Point of Care Ultrasound
Ultrasound is the doctor’s new stethoscope. At UIC, residents are exposed to point of care ultrasound (POCUS) throughout their training, starting in Intern year.
Ultrasound is a critical tool that is used in the intensive care units, emergency department, surgical elective, and in patient resuscitation efforts on the medical services. Additionally, interns are exposed to transthoracic echocardiography during the cardiology elective at the Jesse Brown VA. At the end of intern year, trainees spend the last two months of their internship within our UIC department and participate in a two-month orientation. This is optimal in preparing interns to transition smoothly into CA-1 year. Point of care ultrasound is introduced during orientations so that residents can use this instrument in caring for patients. The curriculum includes a general overview of ultrasonography including ultrasound physics, probe selection, ergonomics and view optimization. During anesthesia months interns can expect to interact with ultrasonography during placement of central lines or arterial lines and transthoracic echocardiography in the operating room. Our goal is to introduce the basics of ultrasound early in training so that the residents can utilize this valuable tool throughout the training period.
Residents apply the basic concepts of ultrasounds throughout the CA1 year. OR, ICU and PACU patients may decompensate and require immediate evaluation using ultrasound. With direct supervision and guided technique residents may utilize point-of – care ultrasound (POCUS) to evaluate for pneumothorax, pleural effusions and identify global cardiac dysfunction and initiate a targeted treatment until definitive diagnostics are pursued. While on the obstetric anesthesia rotation lumbar ultrasound is routinely used to identify and evaluate spinal anatomy for challenging neuraxial techniques on high risk parturients.
See Dr. Galvan’s ASA presentation on ultrasound.
The regional anesthesia rotation prioritizes ultrasonography for all upper extremity, lower extremity and truncal perioperative blocks. Ultrasound guided regional blocks are also utilized at off-campus rotations such as Jesse Brown VA hospital and Northshore. Graduating CA-3 residents’ regional ultrasound skills are tested via OSCE board preparation workshops held by regional anesthesia faculty. Prior to the cardiac and liver transplant rotation experience, each resident is assigned to a two-week rotation in trans-esophageal echocardiography (TEE). In addition to didactics and hands-on TEE, residents also use our TEE simulator and an online curriculum with dedicated modules.
Our senior residents are quick to use ultrasound in placing challenging PIV, arterial lines, or to evaluate the heart and lungs during intra-operative instability. Ultrasound skills are routinely used by senior residents during OR crisis and challenging cases off-hours and while on-call. Senior residents at this level will also participate in teaching and facilitating basics of ultrasonography for medical students and junior residents.
The ultrasound curriculum is rapidly evolving to meet our broadening scope of practice. Graduating residents will graduate with competency in ultrasonography skills to meet the growing needs of peri-operative patient care.