My new instrument in the last 2 years has been the ultrasound probe. It adds tremendous value to my physical exam. Residents in our program have traditionally been learning ultrasound skills as part of examining the patient: especially in the ICU. Lungs look wet, kidneys look ok, bladder is full and IVC is plump.. We have now gotten information that can really make the care of the patient really swift. Official ultrasounds are still obtained but a quick and important organ examination can save lives and critical time..
Besides, I now feel that as nephrologists, this might be an important skill that we need to develop and gain acceptance too. A patient calls and says he cannot urinate and he is having pain and he has known CKD. You see him but you are concerned about potential distal obstruction:- A quick bladder sonogram in the office can reveal the obstruction or distended bladder with urine and rather than an ER visit, you can promptly send this patient to the Urologist for foley insertion and home.
A dialysis patient tends not usually gain weight ( maybe 1kg between treatments) , comes in slightly short of breath. A lung ultrasound done by you reveal B lines and in multiple views suggesting fluid overload. This allows you to take off 2kg today and patient feels better. Alternatively, you would have done that anyway but also perhaps exposed the patient to an X-ray that might have not been necessary.
My practice has changed with this revelation. Training our faculty and fellows in this important skill- sonogram of the bladder and kidney and lung US and IVC for volume status is important. In the era of declining interest in nephrology, perhaps this skill might shed some excitement in the field of nephrology. Lung US compares favorably to CT scan for detection for pulmonary edema and might be better than CXR.
The Emory course on sonogram might be the excellent course. What I envision is more of a short burst of courses that can really help us use this in clinical practice like we use our stethoscope, and not focus on using it for billing/coding etc. purposes. Let’s save lives by making a difference in our patients in a fast paced manner , avoid ER visits and giving them a more comprehensive care in the Nephrology clinic.
Here are some interesting references !