Orientation

to WMed Rotations for Emergency Medicine Residents:

ULTRASOUND SHIFTS

Original credit for an ultrasound rotation guide, when it was still a discrete mini-rotation, goes to Katie McLogan,
DO, a former KCMS/WMed EM resident who completed her residency in June 2014. Below is an updated guide
which is based on her work.

WHAT THIS GUIDE CONTAINS:

• Location and how to get there;
• An overview of duties and time commitment involved;
• An overview of documentation;
• A "usual day/night";
• General pointers and miscellaneous, but useful, information.

LOCATION AND DIRECTIONS:

Put simply, your ultrasound shift can be held at either of the Kalamazoo emergency departments which you will
already know by the time of even your first ultrasound shift.

DUTIES AND HOURS:

In the past, we had a dedicated ultrasound week. More specifically, you had one ultrasound week as an intern,
then another ultrasound week as a PGY-3 with an intern, totaling two weeks of dedicated ultrasound time in
addition to ultrasound time during ED shifts and any off-service use, particularly in the ICU.

Early in the 2015-2016 residency year, the decision was made to convert this to a month-by-month approach in
that most months, you will have a dedicated six-hour ultrasound shift, and you will not have a standalone week of
"just" ultrasound as it was before.

That said, there are a few other things to mention:

• If you are on an ultrasound shift with someone else, please decide on a hospital for your shift ahead of
time.
• As of this writing, shifts are scheduled for 0800-1400 and 1400-2000. Depending on block coverage, there
may be vacant ultrasound shifts. If you are scheduled for any given day, and the "other" ultrasound shift is
unfilled, you may make alternative arrangements on time with anyone else on shift with you.
• "Emergency Medicine Ultrasound" is a worthwhile text and is available from
www.accessemergencymedicine.com; site access can be had through WMed or Bronson's own
institutional login credentials.
• ACEP actually maintains a set of online modules with quizzes -- www.emsono.com/acep/exam.html --
which must be complete by the end of residency. As a matter of practicality and education, just complete
one module per ultrasound shift.

DRESS:

Scrubs are acceptable.

Last revised: Saturday, September 19, 2015

DOCUMENTATION:

Ultrasound shift documentation is unique. First of all, you do not need to complete a full, proper ED note as if you
were primarily seeing any given patient.

For any bedside ultrasound studies you perform at Bronson, there is an Epic smartphrase (.edultrasound or similar,
as this may change between this writing and your shift) that you should use in a separate, standalone note in the
patient's chart. Basically, you must document in the patient's chart that an educational, point of care ultrasound
was performed, that it was not a diagnostic study, and the patient was aware of the nature of the study and
consented to it.

There is not a completely formal requirement to document your ultrasonography at Borgess, but you should. It is
good form in many ways, ranging from good housekeeping to good medicolegal practice, to simply include in the
chart something similar to the above. This may be done on the ED template or a separate note, or, conceivably,
could be placed in Cerner electronically.

A TYPICAL SHIFT:

One thing needs to be said up front: only image patients who have a confirmatory study. For example, a patient
with a CT of the abdomen and pelvis would be a good candidate for a FAST exam, renal ultrasonography, aortic
imaging, and/or anything else included in the CT. Similarly, anybody with a formal ultrasound ordered may have
one performed by you for educational/comparative purposes.

After you look at the tracking board and identify someone who may be eligible for such a study, talk to that
patient's attending physician to obtain permission. Some patients will not want to participate in this, and there
may be a dynamic in the room that would make performance of such a study a bad idea.

There will be a certain ebb and flow to the day, so some downtime is not unexpected. This would be a good time
to complete one of the ultrasound modules mentioned above.

MISCELLANY:

Ultrasound shifts are, in many ways, self-directed shifts. You will not be as busy as you are on typical department
shifts, and what you get from an ultrasound shift will, in many ways, be shaped by what you put into it.
Additionally, residents vary in how much interest they have in ED ultrasonography. Some residents use ultrasound
only as much as "necessary" (FAST exams, evaluation for cardiac tamponade, and central line placements).
Conversely, one of our fairly recent graduates was interested enough to complete the prerequisite number of
scans and meet other requirements mandated by the American Registry for Diagnostic Medical Sonography and
ultimately earned his RDMS designation.

Regardless, get as much as you can from dedicated ultrasound time, as it is a valuable tool for what we do.

As an aside, there is an ultrasound simulation tool named "SonoSim", available in the WMed simulation center,
which may be useful. This is computer software with what actually looks like an ultrasound probe which attaches
to the computer by USB. SonoSim can be used as a primer on relevant anatomy, landmarks, and other details of
any given study. Historically, three simulation scans have counted as the equivalent of one "live" scan.

Last revised: Saturday, September 19, 2015