Ultrasound

Rotation Curriculum

Residents will rotate for 2 weeks in their PGY1 year, PGY 4 year and have the option to rotate as an elective.

During their rotations they will become proficient in several areas as defined by ACEP guidelines

During their 2 week rotation they will have a minimum of 8 proctored shifts where they will work closely with attendings, get immediate feedback, image review, update scan log, pre and post tests, journal club. They will complete the minimum requirement of 25 scans in these areas and must have a certain percentage of positive scans in order to be credentialed.

Residents will take a pre test at the beginning of the rotation. The test will be provided by Dr. Chanler-Berat

Residents will fill out Reporting form on each scan submitted. A copy of the forms can be found at the bottom of this page

Residents will receive US lectures during their rotation

  • Physics/Knobology
  • FAST
  • RUQ/Renal
  • ECHO/Lung/Aorta/IVC
  • Vascular Access
  • US Guided Procedures (Thoracentesis, Paracentesis, LP, Nerve Blocks, Reductions)
  • DVT, Testicular, Ocular

When residents are performing ultrasounds and are not on rotation the patients must have an official study (CT/US)

FAST: Residents will learn the standard four view focused abdominal sonography for trauma (FAST) exam which will help facilitate care during trauma/resuscitations.

  • Right hepatorenal, left perisplenic, suprapubic/pelvic and cardiac views.
  • The primary goal of the FAST exam is to detect free fluid within the abdomen, pelvis and pericardial sac.
  • Expanded FAST (e-FAST) exam for evaluation of the thoracic cavity. The primary goals of the e-Fast exam are to detect pneumothoraces and pleural cavity free fluid.

OB/GYN: Residents will learn transabdominal and transvaginalapproaches for OB/GYN sonography. The primary goal of 1st trimester GYN ultrasound is the detection of intrauterine pregnancy defined as yolk sac or more.

  • Advanced goals of first trimester OB/GYN sonography include evaluation of the adnexae and detection of ectopic pregnancy.

Hepatobiliary: The primary goals:

  • Evaluation for gallbladder stones and assessment of the sonographic Murphy's sign.
  • Advanced goals include detection of the secondary signs of cholecystitis such as gallbladder wall thickening and peri-cholecystic fluid.

GenitourinaryThe primary goals:

  • Evaluation of obstruction and acute urinary retention. Both kidneys will be examined for hydronephrosis and the bladder assessed for size.
  • Advanced goals include evaluation for kidney stones and other renal pathologies. Bladder Volume. Post Void Residuals. Assess for ureteral jets.

Aorta: Assessing for Abdominal Aortic Aneurysms.Training will be given in the examination of the entire abdominal aorta from diaphragm to the bifurcation of the iliac arteries. The primary goal:

  • To recognize the presence of an abdominal aortic aneurysms defined as an aorta greater than 3 cm in diameter and iliac arteries greater than 1.5 cm in diameter.

Cardiac: The primary goals of Emergency ECHO

  • Visualize the heart in 4 views: Subxiphoid, Parasternal Long, Parasternal Short and Apical four views.
  • Detection of pericardial effusions and gross determinations of left ventricular cardiac contractility.
  • Utilize sonography to help facilitate care during resuscitations and shock states. IVC visualization and measurement throughout the respiratory cycle to gain insight on the patient’s volume status.
  • Advanced goals of bedside echocardiography include evaluation of the heart for signs of cardiac tamponade, with diastolic collapse of the right ventricle or atrium.

Vascular Access:The use of ultrasound to guide both peripheral and central venous vascular access will be emphasized. Residents will learn to use ultrasound to aid in placement of central lines in the internal jugular, subclavian and femoral veins in order to minimize the risk of these procedures to patients. Ultrasound guided peripheral venous access to the basilic and brachial veins of the arm will also be taught.

Many other sections can be covered once residents become proficient in above areas. Some other Advanced techniques include the following:

  • DVT
  • Testicular
  • Ocular
  • Procedures
  • Musculoskeletal
  • Foreign Body
  • Abscess/Cellulitis

Residents will submit their Ultrasounds along with QI sheets each week during their rotation and will be reviewed and recorded during image review.

Residents must complete a minimum of 150 quality scans in order to receive a certificate of accomplishment as outlined by ACEP ultrasound criteria. This certificate can be used for hospital credentialing at future jobs. (See sample certificate)

 

ROTATION INFORMATION

Where: ED

When: During Dr. Chanler-Berat’s shifts in the ED (Check attending schedule)

Supervisors: Dr. Chanler-Berat

  • Email: belgian126@gmail.com

Attire: Scrubs

Preparation: Please review the curriculum handouts prior to the beginning of your rotation. Please read the required reading delineated in this handout. You can also review sonoguide.com for indications, relevant anatomy, techniques, and interpretation. The pearls and pitfalls at the end of each section are particularly helpful. The book Manual of Emergency and Critical Care Ultrasound is also a great resource, there is a copy in the Attending Office.

Expectations: Come in when supervisors are working and they will show you the basics of utilizing the machine. They can assign you to scan certain patients or you can ask other residents for patients who could use an ultrasound. Save your images with your name and your supervisor's name. You can also scan when your supervisors are not in the ED, but only on patients who will receive other definitive imaging of the same area (for liability purposes). Also make sure to fill out an Ultrasound report document for the appropriate scans done and get them signed by the supervising attending and place them in the black bins located in blue and green zone. If you have any questions or are not capturing the desired image – ask for them to come to bedside to help you. Review all your images with your supervisors and don’t forget to log them on e-value!

 

Ultrasound Report Documents

Please fill out the appropriate form for each scan performed. Make sure the supervising attending signs the form as well. Place completed form in one of the black boxed found on either Blue or Green

 

Ultrasound of the Month

Please fill the form below with information on any interesting case you had during the previous month. Forward the completed form to Dr. Chanler-Berat at belgian126@gmail.com or jchanlerberat@tbh.org. Cases can include textbook cases, interesting pathology, great saves, etc. Prizes will be awarded to the winner and runner up each month

Ultrasound of the Month Submission Form