UCSF Fresno Department of Emergency Ultrasound Fellowship
Ultrasound is established as an essential tool in the emergency department. Current literature supports its use displaying decreased wait times, expedited diagnosis and treatment, and improved patient outcomes. Ultrasound first made its appearance in emergency medicine with the evaluation of the critical trauma patient using focused abdominal sonography in trauma (FAST), supported by both the American College of Emergency Physicians (ACEP) and the American College of Surgeons (ACS) in the advanced trauma life support (ATLS) course. Since this initial implementation, the use of emergency ultrasound has grown rapidly to include studies for both diagnostic purposes and procedural guidance. Diagnostic emergency ultrasound is an established tool in the evaluation of biliary diasease, aortic aneurysm, ectopic pregnancy, cardiac pathology, sepsis, pneumothorax, hemothorax, and the evaluation of the trauma patient for free fluid in the abdomen. Procedural ultrasound has been shown to increase success and decrease complications of paracentesis, pericardiocentesis, central and peripheral venous cannulation, and abscess incision and drainage. In addition to the established uses of ultrasound in the emergency department, new indications continue to emerge including confirmation of fracture reduction, evaluation for tendon laceration, and evaluation for tenosynovitis to name a few. The RRC in Emergency Medicine requires an ultrasound curriculum during residency training, and post-graduate specialization is sought for those interested in further training and academic development.
The ultrasound program at the UCSF Fresno Emergency Medicine Residency was started in 1996 by Dr. Carolyn Chooljian. The program has now grown to three faculty dedicated to teaching, supervision and performance of ultrasound and related activities. Dr. Brian Chinnock is RDMS certified. Dr. Rimon Bengiamin has completed an ultrasound fellowship.
The patients seen in our emergency department provide a rich source of clinically appropriate ultrasound material. We see many patients with indications for emergency ultrasound. Ultrasound is routinely used in our ED to evaluate trauma patients for free intraperitoneal fluid on FAST scans. The results are often key to the further plan of management and evaluation of the patient by the trauma team. ED ultrasound has on many occasions rapidly indicated the best direction of management and care of our patients with problems such as those with abdominal aortic aneurysms, pericardial tamponade, ectopic pregnancy, cardiac arrest, and many other immediate time sensitive situations.
Residents at UCSF Fresno receive both didactic and hands-on training in ultrasound. The three core ultrasound faculty present a curriculum of 6 core ultrasound lectures each year covering the essential emergency ultrasound topics of trauma/thoracic (EFAST), biliary, aorta, renal, cardiac, pelvic, and procedural ultrasound. Residents have the opportunity to learn ultrasound hands-on through weekly ultrasound clinics where faculty devote time solely to bedside ultrasound education. All residents are required to complete a set number of ultrasounds, as recommended by ACEP, in each of the six core areas and receive certification as part of completion of their residency. Residents with a particular interest in ultrasound may spend elective time or devote their senior area of concentration to ultrasound.
Our program has been involved in many research projects, having participated in the Sonography Outcomes Assessment Program (SOAP), an ultrasound research consortium, as well as individual studies from our institution currently in progress and being proposed. Current ultrasound teaching faculty have produced many teaching materials including a CD-ROM study program of pelvic ultrasound for emergency physicians and three sets of teaching DVDs and manuals that are available nationally. Several podcast instructional videos have also been recently published online, including thoracic ultrasound and gallbladder ultrasound. The faculty has also been involved in teaching ultrasound at the state and national levels, having taught at Cal-ACEP, ACEP, and TCEP (Texas-ACEP) sponsored courses, as well as at smaller arranged courses.