Emergency Medicine US

https://med.emory.edu/departments/emergency-medicine/education/medical-student/ultrasound-elective.html
The use of emergency ultrasound is now commonplace in community and academic emergency departments. Focused bedside emergency ultrasound is utilized to diagnose acute life-threatening conditions, to guide procedures, and to help emergency medicine physicians make real-time decisions regarding patient treatment and care. Emergency ultrasound is a goal-directed focused ultrasound examination that answers specific and important clinical questions.
The goal of the Emergency Ultrasound Elective is to expose fourth-year medical students to the core ultrasound applications used in daily practice by emergency medicine physicians. This elective will allow students to develop hands-on skills in image acquisition and bedside interpretation of images. Students will be expected to perform 100 independent ultrasound exams, which will be reviewed for quality and completeness by ultrasound credentialed faculty.
Residents and interns are often called upon to perform ultrasound-guided procedures and quickly develop competence with the use of ultrasound. This elective will provide medical students with early hands-on exposure to this valuable tool. Students will develop competency in performing:

• FAST
  
• AAA
  
• Cardiac
  
• Biliary
  
• Renal
  
• Thoracic
  
• Soft tissue/Abscess imaging.
  

Students will also be exposed to more advanced emergency ultrasound applications, including:

• Ocular
  
• Advanced cardiac
  
• DVT
  
• Testicular
  
• Procedural applications.
  

During this rotation, students will spend their mornings performing self-directed learning activities and completing online didactic modules. In the afternoons, students will perform supervised scanning shifts with residents and ultrasound faculty.

Objectives

The objectives of the month-long Emergency Ultrasound Elective are for students to: 

• Develop competence in basic image acquisition. They will be able to operate an ultrasound machine in its basic form, understanding how to select the proper probe for the given study, how to adjust gain and depth to optimize the image and how to archive appropriate images.
  
• Perform at least 100 independent ultrasound exams over the course of the month-long rotation.
  
• Demonstrate how to appropriately drape patients, and be respectful of patient comfort and privacy while performing exams.
  
• Learn to identify the key anatomic landmarks for the following studies: FAST, AAA, cardiac, biliary, renal, thoracic, and soft tissue/abscess.
  
• Learn to identify the key ultrasonographic findings used to diagnose the following pathologic conditions: cholecystitis, pneumothorax, hydronephrosis, ascites, AAA, and abscess.
  
• Learn to identify free fluid (ascites or blood) on an abdominal ultrasound.
  
• Learn to identify fluid (pleural effusion or hemothorax) on a thoracic ultrasound
  
• Learn the indications for core ACEP ultrasound applications.
  
• Learn the types of ultrasound artifacts and their role in image acquisition.
  
• Present one journal club article over the course of the month
  
• .https://www.google.com/search?client=firefox-b-d&q=Grady+ECC+and+EUHM+ED+ultrasound
  Our Section (US ELECTIVE) teaches an ultrasound module for first-year medical students during their anatomy course. Faculty receive ultrasound education as part of our departmental faculty development series.
  

• Ultrasound Fellowship

  The Section of Emergency Ultrasound offers an Emergency Medicine Ultrasound Fellowship. We are committed to training fellows that are prepared to be leaders in emergency ultrasound.
  
  

Expectations

• Students will perform bedside ultrasounds on emergency department patients in the Grady ECC and EUHM ED under the supervision of ultrasound faculty and residents rotating on the Ultrasound rotation. At the beginning of the rotation, these scans will be directly supervised by a faculty member or residents at the bedside. After developing competency, students may perform scans independently and then review their images with supervising physicians. Students will also observe scans performed by resident physicians.
  
• Students will be expected to attend a weekly 1-hour didactic lecture focused solely on student learning objectives. Students will have one-on-one time with Ultrasound faculty and fellows that will focus on their independent skill development.
  
• Students are expected to attend weekly ultrasound video review on Wednesday afternoons from 1pm-5pm. These sessions include image review, a bimonthly journal club, and didactic lectures.
  
• Students are expected to attend the emergency medicine department's resident conference and grand rounds each Tuesday morning from 8am-12pm. Students will schedule one 2-3 hour session during the month to observe pediatric ultrasound faculty and residents scan at Egelston.
  
• Students will spend one 2-3 hour session during the month at the simulation center or with faculty using vascular phantoms to practice skills with the use of ultrasound for procedural guidance.
  
• Students are expected to complete the American College of Emergency Physicians online ultrasound curricula. Students will complete online tests to assess progress during the rotation. Students will be provided with a copy of "Emergency Ultrasound Pocket Reference" by Lyon, Menckhoff, Shiver (2008) to read and reference during their rotation. Emergency Ultrasound. 2nd edition. Ma, Mateer, Blaivas (2008) may be helpful for students wishing to read more in-depth into ultrasound topics but is not required.
  

Conferences

The didactic portion of this course is primarily through self-study with online modules. Once students develop basic competency with scanning, they will scan independently under the indirect supervision of ultrasound faculty and residents. This elective fosters clinical reasoning as students are required to independently record interpretations of their scans at the bedside, and their clinical interpretations and reasoning will then be reviewed with faculty. This rotation will also help students with problem-solving by allowing them to contextualize the findings on ultrasound examination within a patient's larger clinical picture.

Evaluations and Grading

This is a Pass/Fail course. Students will be asked to meet with a faculty member at the two-week mark to perform a self-evaluation and to review their progress on the rotation. By the third week, students will have completed an online test which will be used to assess their grasp of the course knowledge objectives. Each student will need to complete 100 scans over the course of the 4-week rotation to pass. All student-performed scans will be directly supervised by emergency ultrasound credentialed faculty or recorded for subsequent quality assurance review at our weekly image review session
 https://med.emory.edu/departments/emergency-medicine/education/medical-student/ultrasound-elective.html

Pyloric Stenosis (Infant with Vomiting)
Like many pathologies in pediatrics, pyloric stenosis is best evaluated with ultrasound. Remember, pyloric stenosis is caused by 1/hypertrophy of the muscular layer of the pylorus and 2/ failure of the pylorus to relax, leading to 3/ gastric outlet obstruction. Pyloric stenosis is the most common cause of vomiting requiring surgery in infants. It is more common in first born male infants.
To locate the pylorus on ultrasound, use the linear probe in a transverse position and first locate the gallbladder. The pylorus should be found posterior to the gallbladder. If the pylorus is thickened, you can see a “target” or “donut” sign
 To assess for pyloric stenosis, first measure the muscular layer of pylorus in longitudinal and transverse views. >3mm thickness raises concern for hypertrophy. Then measure the length of the pyloric canal. There is a range in the radiology literature for abnormal pyloric channel length from >15 to 19 mm
 Another way to evaluate the pylorus is to check for passage of gastric contents : if you see gastric contents moving freely through an open pylorus, then pyloric stenosis is much less likely

more....
kamalsayedkamalsayed