A focus on PoCUS – A reflection on the value of a PoCUS elective as a medical student

Medical Student PoCUS Elective Reflection

Nick Sajko

Class 2019 Dalhousie Medicine

@saj_ko

 

Nick Sajko, reflects on his experience after completing the SJRHEM PoCUS Elective. Nick is now a PGY1 in Emergency Medicine at the University of Alberta.


 

When my fourth and final year of medical school came around, I was at a crossroads: What did I want to do for the rest of my life? As many will attest, this question influences the choices you make in your clerkship years, especially in deciding on fourth year electives. I was ironically unfortunate in the fact that I had a broad range of interests in a system that does not always benefit those in my situation. I chose electives in Emergency Medicine, Internal Medicine, and Family Medicine – all of them providing valuable learning opportunities and a chance to hone my skills as a junior clinician. However, these “classic” or “bread and butter” electives paled in comparison to the experiences I obtained through my Point of Care Ultrasound (PoCUS) elective at SJRH – a unique elective opportunity relevant to any medical trainee.

 

It is my hope that this reflection piece will provide insight into those deciding on their elective choices and convince some of you to choose a few electives that are off the beat and path and unique. In particular, an elective in the field of PoCUS – a tool that is more useful than some may consider.

 


 

What does a PoCUS elective at SJRH entail? What can I expect?

 

My elective consisted of regularly scheduled shifts within the Emergency Department, paired with senior staff who have specialized training in PoCUS. During these shifts, I would see patients as if I was conducting a bread and butter Emergency Medicine elective, however, cases would be chosen based on the potential for ultrasound practice. This allowed me to gain a remarkable appreciation for the breadth of PoCUS applications within the primary care setting, while also allowing me to gain extremely valuable hands on time with ultrasound in a supervised setting.

 

In addition to the above, I was provided with numerous resources so as to allow for self-directed learning. One of the most valuable resources provided was the opportunity to use the SJRH EM state-of-the-art PoCUS simulator – an invaluable tool for any level of PoCUS experience. Closer to the end of this elective experience, I was offered opportunities to write PoCUS focused case-reports, as well as undergo PoCUS competency exams to solidify my skills within this setting.

The skills I learned in this elective carried forward with me into my various other electives, and provided me with a unique skill-set as a junior learner. Whether it was doing point of care ECHO in my cardiology elective, FAST scans during trauma-codes in my other Emergency Medicine electives, or assessing volume status in complex general internal medicine patients, my competency in these PoCUS applications definitely impressed both residents and staff alike during my fourth year!

 


Why is PoCUS relevant to me as a medical student wanting to specialize in: (insert hyper-specific / niche specialty here)

One question many people may have at this point is, “why would I do this if I wasn’t interested in Emergency Medicine?”. PoCUS is a constantly evolving field, with new and innovative applications being seen in clinical practice constantly. With this, PoCUS can play a huge role in many different specialties: Internal Medicine physicians use PoCUS to provide support to presumed diagnoses and perform certain procedures (such as placing central lines), while surgeons can utilize PoCUS in the examination of traumas, as well as to support diagnoses in the pre- and post-operative patient. PoCUS is steadily becoming a sought after skill in most of the medical and surgical specialties, where proficiency in its use and interpretation can set you apart from other trainees, and more importantly, add to the competency of your patient care!

The value of having this elective through the Emergency Department allows for students to test their skills in the undifferentiated patient – something that will provide learners with enhanced deduction and reasoning skills, no matter what specialty they are interested in. It also allows learners to have access to a huge pool of patients, with a wide breadth of medical problems, thus optimizing this unique elective’s value.

 


 

Is choosing a “unique”, “niche”, or “extra-focused” elective, such as PoCUS, detrimental to my CaRMS application?

Fourth year electives and CaRMS amalgamate into a cruel and unusual game – while most medical school staff and administrators will tell you that your fourth year electives are to be used to “try new things”, this is often not the reality. With the competitiveness of specialties on a constant upward trend, more and more learners choose to conduct the majority of their electives in the single specialty they are interested in. This is great for those who are certain about the field they want to practice in, but creates a predicament for those of us who want to explore a number of options before making a decision.

As I mentioned above, I was in the latter group – with interests spanning 3 different specialties, including some very competitive ones. I chose to go against the grain, so to speak, and opted to conduct a variety of electives in different specialties – including some niche electives in things such as PoCUS. Not only were these opportunities fantastic from a learning point of view, I would argue that they allowed me to stand out amongst a sea of similar applicants and provided me with a unique skill set – something that I think most programs will find enticing! But most importantly, they were fun, exciting, and allowed me to experience my fourth year of medical school the way its advertised.

For those that know their specialty of choice, I would provide the same advice – use this year to experience new things and create a unique learning identity that will set you apart from the rest.

 


 

After all the worry and panic with my elective choices, feeling like I wasn’t committed enough to one specific specialty, I ended up matching to my first-choice field and location. I think this is in large part due to the fact that I was well-rounded in my experiences and had taken the chance to explore unique learning opportunities through this fantastic elective at SJRH. The staff, the environment, and the resources that come with the PoCUS elective at SJRH EM are second to none – I am confident in saying that this elective was the most beneficial and enjoyable component to my fourth year training. Hopefully my thoughts and reflections on this experience will allow some of you to follow a similar path.

 

Nicholas Sajko, B.Sc, MD

Emergency Medicine PGY1

University of Alberta

 


 

Click here for more information on the SJRHEM PoCUS Electives and Fellowships

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PoCUS – Dilated Aortic Root

Medical Student Clinical Pearl

James Kiberd

Class 2019 Dalhousie Medicine

Reviewed and Edited by Dr. David Lewis


Case:

A 66 year-old female presented to the Emergency Department with shortness of breath and back pain. She had a known dilated aortic root, which was being followed with repeat CT scans. Given the nature of her presenting complaint, a PoCUS was performed to assess her aorta.

 

 

 

Long Axis Parasternal View:

PoCUS for Cardiac imaging has been studied in the acute care setting; focusing on the assessment for pericardial effusion, chamber size, global cardiac function, and volume status, and cardiac arrest.1

In the setting of acute aortic dissection, further evaluation is often recommended depending on the practitioner’s skill level.2 There have been case reports where ultrasound has been used to assess both Type A and Type B aortic dissections.3–5

In order to assess the aortic root, have the patient in a supine position. Either the phased array or the curvilinear probe can be used depending on examiner’s preference. The probe should be positioned with the marker towards the patient’s right shoulder on the anterior chest to the left of the patient’s lower left sternal border. By tilting the transducer between the left shoulder and right hip, long axis views are obtained at different levels with the goal of identifying four main structures; the aorta, the left atrium, and the right and left ventricles. The parasternal long axis view of our patient is shown in Figure 1, where her aortic root measured 3.83cm.

 

Figure 1: Parasternal Long Axis View of Heart: Patient’s root diameter was found to be 3.83cm.

More generally, this view can be used to assess left ventricular contractility and the presence of pericardial effusion, which were not present in this patient. She went on to have a confirmatory CT scan where her aortic root was found to be unchanged from her last scan and was 3.8 cm in diameter as assessed by PoCUS.

In Summary:

Although not rigorously studied to assess aortic root dilatation at the bedside, we present a case where PoCUS was reliable in the assessment of the aortic root. There have been other cases of aortic dissection identified by ultrasound in the emergency department setting, however confirmatory studies (either CT scan or formal echocardiography) are still recommended.


References:

  1. Labovitz AJ, Noble VE, Bierig M, et al. Focused cardiac ultrasound in the emergent setting: A consensus statement of the American society of Echocardiography and American College of Emergency Physicians. J Am Soc Echocardiogr. 2010;23(12):1225-1230. doi:10.1016/j.echo.2010.10.005.
  2. Andrus P, Dean A. Focused cardiac ultrasound. Glob Heart. 2013;8(4):299-303. doi:10.1016/j.gheart.2013.12.003.
  3. Perkins AM, Liteplo A, Noble VE. Ultrasound Diagnosis of Type A Aortic Dissection. J Emerg Med. 2010;38(4):490-493. doi:10.1016/j.jemermed.2008.05.013.
  4. Bernett J, Strony R. Diagnosing acute aortic dissection with aneurysmal degeneration with point of care ultrasound. Am J Emerg Med. 2017;35(9):1384.e3-1384.e4. doi:10.1016/j.ajem.2017.05.052.
  5. Kaban J, Raio C. Emergency department diagnosis of aortic dissection by bedside transabdominal ultrasound. Acad Emerg Med. 2009;16(8):809-810. doi:10.1111/j.1553-2712.2009.00448.x.
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PoCUS – Pleural Effusion

Medical Student Clinical Pearl

James Kiberd

Class 2019 Dalhousie Medicine

Reviewed and Edited by Dr. David Lewis


Case: 

A 90 year-old male presented with worsening shortness of breath on exertion, crackles bilaterally at the bases on auscultation with known history of congestive heart failure. Bedside ultrasound was performed to assess for pleural effusion

Lung Views:

In order to perform ultrasound of the lungs, there are four views that are obtained (see Figure 1). Place the patient supine. The high frequency linear array transducer is often used, but either the phased array or curvilinear transducers can be used. The first views are taken at both right and left mid-clavicular lines of the anterior chest. With the marker of the transducer pointed toward the patient’s head, a minimum of 3-4 rib spaces should be identified. The next views are of the posterior-lateral chest. The patient can be supine or in the sitting position. It is these views where a pleural effusion can be identified.

Figure 1: Chest views with ultrasound. ‘A’ are anterior chest view positions and ‘B’ are posterolateral view positions

Pleural Effusion

Pleural effusion is assessed by ultrasound placing the transducer in the midaxillary line with the marker oriented toward the patient’s head. On the patient’s right side the diaphragm, the liver, and the vertebral line can be seen. On the left, the diaphragm, spleen, and vertebral line should be in view. In a patient without pleural effusion, one should not be able to visualize the lung as it is mostly air and scatters the sound produced by the transducer. However, in the presence of pleural effusion, the area above the diaphragm is filled with fluid and therefore will appear anechoic. In addition, the vertebral line will be present past the diaphragm as the fluid allows the sound waves to propagate and not scatter. This is known as the ‘spine sign’ (also known as the ‘V-line’). Finally, one is often able to see the atelectatic lung float and move with respirations in the fluid, this is known as the ‘sinusoid sign.’ These are the three criteria outlined by consensus statements in the identification of pleural effusions.1 Occasionally, the area above the diaphragm may look like spleen or liver, but this is known as ‘mirror image’ artifact and is normal.2 Figure 2 shows both the right and left views of our patient.

Figure 2: Pleural effusion showing anechoic pleural fluid, atelectatic lung, and ‘spine sign

Accuracy with Ultrasound

Ultrasound is more accurate than either chest x-ray or physical exam in the identification of small pleural effusions.3 For a chest x-ray to identify fluid there usually needs to be more than 200cc present.2 A meta-analysis found that ultrasound had a mean sensitivity of 93% (95%CI: 89-96%) and specificity of 96% (95%CI: 95-98%).4

 

Our patient went on to have a chest x-ray where he was found to have bilateral pleural effusions (see Figure 3).

Figure 3: Bilateral pleural effusions seen on chest radiography in our patient.

In Summary

Three criteria are used to identify pleural effusion on ultrasound; anechoic fluid above the diaphragm, the ability to visualize the spine above the diaphragm (‘spine sign’), and atelectatic lung moving with respirations (‘sinusoid sign’). Lung ultrasound for the detection of pleural effusion is more reliable to identify small effusions in comparison to both radiography and physical exam.


References:

  1. Volpicelli G, Elbarbary M, Blaivas M, et al. International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med. 2012;38(4):577-591. doi:10.1007/s00134-012-2513-4.
  2. Liu RB, Donroe JH, McNamara RL, Forman HP, Moore CL. The practice and implications of finding fluid during point-of-care ultrasonography: A review. JAMA Intern Med. 2017;177(12):1818-1825. doi:10.1001/jamainternmed.2017.5048.
  3. Wong CL, Holroyd-leduc J, Straus SE. CLINICIAN ’ S CORNER Does This Patient Have a Pleural Effusion ? PATIENT SCENARIO. Jama. 2010;301(3):309-317. doi:10.1001/jama.2008.937.
  4. Grimberg AI, Carlos Shigueoka DI, Nagib Atallah III Á, et al. Diagnostic accuracy of sonography for pleural effusion: systematic review Acurácia diagnóstica da ultrassonografia nos derrames pleurais: revisão sistemática
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ECCU IP School 24th November – New Places Now Available!

Are you finding it difficult to get your supervised scans for CPoCUS Core IP. We are here to help!

We have just been able to open up a few spaces on the ECCU IP School 24th November in Saint John, NB.

CPoCUS IP instructors will supervise up to 90 scans in this 1-day session.

Book Here Now

ECCU IP School – Application and Payment

Staff Physicians – $850

Residents – $550

 

 

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Fall ECCU Conference Workshop – 28th September

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
  • PoCUS hot topics and updates
    • PoCUS in Rural Health
    • Why aren’t you doing THIS with PoCUS?
    • How to be a leader in PoCUS
  • Top PoCUS research
  • IP2 Diagnostic stream lectures
  • Hands-on scanning workshops


  • Choose your own workshop
    • Pediatrics, Cardiac, Lung, IVC, DVT, Gallbladder, DVT, Aorta, FAST, Obstetric
  • CPoCUS approved
  • CCFP CME approved
  • Bring the family and stay for the weekend
    • Top golf resort, whale watching, explore the islands

 

Click Here for More information and Booking

 


 

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Fall ECCU Fest 2018 – PoCUS Conference Workshop and ECCU2 Course

September 27th – 28th 2018

The Algonquin Resort in St. Andrews by-the-Sea, New Brunswick, Canada

Atlantic Canada’s top PoCUS event

UPDATE

 

Now open for applications/booking – Only a few places still available

 

The ECCU Conference is being held in conjunction with the ECCU2 Advanced Applications Course in order to provide those attending the course and other delegates with an opportunity to access an update in the hottest clinical PoCUS topics. The focus will be on presenting the best emerging evidence, strategies for developing a local PoCUS program and developing competencies.

Includes:

  • International PoCUS experts
  • Clinical PoCUS hot topics and updates
  • Top PoCUS research
  • IP2 Diagnostic stream lectures

Conference delegates will have access to the Diagnostic stream lectures of the ECCU2 Advanced Applications Course, which will include an Gallbladder, Renal, DVT and Ocular

Invited Faculty – 2018

Dr. Hein Lamprecht – South Africa – (ECCU Fest 2018) – PoCUS Educator Extraordinaire – IFEM – WinFocus

Dr. Peter Croft – USA – (ECCU Fest 2018) – New England PoCUS disrupter –past MGH PoCUS Fellow

Dr. David Mackenzie – USA – (ECCU Fest 2018) – Canadian New Englander, PoCUS innovator – past MGH PoCUS Fellow

 

Also our top Dalhousie Faculty of PoCUS Experts

 


 

Open for applications and booking: More Information Here

 

There are only 2 places left on the 2 day Advanced Apps ECCU 2 course, however we still have good availability for the 1 day conference workshop

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Infectious flexor tenosynovitis

“Don’t pull my finger!” – a case of flexor tenosynovitis.

Resident Clinical Pearl (RCP) – July 2018

Mandy Peach – FMEM PGY3, Dalhousie University, Saint John NB

Reviewed by Dr. David Lewis

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
  • Pain with passive extension
  • Tenderness along the tendon sheath

Figure 1: Sketchy Medicine – Flexor Tenosynovitis http://sketchymedicine.com/2012/10/flexor-tenosynovitis-kanavels-signs/

 

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:

  1. 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.
  2. Flexor Tenosynovitis (Karavel’s signs). Sketchy Medicine. Retrieved from http://sketchymedicine.com/2012/10/flexor-tenosynovitis-kanavels-signs/ June 12, 2018.
  3. Tintinalli, JE. (2016). Flexor Tenosynovitis (8th ed.) Tintinalli’s Emergency Medicine: A Comprehensive Study Guide (page 1922). New York: McGraw-Hill.

 

 

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PoCUS and Clavicle Fractures

Using PoCUS to diagnose clavicular fractures

Medical Student Clinical Pearl – May 2018

Danielle Rioux – Med III Class of 2019, Dalhousie Medicine New Brunswick 

Reviewed by Dr. Mandy Peach and Dr. David Lewis

Case: A 70 year-old man presented to the emergency department with pain in his left shoulder and clavicular region following a skiing accident. He slipped and fell on his left lateral shoulder while he was on skis at the ski hill. He has visible swelling in his left shoulder and clavicular region, and was not able to move his left arm.

On exam: The patient was in no sign of distress. He was standing and holding his left arm adducted close to his body, supporting his left arm with his right hand. There was swelling and ecchymosis in the left clavicle, mid-shaft region, with focal tenderness. On palpation, there was crepitation, tenderness, swelling, and warmth in this region. He was unable to move his left shoulder due to pain. His neurovascular exam on his left arm was normal. Auscultation of his lungs revealed normal air-entry, bilaterally and no adventitious sounds.

Point of Care Ultrasound (PoCUS): We used a linear, high-frequency transducer and placed it in the longitudinal plane on the normal right clavicle (see Image 1.), and the fractured left clavicle (see Image 2.). Image 3 shows the fractured clavicle in the transverse plane.

Image 1. PoCUS of normal right clavicle along the long axis of the clavicle (arrows depict the hyperechoic superficial cortex with deep acoustic shadowing).

Clip 1. PoCUS of normal right clavicle along the short axis of the clavicle. The transducer is moving from the lateral to medial, note the visible hyperechoic curved superficial cortex and the subclavian vessels at the end of the clip. 

Image 2. PoCUS of normal right clavicle along the short axis of the clavicle (arrows depict the hyperechoic superficial cortex with deep acoustic shadowing).

Image 3. PoCUS of a fracture in the left clavicle along the long axis of the clavicle

Clip 2. PoCUS of a fracture of the left clavicle, viewed in the long axis of the clavicle. Compare this view with image 1.

Clip 3. PoCUS of a fracture in the left clavicle viewed in the short axis of the clavicle. Compare this view with Clip 1. Note the fracture through the visible cortex and the displacement that becomes apparent halfway through the clip.

Radiographic findings: Radiographic findings of the left clavicle reveal a mid-shaft spiral clavicular fracture.  (Image 4).

Image 4. Radiographic image of fractured left clavicle.

 

Take home point: Research has shown that Ultrasonography is a sensitive diagnostic tool in the evaluation of fractures (Chapman & Black, 2003; Eckert et al., 2014; Chen et al., 2016).

This case provides an example of how PoCUS can be used to diagnose clavicle fractures in the emergency department. In a rural or office setting where radiography is not always available, PoCUS can be used to triage patients efficiently into groups of those with a fracture and those with a low likelihood of a fracture. This would enable more efficient medical referrals while improving cost-effectiveness and patient care.

References:

Chapman, D. & Black, K. 2003. Diagnostic musculoskeletal ultrasound for emergency physicians. Ultrasound, 25(10):60

Eckert, K., Janssen, N., Ackermann, O., Schweiger, B., Radeloff, E. & Liedgens, P. 2014 Ultrasound diagnosis of supracondylar fractures in children. Eur J Trauma Emerg Surg., 40:159–168

Chen, K.C., Chor-Ming, A., Chong, C.F. & Wang, T.L. 2016. An overview of point-of-care ultrasound for soft tissue and musculoskeletal applications in the emergency department, Journal of Intensive Care, 4:55

This post was copyedited by Dr. Mandy Peach

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Fall ECCU Fest 2018 – PoCUS Conference Workshop and ECCU2 Course

September 27th – 28th 2018

The Algonquin Resort in St. Andrews by-the-Sea, New Brunswick, Canada

 

Atlantic Canada’s top PoCUS event

 

Now open for applications/booking

 

 

The ECCU Conference is being held in conjunction with the ECCU2 Advanced Applications Course in order to provide those attending the course and other delegates with an opportunity to access an update in the hottest clinical PoCUS topics. The focus will be on presenting the best emerging evidence, strategies for developing a local PoCUS program and developing competencies.

Includes:

  • International PoCUS experts
  • Clinical PoCUS hot topics and updates
  • Top PoCUS research
  • IP2 Diagnostic stream lectures

Conference delegates will have access to the Diagnostic stream lectures of the ECCU2 Advanced Applications Course, which will include an Gallbladder, Renal, DVT and Ocular

Invited Faculty – 2018

Dr. Hein Lamprecht – South Africa – (ECCU Fest 2018) – PoCUS Educator Extraordinaire – IFEM – WinFocus

Dr. Darryl Wood – UK/South Africa – (ECCU Fest 2018) – PoCUS bushcraft on the frontline

Dr. Peter Croft – USA – (ECCU Fest 2018) – New England PoCUS disrupter –past MGH PoCUS Fellow

Dr. David Mackenzie – USA – (ECCU Fest 2018) – Canadian New Englander, PoCUS innovator – past MGH PoCUS Fellow

 

Also our top Dalhousie Faculty of PoCUS Experts

 


 

Open for applications and booking: More Information Here

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Great ideas and making things better

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.
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New – Dal SJRHEM PoCUS Fellowship/Elective

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:

 

  1. Clinical: optimizing image acquisition and interpretation skills for both core and advanced emergency and point of care ultrasound applications
  2. 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.
  3. 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.
  4. 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.

 

For more information click here

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