AAA

Clinical Indications

1. Abdominal pain / Flank pain / Back Pain in concerning patient population.
2. Any of the above with hypotension.
3. Any pulsatile abdominal mass
4. Known history of AAA under surveillance or history of AAA repair.
5. In reality, if you have any clinical suspicion of AAA (If you think about it, do it!!!)

Views

1. Transverse proximal abdominal aorta
2. Transverse distal abdominal aorta
3. Longitudinal abdominal aorta
4. If aneurysm present then transverse image and longitudinal image at the point of largest diameter
5. All images should have maximal diameter measurement (outer wall to outer wall).

Documentation

1. Document presence of AAA and location (distal or proximal).
2. Document quality of scan and any difficulty with body habitus, bowel gas and maneuvers used (such as RUQ/LUQ or angulated view)
3. Document size with both AP and Transverse maximum dimension.
4. Document presence of free fluid or dissection flap if seen.

Credentialling Requirement

1. Completion of Accredited Course, ACEM Online module or Online Training Module (UTEC) 
2. Attend our ED workshop or arranged 1-on-1 sessions with members of US-SIG.
3. Logbook with 15 AAA scans, including 3 positive (not necessarily directly supervised but compared to gold standard).  All compared to gold standard result (CT scan).
4. Two formative assessments (supervised by Sonologist and advice provided throughout)
5. One summative assessment by Sonologist using provided assessment form.

6.  Ongoing accreditation requires 15 Aorta scans over a 2yr period.

Definition of Sonologist

A sonologist is used to include practitioners who have successfully completed this credentialing process or equivalent (DDU, Radiologist, DMU or AMS or sonographer registered with NZ MRTB in the relevant field, CCPU in the relevant field, PGCert / Dip of Clinical Ultrasound).

Resources

Phillips AAA Tutorial

AAA Video by 5MinSono

Introduction to Bedside US Volume 1 and 2 by ultrasoundpodcast.com