Advanced Ultrasound
Elective Name: Advanced Ultrasound
Elective Mentor: Dr. Stephanie Tseeng
Elective Location: LLUMC
Elective Duration: 2 or 4 weeks
Elective Description: Diagnostic US has become increasingly useful in emergency departments (EDs) across the country. All EM residents are required to have exposure to point-‐of-‐care ultrasound (POCUS) within their post-graduate training. This rotation is designed to provide a more in-‐depth and hands-‐on familiarity with POCUS at the bedside. The advanced US elective starts with a brief overview of basic US applications and then progresses to advanced US applications and their role in clinical decision-making.
Educational Goals: To equip the senior resident with POCUS modalities that assist in clinical care decision-making and the rapid disposition of patients in preparation for their practice after residency.
Opportunities include:
1. Advanced hemodynamics (e.g. ECHO)
2. Advanced procedures (including but not limited to):
• Peripheral nerve blocks
• Peripheral IV insertion
3. Musculoskeletal US
4. Involvement in the QI/QA process
5. Can be tailored to the specific interests of the resident
Educational Objectives:
1. Patient Care (PC)
PC1 Emergency Stabilization
POCUS helps prioritize initial stabilization actions for the resuscitation of a critically ill or injured patient and with the reassessment after a stabilizing intervention.
PC3 Diagnostic Studies
Correct interpretation of POCUS aids with probability of disease and potential alteration in management of the patient.
PC4 Diagnosis
POCUS can help narrow and prioritize the differential diagnoses to determine management.
PC6 Observation and Reassessment
POCUS helps with the re-‐evaluation of patients undergoing ED observation and helps determine differential diagnosis, treatment plan and disposition.
PC11 Anesthesia and Acute Management
POCUS can help provide safe acute pain management and anesthesia to patients.
PC12 Other Diagnostic and Therapeutic Procedures: Goal-‐directed Focused Ultrasound
Goal-‐directed focused US for the bedside diagnostic evaluation of emergency medical conditions and diagnoses, resuscitation of the acutely ill or injured patient and procedural guidance.
PC13 Other Diagnostic and Therapeutic Procedures: Wound Management
POCUS can help assess and appropriately manage wounds in ED patients.
PC14 Other Diagnostic and Therapeutic Procedures: Vascular Access
POCUS can help successfully obtain vascular access in ED patients.
2. Medical Knowledge (MK)
POCUS is a necessary part of the knowledge for the EM resident and is included in the certifying examinations.
3. Systems-‐based Practice (SBP)
SBP1 Patient Safety: Participates in performance improvement to optimize patient safety.
Involvement in the QA/QI process for ED POCUS will demonstrate involvement in an institutional process to optimize ED practice and patient safety.
SBP2 Systems-‐based management: Participates in strategies to improve healthcare delivery and flow.
POCUS helps with cost-‐effective care and patient turn-‐around.
SPB3 Technology: Uses technology to accomplish and document healthcare delivery.
The resident will be involved in correct POCUS documentation to ensure that medical records are complete and accurate.
4. Practice-‐based Performance Improvement (PBLI)
PBLI Participates in performance improvement to optimize ED function, self-‐learning and patient care.
Resident involvement in the POCUS QA/QI process will aid with optimizing ED practice and providing assessment/feedback.
5. Professionalism (PROF)
PROF1 Professional Values: Demonstrates compassion, integrity and respect for other as well as adherence to the ethical principles relevant to the practice of medicine.
POCUS gives the resident additional opportunities to interact with patients and practice professionalism.
PROF2 Accountability
POCUS practices provides the resident with additional opportunities for recognizing limits of knowledge, asking for help and demonstrating basic professional responsibilities.
6. Interpersonal and Communication Skills (ICS)
ICS1 Patient Centered Communication
Additional POCUS practice can give the resident opportunities for demonstrating interpersonal communication within the treatment team and with the patient.
ICS2 Team Management
The resident doing advanced POCUS in the ED can ensure effective communication and respect between the care teams and patient.
Assessment Tools: Sonosim Modules and Standard Direct Observation
Readings/Resources:
http://www.ultrasoundpodcast.com/
http://community.saem.org/blogs/matt-‐fields/2014/09/07/aeus-‐narrated-‐lecture-‐series
https://www.acep.org/ultrasound/#sm.00001n0jhg6r0dpiqu0140alvlah0
https://www.aseuniversity.org/ase/
Tips for Success:
• Embrace scans that you’re not comfortable with
• Scan every patient you can, including those with difficult body habitus
• Read and practice the techniques
• Imagine how every scan will help with clinical decision