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Graduate Medical Education


​PGY1 Core Rotation

The PGY1 Ultrasound Rotation is centered in the emergency department at Denver Health Medical Center.  During this 2-week rotation, residents  obtain the basic skills needed to perform point-of-care ultrasound in the clinical setting.  This rotation consists of lectures, hands-on scanning, direct teaching by the fellows, and video review of image acquisition and interpretation.

For more details: http://education.denversono.com/

PGY3 Advanced Rotation

The PGY3 Ultrasound Rotation is dedicated to confirming competency in core emergency point-of-care ultrasound skills introduced during the PGY1 rotation.  Residents will complete a 1-week rotation at the University of Colorado with dedicated teaching objectives including advanced echo, trans-vaginal ultrasound, nerve blocks, lung, ocular applications. 

Point-of-care ultrasound approaches to syndromes such as undifferentiated hypotension, abdominal pain, and dypsnea will be emphasized.  The format of this rotation is flipped classroom and interdisciplinary in nature with faculty from critical care, simulation, sports medicine, and the emergency point-of-care ultrasound.

 Description

 
PGY-3 Advanced Track Point-of-Care Ultrasound
 
Welcome to the PGY-3 Ultrasound Rotation. This new rotation will have you scanning with faculty throughout the week. We are hoping to make each session as compact and educational as possible.
 
Point-of-Care Course Topics
1) Basic echo review and advanced echo techniques
2) Lung
3) Pelvic
4) Ultrasound guided Peripheral Nerve Blocks
5) Joint Arthrocentesis and Tendon Pathology
6) DVT
7) Ocular
8) Simulation is setting of undifferentiated pathology
9) Trans Esophageal Echo
10) Biliary
 
Course Objectives
1) Ability to utilize ultrasound to work up patients with undifferentiated hypotension
2) Ability to utilize ultrasound to work up patients with undifferentiated dyspnea
3) Proficiency in applications necessary for objectives 1 and 2
4) Proficiency in MSK applications
5) Exposure to critical care ultrasound which includes scanning in the MICU and exposure to trans-esophageal echo 
 
Schedule
Begins: Monday at 8:00
Ends: Friday by 17:00
 
Requirements
1) 5 DVT US studies 
2) 5 advanced cardiac echo studies 
3) 5 lung scans
4) 2 TV scans
5) 5 Ocular scans
6) 5 Biliary scans 
7) Perform 3 USGPIV
 
QA
1) You are expected to attend the University Point-of-Care Ultrasound meeting and present 5 different types of studies for review.
2) You are expected to participate in QA of studies performed in the department during the week.
 
Critical Care
1) Please attend the TEE hands on simulator session.
 
Resources
1) E-books: Introduction to Bedside Ultrasound, Volume 1 and 2.  Matt Dawson and Mike Mallin.
1

 Objectives

CARDIAC OBJECTIVES:

1.  Transducers

2.  Patient positioning

3.  Demonstrate proper technique required to obtain and optimize the 4 standard transthoracic views of the heart with consistent probe and screen orientation in the subxiphoid, parasternal, and apical windows.

4.  Correctly identify the four heart chambers and great vessels

5.  Recognize and interpret RA and RV dilatation

6.  Correctly identify pericardial effusions and tamponade physiology

7.   Differentiate pericardial and pleural effusions

8.   8 EPSS, Estimate global LV systolic function 

9.   Evaluate volume responsiveness using a variety of methods 

10. Evaluate global longitudinal strain and peak strain 

 

DVT OBJECTIVES:

Key points:

1. Correct positioning of patient

2. Identify key structures starting at the inguinal ligament. Identify the common femoral vein, Saphenofemoral junction, and bifurcation of the femoral and deep femoral veins in the proximal thigh.

3. Fully compress the veins with the transducer to demonstrate no intraluminal clot.​​​

4. In the popliteal fossa, identify the popliteal artery and vein. The vein often lies deep to the artery. Fully compress the vein with the transducer.

 

LUNG OBJECTIVES:

1. Demonstrate correct scan technique and image acquisition in the minimal criteria 6 positions of the thorax

2. Demonstrate and verbalize understanding of the following concepts

        Lung sliding

        A-lines

        B-lines

        Pleural fluid

3. Demonstrate and verbalize understanding of the following lung diagnoses

        No acute findings

        Pneumothorax

        COPD

        CHF

        Pneumonia

 

MSK OBJECTIVES:

1. Shoulder

        Anatomy

        Humeral head ultrasound position (related to dislocation)

        Dislocation

        AC joint ultrasound position

        Biceps tendon

        Dislocation

        Arthrocentesis

2. Elbow

        Anatomy

        Dislocation

        Arthrocentesis

3. Hip

        Arthrocentesis

4. Knee

        Arthocentesis

 

OCULAR OBJECTIVES:

1. Identify normal anatomy and key anatomic relationships: eyelid, cornea, sclera, anterior chamber, iris, pupil, lens, vitreous body, retina, optic nerve sheath.

2. Recognize globe rupture, ocular foreign bodies, lens displacement, vitreous hemorrhage, retinal detachment, retrobulbar hematoma, increased intracranial pressure. See Bedside Ultrasound iBook by Mike Mallin and Matt Dawson Volume 2 Chapter 16 for examples.

3. Optic nerve sheath diameter (ONSD) can be used to identify patients with increased intracranial pressures. ONSD >5 mm is associated with elevated intracranial pressures. However, there is wide variability in normal ONSD in asymptomatic patients with normal intracranial pressure.

 

PERIPHERAL NERVE BLOCK OBJECTIVES:

1. Femoral Nerve Block

2. Forearm Blocks

        Medial, Ulnar, Radial Nerve Block

3. Ankle Blocks

        Posterior Tibial Nerve Block

4. Brachial Plexus

        Interscalene Block for Shoulder Dislocation

 

SIMULATION OBJECTIVES:

Learning objectives undifferentiated hypotension

1. Demonstrate hemodynamic interpretation and management of the hypotensive patient

2. Demonstrate and interpret poc u/s evaluation for IUP

3. Demonstrated and interpret poc u/s evaluation for DVT/PE 

Learning objectives undifferentiated dyspnea

1. Demonstrate cardio-pulmonary interpretation and management of hypotensive patient

2. Demonstrate and intepret poc u/s evaluation of ADHF

3. Demonstrate and interpret poc u/s evalution of COPD

4. Demonstrate and interpret poc u/s evaluation of PNA/sepsis 

 

TEE OBJECTIVES:

1. Transducer

2. Patient positioning

3. Demonstrate proper technique required to obtain and optimize the 4 standard transesophageal views of the heart

        Mid-esophageal 4 chamber

        Mid-esophageal long axis with and without color

        Transgastric short axis

        Bi-caval view with M-mode

4. Recognize fine ventricular fibrillation

5. Recognize a pericardial effusion

 

PELVIC OBJECTIVES:

1. Identify an IUP

        gestational sac

        double decidual sign

        yolk sac

        fetal pole

        FHT

        endomyometrial mantle (greater than or equal to 7mm)

2. Identify features of an ectopic

        free fluid around the uterus

        no IUP in uterus

        identify ovaries in adnexa

        identify suspicious masses in adnexa

BILIARY OBJECTIVES:

1. Demonstrate correct scan technique and image acquisition in the minimal criteria 

2. Demonstrate and verbalize understanding of the following concepts

        Sagittal view with evaluation of the neck of the gallbladder 

        Recording and demonstration of the portal vein with common bile duct

        Transverse view of the gallbladder with sweep through

3. Demonstrate and verbalize understanding of the following diagnoses

        No acute findings

        Biliary colic

        WES

        Acute cholecystitis​

​ ​

7

 List of Rotators

 

11/4

 

12/2

 

1/27

 

3/30

 

4/27

James Engeln 

 

Christopher Erley

 

Arian Anderson

 

Chelsea Dymond

 

Jeremy Collado

Nick Kelly

 

Davida Hemmy

 

 

Adam Esch

Reid Haflich

Sasha Kaiser

 

Alexander Quinones

 

Sarah Markus

Nik Matsler

 

Joe Noack

 

Liz Malik

 

Irene Hurst (PEM)

Matt Mendes

 

Ross Orpet

 

Lesley Pepin

 

Sam Paskin-Flerlage

 

 

Melisa Tanverdi (PEM)

 

Stephen Gradwohl (PEM)

 

 ​


2

 Schedule


Dec02 Final.JPG







For Transvaginal US, call the day prior and find out the schedule for pelvic ultrasounds being performed.

Main Desk: 720-848-1864 (Ask for Britt Smith or Tracy Bieker)

Tracy Bieker’s direct line: 720-848-1880​


​​8

 Flipped Classroom Assignments


 FCA.PNG

 
4

 Post-Rotation Evaluation