Page 63 - JSOM Winter 2021

presentation after primary exam revealed bruising to the left Tasks
flank and chest, with stable vital signs on presentation. After Curvilinear probe selected
1 hour he presents dyspneic, diaphoretic with moderate cen- Yes ( ) No ( )
tral chest pain, lightheaded, and nauseous. Application of gel
PMHx: GSW to right calf 1 year ago with DVT as Yes ( ) No ( )
a complication. Probe orientation with marker cephalad
Physical exam: Yes ( ) No ( )
BP 80/60mmHg, HR 105/min, Sao 90% (face mask 8L), Image optimization
2
RR 18/min Yes ( ) No ( )
Lung fields clear. Muffled heart sounds. Please identify the following structures:
ECG: No ischemic changes. Low voltage. Liver in the right upper quadrant
CXR: Small right pleural effusion. No evidence of Yes ( ) No ( )
pneumothorax. Kidney in the right upper quadrant
Yes ( ) No ( )
Tasks Morison’s pouch
Most appropriate probe selected (Please write which probe was Yes ( ) No ( )
selected by the trainee) Spleen
Yes ( ) No ( ) Probe selected: ______________ Yes ( ) No ( )
Probe orientation with marker cephalad Kidney in the left upper quadrant
Yes ( ) No ( ) Yes ( ) No ( )
Image optimization Bladder
Yes ( ) No ( ) Yes ( ) No ( )
Identification of locations for TTE examination Pleura on left and right upper quadrants
Yes ( ) No ( ) Yes ( ) No ( )
Please obtain the following images from a starting position of
the probe in the patient’s right shoulder: Station 5: Ultrasound-guided Vascular Access
Parasternal long axis (Live Model)
Yes ( ) No ( ) Scenario
Parasternal mid-papillary short axis A 36-year-old Operator was brought to the Role 1 STP af-
Yes ( ) No ( ) ter resuscitation for a lower extremity blast injury resulting
Apical 4-chamber in amputation below the right knee. A tourniquet is in place
Yes ( ) No ( ) with good hemostasis. He has received 2 units of LTFWB. An
18-gauge PIV is not flushing, and 20-gauge PIV is working but
Subcostal 4-chamber
Yes ( ) No ( ) very slow and you cannot draw back on it.
Subcostal inferior vena cava Vitals signs: 100/60mmHg, HR 60/min.
Yes ( ) No ( ) You decide to place a central venous line in the right internal
Ask the trainee what the most likely diagnosis is. Is the diag- jugular vein for resuscitation and potential need for pressor/
nosis correct? ionotropic support.
Yes ( ) No ( )
Tasks
Optimizes position of the patient
Station 4: Rapid Ultrasound in Shock and Yes ( ) No ( )
Hypotension (RUSH) (Simulator)
Identifies internal jugular vein
Scenario Yes ( ) No ( )
A 25-year-old Operator brought to the Role 2 FOB intubated Identifies carotid
and blood transfusing through a femoral central line. The Yes ( ) No ( )
patient was found unconscious on the side of the road with Evaluation “in plane” and “out of plane” of internal jugular
bruises on his abdomen and chest with a large crater from a and carotid (ASK SPECIFICALLY)
presumed IED 20 yards away. After a quick assessment, it was Yes ( ) No ( )
determined he needs to go to the OR.
PMHx: not known Activates color flow Doppler (ASK SPECIFICALLY)
Yes ( ) No ( )
Vital signs: BP 70/45mmHg, pulse 130/min
The surgeon asks for a quick ultrasound exam to rule out
intra-abdominal bleeding.

Ultrasound for Special Operations Medics | 61