Competency-based medical education (CBME) is an outcomes-based approach to the design, implementation, assessment, and evaluation of a medical education program using an organizing framework of competencies.
Competence by Design (CBD) is the Royal College’s version of CBME. It is a transformational change initiative designed to enhance CBME in residency training and specialty practice in Canada.
The first stage in residency is known as Transition to discipline. It emphasizes the orientation and assessment of new trainees. Foundations of discipline, the second stage, covers broad-based competencies that every trainee must acquire before moving on to the third stage, which is known as Core of discipline. The third stage covers more advanced, discipline-specific competencies. As part of CBD, the Royal College is also exploring moving the Royal College exam to the end of this stage.5 The fourth and final stage of residency education is known as Transition to practice. During this stage the trainee demonstrates readiness for autonomous practice
We still have availability for delegates wanting to attend the Fall ECCU Conference Workshop on the 28th September at the beautiful Algonquin Resort in St. Andrews, New Brunswick.
International PoCUS experts from South Africa, USA and Canada
A 24 year old male rugby player presents to the emergency department with left sided shoulder pain. He reports being hit in the middle of the game followed by a pop to his shoulder. Since that time he has had ongoing pain and limited movement. His vitals are normal but he appears uncomfortable. He shows no signs of neurological or vascular injury. History and physical exam is otherwise benign.
Dislocated shoulder is suspected, but is there a way to quickly diagnose prior to x-ray and therefore expedite administration of pre-procedural analgesia and preparation of procedural team and room?
POCUS: Shoulder Background
The shoulder is a ball-in-socket joint with a large range of motion and has a high risk of dislocation due to its shallow joint depth and limited tendinous support inferiorly. Most commonly, the shoulder will dislocate with the humeral head anterior to the glenohumeral rim due to an superiorly placed force upon the humeral head. Posterior dislocations are less common and commonly due to higher mechanism of injuries such as seizure or electrical shock.
Diagnosis of shoulder dislocation is commonly made by x-ray but this method has its downsides including time to diagnosis and increased radiation exposure. An important consideration is the use of POCUS during shoulder reduction. This technique allows for real time confirmation and potentially avoids the need for repeat sedation if failed reduction discovered by a trip to the x-ray department. A recent prospective observational study of 73 patients in the emergency department revealed an accuracy of 100% sensitivity and specificity for shoulder dislocation and relocation (reference 1). Finally, considering there is increased risk of neuro-vascular complications with time to relocation; a decrease in duration to diagnosis could potentially improve patient care.
POCUS: Shoulder Technique
Get patient to sit up to allow availability to the posterior portion of the patient shoulder.
Support the patients elbow while positioning the shoulder in adduction and internal rotation.
Using the curvilinear probe, landmark just inferior to the scapular spine and follow it laterally until you find the glenoid (G) and humeral head (HH) (Shol1).
Shol 1
You should find the humeral head (HH) as a circular structure lateral to the glenoid fossa (G) if in joint. Note the Glenoid labrum (L).
To confirm, you can internally and externally rotate the arm and visualize the humeral head freely moving within the glenoid (Shol2/Shol4) (reference 2). Note the overlying deltoid (most superficial) and the infraspinatus tendon that becomes more apparent during internal rotation.
Shol2
Shol4
If the shoulder is anteriorly dislocated you will see the humeral head displaced inferiorly (Shol5/Shol6) (reference 2,3)
If the shoulder is posteriorly dislocated you will see the humeral head more superficial than expected (Shol5) (reference 2,3)
Shol5
Shol6
Conclusion:
POCUS is an easily available and non-invasive tool in the emergency department. It can be used in cases such as this to improve patient flow, decrease time to diagnosis, and confirm reduction.
Reference:
Abbasi, S., Molaie, H., Hafezimoghadam, P., Amin Zare, M., Abbasi, M., Rezai, M., Farsi, D. Diagnostic accuracy of ultrasonogrpahic examination in the management of shoulder dislocation in the emergency department. Annals of Emergency Medicine. Volume 62:2. August, 2013, pg. 170-175.
You are working a rural ED and a 70 yo male presents with an injury to his right hand about one week ago. He has no known past medical history, is widowed and lives alone. He has no family doctor; a family member made him come in.
In triage he denies any major discomfort in the finger, and has taken nothing for pain. However he has noticed it is increasing in size, becoming more red and even black in places.
Vital signs show he is hypertensive, but otherwise afebrile with a normal heart rate.
You walk into the room to do the assessment and immediately your eyes are drawn to his hand:
WHOA.
As you get further history it turns out the injury was a rusty nail to the digit – it just keeps getting better.
You are worried about an infectious flexor tenosynovitis – a can’t miss diagnosis. This is when purulent fluid collects between the visceral and parietal layers of the flexor tendon1. This infection can rapidly spread through the deep fascial spaces. Direct inoculation, like this penetrating injury, is the most common cause1.
4 clinical signs of tenosynovitis – Kanavel’s signs
‘sausage digit’ – uniform, fusiform swelling
Digit is held in flexion as the position of comfort
As you can imagine this guy had all 4 signs – slam dunk diagnosis, with a little gangrene at the tip to boot. But the diagnosis isn’t always clear cut, and some of these are late signs of infectious flexor tenosynovitis. Patients may present earlier in the course of illness, so what can we use to help diagnose this condition? PoCUS of course!
Place a high frequency linear probe at the wrist crease where you should visualize flexor tendons overlying carpel bones.
Figure 2: Normal flexor tendons (yellow) and carpel bones in transverse plane1
In infectious flexor tenosynovitis you would see anechoic edema and debris in the flexor tendon sheath, and potentially thickening of the synovial sheath. You can assess in both longitudinal and transverse planes.
Figure 3: Transverse (A) and Longitudinal (B) images showing edema in flexor tendon sheath1.
Treatment:
So the most common bug that causes these infections is Staphylococcus, however they can be polymicrobial2. Broad spectrum coverage is required – think ceftriaxone or pip tazo. If there is concern for MRSA than vancomycin would be indicated.
But let’s remind ourselves – he had exposure to a rusty nail – you must cover Pseudomonas as well.
We chose ceftriaxone and ciprofloxacin, administered a tetanus (he never had one before) and urgently contacted plastics. He stayed overnight in the rural ED and was transferred out the next morning for OR. Unfortunately, he did have up having the digit amputated but he recovered well.
Take home message: Flexor tenosynovitis is a surgical emergency – examine for Kanavel’s signs. Ultrasound can be helpful in confirming diagnosis in the right clinical context. Cover with broad spectrum antibiotics, consider MRSA or Pseudomonas coverage if indicated. Urgent plastics referral needed.
References:
Padrez, KP., Bress, J., Johnson, B., Nagdev, A. (2015). Bedside ultrasound Identification of Infectious Flexor Tenosynovitis in the Emergency Department. West J Emerg Med; 16(2): 260-262.
The majority of pharyngitis cases are caused by viruses. For those attributed to bacterial sources, throat culture is the gold standard for confirmation and group A streptococcus is the main bacterial agent involved¹. For pharyngitis believed to be bacterial in nature, antibiotics are prescribed to reduce the risk of developing rheumatic fever, the duration of symptoms, and transmission to others. For cases where antibiotics are prescribed, the first line medication is penicillin, due to the low resistance of group A streptococcal bacteria to this group of medications. Commonly recommended regimens include:
Penicillin V
Pediatrics
40 mg/kg/day (divided BID or TID) to a max of 750 mg x 10 days
250 mg BID
Adults
300mgTID x 10days or
600mgBID x 10days or
500mgBID x 10days
Amoxicillin
Pediatrics
40 mg/kg/day (divided BID or TID) x 10 days to maximum of 1000 mg/day
Adults
500 mg BID x 10 days
An alternative treatment regimen
Common antibiotic regimens require multiple doses per day. This can be difficult for compliance purposes, especially in pediatric patients who may not like to take medications due to the taste and where difficulty with administration of doses at school may be a concern. Recommendations in recent years have included an alternate dosing schedule which allows for a single dose of antibiotic daily for patients. Possible advantages of this approach are improved compliance due to single daily dosing as well as reduced cost for patients and their families. The recommendation is 50 mg/kg once daily to a maximum of 1000mg for 10 days and is appropriate for children > 3 years old and adults.
Bottom line: Amoxicillin 50 mg/kg once daily (max 1000 mg daily) is an acceptable alternative to multiple daily doses of penicillin or amoxicillin for treatment of Group-A streptococcal pharyngitis infections.
References:
1. Caglar D, Kwun R, Schuh A. Mouth and throat disorders in infants and children. In: Tintinalli JE, Stapczynski J, Ma O, Yealy DM, Meckler GD, Cline DM, editors. Tininalli’s emergency medicine 8th ed. New York: McGraw- Hill; 2016
2. Rx files [Internet]. Pharyngitis: Management considerations; 2017 Mar [cited 2018 May 21]. Available from: http://www.rxfiles.ca/rxfiles/uploads/documents/ABX-Pharyngitis.pdf
3. CDC.gov [Internet]. Group A Streptococcal Disease: Pharyngitis; 2017 Sep 16 [cited 2018 May 21]. Availbale from: https://www.cdc.gov/groupastrep/diseases-hcp/strep-throat.html
4. Gerber MA, Baltimore RS, Eaton CB, Gewitz M, Rowley AH, Shulman ST, et al. Prevention of rheumatic fever and diagnosis and treatment of acute streptococcal pharyngitis. Circulation. 2009 March. 119: 1541-1551.
5. Shulman ST, Bisno AL, Cleg HW, Gerber MA, Kaplan E, Lee G, et al. Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the infectious diseases society of America. Clin Infec Dis. 2012 Nov; 55(10): e86-e102. Available from: https://academic.oup.com/cid/article/55/10/e86/321183
6. Andrews M, Condren M. Once-daily amoxicillin for pharyngitis. J Pediatr Pharmacol Ther. 2010 Oct-Dec. 15(4): 244-248.
Congratulations to all our researchers presenting at CAEP Calgary 2018. This year we have had a total of 13 research abstracts accepted for either oral or poster presentation, 2 invited presentations and 1 track chair. We are also involved in a number of administrative, academic and research committee meetings across the conference.
Last years presentations (CAEP Whistler 2017) can be viewed here
Combatting sedentary lifestyles; can exercise prescriptions in the Emergency Department lead to a behavioural change in patients? – Presenter – David Lewis
Interprofessional airway microskill checklists facilitate the deliberate practice of surgical cricothyrotomy with 3-D printed surgical airway trainers – Presenter – James French
Interprofessional airway microskill checklists facilitate the deliberate practice of direct intubation with a bougie and airway manikins – James French
Congratulations to Dr Mandy Peach, PGY2 in the EM/FM program, on her success in receiving the Doug Sinclair Top Resident Research Award at the Dalhousie University Emergency Medicine Research Day 2018 and also Top Project at the Dalhousie Saint John FM/EM Project/Research Day 2018. Mandy presented her research on Sonography in Hypotension (SHoC-ED) diagnoses and shock categories.
Well done Derek Rollo and Luke Taylor for their joint runners up position. Derek presented his work on the ECPR/ED-ECMO feasibility study, and Luke presented on Sonography in Hypotension (SHoC-ED) resuscitation markers.
Congratulations to Dr. Kavish Chandra – recipient of the Iype/Wilfred Resident Award!
Dr. Chandra, a PGY3 in the Integrated Family Medicine/Emergency Medicine program, was one of 3 recipients of the prestigious Iype/Wilfred award. This is awarded annually by the New Brunswick Medical Society to residents who have demonstrated outstanding achievements during their residency training in New Brunswick. Recipients are recognized as being leaders in research and professionalism, and who do so while showing compassion and caring towards patients and colleagues.
This award will be presented to Dr. Chandra at the Celebration of Medicine ceremony hosted by the New Brunswick Medical Society on May 26, 2018.
Congratulations, Dr. Chandra!
Far right: Dr. Chandra in a simulation training session
The goal of this resident clinical pearl is to discuss two different methods of achieving complete anesthesia of the hand. Hopefully, by the end of this article, you will have the knowledge to perform both methods in the emergency department. The first method is ultrasound (US)-guided nerve blocks of the ulnar, median, and radial nerves. The second method is the “tumescent anaesthesia” approach used by many hand surgeons around the world for wide-awake hand surgery, including local, local anesthetic guru and plastic surgeon, Dr. Donald Lalonde who provided many of the clinical pearls in this article.
Method 1: Ultrasound-guided nerve block
In a recent article by Amini et al. (2016), 84% of 121 emergency medicine residency programs surveyed in the United States reported that US-guided nerve blocks are performed at their institution. Of the 16 different nerve blocks reported, forearm blocks were the most commonly performed (74%) (Table 1). The main indications for nerve blocks are outlined in Table 2 1.
Table 1 and 2 from Amini et al., 2016 1
Three major nerves, median, ulnar, and radial, provide sensory innervation of the hand (Figure 1). Each nerve needs to be blocked in a simple straightforward approach, which was shown to to be quick, safe and effective. After a 1-hour training session, residents, fellows, and staff emergency physicians had 100% success rate with no rescue anesthesia on 11 hand pathology patients presenting to the ED. The blocks were performed in a median time of 9 minutes with no complications 2.
Radial Nerve: Palpate the radial artery in the volar aspect of distal forearm then place the US probe over the artery in a transverse orientation. Move the probe proximally until you clearly identify the radial nerve (Figure 3), which is located at the radial aspect of the radial artery. Insert your needle using an in-line approach (Figure 4). Inject 5-10cc of 1% lidocaine with epinephrine until you can clearly see the nerve bathed in lidocaine.
Pearl: The radial nerve is often difficult to visualize in the forearm. The radial nerve is more easily visualized above the elbow along the spiral groove of the humerus. Place the probe in a transverse orientation along the lateral aspect of the humerus between the brachioradialis and brachialis muscles. This block is more proximal and will require longer time to peak anesthesia.
Ulnar nerve: Use the exact same 2-step approach but on the ulnar side of the forearm. The ulnar nerve is located at the ulnar aspect of the ulnar artery (Figure 3).
Median nerve: The median nerve lies between the palmaris longus and the flexor carpi radialis. Position the probe in the transverse plane over this location. Insert your needle from either side using an in-plane or out-of-plane approach
Pearl: the median nerve and the many tendons of the distal forearm can be difficult to distinguish. You can identify the nerve by tilting the probe, which causes the tendons to disappear, as the US waves are no longer reflected back to probe, while the median nerve fibers still reflect waves back to the probe. Alternatively, you can slide the probe proximally where the tendons transition to muscle fibers, allowing the median nerve to be easily distinguishable.
Pearl: The palmar cutaneous branch of the median nerve that supplies the thenar eminence branches off before the carpal tunnel. Make sure you move the probe proximally before blocking the nerve so you don’t miss this important sensory branch.
Pearl: The more local anesthetic, the better! Some resources recommend 3-5cc of 1% lidocaine per nerve. Why not use 10cc or more for each nerve? You will still be safely under 7mg/kg limit.
Figure 3. Ultrasound identification of the ulnar nerve (left), median nerve (middle), and radial nerve (right). (Figure from Liebemann et al, 2006) 2.
Figure 4. Ultrasound guided ulnar nerve block using an in-plane technique (Figure from Sohoni et al., 2016) 3.
Tumescent means “Swollen”. In relation to local anaesthesia, Dr. Lalonde provides the following definition in his textbook Wide-Awake Hand Surgery: “Injecting a large enough volume of local anesthetic that you can see it plump up the skin and feel its slightly firm consistency with your finger through the skin” 4. The tumescent anesthesia approach has been described in depth for a variety of hand surgeries 4-6.
Using a 10cc syringe, aim for the space directly between the median and ulnar nerve (figure 5 and Video 1). As you puncture the skin, Inject 3-5cc in the subcutaneous space. This is critical to block superficial nerves in this region, including the palmar cutaneous branch of the median nerve. Then, move your needle >3-4mm deeper through the superficial fascia in the forearm compartment where the median and ulnar nerves reside. Inject the remainder of your 10cc syringe into this space. With a single poke, the ulnar and median nerve distributions should be completely anesthetized.
Now, all that remain are the superficial branches of radial nerves and the posterior interosseus nerve. The superficial branches of radial nerve lie over the anatomical snuffbox. Insert your needle within 1cm of your previously anesthetized skin and blow local anesthesia into the subcutaneous space as you slowly move your needle towards the radial aspect of the wrist until you have a tumescent area of local anesthesia over the snuffbox. For the PIN, which is primarily a motor branch of radial nerve but has some sensory contribution, palpate the distal radial ulnar joint of the dorsal aspect of the wrist. The PIN runs along the interosseous membrane so the needle needs to pass through the deep fascia of the forearm. Inject another 5cc of lidocaine in this location.
Figure 5. Tumescent anesthesia of the median and ulnar nerve 5.
Video 1. Tumescent anesthesia of the hand (courtesy of S. Hurley).
Which approach is better?
No studies have directly compared the two approaches discussed in this article. A recent Cochrane review article reviewed compared US-guided vs. anatomical landmark technique vs. trans-arterial vs. peripheral nerve stimulation for lower and upper limb blocks by trained anaesthetists. They found US-guided had greater success rates, less conversions to general anesthetic, lower rates of parathesias and vascular puncture 7.
A recent small randomized control trial compared US-guided nerve blocks of the forearm to anatomical landmark-based technique and found 14 of 18 ultrasound-guided forearm blocks were successful, as opposed to 10 of 18 for the anatomical technique 3.
Pearl: The tumescent anesthesia technique blocks both smaller and larger nerves of the hand and will likely achieve faster anesthesia compared to nerve blocks of the ulnar, median, and radial nerve. Expect up to an hour for the large nerve blocks to take full effect.
Conclusions
Both methods, US-Guided nerve blocks and tumescent anesthesia are safe, effective, and relatively easy options to achieve complete anesthesia of the hand. For both techniques, remember basic principles for minimizing pain during injection of local anaesthesia to optimize patient comfort and satisfaction 4-6.
References
Amini R, Kartchner JZ, Nagdev A, Adhikari S. 2016. Ultrasound‐Guided nerve blocks in emergency medicine practice. Journal of Ultrasound in Medicine 35: 731-736.
Liebmann O, Price D, Mills C, et al. 2006. Feasibility of forearm ultrasonography-guided nerve blocks of the radial, ulnar, and median nerves for hand procedures in the emergency department. Ann Emerg Med 48: 558-562.
Sohoni A, Nagdev A, Takhar S, Stone M. 2016. Forearm ultrasound-guided nerve blocks vs landmark-based wrist blocks for hand anesthesia in healthy volunteers. Am J Emerg Med 34: 730-734.
Lalonde D. 2016. Wide awake hand surgery, CRC Press, Taylor & Francis Group. Boca Raton, FL.
Lalonde DH. 2010. “Hole-in-one” local anesthesia for wide-awake carpal tunnel surgery. Plast Reconstr Surg 126: 1642-1644.
Farhangkhoee H, Lalonde J, Lalonde DH. 2012. Teaching medical students and residents how to inject local anesthesia almost painlessly. Can J Plast Surg 20: 169-172.
Lewis SR, Price A, Walker KJ, McGrattan K, Smith AF. 2015. Ultrasound guidance for upper and lower limb blocks. The Cochrane Library.
A 16 year old girl comes in by ambulance, after fainting while singing at church on a Sunday morning. Her vitals are: HR 90, RR 16, Temp 36.5, BP 92/64. O2 Sat 99% on RA. On arrival she is alert and looks well. She explains that she stood up to sing, felt lightheaded and then, soon after, lost consciousness. The paramedic lets you know witnesses say she turned ashen grey and sweaty, and was out for about 2 minutes. She had some ‘seizure like activity for 10 seconds’ with a few twitches in different parts of her body. The patient states she was fully recovered within a few minutes. Family history is unremarkable, with no sudden early deaths. Physical examination is also unremarkable. The nurse rolls in an ECG machine to check her rhythm.
What investigations does she require?
Why It Matters?
Pediatric syncope is very common in the emergency setting, accounting for ~1 % of pediatric emergency visits. Between 15 and 50% of children will have at least one syncopal event in their childhood (peaking in adolescence). – It’s a common problem!
The problem?
Historically, working up pediatric syncope has varied widely. ECG use has been routine and some centers have regularly ordered bloodwork, CTs and even EEGs. This onslaught of testing has led to increased hospital costs, stressful false positives for patients and has not improved patient outcomes. Plus, reading pediatric ECGs can be challenging – see the end of this pearl.
A potential solution
In 2017, the Canadian Cardiovascular Society and Canadian Pediatric Cardiology Association published a position statement on an approach to pediatric syncope¹ Full Article – click here
A thorough history and physical can be sufficient in low risk patients – no investigations are required for many pediatric syncope presentations.
Red flags
Lack of Prodrome: warm/clammy sensation, lightheaded ness, visual changes. Having a prodrome is the most important factor in benign syncope
Midexertional syncope; however post exertional syncope (having an opportunity to stop) is typically benign
Chest Pain preceding the event
Prolonged loss of consciousness
Family history of cardiovascular disease/sudden death
Palpitations are common in vasovagal events (although evidence around this not robust)
Involuntary movement is also common in vasovagal syncope. Benign movements can be a muscle twitch to violent jerks of the whole body
Investigative Algorithm
Figure 1. Pediatric syncope investigative algorithm, adapted from Sanatani et al. (2017)
The Evidence
To create this position statement, the Canadian Cardiovascular Society (CCS) performed a literature review of 4307 references, ultimately including 231 articles for full-text review.
Most of the studies referred to in the article are retrospective reviews. Therefore, recommendations in the position statement were mostly graded as ‘Strong recommendation, low level of evidence’. I found the most compelling evidence against routine ECG was the statement: “The ECG was the only indicator of cardiac disease in 5 of 480 patients (1%) and causality could not be determined”.¹ However, they did not list a reference for this statement and I’m not sure what study they drew this conclusion from. I do feel they make a compelling case against over investigation, but as in many areas of medicine, the evidence could be more robust.
Pediatric ECGs – how to interpret?
The nurse hands you the ECG, what features are worrisome on a pediatric ECG?
See following chart from the CCS¹
Figure 2. Pediatric ECG findings in syncope, adapted from Sanatani et al. (2017)
In summary, red light features should prompt an emergent cardiology referral. Yellow light features should prompt a non-urgent cardiology referral while green light features are normal variants and require no further work up.
Case Resolution
There were no red flags, arguably she requires no investigations, not even an ECG. Of course, clinical acumen trumps guidelines, but at least you will be CCS endorsed if you chose to not do any further investigations.
References
Sanatani, V. Chau, A. Fournier, A. Dixon, R. Blondin, R. Sheldon. Canadian Cardiovascular Society and Canadian Pediatric Cardiology Association Position Statement on the Approach to Syncope in the Pediatric Patient. Canadian Journal of Cardiology. 2017; 33: 189-198.
I heard Dr. Dylan Blacquiere speaking on the radio while driving home after one of those busy D2 shifts on Friday, and it really cheered me up to hear him describe how we all in Saint John are leading the way in managing acute stroke care. http://www.cbc.ca/player/play/1152508483846
From EMS, through Emergency Medicine, diagnostic and intervention radiology, internal medicine and neurology, Saint John Regional Hospital (probably more appropriately Saint John University Hospital) provides a world class service for stroke patients in New Brunswick.
This got me thinking about many of the other innovations and ideas that we continue to push forward locally, especially relating to emergency medicine, and how important it is not to let ourselves become disillusioned by busy shifts, perceived administrative inertia, perceived injustices, crowding and many of the negatives we face, and will likely continue to face for sometime.
To name but a few, we can be proud of the integrated STEMI program we have from EMS to Cath Lab, the Point of Care Ultrasound program that leads in this nationally and beyond, the new Trauma Team leadership program, the patient wellness initiatives such as the photography competition corridor that make things just a little brighter for patients, the regionally dominant and growing simulation program, the regional and local nursing education programs, the nationally unique and hugely popular 3 year EM residency program, the impact of our faculty on medical education at DMNB, the leading clinical care provided by a certified faculty of emergency physicians, our website, our multidisciplinary M&M and quality programs, many of the research initiatives underway including development of an ECMO/ECPR program with the NB Heart Centre, improving detection of domestic violence, innovations around tackling crowding, preventing staff burnout, better radiology requesting, encouraging exercise prescriptions, and much more.
I was particularly impressed how Dylan explained the integrative approach that was required to improve stroke care, and how that was achieved here. There are many other areas that we can also improve, innovate and lead in. Every day we see ways to make things better.
I hope that at this point in our department’s journey, we can continue to make the changes that matter, for patients, our departmental staff, physicians, nurses and support staff alike.
I encourage all of us to think of one area we can improve, to plan for change and for us all to support each other to achieve those improvements. Some of our residents are embarking on very interesting projects, such as designing early pregnancy clinic frameworks, models to improve performance under stress, and simulating EMS ECPR algorithms – all new innovations, not just chart reviews of what we are already doing. I encourage us all to support them, and others with these projects, and to begin to create innovation priorities for the department.
The Dalhousie University (DU) Emergency Point of Care Ultrasound Elective and Fellowship Program at Saint John Regional Hospital (SJRH) with an optional up to 1 month placement in Pediatric PoCUS at the IWK Health Centre Pediatric Emergency Department
There are four primary components to the mini-fellowship and fellowship programs:
Clinical: optimizing image acquisition and interpretation skills for both core and advanced emergency and point of care ultrasound applications
Education: developing lecturing and teaching skills by developing an emergency ultrasound lecture portfolio and contributing to the program’s educational mission. Acquiring expertise at bedside ultrasound teaching and assessment.
Administration: understanding the critical components required to run an emergency ultrasound program, set up and deliver educational events/courses and how to best utilize information technologies for image archiving, database management, and quality assurance.
Research: understanding the state of emergency ultrasound research by participating in ultrasound journal club activities and developing an independent research project from its inception to publication.
