Ultrasound

Dietrich Jehle, MD, Director of Ultrasonography and Vice Chair of the Department of Emergency Medicine, is directly involved with training emergency medicine residents in ultrasound use in the emergency department. He is one of the pioneers of emergency department bedside ultrasound and co-authored the first book on Ultrasound in Emergency Medicine and the first trauma ultrasound book, Ultrasound in Emergency Medicine and Ultrasonography in Trauma: The FAST Exam. The latter was written for the American College of Emergency Physicians Meeting in Dallas, Texas in 2003. Dr. Jehle also authored the first studies of Ultrasound by Emergency Physicians in the diagnosis of blunt abdominal trauma, intrauterine pregnancy vs. ectopic pregnancy, gallbladder disease and abdominal aortic aneurysms.

An interesting fact to note is that the very first trauma ultrasound by emergency physicians in the United States was performed at SUNY at Buffalo.

Bedside ultrasound is a clinical skill that every emergency physician should master. 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 pericadial 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.

Ultrasound Rotation

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 hrs/wk. 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. 

Additional clinical experience includes the following:

• 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.

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).

Didactic experiences include :

• Participation in a two day course on emergency ultrasound prresented by senior faculty members.
• Reading the textbooks “Ultrasound in Emergency Medicine” by Heller and Jehle, and "Ultrasonography in Trauma: The FAST Exam" by Jehle and Heller, and discussing these with the rotation director.
• 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 techinician, review of technical and clinical skills by the rotation director, and completion of a written exam.

Advanced Ultrasound Elective

Residents completing this elective will be eligible to take the Registered Diagnostic Medical Sonographer (RDMS) certification exam immediately following graduation.

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.

Here are some comments the residents shared about their ultrasound rotation experience:

"After my ultrasound rotation, I feel very confident using several ultrasound techniques on my own to help quickly make a diagnosis. Dr. Jehle always offers tips and instruction on improving skills and helps our program be on the cutting edge of ultrasound use in the ED." Mike Mann, MD, PGY2 Resident

"I felt like I gained more confidence as I did more scans. It is helpful to be able to do several in a row when you are working on a particular technique and also when you are gaining familiarity with a machine." John Dayton, MD, PGY2 Resident

"Your ultrasound experience will be outstanding. Erie County Medical Center is a Level 1 Trauma Center boasting the best trauma outcomes in New York State. As an integral part of the ECMC team, you will participate in the initial evaluation and management of critically injured patients. You will have a month dedicated to performing ultrasonography in this setting with the guidance of renowned faculty." Peter Riga, MD, PGY1 Resident

"Ultrasound rotation was great! I am glad I did it early in the year as I have used it on just about every rotation so far, and I am sure that I will continue using it and developing my skills with it." Veronica Bonales, MD, PGY1 Resident