Emergency Ultrasound Pediatric EM Fellow Rotation

Course Requirements:

  1.  Orientation:  Fellows will meet with Ultrasound Faculty prior to, or on the first day of the rotation for further orientation to the US rotation.
  2.  ED Ultrasound Studies
    • Participants will obtain 150 ultrasound scans to cover all of the core emergency ultrasound applications:
      • E-FAST
      • Renal
      • Gallbladder
      • GI (appy, intussusception, pyloric stenosis, SBO)
      • Pelvic (transvaginal and transabdominal)
      • Cardiac
      • Thoracic (lung)
      • Soft Tissue
      • DVT
      • Ocular
    • Fellows are to report to the ED and identify themselves as on the US rotation, performing any clinically relevant POCUS examinations in conjunction with the treatment team.  “Clinically relevant” are performed for a specific indication to answer a focused clinical question germane to the patient’s complaint and work up.  These scans must be entered in the patient’s EPIC chart via the Procedure Note for ED Ultrasound.  These images must be reviewed by the EM Attending in the area who is responsible for the patient’s care.
      • If no clinically relevant scans are needed, the Fellow may complete exams for educational purposes on consenting patients or colleagues.  Educational scans do not require an attending overread or EMR documentation, however, they do require the verbal informed consent of the patient or their medical decision maker.  This is outlined here.
  3. ED POCUS Workflow
    • All images will be subject to the Emergency Department Ultrasound QA process for evaluation.  Participants are expected to produce enough images of acceptable quality to meet at least 75% of the total number of scans required by ACEP guidelines (150 of 250 required).
      • Minimum requirements for each view are outlined here
    • Scans are tracked using Scan Logs and the Q-Path system.
      • Q-Path is found on computers in the ED, Resident Lounge, and via VPN if you contact Debbie Eurom for the link.  Once submitted, scans will be reviewed by an US faculty for quality.
      • Ultrasound scans performed outside of the ED (e.g. OB, ICU, Wolfsons, etc.) will count toward the 250 goal as long as they are logged on the Scan Log and signed off by a preceptor.  Be sure to place a patient sticker on your log page and check off all scans performed.  Scan Logs are to be turned in to Debbie Eurom in the ED office at the end of your rotation.
    • Q-Path– Participants are required to log into the image storage/QA system to view and curate their scans and submit them for QA.  Please review how to do so below. 
  4. Educational Content (Readings/Podcasts/Videos):
  5. ACEP Ultrasound Test: 
    • Participants will be required to complete and pass all 12 sections of the online Emergency Ultrasound Exam created by the American College of Emergency Physicians (ACEP).  These include Physics, Cardiovascular, Urinary Tract, Trauma, Soft-Tissue, Biliary, AAA, Procedural, First-Trimester Pregnancy, etc.
    • Complete each of the quizzes, and save your results/score page either as a pdf or a screen shot (if you don’t know how to download them), and email them to Debbie Eurom.  You can also print them all and place them on Dr. Duran or Dr. Shannon’s door by the end of the rotation.
  6. Scan Rounds:  Ultrasound QA Rounds are scheduled on Wednesday mornings at 9am.  We will discuss ultrasound topics, answer questions, and review scans performed in the previous week.  Depending on the make up of the team, we will then perform supervised scanning in the ED, with an emphasis on new applications or interesting cases.
  7. SonoSim:  Simulated Ultrasound Trainer
    • During your US rotation, you will be expected to complete the training modules available in the CSESaR Sim Center on the SonoSim laptop.  Your completion and scores will be part of your rotation evaluation.
    • The assigned modules will likely take a whole afternoon, and there is only one laptop console.  Please contact the SimCenter (Elizabeth.catoe@jax.ufl.edu or Joel.hart@jax.ufl.edu) one week prior to your US Block to schedule your time to complete the learning modules so there is no overlap with other learners.  Your loginid and password will be emailed to you by the SonoSim system.
      • PGY1 – Fundamentals of US, Cards, 1st Trimester Preg, Renal, EFAST, IVC, Bowel/Biliary, Ao/IVC
      • PGY2– Fundamentals of US, MSK, Ocular, RUSH, Pulm, Soft Tissue
      • PGY3 – Fundamentals of US, FOCUS/Advanced Cards, RUSH, EFAST, Ao/IVC (this is mostly catch-up for the next 2 years)
      • Peds Fellows – Fundamentals of US, EFAST, Soft Tissue, Renal, Bowel/Biliary,       MSK, 1st Trimester Preg, Pulm
  8. Ultrasound Guided Peripheral IV Access:  Fellows are required to successfully complete the ED USGPIV training program.  Check the Calendar of Events or the bulletin board in the ED Command Center for posted class times.  Alternately, email Jonathan Taunton (jonathan.taunton@jax.ufl.edu) to reserve a spot in one of the scheduled courses.  Prior to the course, complete the Pre-Test linked below and then watch the lecture.
  9. Trauma Center FAST Exams: Fellows will be required to attend all trauma activations (be sure your pager will receive trauma alerts) during the day while on the US rotation and are required to participate in the E-FAST exam during the evaluation.  The images must be shown to an Attending EM Physician and documented in the patient’s chart via a Procedure Note as with any Clinical Relevant study.
  10. Emergency Ultrasound Journal Club:  The Fellow will also attend the monthly E-Journal Club meeting taking place the Wednesday evening of their rotation month.  This meeting is held via webcast and can be accessed via phone app, computer or telephone.  Topic and article will be sent prior to event and must be reviewed prior to the JC to ensure resident participation.
Deliverables:
At the end of the rotation please turn in the following to Dr. Duran or Debbie Eurom, her assistant:
  1. Ultrasound Scan Logs
  2. USGPIV pre-test, post-test, competency completion check off sheet
  3. ACEP Ultrasound Test printouts