A Blueprint for an Integrated Point-of-Care Ultrasound Curriculum for Nephrology Trainees

Point-of-care ultrasonography (POCUS) is a limited ultrasound study performed by the clinician at bedside as a component or an adjunct to physical examination. POCUS has multiple applications in nephrology practice including evaluation of obstructive uropathy, objective assessment of volume status, arteriovenous access assessment, and procedural guidance. However, unlike specialties such as emergency medicine, POCUS training is not yet integrated into most nephrology fellowship curricula, and the sonographic applications taught vary widely among fellowship programs. In this article, we have used our institutional experience to provide a roadmap or blueprint for nephrology programs looking to create a POCUS program. We provide an overview of the curriculum including the basic organization, applications taught, online resources, milestone development, and quality assessment. We also discuss the nuances of POCUS workflow and perspectives on billing for these limited studies. In addition, we share the evaluation forms and sample documentation we use in our program. Future support, in the form of endorsed nephrology society guidelines, are needed before POCUS training is universally incorporated across nephrology fellowship programs.

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Point of Care Ultrasonography for Objective Assessment of Heart Failure: Integration of Cardiac, Vascular, and Extravascular Determinants of Volume Status

Cardiorenal Medicine ◽

10.1159/000510732 ◽

2021 ◽

pp. 1-13

Author(s):

Abhilash Koratala ◽

Amir Kazory

Keyword(s):

Heart Failure ◽

Point Of Care ◽

Objective Assessment ◽

Prognostic Significance ◽

Volume Status ◽

Lung Water ◽

Ultrasound Evaluation ◽

Reliable Assessment ◽

Poor Outcomes ◽

Point Of Care Ultrasonography

Background: Lingering congestion portends poor outcomes in patients with heart failure (HF) and is a key target in their management. Studies have shown that physical exam has low yield in this setting and conventional methods for more precise assessment and monitoring of volume status (e.g., body weight, natriuretic peptides, and chest radiography) have significant inherent shortcomings. Summary: Point of care ultrasonography (POCUS) is a noninvasive versatile bedside diagnostic tool that enhances the sensitivity of conventional physical examination to gauge congestion in these patients. It also aids in monitoring the efficacy of decongestive therapy and bears prognostic significance. In this narrative review, we discuss the role of focused sonographic assessment of the heart, venous system, and extravascular lung water/ascites (i.e., the pump, pipes, and the leaks) in objective assessment of fluid volume status. Key Messages: Since each of the discussed components of POCUS has its limitations, a combinational ultrasound evaluation guided by the main clinical features would be the key to reliable assessment and effective management of congestion in patients with HF.

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Non-Invasive Intracranial Pressure Evaluation in an Emergency Room – Point-of-Care Ultrasonography

Arquivos Brasileiros de Neurocirurgia Brazilian Neurosurgery ◽

10.1055/s-0036-1594301 ◽

2016 ◽

Vol 38 (04) ◽

pp. 279-283

Author(s):

Daniel Damiani ◽

Durval Damiani

Keyword(s):

Intracranial Pressure ◽

Randomized Trials ◽

Point Of Care ◽

Current Data ◽

Point Of Care Ultrasound ◽

Medical Specialties ◽

Non Invasive ◽

Nerve Sheath ◽

Invasive Method ◽

Point Of Care Ultrasonography

AbstractPoint-of-care ultrasound is modifying conducts in emergency care. The various medical specialties, in addition to traditional indications in cases of multiple trauma, are using this technique for rapid diagnosis at the bedside without patient mobilization and without radiation. Point-of-care ultrasound in neurocritical patients, through its transorbital window, can estimate the intracranial pressure by a non-invasive method. Through the measurement of the diameter of the optic nerve sheath 3 mm posterior to the retina, the intracranial pressure is estimated if the value of the diameter is > 5 mm, as it has been verified in other studies. The present article describes the most current data on this topic, and it also highlights the need for more multicentric and randomized trials to determine the correct cut-off points that represent the high sensibility and specificity of the method.

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158: Present and Future of Emergency Point-of-Care Ultrasound in Pediatric Emergency Fellowship Programs in Canada

Paediatrics & Child Health ◽

10.1093/pch/20.5.e91 ◽

2015 ◽

Vol 20 (5) ◽

pp. e91-e91

Author(s):

J Hoeffe ◽

MP Desjardins ◽

J Fischer ◽

B Carrière ◽

J Gravel

Keyword(s):

Point Of Care ◽

Pediatric Emergency ◽

Point Of Care Ultrasound ◽

Fellowship Programs

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Stevens-Johnson Syndrome complicated by obstructive uropathy, pneumothorax, and pneumomediastinum: a case report and literature review

Burns & Trauma ◽

10.1186/s41038-019-0153-4 ◽

2019 ◽

Vol 7 ◽

Author(s):

Damian Bruce-Hickman ◽

Xiao Jiang ◽

Joshua Jin-Ping Thia ◽

Amit Kansal

Keyword(s):

Point Of Care ◽

Obstructive Uropathy ◽

Kidney Injury ◽

Stevens Johnson Syndrome ◽

Mechanically Ventilated ◽

Ureteric Stenting ◽

Johnson Syndrome ◽

Air Leak Syndrome ◽

Point Of Care Ultrasonography ◽

Gross Haematuria

Abstract Background Stevens-Johnson Syndrome (SJS) is an acute mucocutaneous eruption with blisters of the skin and haemorrhagic erosions of mucous membranes. This report describes air-leak syndrome and obstructive uropathy occurring simultaneously in a teenage patient affected by SJS. Case presentation A 17-year-old Malay female with SJS suffered from bilateral pneumothoraces, pneumomediastinum, and obstructive uropathy as early complications of her disease. She required intubation, chest tube insertion, and bilateral ureteric stenting as part of her intensive care management. These extra-cutaneous complications of renal and pulmonary systems were likely secondary to widespread epithelial detachment. Conclusion Despite paucity of cases in adult literature, post-renal causes for acute kidney injury must be considered in SJS, especially in the setting of gross haematuria. Bedside point-of-care ultrasonography may be a useful tool for excluding obstructive uropathy. Pneumothorax is a rare but documented complication of SJS in paediatric cases and, to a lesser extent, adult patients. Extra care should be exercised when caring for mechanically ventilated patients suffering from SJS.

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Emergency medicine point-of-care ultrasonography: a national needs assessment of competencies for general and expert practice

CJEM ◽

10.2310/8000.2013.131205 ◽

2015 ◽

Vol 17 (1) ◽

pp. 74-88 ◽

Cited By ~ 11

Author(s):

Lisa M. Fischer ◽

Michael Y. Woo ◽

A. Curtis Lee ◽

Ray Wiss ◽

Steve Socransky ◽

...

Keyword(s):

Emergency Medicine ◽

Needs Assessment ◽

Point Of Care ◽

Core Competency ◽

Fellowship Training ◽

Essential Elements ◽

Fellowship Programs ◽

Point Of Care Ultrasonography ◽

Residency Program Directors ◽

Expert Practice

AbstractIntroductionEmergency medicine point-of-care ultrasonography (EM-PoCUS) is a core competency for residents in the Royal College of Physicians and Surgeons of Canada and College of Family Physicians of Canada emergency medicine (EM) training programs. Although EM-PoCUS fellowships are currently offered in Canada, there is little consensus regarding what training should be included in a Canadian EM-PoCUS fellowship curriculum or how this contrasts with the training received in an EM residency.ObjectivesTo conduct a systematic needs assessment of major stakeholders to define the essential elements necessary for a Canadian EM-PoCUS fellowship training curriculum.MethodsWe carried out a national survey of experts in EM-PoCUS, EM residency program directors, and EM residents. Respondents were asked to identify competencies deemed either nonessential to EM practice, essential for general EM practice, essential for advanced EM practice, or essential for EM-PoCUS fellowship trained (‘‘expert’’) practice.ResultsThe response rate was 81% (351 of 435). PoCUS was deemed essential to general EM practice for basic cardiac, aortic, trauma, and procedural imaging. PoCUS was deemed essential to advanced EM practice in undifferentiated symptomatology, advanced chest pathologies, and advanced procedural applications. Expert-level PoCUS competencies were identified for administrative, pediatric, and advanced gynecologic applications. Eighty-seven percent of respondents indicated that there was a need for EM-PoCUS fellowships, with an ideal length of 6 months.ConclusionThis is the first needs assessment of major stakeholders in Canada to identify competencies for expert training in EM-PoCUS. The competencies should form the basis for EM-PoCUS fellowship programs in Canada.

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Uveal Melanoma Identified as Ocular Mass on Point-of-care Ultrasound

Clinical Practice and Cases in Emergency Medicine ◽

10.5811/cpcem.2021.4.52115 ◽

2021 ◽

Vol 5 (3) ◽

pp. 367-368

Author(s):

Hannah Spungen ◽

Daniel Weingrow

Keyword(s):

Emergency Department ◽

Retinal Detachment ◽

Uveal Melanoma ◽

Vision Loss ◽

Point Of Care ◽

Black Spot ◽

Distant Metastases ◽

Posterior Chamber ◽

Point Of Care Ultrasound ◽

Point Of Care Ultrasonography

Case Presentation: A 41-year-old man presented to the emergency department with five months of progressive monocular vision loss in his right eye, which he described as a gradually descending and enlarging black spot. He had no light perception in his right eye with elevated intraocular pressure and an afferent pupillary defect, while his left eye visual acuity and pupillary exam was normal. Point-of-care ultrasound demonstrated a hyperechoic, pedunculated mass in the posterior chamber of his right eye, consistent with a diagnosis of ocular melanoma. Ophthalmology scheduled the patient for an elective, right eye enucleation the following week, after which a diagnosis of uveal melanoma (UM) was confirmed on histopathology. Discussion: Uveal melanoma is an uncommon diagnosis that requires prompt intervention and surveillance due to the possibility of distant metastases arising in up to 50% of patients. Emergency department diagnosis of UM may be confounded by features of other intraocular pathology, such as increased ocular pressure or the finding of retinal detachment on fundoscopy. When emergency providers encounter glaucoma or retinal detachment on physical exam, point-of-care ultrasonography represents a key adjunct in the timely diagnosis and referral of this potentially vision- and life-threatening malignancy.

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Comprehensive residency-based point-of-care ultrasound training program increases ultrasound utilization in the emergency department

10.21203/rs.3.rs-27350/v1 ◽

2020 ◽

Author(s):

Wei-Lung Chen ◽

Chan-Peng Hsu ◽

Po-Han Wu ◽

Jiann-Hwa Chen ◽

Chien-Cheng Huang ◽

...

Keyword(s):

Emergency Department ◽

Soft Tissue ◽

Training Program ◽

Test Score ◽

Point Of Care ◽

Point Of Care Ultrasound ◽

Ultrasound Studies ◽

Training Course ◽

Hemodynamic Assessment ◽

Procedural Guidance

Abstract Background: Point-of-care ultrasonography (POCUS) is a prompt and simple tool for the urgent diagnosis and treatment of patients in the emergency department (ED). It has contributed to improvements in patient treatment quality, procedural safety, timeliness of care, diagnostic accuracy, and cost reduction. We developed a comprehensive residency-based POCUS training program for ED residents and determined its effect on ultrasound utilization in the ED.Methods: We conducted a retrospective cohort study in the ED of a university-affiliated medical center, evaluating a centralized residency-based POCUS training course from July 2017 to June 2018 for ED residents that included 12 core ultrasound applications: trauma, intrauterine pregnancy, abdominal aortic aneurysm, echocardiography and hemodynamic assessment, hepatobiliary system, urinary tract, deep vein thrombosis, soft tissue and musculoskeletal, thoracic-airway, ocular, bowel, and procedural guidance. Each application comprised a combined lecture and hands-on practice session that lasted for 2 hours. Pre-tests and post-tests, including still image and video interpretation, were performed. Utilization of POCUS among ED residents before and after the POCUS training course (July 2016–June 2017 and July 2018–June 2019) was calculated and analyzed using the Wilcoxon signed-rank test.Results: In total, 16 residents participated and completed the entire training course. The post-test score improved significantly compared to the pre-test score by a median of 12 points (p = 0.04). Utilization of POCUS among the ED residents increased significantly from 0.15 ultrasound studies per patient per year to 0.41 ultrasound studies per patient per year (p < 0.01) after completion of the entire training course. Increased POCUS scanning percentages over the cardiac, soft tissue, abdominal region, vascular system, procedural guidance, and ocular regions were also noted after providing the curriculum.Conclusions: There was a significant increase in POCUS utilization among ED residents after a comprehensive residency-based POCUS training program.

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Considerations for Implementing Point-of-Care Ultrasound in a Community-Based Family Medicine Residency Program

Journal of Medical Education and Curricular Development ◽

10.1177/2382120519884329 ◽

2019 ◽

Vol 6 ◽

pp. 238212051988432

Author(s):

Megan Weemer ◽

Matt Hutchins ◽

Eric Beachy ◽

Nicole McGuire

Keyword(s):

Family Medicine ◽

Residency Program ◽

Point Of Care ◽

Point Of Care Ultrasound ◽

Family Medicine Residency ◽

Vein Thrombosis ◽

Recent Graduates ◽

Barriers To Implementation ◽

Procedural Guidance ◽

Deep Vein

Background: Prior to implementing Point-of-Care Ultrasound (POCUS) training into our Family Medicine Residency Program, we sought to determine opinions on the most relevant applications according to current Family Medicine residents and recent graduates. As there are so many POCUS applications relevant to Family Medicine, it would be efficient to teach only the most relevant scans. Objective: Examine current POCUS use and the perception of future use among current residents and recent graduates of a Family Medicine Residency Program. Methods: In 2017, an electronic survey was used to examine differences in perceptions regarding the value of POCUS applications, benefits of use, and potential barriers to implementation. Results: Of the 88 surveys sent, 21 of 21 current residents (100%) and 28 of 67 recent graduates (41.8%) completed the survey with a total completion rate of 55.7%. The POCUS practices differed between groups. Current residents were significantly more likely than recent graduates to use POCUS for vascular procedural guidance and other procedural guidance. Recent graduates were significantly more likely to report POCUS use for abdominal aortic aneurysm screening and lower extremity Doppler screening for deep vein thrombosis. All P values were significant at the .05 level. Conclusions: Point-of-Care Ultrasound training is generally desired by current residents. Some applications are perceived to be of sufficient utility by current residents and recent graduates. Findings would justify investment of time and effort required to implement POCUS training in Family Medicine Residency curriculums. Curriculum should focus on applications viewed as high priority based on usage rates.

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