Scope of Practice
January 1, 2002 4 minutes read
Scope of Practice
The scope of practice outlines for applications in the Emergency Department
All examinations will be performed consistent with established credentialing guidelines. Persons that are not credentialed to perform bedside emergency ultrasonography by the Department of Emergency Medicine will need to obtain follow-up confirmatory studies on all patients, until the physician is credentialed. The exception to this will be educational scans performed strictly for practice. For such studies there will be documentation that the patient was informed of the nondiagnostic nature of the examination, that no formal follow-up study will be obtained, and that the patient gave verbal agreement to helping aid in teaching the physician performing the educational ultrasound scan.
FAST (Focused Abdominal Sonography for Trauma): Performed during the secondary survey of a trauma patient. The study will consist of evaluation of Morison’s pouch, right pleural cavity just above the diaphragm, right paracolic gutter, subxiphoid and — if needed — parasternal view, splenorenal recess, left pleural cavity just above the diaphragm, left paracolic gutter, and suprapubic view in longitudinal and transverse views.
The goal of the examination will be to identify the presence of free fluid in the peritoneum, pericardium, or pleural space.
All examinations will be taped in entirety and recorded on the medical record.
Aorta: To evaluate the abdominal aorta for evidence of AAA (abdominal aortic aneurysm). Any patient arriving emergently with abdominal or back pain with hypotension will be evaluated emergently with bedside ultrasonography. Findings consistent with AAA will lead to immediate notification of a vascular surgery-attending physician. Any patient over the age of 50 who has back or abdominal pain and stable vitals will have consideration for a bedside abdominal ultrasound to evaluate the diameter of the abdominal aorta. Positive findings will be referred for abdominal computed tomography.
All examinations will be taped and recorded on the medical record. Diameter of the aorta will be measured in three points: proximal, middle, and distal.
Endovaginal and Transabdominal sonography: To determine the presence of intrauterine pregnancy. Determination of such will require identification of the bladder, uterine fundus, cervix, and vaginal stripe. The diagnosis of a live intrauterine pregnancy will be made only once all of the above have been identified and a gestational sac with fetal pole and fetal heartbeat are documented. M-mode will be used to document fetal heart rate when identified.
All examinations will be taped and recorded on the medical record.
Lower Extremity Duplex for deep venous thromboses: To determine the presence of deep venous thromboses in the proximal veins of the lower extremity. Venous compression and augmentation will be tested for at the common femoral and superficial femoral and deep femoral junction. Also tested will be the popliteal vein. If thrombosis is discovered, attempts will be made to locate and document its most proximal end. All studies will be videotaped and documented on the medical record. All patients with negative studies will be referred for a follow-up scan to check for propagation of distal deep venous thromboses in 5-7 days.
Cardiac Arrest/Resuscitation: To be performed at the bedside in a medical code. The study will be used to evaluate for myocardial contractility, pericardial effusion, global wall motion abnormalities, and general hydration status of the patient.
Vascular Access: To be used at the bedside for gaining vascular access in any patient with difficult access. These will include arrest patients who require central lines and patients with difficult peripheral access that requires ultrasound guidance for a peripheral intravenous. All examination will be videotaped and recorded in the medical record. Additionally, ultrasound-guided access will be recorded in the procedures section of the medical record.
Gallbladder: Evaluation of the gallbladder will be performed at the bedside for the detection of stones or sludge in the gallbladder. This test will be performed on patients presenting with right upper quadrant or epigastric pain. The operator will obtain multiple views of the gallbladder in transverse and longitudinal planes. The gallbladder dimensions and wall thickness will be measured and recorded. If noted, sludge, gravel, mass, stones, and pericholecystic fluid will be recorded. The examination will be recorded on video and documented on the medical record. Views of the common bile duct will be obtained and measurement of the diameter made.
Renal: Evaluation of the kidney or kidneys for presence of hydronephrosis. This test will be performed on patients presenting with signs or symptoms of renal colic. The operator will obtain longitudinal and horizontal views of both kidneys for comparison. The degree of hydronephrosis will be judged as mild, moderate, or severe. The examination will be recorded on video and in the ultrasound log. A note will be made in the patient’s chart.
Urinary bladder: Evaluation of the urinary bladder will be performed on patients in whom the size of the urinary bladder needs to be known. Such patients will include, but not be limited to, urine retention or oliguria. Also evaluation of the urinary bladder will be used to confirm Foley catheter placement. The operator will obtain both longitudinal and horizontal views of the urinary bladder.
Source: Michael Blaivas, MD, RDMS, North Shore University Hospital, Manhasset, NY.
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