PGY3 Advanced Ultrasound
Objectives
Overall Objectives:
1) Demonstrate knowledge of correct transducer
2) Demonstrate correct patient positioning for each study and understanding of how to optimize positioning on a more difficult patient
Cardiac Objectives:
1) Demonstrate proper technique required to obtain and optimize the 4 standard transthoracic views of the heart with consistent probe and screen orientation in the subxiphoid, parasternal, and apical windows.
2) Correctly identify the four heart chambers and great vessels
3) Recognize and interpret RA and RV dilatation
4) Correctly identify pericardial effusions and tamponade physiology
5) Differentiate pericardial and pleural effusions
6) Correctly estimate EF using EPSS, Estimate global LV systolic function
7) Evaluate volume responsiveness using a variety of methods
8) Evaluate global longitudinal strain and peak strain
Lung Objectives:
1) Demonstrate correct scan technique and image acquisition in the minimal criteria 6 positions of the thorax
2) Demonstrate and verbalize understanding of the following concepts
Lung sliding
A-lines
B-lines
Pleural fluid
3) Demonstrate and verbalize understanding of the following lung diagnoses
No acute findings
Pneumothorax
COPD
CHF
Pneumonia
DVT Objectives:
1) Identify key structures starting at the inguinal ligament
Common femoral vein
Saphenofemoral junction
Bifurcation of the femoral and deep femoral veins in the proximal thigh.
Popliteal vein
Popliteal trifurcation
2) Fully compress the veins with the transducer to demonstrate no intraluminal clot.
3) Demonstrate understanding of false positives – inadequate pressure, Baker’s cyst, superficial thrombophlebitis, gastrocnemius tear
Biliary Objectives:
1) Demonstrate correct scan technique and image acquisition in the minimal criteria
2) Demonstrate and verbalize understanding of the following concepts
Sagittal view with evaluation of the neck of the gallbladder
Recording and demonstration of the portal vein with common bile duct
Transverse view of the gallbladder with sweep through
3) Demonstrate and verbalize understanding of the following diagnoses
No acute findings
Biliary colic
WES
Acute cholecystitis
Ocular Objectives:
1) Identify normal anatomy and key anatomic relationships
Eyelid
Cornea
Sclera
Anterior chamber - iris, pupil, lens
Vitreous body
Retina
Optic nerve sheath
2) Recognize globe rupture, ocular foreign bodies, lens displacement, vitreous hemorrhage, retinal detachment, retrobulbar hematoma, increased intracranial pressure.
3) Demonstrate knowledge of methods to ocular ultrasound to identify patients with increased intracranial pressures.
MSK Objectives:
1) Shoulder
Anatomy
Humeral head ultrasound position (related to dislocation)
Dislocation
AC joint ultrasound position
Biceps tendon
Dislocation
Arthrocentesis
2) Elbow
Anatomy
Dislocation
Arthrocentesis
3) Hip
Arthrocentesis
4) Knee
Arthrocentesis
Nerve Block Objectives:
1) Demonstrate and verbalize understanding of indications and contra-indications
2) Lower Extremity Blocks
Femoral Nerve
Posterior Tibial Nerve
3) Upper Extremity Blocks
Interscalene
Supraclavicular
Forearm - Medial, Ulnar, Radial
4) Truncal Blocks
Serratus Anterior
Erector Spinae
5) Demonstrate knowledge of local anesthetic dosings
6) Demonstrate understanding of LAST
Pelvic Objectives:
1) Identify an IUP - Gestational sac, double decidual sign, yolk sac, fetal pole
2) Demonstrate how to safely/correctly calculate FHR
3) Demonstrate understanding of how to calculate endomyometrial mantle and explain its clinical importance
4) Identify features of an ectopic
Free fluid around the uterus
No IUP in uterus
Identify ovaries in adnexa
Identify suspicious masses in adnexa
TEE Objectives:
1) Demonstrate proper technique required to obtain and optimize the 4 standard transesophageal views of the heart
Mid-esophageal 4 chamber
Mid-esophageal long axis with and without color
Transgastric short axis
Bi-caval view with M-mode
2) Recognize fine ventricular fibrillation
3) Recognize a pericardial effusion
Pediatric Objectives:
1) Demonstrate proper technique required to obtain and optimize pediatric bedside ultrasound images
2) Demonstrate understanding of identifying/diagnosing common pediatric abdominal complaints
Appendicitis
Pyloric Stenosis
Intussusception
3) Demonstrate basic understanding of pediatric MSK ultrasound for conditions like hip effusions.
Simulation Objectives:
1) Undifferentiated hypotension
Demonstrate hemodynamic interpretation and management of the hypotensive patient
Demonstrate and interpret POCUS evaluation for IUP
Demonstrated and interpret POCUS evaluation for DVT/PE
2) Undifferentiated dyspnea
Demonstrate cardio-pulmonary interpretation and management of hypotensive patient
Demonstrate and interpret POCUS evaluation of ADHF
Demonstrate and interpret POCUS evaluation of COPD
Demonstrate and interpret PCOUS evaluation of PNA/sepsis