EMERGENCY ULTRASOUND
LIAISON:
Director/Rotation Coordinator:
Dr. Tina Bhandari: tina.bhandari@mail.utoronto.ca
Assistant Director:
Dr. Jordan Chenkin: jordan.chenkin@utoronto.ca
Rotation Scheduling: nima.heirat@sunnybrook.ca
Nima Heirat Telephone: (416) 480-5959
Administrative Assistant: paola.tiveron@sunnybrook.ca
Paola Tiveron Telephone: (416) 480-4037
Location: Sunnybrook Health Sciences Centre, C753
GOALS:
Emergency medicine residents on the advanced emergency ultrasound elective should focus on
the following main areas:
1. Understand the role of and indications for advanced emergency ultrasound in the care of
the emergency medicine patient
2. Become proficient in Advance Cardiac, Lung, Gallbladder, DVT, Ocular, IVC, Joints and
Nerve scans
3. Complete 25 scans in each of Advanced Cardiac, Lung, Gallbladder and DVT
4. Spend time in Echo lab and ultrasound department learning from personnel trained in
ultrasound
5. Learn to evaluate quality of scans and techniques for improvements
6. Understand the evidence supporting the use of emergency ultrasound
7. Appreciate the limitations of emergency ultrasound
8. Prove competency in Advanced Ultrasound on final exam
OBJECTIVES:
Upon completion of the rotation, residents should be able to:
Medical Expert
1. Understand the advanced knobology of the ultrasound machine
2. Demonstrate understanding and proficiency with the use of the phased array probe
3. Demonstrate proper ultrasound technique including probe manipulation and image
optimization
4. Demonstrate proficiency at image generation and interpretation in the following areas:
a. Advanced Cardiac including parasternal long and apical four chamber views
assessing chamber size and function, cardiac activity and pericardial effusions
b. Lung including detection of pneumothorax, pulmonary edema and pleural
effusion
c. Gallbladder including detection of gallstones and cholecystitis
d. DVT including detection of thrombosis
5. Demonstrate competency at image generation and interpretation in the following areas:
6.
7.
8.
9.
a. Ocular including detection of retinal detachments, posterior vitreous
hemorrhages and papilledema
b. IVC including assessing size/fullness and applying this in the context of the
patient’s fluid status
c. Joints including detection of fluid and, if necessary, subsequent aspiration under
ultrasound guidance
d. Nerves including understanding the technique and optimal locations to provide
analgesia for different indications
Understand the importance of rejecting indeterminate scans
Understand the emerging role for bedside ultrasound for advanced applications
To be able to apply emergency ultrasound findings in clinical management of emergency
patients
Understand the limitations of emergency ultrasound
Communicator
1. Converse effectively and sensitively with patients and their families.
2. Ensure patients understand the differences between emergency ultrasound and
radiology-performed scans
3. Communicate and document ultrasound findings appropriately
4. Demonstrates effective communication skills when teaching ultrasound skills to others
Collaborator
1. Work effectively as part of a health care team
2. Understands how emergency ultrasound contributes to the overall care of the patient
3. Develops understanding of how other specialties incorporate bedside ultrasound into
their practice
4. Spends time at the Sunnybrook Echo Lab to understand the process of formal
echocardiography
5. Spends time at the Sunnybrook Ultrasound Department to understand the process of
formal ultrasounds
Manager
1. Demonstrates proper documentation and archiving of ultrasound scans
2. Understands the importance of Quality Assurance system to monitor scans being
performed
3. Schedules sufficient ultrasound scanning shifts to complete required scans
4. Manages time efficiently
5. Demonstrates proper care of the ultrasound equipment
6. To understand the background of emergency ultrasound and the role that it has played in
changing the bedside diagnostic environment.
7. Understands the medico-legal implications of emergency ultrasound in patient care and
in physician certification process
Health Advocate
1. Acts as an advocate for individual patients in the emergency department
2. Understands the importance of access to emergency ultrasound devices for all
resuscitation and acute care areas of the emergency department
Scholar
1. Critically evaluate the literature as it pertains to emergency ultrasound
2. Understand the evidence supporting the commonly performed emergency ultrasound
scans
3. Understand the limitations of emergency ultrasound literature and the need for further
high-quality research in this area
Professional
1. Be sensitive to any discomfort caused by ultrasound scans, especially when performing
training scans or when scanning volunteers
2. Adhere to the code of ethics of the CMA and the institution
3. Treat patients and colleagues with respect
4. Self-evaluate, including insight into strengths and weaknesses
5. Demonstrate commitment to lifelong learning
6. Be responsible, reliable, punctual, and accountable for one’s actions