Emergency Ultrasound

Brian Monaco, director of emergency ultrasonography, is directly involved with training emergency medicine residents in ultrasound use in the emergency department.

The first trauma ultrasound by emergency physicians in the United States was performed at Erie County Medical Center, one of the primary residency rotation sites.

With the use of bedside ultrasound by the emergency physician, a diagnosis can be made rapidly and definitive care arranged in a timely fashion.

The four acutely life-threatening emergencies for which delay in definitive care is unjustified are: abdominal aortic aneurysm, traumatic hemoperitoneum, ectopic pregnancy and pericardial tamponade. Other indications for emergency ultrasound include gallbladder disease and obstructive uropathy.

Our program is also utilizing ultrasound to identify retinal detachments and placing of central lines.

Residents who graduate from the program will be credentialed to use ultrasound in the emergency department to evaluate for the conditions listed above.

The educational objectives of the ultrasound rotation are to:

• know the capabilities and limitations of bedside ultrasound
• identification of common pathologic findings
• organ definition/identification
• speed in obtaining images (e.g. FAST exam in ~60 seconds)
• satisfactory performance of  at least 50 studies in each major anatomic area (female pelvis, cardiac, abdominal)

During their first year, each resident will complete a one-month ultrasound rotation. The primary experience consists of hands-on examination of emergency department patients. There will be hands-on ultrasound exams of emergency department patients and didactics for a minimum of 40 hours a week. There will be a minimum of 40 hours of imaging and didactics per week during the 4-week rotation. Both indicated and non-indicated exams will be performed. Residents will therefore image a variety of pathologic conditions and gain experiences with normal sonographic anatomy and variations.

Clinical experiences include:

• first trimester and other female pelvic ultrasound exams with an obstetrician/gynecologist
• cardiovascular exams with a cardiologist to supplement cardiovascular ultrasound experience
• individualized training with a certified ultrasound technologist to improve the residents’ ability to obtain high quality ultrasound images
• training in the operations and clinical care delivered via telemedicine

Didactic experiences include:

• participation in a two-day course on emergency ultrasound presented by senior faculty members
• ​reviewing of teaching videotapes and CDs
• reviewing teaching files with faculty
• reviewing images obtained by the resident with faculty

At the end of the rotation, the resident will be evaluated based on individual studies reviewed and approved by faculty or technician, review of technical and clinical skills by the rotation director and completion of a written exam.

The Advanced Ultrasound Rotation is an elective offered during PGY-2 or PGY-3. The advanced US rotation includes greater depth of exposure and expertise in Emergency Ultrasound.

During this rotation the emergency medicine resident performs the following:

• meets daily with Cardiology, Radiology, Vascular Surgery, Anesthesia (nerve blocks) to review ultrasound studies
• reviews and interprets a minimum of 400 studies from the PACS system which are logged and turned in to the ECMC residency coordinator
• reviews and interprets 100 echocardiograms off of the PACs system and turns in a log sheet
• performs a brief academic presentation on bedside ultrasonography to the ultrasound fellow, director and first-year resident weekly
• attends presentations on selected topics in emergency ultrasonography
• performs scanning shifts with first-year ultrasound resident twice a week
• presents interesting scans and findings (1-hour presentation) from his/her month to the US Track group

Upon completion of this rotation and graduation from the residency program, the emergency medicine resident is then eligible to take the RDMS exams in physics and abdomen, enabling the physician to become credentialed by the ARDMS Board.

Residents also have the opportunity to do an advanced ultrasound scholarly track for fulfillment of their research requirement. This track will allow the resident to be eligible to take the RDMS (ultrasound tech exam) on completion of the emergency medicine residency program.