PGY2 Ultrasound Rotation

This is a 4 week rotation in emergency point-of-care ultrasound (POCUS).

The goal of this rotation is to provide you with the core knowledge base, bedside image acquisition/interpretation skill, and a framework for clinical integration to allow you to use bedside ultrasound in your daily practice of Emergency Medicine

During the block, residents will receive orientation to emergency ultrasound (EUS) including basic & advanced emergency EUS applications. The training sessions cover fundamental ultrasound physics, as well as diagnostic and procedural emergency ultrasound examinations and interpretations.

During orientation & the dedicated rotation, a combination of didactics, experiential learning and proficiency assessments will be employed. The following clinical ultrasound application topics will be covered:

  • Trauma/EFAST

  • Intrauterine Pregnancy (transabdominal and transvaginal)

  • AAA

  • Cardiac/Volume Assessment

  • Biliary

  • Renal/Urinary Tract

  • DVT

  • Soft Tissue/Musculoskeletal

  • Thoracic/Airway

  • Ocular

  • Procedural Guidance

  • Bowel

Clinical experience

  1. Supervised scanning shifts - please refer to Google calendar for dates/times to meet faculty in the ED for bedside scanning and teaching.

  2. Independent scanning shifts - during times when there is no supervised scanning, the resident should be scanning independently in the ED. Patients scanned independently should have a confirmatory study as a gold standard (e.g. CT abdomen, CXR, confirmatory US performed by radiology).

  3. Ultrasound tech scanning shifts - Tuesdays and Thursdays from 4 - 7 pm you will be scanning with Lisa (Lisa.Majeski@hcahealthcare.com), and Scott, respectively. You are responsible for communicating with Lisa if you are not available to scan with her. She is RDMS and RVT certified, so she can serve as your confirmatory study for anything abdominal, as well as DVT studies

  4. Weekly education/QA meetings - these take place every Monday at 9am in the conference room of the Ocean View Building. You must attend all Monday meetings during your rotation.

Schedule

The PGY1 ultrasound rotation is shared with Ophthalmology.  

OPHTHALMOLOGY 

  • The intern should attend ophthalmology rounds on Monday, Tuesday, Wednesday at 7am.

  • Furthermore, while you are in the ED for ultrasound, ask the Purple Resident and Wilmer consult team to alert you when a patient presents with ocular complaints, and involve yourself in the examination and teaching with the ophthalmology team. You can borrow an ASCOM phone at the beginning of the day so that you will be easily accessible.

ULTRASOUND

  • An US faculty member will meet with you on the first day of the rotation for orientation and introductory scanning shift.

  • In general, the intern should be in the ED from Monday-Friday for scanning. At least 4 hours a day should be devoted to bedside US scanning to be able to meet rotation requirements.

  • The intern must attend resident conference every Friday morning.

  • The US rotation is a clinical rotation, and scheduling of other commitments must be approved in advance by the US faculty.

Requirements

1) CLINICAL 

  • Perform at least 90 high quality and correctly interpreted ultrasound studies and complete appropriate reports in Qpath.

  • Required views are listed on HopEM Ultrasound site.

  • Attend all Thursday education/QA meetings while on rotation (usually 9a-12p in the Bayview ED 4th floor conference room).

2) READING

Read the following brief chapters in Noble's Manual of Emergency and Critical Care Ultrasound.  It's available online on the JHU library website:  https://catalyst.library.jhu.edu/catalog/bib_4300823

  • Chapter 1: Fundamentals

  • Chapter 2: FAST

  • Chapter 3: Cardiac

  • Chapter 5: Aorta

  • Chapter 6: Renal and Bladder

  • Chapter 7: Gallbladder

  • Chapter 9: Respiratory

  • Chapter 11: Skin and soft tissue

  • Chapter 15: Vascular access

3) ASSESSMENT

Complete the following ACEP ultrasound online exams athttps://ecme.acep.org/diweb/gateway/init/1/f/catalog*2Fitem*2Feid*2F320000VA

You must achieve a minimum score of 70%.  You can take the exam as many times as necessary to achieve this.  Submit your printed score reports at the end of the rotation.  It is wise to keep a copy of your test results for your records, as you will be required to complete all tests by the end of the PGY2 Ultrasound rotation.

  • Aorta

  • Biliary

  • Cardiac

  • FAST (Trauma)

  • GU (Renal and Scrotal)

  • Physics

  • Procedural

  • Soft Tissue & Musculoskeletal

At the end of the PGY1 Introductory US rotation, please submit a completed Ultrasound Rotation Checklist (together with your ACEP exam reports) to Dr. Fong's mailbox in the ED administrative offices (next to resident mailboxes).

Contact information

First contact for PGY-1 rotation questions is:  Casey Wilson, MD: cwilso99@jhmi.edu

Randall Rhyne, MD:  rrhyne@jhmi.edu
Tiffany Fong, MD: tfong3@jhmi.edu