Emergency Medicine Residency Handbook 2009 Edition table of contents chapter page

Dr. Andrew Miller

Chief Resident of Research

Beeper: 917-218-8420

[e-mail]

Arun Subramanian,PhD

Research Coordinator

[e-mail]

EMERGENCY ULTRASOUND ROTATION

TRAINING LEVEL: PGY 3 AND/OR PGY 4

DURATION: 4 WEEKS (2 WEEKS as PGY-3 and 2 WEEKS AS PGY-4)

LOCATION: UHB and KCH ED

FACULTY:
Dr. Stone Cell: [phone]

Email: [e-mail]

Dr. Langsfeld Cell: [phone]

Email: [e-mail]

Dr. Secko Cell: [phone]

Email: [e-mail]

Dr. Partida Cell: [phone]

Email: [e-mail]

Dr. Gullett Cell: [phone]

Email: [e-mail]

Dr. Chi Pager: [phone]

Email: [e-mail]

Dr. Gleyzer Pager: [phone]

Email: [e-mail]

FELLOWS 2009-2010:
Dr. Chilstrom Cell: [phone]

Email: [e-mail]

Dr. Elavunkal Cell: [phone]

Email: [e-mail]

Dr. Mehta Cell: [phone]

Email: [e-mail]

Dr. Papanagnou Cell: [phone]

Email: [e-mail]

OBJECTIVES:

1. 
   To understand basic physics and instrumentation of medical ultrasound equipment
   
2. 
   To learn how to use the ultrasound systems available in KCH and UHB Emergency Departments
   
3. 
   To review normal sonographic anatomy and pathophysiology of the thorax, abdomen and pelvis.
   
4. 
   To understand indications and limitations of bedside emergency ultrasound.
   
5. 
   To learn how to perform the following studies:
   
   1. 
      Extended Focused Assessment with Sonography in Trauma (e-FAST)
      
      1. 
         Hemoperitoneum
         
      2. 
         Hemopericardium
         
      3. 
         Hemothorax
         
      4. 
         Pneumothorax
         

2. 
   Focused Gynecologic and Obstetric Ultrasound
   
   1. 
      Intrauterine pregnancy
      
   2. 
      Ectopic pregnancy
      
   3. 
      Threatened/Incomplete/Complete Abortion
      
   4. 
      Ovarian cysts/adnexal masses
      

3. 
   Focused Biliary Ultrasound
   
   1. 
      Gallstones
      
   2. 
      Cholecystitis
      
   3. 
      Choledocholithiasis
      

4. 
   Focused Echocardiography
   
   1. 
      Pericardial effusion
      
   2. 
      LV and RV function
      
   3. 
      Gross valvular abnormalities
      
   4. 
      Volume assessment
      

5. 
   Focused Abdominal Aorta Ultrasound
   
   1. 
      Aortic aneurysm
      
   2. 
      Aortic dissection
      

6. 
   Focused Renal Ultrasound
   
   1. 
      Hydronephrosis
      
   2. 
      Urolithiasis
      

7. 
   Focused Vascular Ultrasound
   
   1. 
      Deep venous thrombosis
      

8. 
   Focused Skin and Soft Tissue Ultrasound
   
   1. 
      Abscess
      
   2. 
      Foreign body
      
   3. 
      Cellulitis
      
   4. 
      Tendon injuries
      
   5. 
      Fractures
      
   6. 
      Dislocations
      

9. 
   Focused Ophthalmic Ultrasound
   
   1. 
      Retinal detachment
      
   2. 
      Vitreous hemorrhage
      
   3. 
      Lens dislocation
      
   4. 
      CRAO/CRVO
      

10. 
    Ultrasound guided vascular access and additional US guided procedures
    

ATTENDANCE AND SCHEDULE: YOU MUST E-MAIL THE ULTRASOUND DIRECTOR AT LEAST ONE WEEK PRIOR TO THE START OF YOUR ROTATION SO WE CAN ADJUST OUR SCHEDULES TO MEET WITH YOU

During the rotation the resident is expected to be present in the Department Monday – Friday 9am – 5 pm. Attendance is mandatory. Specific daily tasks will be assigned by the individual Attending of the day. On the first day of the rotation the resident is to report to the Kings County Emergency Department Offices to meet with Ultrasound Faculty and/or Fellows for orientation at 0900AM. Attendance at Wednesday Conference is mandatory.

DIDACTIC TRAINING: Before starting the rotation, make sure you obtain a copy of the Guide to the Senior Resident Rotation for specific instructions on the use of the machines and an introduction to Emergency Ultrasound and the Ultrasound Curriculum

In the beginning of the rotation the resident will be assigned specific readings including articles and chapters from several textbooks. Articles will be provided. All textbooks are available at the Downstate Medical Library and in on-line format. Ultrasound Journal Club will be conducted during the second week of the rotation and residents are required to briefly discuss a paper from the recent literature relevant to Emergency Ultrasound.

CLINICAL TRAINING:

During the rotation, a resident will be assigned to perform the following tasks:

1. 
   Bedside US imaging under direct attending supervision
   
2. 
   Bedside US-guided procedures under direct attending supervision
   
3. 
   Independent bedside US imaging with weekly image review by division faculty
   
4. 
   Responding to trauma codes for bedside e-FAST exams
   
5. 
   Daily machine checks, machine maintenance and restocking of supplies
   
6. 
   Enrollment of patients into active ultrasound research trials
   
7. 
   Instruction of co-residents, interns and students
   

EVALUATION:

Upon completion of the rotation, the resident will be evaluated based on his/her attendance, motivation, didactic knowledge and procedural skills. The evaluation form will be submitted to the residency directors and will be placed in the resident’s file. The resident will have access to the evaluation. The resident will be also asked to evaluate the rotation and provide suggestions on its improvement.

PRIOR TO STARTING THE ROTATION GO TO: http://www.sunysono.com

Then click on "Resources", then click on the Guide to Senior Rotation.

When prompted:

user = suny

Passwords = "s0n0" (to login to the website) and "s0n0graphy" (to open pdf) (those are with zeros, NOT capital o's)
Note:

1. 
   Currently at UHB all studies are stored to the internal hard drive on the Philips HD11XE. At KCHC all studies are stored to the internal hard drives of the SonoSite Micromaxx and SonoSite MTurbo systems. The Division faculty and fellows will orient you to image documentation on the first day of the rotation.
   
2. 
   Image interpretation. ALL STUDIES WITHOUT EXCEPTION MUST CONTAIN THE FOLLOWING:
   
   1. 
      Sonographers’ last name(s)
      
   2. 
      Patient’s MR number
      
   3. 
      Interpretation in text on the screen (i.e. RUQ, no FF)
      
3. 
   Do NOT log your studies into any procedures database. The Ultrasound Division keeps an independent record of your ultrasounds for credentialing and QA purposes.
   

PGY-4 OFF SERVICE ROTATIONS

Free Elective:
Medico-legal

Medical Examiner

Dermatology

Oral Surgery

Others

Administration

Teaching Rotation
ELECTIVE


EM Faculty Liaison: Dr. Christopher Doty pager: [phone]

The elective rotation is an opportunity for residents in their final years of training to gain experience in an aspect of Emergency Medicine that is not part of our formal residency curriculum or in-depth study of a field of EM. In very general terms, the goal of the rotation is for the resident to strengthen an area of clinical weakness or to learn more about one of the subspecialty areas of Emergency Medicine. You are responsible for setting up your own elective.

Rotations away from Kings County are acceptable but require planning on your part. Possibilities for outside rotations include Hyperbarics, Radiology, Burn Unit, Ultrasound training, International Emergency Medicine (South Africa, Lesotho, Mexico, Nepal, Sweden, Haiti, Malawi, Botswana, Jamaica, Turkey, Romania and others), Research, Rural Emergency Medicine, EMS, Pediatrics, or Toxicology and many others.
Creativity in planning your rotation is encouraged, but you must develop an education plan for the rotation. Dr. Doty will want to see your Goals and Objectives for the rotation, so plan them and put them in the planner. All rotations need to be approved by Dr. Doty before arrangements are made with an outside institution. At least 28 days before the rotation, please review your educational plan with Dr. Doty and fill out the elective planner (available from Stephanie Lane and below). If you buy plane tickets or make travel plans without having an approved elective, then YOU HAVE MADE A GRAVE ERROR.
If you are going to be leaving Kings County, we need a letter from the outside institution that states the dates you will be rotating and briefly outlines what will be the expectations for the rotation. If you are going to work in a clinical area, malpractice insurance coverage may be an issue. Your standard residency malpractice coverage only applies to resident activities, and your coverage will apply only to SUNY, its affiliates, and HHC hospitals. It is also possible to apply for SUNY to cover/provide malpractice coverage. This takes time to set up so start early. You can apply with the form below. Dr. Doty does not make the decision to provide this coverage, but will help you set up the elective. Attached is a simple form to be completed while planning your rotation. Finally, upon returning to Kings County you will need a letter certifying proof of the rotation, and to submit a short written synopsis of the rotation or prepare a brief oral presentation.
Please Note:
Omission or Failure to adequately plan your Elective as outlined above will result in irrevocable loss of your Elective time. You will be scheduled for clinical shifts instead. Please comply with this rule.

ELECTIVE PLANNER WORKSHEET
Elective Planner

Name:	Dates of elective:
Elective site:
Subject of elective:
The goal for the elective:
Briefly below or on attached sheet outline your plan for the elective (please include goals/objectives/evaluation methods for the rotation):

MEDICO-LEGAL

Location: Offices of McAloon & Friedman, P.C.
Contact: Offices of McAloon & Friedman