Division of Ultrasound
Emergency Ultrasound has become increasingly prevalent in the management of acute conditions that commonly present in the emergency department.
Clinical care
Emergency ultrasound is used in the resuscitation and evaluation of hypotensive patients, the evaluation of patients who present following acute trauma, the evaluation for the presence of abdominal aortic aneurysms (AAA), recognition and detection of first trimester pregnancy complications, detection of pericardial effusion and evaluation of cardiac function, renal and biliary applications, evaluation for deep venous thrombosis, as well as assistance in a number of procedural applications such as line placement, peripheral nerve blocks, and assessment and drainage of localized fluid collections.
Wishard and Methodist see nearly 200,000 patient visits per year. Almost 4000 ultrasounds are performed annually within the two emergency departments. All scans are recorded on a combination of video and still imagery and are evaluated for quality assurance and educational purposes by the respective ultrasound directors at each hospital.
Each emergency department has two ultrasound machines that have curved abdominal, linear, endocavitary, and phased-array probes for wide variety of applications. Wishard also has a dedicated machine for vascular access.
Residency Training
The training of residents and emergency ultrasound incorporates a combination of didactic sessions, year directed hands-on workshops, self-study, literature review, video review, and
primary bedside teaching in the emergency department to learn to properly evaluate patients with this bedside tool to speed diagnosis, guide resuscitation, and improve patient safety. Ultrasound training both uses simulation and is being incorporated into the simulation training that is part of the residency program. Residents receive training in all common applications of ultrasound within the emergency department as well as training in ultrasound documentation, program development, and billing issues.
PGY-1
Interns have a primary orientation day to ultrasound during their first month when they have lectures on all the primary ultrasound applications and hands-on sessions to become familiar with the machines and scanning. Each intern then spends a week of the anesthesia/ultrasound rotation with the ultrasound directors performing scans at the bedside and receiving additional didactic teaching.
PGY-2 and PGY-3
An ultrasound elective is available for upper-level residents providing additional training in both the primary applications and some secondary applications of ultrasound within the emergency department. Additional time can be scheduled at other points within the curriculum such as during the "Triple Threat" block, during knowledge translation shifts, and at other times with the prior notice to the ultrasound directors.
Additional Learners
Teaching is also provided to rotating off service residents, medical students, emergency department faculty, and emergency department nursing staff for a variety of applications that aid in patient care.
Credentialing
Credentialing is both provided for residents and required over the course of the three-year residency. Residents graduate with superior ultrasound knowledge and expertise--skills that are increasingly sought in both community practice and academia. This includes a minimum total of 150 approved scans, with additional requirements in a variety of specific scanning applications, and meets the current ACEP guidelines.
Ultrasound Directors
Hal Minnigan, MD and Gregory Snead, MD currently direct ultrasound education within the IUEM Residency Program. Both directors have significant experience within the area of ultrasound education and are active at the national level within ACEP, SAEM, and other organizations focusing on ultrasound. Similarly both directors have published peer-reviewed articles in the area of emergency ultrasound and ultrasound education.
