MUSC Internal Medicine Bedside Ultrasound Curriculum
Overall objectives:
1. Understand the basic physics of ultrasound technology
2. Appreciate the clinical role for bedside ultrasound
3. Differentiate between types of ultrasound transducers and select correct transducer for
particular bedside applications
4. Visualize the normal sonographic appearance of solid organs, soft tissues and vascular
structures
5. Recognize abnormalities in the solid appearance of solid organs, soft tissues and vascular
structures that can acutely change clinical management
6. Appreciate current literature supporting ultrasound education for IM Residency Programs
Useful resources:
http://emergencyultrasoundteaching.com/ - Dr. Geoff Hayden’s website containing lots of great videos,
articles, images, cases, and links to other great resources
http://learn-us.vanderbiltem.com/ - ER based – lots of great videos
http://www.susme.org/learning-modules/learning-modules/ -USC School of Medicine website that has
physics lectures, etc
http://www.critcaresono.com/ -- tutorials, images, practice clips
http://www.nejm.org/multimedia/medical-videos/- procedural videos for paracentesis, thoracentesis,
central and peripheral line placement.
1. Knobology Learning Objectives – Ultrasound basics
1. Understand orientation of ultrasound probe to the patient
2. Understand orientation of ultrasound probe to the ultrasound screen
3. Identify the appropriate ultrasound probes for various bedside applications: cardiac
imaging, pleural imaging, soft tissue imaging, central line placement, and paracentesis
4. Understand how to take and annotate ultrasound images
5. Understand basic ultrasound physics
6. Understand basic ultrasound language (ie hypoechoic, anechoic, hyperechoic)
7. Recognize common ultrasound artifacts – acoustic shadowing, mirror image
Resources:
Moore, C. Point-of-Care Ultrasonography. NEJM. February 24, 2011.
http://emergencyultrasoundteaching.com/narrated_lectures.html - Physics and Knobology lecture
http://www.susme.org/learning-modules/learning-modules/
2. Pulmonary Ultrasound Learning Objectives
A . Recognize the normal appearance of visceral and parietal pleura using 2D and M-mode
imaging
1. Identify ribs, rib shadowing, intercostal space and pleural line
2. Identify A lines
3. Identify lung sliding with respiration
4. Use M-mode to identify normal lung pattern (“seashore sign”)
5. Appreciate the anatomical relationship of lung, diaphragm and liver/spleen and be able
to point out all structures
B. Recognize common lung abnormalities
1. Identify B lines
2. Assess for pleural effusion
3. Assess for pneumonthorax
4. Assess for consolidation
C. Identify Deep Vein Thrombosis
Resources:
Ding et al. Diagnosis of Pneumothorax by Radiography and Ultrasonography:A Meta-analysis. Chest.
2011; 140(4):859–866
Turner, J. Thoracic Ultrasound. Emerg Med Clin N Am 30 (2012) 451-473
Zanobetti et al. Can Chest Ultrasonography Replace Standard Chest Radiography for Evaluation of Acute
Dyspnea in the ED? Chest. CHEST 2011; 139(5):1140–1147
http://www.critcaresono.com/page.php?page=27 – lung US
http://www.critcaresono.com/page.php?page=29 – pleural US
http://www.sonosite.com/education/learning-center/58/1425 - how to US for pneumothorax
http://www.sonosite.com/education/learning-center/58/1441 - US for detection of pleural fluid
3. Cardiac Ultrasound Learning Objectives
1. Obtain 4 views of the heart: parasternal long axis, parasternal short axis, apical 4
chamber, subxyphoid 4 chamber
2. Identify left atrium, mitral valve, left ventricle, aortic valve, aorta, right ventricle, right
atrium in each view
3. Obtain qualitative assessment of global LV function (be able to determine <30% vs
normal)
4. Obtain qualitative assessment of chamber size and overload
Resources:
https://www.stanford.edu/group/ccm_echocardio/cgi-bin/mediawiki/index.php/Main_Page
http://emergencyultrasoundteaching.com/ - Cardiac Ultrasound
www.sonosite.com/education/learning-center - Cardiac Ultrasound
Arntfield, R. Point of Care Cardiac Ultrasound Applications in the Emergency Department and Intensive
Care Unit – a Review. Current Cardiology Reviews, 2012 (8) 2.
4. Soft Tissue Ultrasound Learning Objectives
a. Identify the appearance of normal soft tissue
b. Recognize the ultrasound appearance of cellulitis
c. Differentiate between cellulitis and abscess
Resources:
Squire, et al. ABSCESS: Applied Bedside Sonography for Convenient Evaluation of Superficial Soft Tissue
Infections. Acad Emer Med July 2005, 12 (7).
http://www.sonoguide.com/abscess.html
http://emergencyultrasoundteaching.com/narrated_lectures.html -- Soft tissue lecture
5. Procedural Ultrasound Learning Objectives
1.
2.
3.
4.
Identify internal jugular vein and common carotid artery
Appreciate the differences between arteries and veins by ultrasound
Verify central venous line placement
Utilize ultrasound for peripheral venous access
5. Identify ascites
6. Appropriately mark site for paracentesis
Resources:
http://emergencyultrasoundteaching.com/narrated_lectures.html - Venous access lecture
http://www.ucdmc.ucdavis.edu/emergency/Ultrasound%20CVC%20tutorial/DynamicUS_Dev29.html US guided central venous access interactive tutorial
www.sonosite.com – several videos on central venous line placement, US guided paracentesis
6. Hypotensive patient/Volume Assessment – Learning Objectives
1.
2.
3.
4.
5.
6.
Identify the IVC
Identify the junction of the right atrium and IVC
Measure the diameter of the IVC 2cm from IVC/right atrial junction
Assess for IVC collapse with respiration or “sniff test”
Correlate IVC diameter with estimated RA pressure
Obtain qualitative assessment of global LV function (be able to determine <30% vs
normal)
7. Obtain qualitative assessment of chamber size and overload
Resources:
Haydar et al. Effect of Bedside Ultrasonography on the Certainty of Physician Clinical Decision making for
Septic Patients in the Emergency Department. Ann Emer Med 2012
Byrne, M. Ultrasound in the Critically Ill. Ultrasound Clin 6 (2011) 235-259
Perera, P. The RUSH Exam: Rapid Ultrasound in Shock in the Evaluation of the Critically Ill Patient. Emerg
Med Clin North Am. 2010 Feb;28(1):29-56.
http://emergencyultrasoundteaching.com/narrated_lectures.html - hypotensive patient and volume
assessement lectures
Stawicki et al. Intensivist Use of Hand-Carried Ultrasonography to Measure IVC Collapsibility in
Estimating Intravascular Volume Status: Correlations with CVP. J Am Coll Surg. 209 (1) July 2009.
http://learn-us.vanderbiltem.com/ - hypotensive patient
7. Literature Supporting Ultrasound Education for IM Residency Programs
1. Keddis et al. Effectiveness of an Ultrasound Training Module for Internal Medicine
Residents. BMC Medical Education 2011. Mayo Clinic
2. Alba et al. Faculty Staff-guided Versus Self-guided Ultrasound Training for Internal
Medicine Residents. Medical Education. 2013. Massachusetts General Hospital.
3. Mourad et al. A Randomized Controlled Trial of the Impact of a Teaching Procedure
Service on the Training of Internal Medicine Residents. Journal of Graduate Medical
Education. June 2012. U. of California at San Francisco