SIU Division of Emergency Medicine 
Phone: 217-545-3518 
Email:  lschneider@siumed.edu 
SIU - Jonathan dela Cruz, MD

EM Ultrasound Curriculum

Ultrasound being shown to residentsProficiency in bedside ultrasonography is a core skill set required of today’s EM residency graduates. It has not only proven to aid in more timely and accurate diagnoses, but has also shown to improve patient treatments and outcomes. SIU’s EM residency training provides its residents with a robust emergency ultrasound curriculum. It is designed to provide the future EM physician with the technical skills of performing procedures and examinations confidently while also providing a strong foundation in ultrasound interpretation. Starting with year directed didactic and skills sessions, the heart of ultrasound training at SIU is through a longitudinal series of ultrasound shifts with the ultrasound director. With two 60,000+ volume emergency departments outfitted each with 4 of the most up to date ultrasound machines on the market, the learning environment is primed for the EM resident to extend their ultrasound expertise into the clinical arena. So what are the specifics you ask? Take a look below at just some of the curricular pieces involved in ultrasound training at SIU.

Jonathan dela Cruz, MD, RDMS Director of Research and Ultrasound

The Ultrasound Core Curriculum

PGY-1 (Estimated 90+ scans)

1) US Day (Orientation Month) Didactic & Hands On Session – EMUS: An Introduction

Half day session during the orientation month where basic ultrasound principles, machine operation, descriptive terminology, and probe/patient orientation are discussed. Residents are then taught the Focused Assessment with Sonography in Trauma (FAST) exam with a skills session afterwards. This is to provide residents with a basic understanding of ultrasound manipulation/orientation as well as prepare them for their trauma rotation. See below for an abbreviated version of the lecture.

2) EM Ultrasound Month (Anesthesia Adjunct)

Required 50 scans by the end of the month

3 supervised US shifts with ultrasound director (10+ scans each shift)

2 or more unsupervised US shifts (10+ scans each shift)

Offline review of ultrasounds after monthly QA is performed by ultrasound director

3) 4 supervised US shifts throughout the year during ED months (10+ scans a shift)

2 days a month are reserved for supervised US shifts with the ultrasound director

Sign-up is directly through the residency calendar

 

PGY-2 (Estimated 70+ scans)

1) US Day (Orientation Month) Didactic & Hands On Session – EMUS: An Intermediate Level

Half day session during the orientation month where advanced ultrasound principles, machine operation, descriptive terminology, and image interpretation are discussed. Residents are then taught the Rapid Ultrasound in Shock and Hypotension (RUSH) protocol with a skills session afterwards. This is to provide residents with a more advance skill set in ultrasound manipulation/interpretation as well as prepare them for their critical care months. See video for an abbreviated version of the lecture.

2) 7 supervised US shifts throughout the year during ED months (10+ scans a shift)

2 days a month are reserved for supervised US shifts with the ultrasound director

Sign-up is directly through the residency calendar

PGY-3 (Fufillment of recommended 150 scans*, Ultrasound teaching)

1)  US Teaching Opportunities

After fulfilling requirements in ultrasound proficiency per the *2008 ACEP ultrasound guidelines policy statement, senior residents participate in ultrasound education of  more junior residents and medical students. Several bedside ultrasound labs are scheduled throughout the year not only for our residency, but also other departments at SIU. Emergency medicine faculty and residents have been and continue to be invited to teach bedside ultrasound techniques to general surgery, trauma surgery, and internal medicine/critical care. PGY-3’s have the opportunity to teach during these sessions to help solidify to their expertise and mastery of emergency ultrasound.

2)  US Elective Month

Senior residents can choose to use their senior elective time to hone their skills in emergency ultrasound. Working in close proximity with the ultrasound director, a PGY-3 can design an elective to fulfill any knowledge or technical skills deficits they want to fill prior to graduation. A highly motivated senior resident can also use this time to prepare for Registered Diagnostic Medical Sonographer (RDMS) certification including obtaining their required 800 reviewed scans as well as test preparation with the ultrasound director.

Ultrasound of the Month (Asynchronous Learning)

First instituted as a friendly competition to spark increased volume of bedside studies, it has now become a melee of ultrasound fun. Every month when all recorded ultrasounds are reviewed for quality assurance the ultrasound director picks a few ultrasound images/clips of interest and names them “Ultrasound of the Month.” These ultrasounds are posted for viewing with questions attached for residents to answer. Residents gain points for the competition by having their ultrasounds selected and for answering questions correctly.

Each year a winner is announced based on overall points and surprised with trophy gifts to cherish and gloat about for the many years to come. Look below for a couple of the past winners of Ultrasound of the Month. Do you know the answers?

What are the definitive treatments for an unstable patient with the following ultrasound findings?

Answer

Answer

Answer

Tube Thorocostomy

A chest tube (chest drain, thoracic catheter, tube thoracostomy, or intercostal drain) is a flexible plastic tube that is inserted through the chest wall and into the pleural space or mediastinum. It is used to remove air (pneumothorax) or fluid (pleural effusion, blood, chyle), or pus (empyema) from the intrathoracic space. It is also known as a Bülau drain or an intercostal catheter.

Surgery

As a general rule, a procedure is considered surgical when it involves cutting of a patient's tissues or closure of a previously sustained wound. Other procedures that do not necessarily fall under this rubric, such as angioplasty or endoscopy, may be considered surgery if they involve "common" surgical procedure or settings, such as use of a sterile environment, anesthesia, antiseptic conditions, typical surgical instruments, and suturing or stapling.

Pericardiocentesis

Pericardiocentesis is a procedure where fluid is aspirated from the pericardium (the sac enveloping the heart).The patient undergoing pericardiocentesis is positioned supine with the head of the bed raised to a 30- to 60-degree angle. This places the heart in proximity to the chest wall for easier insertion of the needle into the pericardial sac. Anatomically, the procedure is carried out under the xiphoid process, up and leftwards.