Introduction to the Bedside Ultrasound Machine & Ultrasonography in Undifferentiated Shock

Ultrasonography is quick, noninvasive, requires no patient preparation and increases diagnostic accuracy and enhances results decreasing patient's mortality and morbidity risks. It has led to a decrease in differential diagnosis and 9% of the time bedside ultrasound (BEDUS) has led to new differential diagnoses. The accessibility of BEDUS has shown to have great value in emergency medicine (EM) and intensive care. BEDUS helps to reduce the use of expensive radiology imagining, mixed venous monitoring, Swan-Ganz catheters and inaccurate central venous pressure monitors. Consequently, BEDUS can help decrease medical cost directly, and indirectly by helping to provide well-timed healthcare. Currently, there is no curriculum available in the state of Utah for training nurse practitioners in bedside ultrasonography for cardiac assessment at the academic level. In addition, EM doctors are not training current Nurse Practitioners (NP) due to the lack of training and utilization of BEDUS by physicians, especially in the rural settings. The objectives of this project were accomplished by creating an electronic book to train students in the functions of a bedside ultrasound machine and its diagnostic use in undifferentiated shock. The project gave specific attention to educating students in the use of the ultrasound machines to assess global left ventricle function and size of the heart since they are the most common bedside cardiac emergencies. The education electronic volume was designed using the electronic book authoring software iBook Author. The final product is an interactive electronic book that can be used as part of the education for BEDUS training at the nursing academic level. The book is designed to introduce students to the ultrasound machine, the basics of its functionality and to a protocol for its use in undifferentiated shock. The electronic book content is based on the most recent evidence in critical care medicine and current protocols for shock as recommended by my content expert Michael Mallin, MD RDCS, RDMS, ASCeXAM. The ultrasound videos, images and pictures used in the volume were in part courtesy of the Sonocloud.com. My content expert, Steven Ballard evaluated the electronic book for design, and Dr. Mallin and his partners evaluated the content and usability in the training of students at the university level. Moreover, my capstone chair and the Acute Care Nurse program director evaluated the content also for consideration of its use to introduce students to the ultrasound machine in critical care medicine. Future recommendations for this project are to add additional chapters and include other education material for other protocols like the Focused Assessed Transthoracic Echocardiography (FATE). The electronic book can also include education in ultrasound-guided procedures like central line placement, thoracentesis, paracentesis and pericardiocentisis. Improvement of the interactive video education can also be included with small lessons for each disease process of the book and the knobology of the ultrasound machine. This will allow the student to have synchronous bedside education at any time during their clinical training