We’re very happy you’ll be joining us and learning to use point of care ultrasound (POCUS) to take better, safer, and faster care of your patients! We’re working hard to make this curriculum easy to follow and responsive to your needs, so if there are any issues (i.e. out of sequence modules, broken links…), please let your directors know!

Intern Ultrasound Experience:

• Basic ultrasound training will occur concurrently with intern on-boarding in the ED.  It is expected that participants will complete didactic lectures prior to the day of their scanning with ultrasound faculty.  A schedule for the ultrasound experience can be found here – Intern US Schedule
  • “Blue” and “Orange” Team designations can be found near the bottom of the appropriate year’s sheet.
  • There will be a mix of didactic and hands-on training: please be sure to complete the prerequisite didactic modules prior to the hands-on for that topic.
    • This means that your first readings and quizzes will take place prior to the first day of the On-Boarding! (as an example, in 2021, both Blue and Orange Teams will need “Day One” didactics complete by 6/29, whereas Blue Team will need to complete E-FAST didactics by 7/2, & Orange Team by 7/9.

• Pre-Course Survey
• Ultrasound-Guided Peripheral IV (USGPIV) Pre-Test (10 ?’s)
• watch the USGPIV training video (25 min) after completing the Pre-Test:

•  Finally, review the following posts (see below for instructions):
  • AEUS Narrated Lecture: Physics (20 min, 6 ?’s)
  • AEUS Narrated Lecture: Peripheral IV (11 min, 5 ?’s)

You should be taken to the website via link provided to your jax.ufl.edu email account. This email contains your AEUS Lecture series UserID (firstinitiallastname) and a password they provide. The landing page is:

https://participant.easy-lms.com/saem-lecture-series-test/login

You should be assigned to the University of Florida College of Medicine Jacksonville Group, and the modules should be in order of required completion. However, you are not permitted to advance until you have completed the prior Module! If a test is failed, you may try again (immediately, if you like). Your record of attempts will be archived on the “Results” tab of the course, but may not be appear to be updated when you successfully retake the test. Therefore, be sure to download your Certificates as pdfs and send them to Debbie Eurom (they should also be emailed to you from the website, but just in case). Even after completing a Module successfully, you may have to return to the “Overview” screen to refresh the website and proceed to the next Module.

• These videos & AEUS modules must be reviewed prior to the scanning session dealing with that topic as per the published Intern schedule. (For example, the 2021 Blue Team will need to complete the didactic assignments & AEUS quizzes for Soft Tissue POCUS [found in the section below] before their session on 7/16)
• Further recommended study resources for each of the topics below are linked at the bottom of the page or in the password-protected “Resources” section.
  • Feel free to move through the material at a faster than scheduled pace if you are comfortable doing so– you may also review the “Procedures” or “PGY-2” or even “PGY-3” Curricula if you feel ready to take on some advanced topics!

USGPIV Course

Residents are required to successfully complete the ED USGPIV training program.  If the Intern USGPIV session is missed, you must schedule a make-up session– check the Calendar of Events or the bulletin board in the ED Command Center for posted class times. There will be scan sessions during your On-Boarding during which you will be called upon to place USGPIVs. You must complete 5 proctored USGPIVs to complete the course. These are recorded on the USGPIV Competency Form. You may be signed-off by any midline-certified ED Tech, or Drs. Shannon or Duran-Gehring.

Extended-Focused Assessment with Sonography in Trauma

• E-FAST – Core Ultrasound (5 min)
• E-FAST by Dr. Petra Duran-Gehring (30 min)

• AEUS Narrated Lecture: eFAST (20 min, 11 ?’s)

Gall Bladder / Biliary POCUS

• 5-Minute Sono – Gallbladder (2020)
• ACEP SonoGuide – Gallbladder
• AEUS – Limited Biliary Ultrasound by Dr. Joseph Minardi (16 min, 8 ?’s)

Aorta POCUS

• 5-Minute Sono – AAA
• 5-Minute Sono – Ao Dissection
• ACEP SonoGuide – Aorta
• AEUS – Limited Abdominal Aortic US by Dr. Arthur Au (13 min, 6 ?’s)

Renal POCUS

• 5-Minute Sono – Hydronephrosis
• 5-Minute Sono – Bladder Volume
• ACEP SonoGuide – Renal
• AEUS – Renal Ultrasound by Peregrine Dalziel (25 min, 8 ?’s)

Soft Tissue & Musculoskeletal POCUS

• 5-Minute Sono – SSTI
• 5-Minute Sono – FB
• 5-Minute Sono – Nec Fasc
• US for SSTI by Geoff Hayden (16 min)
• US for Foreign Body by Geoff Hayden (10 min)
• ACEP SonoGuide – Soft Tissue
• ACEP SonoGuide – Abscesses

Cardiac POCUS

* A Note About Orientation *

At UF JAX, the Ultrasound Division teaches the “General” or “Radiology” convention of cardiac ultrasound.  In contrast with the “Cardiology” convention you will see on TTE’s performed on your patients, our cardiac POCUS studies will maintain the Orientation marker (aka “dot”) on the left (from the Operator’s perspective) of the screen.  The Cardiology convention has the dot on the Operator-Right side of the screen.  You will see a mix of these conventions as you seek out cardiac ultrasound learning resources on the internet, and should be aware of the difference, which isn’t complicated, but can be confusing.

Simply, for your studies at UF JAX, keep the probe marker– which corresponds to the on-screen “dot”– to the patient’s right side in all of your basic cardiac views, and recognize that some of your images will be right-left reversed when compared with Cardiology’s images.  Examples are displayed below, and a reference article is linked here and in the Protected Resources section if you have questions.

•  5-Minute Sono – Cardiac Views
• 5-Minute Sono – Cardiac Function
• 5-Minute Sono – Effusion
• 5-Minute Sono – IVC
• AEUS – Limited Echo, Part 1 by Dr. Chris Moore (27 min)
• AEUS – Limited Echo, Part 2 by Dr. Chris Moore (26 min)

Pelvic POCUS – TAUS, TVUS

• ACEP SonoGuide – Early Pregnancy
• AEUS – Limited Transabdominal Pelvic US by Dr. Lorriane Ng (28 min)
• AEUS – Limited Transvaginal Pelvic US by Dr. Meghan Kelly Herbs (18 min)

A benchmark goal is to have completed 150 ultrasound scans during the first year.

• E-FAST
• Renal
• Gallbladder
• Aorta
• Pelvic (transvaginal and transabdominal)
• Cardiac
• Soft Tissue
• DVT*
• Ocular*
• Procedural*
• Thoracic*
  • * These studies will be emphasized during the PGY-2 curriculum

Evaluation of POCUS Skills – the OSAUS

At various points in your training, you will be observed for competency regarding your POCUS skills using a structure assessment. The criteria on which you will be evaluated correlate with your Residency Milestones, and are reproduced below for your benefit, along with a “cheat sheet” for evaluators to help them judge performance based on the outlined parameters. It will be worth your time to review this evaluation rubric.

UF-OSAUS-Objective-Structured-Assessment-of-Ultrasound-Skills

• All Clinical Studies must have images saved and a worksheet completed in QPath and require visualization of the images by the EM Attending responsible for care.  If a scan is being performed for educational purposes only and is found to be normal, no Attending over-read or EMR documentation is indicated– the study is designated as Educational in QPath.  The Pt must be able to provide informed consent for education scans.  Recommendations for consenting patients are reviewed

• All images will be subject to the Emergency Department Ultrasound QA process for evaluation.  Interns 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

Required-Views-UF-US-2019

• Scans are tracked using Scan Logs and the Q-Path system.
  • POCUS scans performed outside of the ED (e.g. OB, ICU, etc.) will count toward the 250 goal as long as they are logged on a Scan Log sheet 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.

US-Scan-Log

• Q-Path is found on computers in the ED, Resident Lounge, and via VPN.

How-to-Get-to-Qpath

• Participants are required to log into the image storage/QA system to view and curate their scans and submit them for QA.
  • Clinical Scans must be reviewed by the Attending of record at the time of clinical decision making and signed by the resident in QPath so the report enters the EMR. Please review how to do so below.
  • Once submitted, scans will be reviewed by an US faculty for quality.

QPath-Epic-Workflow

• Scan Rounds:  Ultrasound QA Rounds are scheduled on Tuesday 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. Attendance during US rotations is required, but QA Rounds are open to any an all at any time. Free, national course level education up for grabs!
• Ultrasound Guided Peripheral IV Access:  Residents are required to successfully complete the ED USGPIV training program during their Intern On-Boarding.  If the Intern USGPIV session is missed, you must schedule a make-up session– check the Calendar of Events or the bulletin board in the ED Command Center for posted class times. You will need to turn in a completed competency form once you’ve been all signed off!
  • 5 proctored USGPIVs per the USGPIV Competency Form

USGPIV-Competency-Form-6-20212

• Emergency Ultrasound Journal Club:  During US rotations, residents will also attend the monthly E-Journal Club (EUSJC) meeting.  This meeting is held via webcast (Zoom) 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.
• SonoDoc – Case-based POCUS Education and review site. Go to the website and complete the indicated cases. Be sure to take a screen shot of your final score for the case, and submit that as evidence of completion.
  • https://sm.stanford.edu/archive/sonodoc/#/home
    • PGY-1:
      • Bobby Brownsberg
      • Calvin Beards
      • Gladys Gonzales
      • Jim Baker
      • Joe Greene
      • Jamal Walker
      • Loraine Lucas
      • Mindy Elliot
      • Maria Hernandez
      • Ron Talbott

• Additionally, two free E-books are available via iTunes for self-study:
  • Introduction to bedside Ultrasound: Volume 1, Dawson and Mallin
  • Introduction to Bedside Ultrasound: Volume 2, Mallin and Dawson

POCUS-Reference-values-5MinSono

• Physics, Knobology, “How do I get a better picture?”
  • US Physics by Dr. Geoff Hayden (20 min)
  • ACEP SonoGuide – Physics for the Beginner
  • 123 Sonography – by Prof. Thomas Binder- US Physics quick reference for optimizing cardiac images

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• USGPIV
  • 5-Minute Sono – USGPIV

• EFAST

• Aorta

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• Renal

1-s2.0-S0196064415014195-main

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• Gallbladder

Emergency-Physician–performed-Ultrasound-to-Diagnose-Cholelithiasis-A-Systematic-Review

• Soft Tissue

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• MSK

• Cardiac

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Understanding-Echo-Reports-Can-Fam-Physician-2006

• Pelvic – OB/GYN

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