all from all the literature, from all the textbooks, from all the journals, from all these top institutions in the country and internationally. We’re curating it as the faculty and putting it together. These are fresh lectures every couple years. We are on the cutting edge, but if you don’t watch those and you don’t take the time, then everything that we’re doing hands-on might not make sense, and you want to come in and optimize those few hours that we get with you. It’s only a day and you get, like you said, all the superheroes and you want to make sure you’re ready to absorb everything that they can give you. So doing that and then just planning that you’ve got to go home and start scanning, that you can’t have a gap. You can’t just say, I’ll do it later, and then six months later it’s just going to all be lost and you’ll feel like you need to do it again.

Dr. McLaughlin: All right. Any other points that you’d like to bring up? Otherwise, we can wrap it up.

Dr. Bain: No. I hope to see all of you with us. We’re having a good time.

Dr. McLaughlin: Yeah, it’s a great course. This concludes another edition of the Society of Critical Care Medicine Podcast. For the Society of Critical Care Medicine Podcast, I’m Diane McLaughlin. Thanks for joining us, Dr. Bain.

Dr. Bain: Thanks so much.

Diane C. McLaughlin, DNP, AGACNP-BC, CCRN, FCCM, is a neurocritical care nurse practitioner at University of Florida Health Jacksonville. She is active within SCCM, serving on both the APP Resource and Ultrasound committees, and is a social media ambassador for SCCM.

This podcast was recorded during the Society of Critical Care Medicine’s 2023 Critical Care Congress. Access essential education online through Congress Digital. More than 120 sessions are available on an easy-to-use platform. Continuing education credit is also available. Some SCCM members receive complimentary access to Congress Digital. To learn more, visit sccm.org/congressdigital.

Join or renew your membership with SCCM, the only multiprofessional society dedicated exclusively to the advancement of critical care. Contact a customer service representative at +1 847 827-6888 or visit sccm.org/membership for more information. The SCCM podcast is the copyrighted material of the Society of Critical Care Medicine, and all rights are reserved. Find more episodes at sccm.org/podcast.

This podcast is for educational purposes only. The material presented is intended to represent an approach, view, statement or opinion of the presenters that may be helpful to others. The views and opinions expressed herein are those of the presenters and do not necessarily reflect the opinions or views of SCCM. SCCM does not recommend or endorse any specific test, physician, product, procedure, opinion or other information that may be mentioned.

Some episodes of the SCCM Podcast include a transcript of the episode’s audio. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors and should not be treated as an authoritative record.

Disclaimer