Common Carotid Artery

The arteries and veins within the body have the important job of carrying the blood from one part of the body to another. The blood carries within it the nutrients and other important elements that the body needs to survive. Therefore, it is important for the blood vessels to remain open, allowing the blood to flow quickly and freely to supply the body with everything it needs to function properly. A vascular assessment is a tool doctors use to evaluate the efficiency of these blood vessels.

When the patient undergoes a vascular assessment, a special ultrasound monitors the function of the blood vessels. The ultrasound wand moves along the exterior of the body to check the major blood vessels. This ultrasound shows the rate of blood flow through the vessels and monitors for any abnormalities that can signify a problem. For instance, a vascular assessment ultrasound can show narrowing of a blood vessel, which restricts flow, or the presence of a blood clot or aneurysm.

After the vascular assessment, you must evaluate the results. Based on these results, you can make a diagnosis, if necessary. Part of that diagnosis may involve ordering medications that thin the blood to help it flow better through the narrowing vessels or break up blood clots. Treating these conditions early can help prevent more serious conditions, such as strokes, heart attacks and even death.

Protecting the blood vessels in the body is important to your patient’s overall health, especially that of the brain. Without proper blood flow, the body’s cells can die and the organs will eventually shut down. Like many other medical areas, preventative maintenance can save your lives. By testing patients who are at an increased risk for diseases of the blood vessels, you can catch these problems before they become a more serious issue for your patients. Those patients at a greater risk can benefit from a routine vascular assessment to monitor for new issues.

 It’s Time For this Old Dog To learn A New Trick!

Sorta Speak…

Anyone who knows me professionally, knows I have my nemesis in the vascular ultrasound world – Venous Insufficiency Studies. Okay, maybe not my nemesis, but I just plain don’t care to face them.

You all know what I mean. That oh so lovely and time consuming exam wile in the most ergonomically incorrect  seated position – on the floor. I don’t know about you, but usually while I’m down there I am internally cursing the varicose vein gods for creating an unfollowable / untrackable / all over the place network of vessels. While wishing there was a better way (or, at least, a more efficient way) of performing these exams I recalled a brochure I received in the mail. Perhaps you have seen it as well.

The IAME Current Practice of Vascular Ultrasound

While reading through the conference description something caught my eye, “Venous Insufficiency”. You don’t say?  ”Venous Insufficiency Evaluations With Live Demonstrations”. Whuh? My Oh My I am so there! Needless to say, I registered immediately just for that small droplet of info they could possibly provide. Doing these exams for so long, I am certain I am simply doing things out of habit rather than necessity.

While venous insufficiency is my desired topic, the course schedule is full of everything I think newbies and veteran techs alike would definitely benefit from. From basic hemodynamics to improving exam interpretations. Not to mention live demonstrations of the various exams.

With 20 years of experience in presenting these conferences and almost 20,000 attendees to date, I’m sure the IAME will certainly cover a subject matter you may need a little brushing up on or an introduction to.

I’ll be attending the upcoming conference that will be held this weekend in Las Vegas, NV. Anyone else planning to attend? See you there!

I’ll let you know how it goes. (Yeah, this won’t stay in Vegas)

Happy Scanning!!!

Shannon Peron, RDCS, RVT

P.S. VEGAS BABY! (Had to)

Hopefully everyone made it through the ARDMS audit with positive results. But, for those of you who were placed on the naughty list and needed some extra time and some additional credits, here’s a re-posting of a popular entry that will hopefully do the trick.

With December 31st fast approaching to complete the registry CME  requirements, people are asking if there are any sites out there offering free CME credits.

Well, my absolute “most favorite” site is GE Healthcare.

• You don’t have to register to use it.
• You don’t have to wait for CD’s (except for echocardiography cases).
• You don’t have to wait for the certificates to be mailed to you.
• You can take the tests as many times as needed to pass.

Of course, there are more than just vascular ultrasound cases. They cover a wide range of sonography topics.

This site may not get you all 30 credits, but it should most certainly help you fill in the gaps.

Here’s the link again:

http://www.gehealthcare.com/usen/ultrasound/msucme.html

Happy Scanning!!!

If anyone has tried to be a lab “instructor” at the school they graduated from in order to gain work experience?

Now, this is a direct contradiction to my belief that it is just wrong for a new grad to attempt to oversee a student, but I think desperate times call for desperate measures. After all, how often do you come across some crazy abnormality scanning another student. Which, of course, lends to the fact that there is no real experience there, but you will be logging hours of “work”.

One more question…

Years ago there was a school who operated on top of an outpatient clinic and the students would get hands-on experience by assisting the instructors who actually scanned the patients. Do these types of schools still exists?

Anyway, just thoughts I had to put out there. I just feel bad sometimes when people ask for advice on how to find a job and I have none to give.

Happy(?) Scanning!!!

Shannon

I would imagine this is on the mind of many of our newbie male techs:

Do male techs have problems with women refusing to let them scan?

My answer in a nutshell is:    It can and will happen. Not often, but yes.

Now this is a question I will also have to put out to any other male tech who would like to answer. Since I am female I don’t encounter this problem. The male techs I supervise seem to not have a big problem with this. Then again, I am usually around if it comes up.

A bit of advice I would give to anyone dealing with all patients (not just female) where you would have to enter “Nether Regions” would be:

• Give a thorough explanation of the procedure. Specifying areas you will be scanning will eliminate surprises. If they say “My calf is the problem” Your response can be something like “Our protocol states we must scan the entire leg starting at the lower pelvis/groin”.
• Only uncover as much as you need to scan. When I have to scan a leg I prefer to tell thepatient to undress from the waist down, leaving on the under garments, and drape the gown across their lap once they are on the table. For some reason not having to wear the gown entirely makes them feel better.
• If you scan only one leg, keep the other leg covered completely, including the sock. Once again, it makes them feel more comfortable.
• Please, Please, Please close the door or pull the curtain. This should be a given, but I know it doesn’t always happen.
• Ask your coworkers not to walk in on an exam. This should be a general rule for all patients. Just because they work there does not give you them the right to invade that patients privacy.

These things will not appease all patients. Don’t be surprised and don’t take it personal if you run into a patient who will outright refuse. It may be a religious belief. The most you can do in those situations where female techs aren’t available is to perhaps offer to have a female in the room as a chaperone (if possible).

Hope this will help.

Happy Scanning!!!

Shannon

” All is right in the world. Nothing to report today”

Yeah Yeah, I heard it just last night. Then I woke up. Bottom line is that news today is rarely uplifing. We are constantly hearing about war, theft, homicide, natural disasters and LAWSUITS.

I have been asked several times about my opinion of technologists carrying their own professional liability insurance. Now here it is:

GET IT and GET IT NOW!

How many stories have you heard about doctors and hospitals being sued for one reason or another? I am sure we don’t even hear about half of the settlements made out of court. They can’t all be due physician and nurses making mistakes. Ever wondered why some of your coworkers have just “disappeared”. Now I’m not saying this is the reason, but it’s not always wrong site surgeries bringing out the lawyers.

Some of us like to believe that once a reading physician signs off on a report we are no longer responsible for the findings. Yeah right! Imagine you were a patient whose toes were amputated because it was reported that there was no flow getting to them. The physician can only report what on the findings he is given. So guess who will be called on the carpet and questioned. That’s right, the tech! Now, what if you were that patients lawyer. Who would you go after? That’s right, everybody. Starting with the deepest pockets all the way down to the smallest.

Some of us would also like to believe that we are covered fully by our employers insurance. You may be correct to some degree, but that won’t stop lawyers from coming after you personally. It has happened and I’m sure a simple internet search will yield a bounty of such cases.

So…

Do I carry my own professional liability insurance?  YES

Do I recommend others carry it?  YES

Is it difficult to get?  NO

Is it affordable? YES (I pay less than $100/year in California*)

Get It Now and Get Scanning!!!

Shannon

* Rates will vary from state to state

Unfortunately, this is too often the case. People mistake heart attack symptoms for indigestion, gas cramps that can often be felt in the chest, or pulled muscles, even the flu. Not all heart attacks occur like they do in the movies with dramatic chest-clenching pain and immediate collapse. To make it more confusing, heart attack symptoms can be different between men and women.

Many heart attacks come on rather quietly with only mild pain, pressure, discomfort which can go on for several hours. People often ignore these mild symptoms and even try to go to work or back to sleep with it! In an attack, every moment counts and ignoring even vague symptoms can result in disaster.

Today I’d like to share with you what I teach my patients about heart attack signs and symptoms and what NOT to ignore, as they could be signs of an impending attack or one that’s already in progress.

Warning Signs of Heart Attack

It’s important to know that many attacks do not involve dramatic chest pain, though some might. It depends on how blocked the arteries are to the heart. However, most heart attacks have one thing in common and that is pressure/discomfort in the center of the chest that can have an off/on, come/go quality to it. Many people who have had an attack liken this pressure to something heavy sitting on their chest. These symptoms may, or may not, be associated with one or more of the following, depending on whether male or female:

•Nausea – even vomiting (women).
•Dizziness – lightheadedness (both men and women).
•Ringing or buzzing in the ears (both men and women).
•Pain or discomfort in the arms, one, or both (men).
•Pain in the back, neck, jaw or stomach (women).
•Shortness of breath (women).
•Breaking into a cold sweat (women).

Time Is Critical

If you experience any of the above symptoms do not wait longer than 5 minutes to call 9-1-1. Emergency Services personnel can start treating for you for a heart attack long before you get to the emergency room.

Of important note, if you live in a remote area, or an urban area where EMS services may be spread thin, and your wait for EMS to arrive may be much longer than it would take you to get there on your own, get to the nearest hospital emergency room, or even a 24 hour walk-in clinic, the fastest way possible at the time.

If you are alone, you may be reluctant to call a neighbor or friend to come and drive you to a hospital in the middle of the night, but if this is at all possible, this is your best and safest bet.

What You Can Do For Yourself

While you are waiting for emergency medical personnel to arrive here are some important things to do and not do:

•Chew 2, 325 mg regular (not enteric coated) aspirins. It would be wise for everyone to carry a small bottle of regular aspirin in a pocket, or keep on your night table, just in case. Taking this type of an aspirin at the onset of what may be heart attack symptoms works like a drug that is administered in the emergency room that helps break up blood clots and allow blood to flow more freely to the heart. Recent research shows that people who chewed 2, regular 325 mg aspirins during symptoms of a heart attack had 50% reduction of blood thromboxane (a blood clot agent) only 5 minutes after chewing it, compared to 12 minutes swallowing it. Do not use an enteric (stomach) coated aspirin, as it takes too long to dissolve and get into the blood stream.

•Call 9-1-1 first instead of your doctor. Don’t waste time calling your doctor. If your symptoms occur outside of normal business hours, you will get their answering service with a pre-recorded message that says, ‘if this is a medical emergency, hang up and call 9-1-1′. So, save yourself the extra time and call 9-1-1 first. If alone, unlock your front door so EMS personnel do not have to waste time trying to get your door open.

•Do not lie down! This can both worsen pain, hasten a heart attack along, and may even cause the heart to arrest. Sit upright on the couch, on your bed, or even on the floor near the door with your back supported by a wall, to prevent a fall and further injury should you become unconscious.

Panic Attack vs. Heart Attack

In the movie, “Something’s Got To Give” Jack Nicholson is rushed into an emergency room thinking he is having a heart attack which turns out to be a panic attack. If you are anxiety-prone, under a lot of stress, and/or being treated for an anxiety disorder, it may be that what you think are heart attack symptoms is actually a panic attack.

Panic attacks can be uncomfortable but they are not life threatening. They occur most commonly in women past the age of 35 and often have hormone imbalances to blame. However, men get them too, just more rarely.

The actual symptoms are caused by adrenaline rushes, which can cause shortness of breath, palpitations, lightheadedness, and nausea – many of the same accompanying symptoms of heart attack. Because of the similarity, many women’s heart attack symptoms are sometimes mistaken for a panic attack. However, panic attack symptoms lessen in intensity fairly quickly if you sit down quietly and take several deep breaths. Real heart attack symptoms usually do not.

Knowing and understanding the difference between heart attack and other conditions that may share similar symptoms, can save your life. Get evaluated by your doctor who can determine your level of risk, whether you are a woman or a man, for a heart attack.

Keep two, 325 mg aspirin close by, and most importantly, don’t ignore ongoing symptoms, call 9-1-1. Even if it turns out to be panic, gas cramps, or those spicy meatballs from dinner, your attention and quick action could save yours, or someone else’s, life.

Mark Rosenberg, M.D.
Institute For Healthy Aging

http://www.vitalmaxvitamins.com

The state of your health can be a deceptive affair. Many of the most serious health problems for which you may be at highest risk – such as stroke, heart disease, abdominal aortic aneurysm, peripheral artery disease and osteoporosis – often show no symptoms until it is too late. Facing a painful, costly health incident due to any one of these conditions can potentially mean becoming a burden to your family in terms of money and time.

Many serious health conditions are preventable if detected early. A failure to get screened can lead to life-long health-related and financial problems, including the possibility of being bed-ridden or functioning at far less than 100% in terms of mental and physical capacity. Serious incidents, such as stroke, can also lead to a lifetime burden on family members who would have to take care of the victim, if they do survive the stroke.

Mobile health screening is a health service introduced only in recent years. It involves an expert team of health technicians and board-certified medical doctors working together to run a series of screening tests to check for the presence of such asymptomatic and serious diseases. As an emerging field, however, many people are still unaware of how mobile health screening works or what it is.

Here are 5 things you should know about mobile health screening:

1. “Mobile” means that screening locations are always changing

Mobile health screenings are “mobile” for two reasons. First, the actual team of technicians travels to the site of a screening event in a specially-equipped vehicle that contains all of the necessary screening equipment. Second, the locations of the events themselves are always changing. That said, screening teams consistently operate out of the same local geographic community from day to day and week to week. Therefore, community members can attend repeated screenings over time without having to travel far.

2. Screenings are held in convenient locations in the community

Mobile health screening events are held in a variety of locations. Churches, community centers, public buildings, gyms and even libraries can serve as a forum for a particular event. Events are planned weeks or months in advance to allow individuals to select an event that most conveniently fits their time and location. Many participants appreciate that the screening events are located in facilities they are familiar with, instead of a doctor’s office or clinic.

3. Screenings cover multiple types of diseases

A number of serious and potentially life-threatening diseases can be screened for. Examples include stroke, heart disease, abdominal aortic aneurysm, peripheral artery disease and osteoporosis. In order to detect stroke risk, for example, the recipient’s carotid arteries are screened for blockages. Meanwhile, screening for heart-related conditions might involve an examination of arterial stiffness or a recipient’s peripheral arteries using special detection equipment.

4. Mobile health screenings are non-invasive and painless

The procedures are completely non-invasive and painless. No needles are used, and recipients are not required to spend time in tight or confined spaces. One of the tools used is ultrasound. This procedure employs similar techniques to those used by doctors to check the pre-natal condition of babies in the womb. The benefit to using ultrasound for screening, over x-ray or CT scan, is that ultrasound does not emit radiation. It is well documented that one CT scan can be equivalent to 300-500 regular x-rays.

5. Screening results can be evaluated by doctors

Screening events take about an hour. Once completed, the recipient simply returns to work, goes home, or otherwise continues about their day. Meanwhile, the results are analyzed by board-certified medical doctors. The doctors provide relevant comments that can be clearly understood by a layperson. When picking a mobile screening company, it is important to pick a company that provides all your images and detailed results back to you promptly so that you can provide them to your own physician upon your next visit.

Mobile health screening is a breakthrough innovation that combines the convenience of locally-accessible events with top-notch, doctor-reviewed screenings that are also inexpensive and painless. Most importantly, the events allow people to find out and potentially drastically reduce their risk of a facing serious and expensive medical incident for as little as $200.

About the Author

Author: Aimee Whitfill

Visit HealthYes! preventive screening to schedule a mobile health screening in your area.

A special television screen meets the challenge of producing superb high-resolution imaging for guiding the surgeon through minimally-invasive vascular surgical procedures. These systems possess special live, three-dimensional imaging tools which deliver extraordinary clarity together with three-dimensional insight, enabling surgeons to see clearly exactly what is happening in real time, and to unerringly guide the robotic arms and tools to navigate the tortuous vasculature. This complete informational picture from inside the patients allows surgeons in hospitals in IL to make immediate, insightful, and well-judged decisions. The images are crisp and virtually free of distortion, so tiny objects and details can be visualized clearly in endovascular surgeries. Moreover, advanced technology for measuring precise X-ray dosages reduces the radiation exposure for both the medical staff and patients while at the same time providing excellent image quality. Vascular procedures often require long fluoroscopy times, and a large number of radiographic images. The DoseWise component of the surgical robot is an integrated system with wide approach to managing X-ray dosages, which allows the surgeon to choose the image quality most appropriate for the procedure, at the lowest X-ray dose possible.

The preset protocols in the imaging system and the automated settings of the fixed X-ray system during minimally-invasive surgery permit clinicians to focus their complete attention on the patient and the procedure. Three dimensional guidance tools support the most complex minimally-invasive surgeries. Even the operating table is automated, with a cradle and tilt movement in order to enable the patient to be positioned optimally for the more invasive and needle-guided puncture procedures. Other robotic capabilities allow clinicians to acquire soft tissue volumes at any time during a vascular surgery procedure. Moreover, robotic heart surgery systems are tailored individually for use in pediatric cardiology, interventional cardiology, and cardiovascular mixed use environments.

The amazing Da Vinci robot is a marvel of modern medical technology. Robotic heart surgery and prostatectomy are now available routinely at hospitals in IL.

Guest Author

Alice Lane

Here’s the latest question (in a nutshell):

Why does more lower extremity DVT’s seem to start in the left leg versus the right leg?

It is likely due to the vessel anatomy of the left pelvic region.  The left common iliac vein lies posterior to the right common iliac artery causing a compression of the vein that is thought to be a contributing factor to the development of DVT.

Now for a side story and question:

A young woman, recently post-partum, presented to an urgent care with severe pain in her left leg. The physician on-duty orders a venous duplex scan to rule out DVT. The technologist performing the exam determines it to be negative for DVT (no blood clot present). So the young woman is discharged with appropriate instructions. Two days later the same young woman returns to the urgent care with a severe increase in the level of pain in her left leg. Once again, a venous duplex scan is ordered. The exam is now performed by technologist number 2. And of course, DVT from top to bottom. Undeniable, no flow whatsoever, DVT.

Of course, this situation raised some eyebrows. The two scans were compared and it was determined that neither of the two technologists were wrong.

Anyone care to venture a guess or speculate what may have occurred or what the patients’ diagnosis was?

You have the floor my friends!

Update/Edit:

A more discerning eye noticed that the spectral doppler analysis of flow in the CFV on scan number one demonstrated loss of phasicity.

(This is why I don’t write case studies)

Happy Scanning!!!