Newbie Question

[nvshelat]

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I'll be an MSI in month or so, and I'm interested in EM; I was glancing at scutwork and I noticed a lot of reviews kept mentioning ultrasound training. What exactly is there to ultrasound training in an EM program, and why is it a big deal?

 

[Radiohead]

Ultrasound in the ED is becoming a very important component of residency training. Basically, the ABEM (or whatever governing board) dictates that during residency training you must do something like 40 scans to graduate. In the vast majority of programs you will do many more than 40. In the ED, U/S is a huge diagnostic tool, and if you, the EM doc, know how to use the U/S machine, it will save you alot of time (instead of calling rads) and will make you some extra pocket change, as well. Here are some common situations where an EM doc uses the U/S machine almost every shift: Abdominal Aortic scan, FAST exam in Trauma, Transvaginal for ectopic, Gall bladder scan, central line placement, r/o DVT, among a few others. In addition to U/S training in residency (which varies b/w programs), you can do a 1 year fellowship in ultrasound. There aren't many, and I am not sure how competitive they are. As an incoming EM intern, I am very excited about ultrasound, and believe that down the road it should be mandatory for EM docs to be credentialed in U/S.

 

[Hard24Get]

I'll be an MSI in month or so, and I'm interested in EM; I was glancing at scutwork and I noticed a lot of reviews kept mentioning ultrasound training. What exactly is there to ultrasound training in an EM program, and why is it a big deal?

Probably will get nailed for this 'cause I'm a newbie, too, but watch one of those "reality" EM shows on Discovery Health to see U/S in action - almost as soon as you realize you need to image for bleeding/rupture/mass, especially one that is potentially urgent, you can be doing it yourself! Just when you thought EM couldn't get any cooler 😎

 

[bartleby]

Ultrasound is a "big deal" in that it is one of the newest and coolest tools in your armamentarium as an emergency physician. Particularly as it has become more difficult to get studies like ultrasounds a) on a stat basis and b) 24 hours a day in many places, we have had to update our skills to provide the best care possible for our patients. CT's are great, but there is a reason that they are referred to by some as "A cold, lonely place where sick patients go to die". Ultrasounds enable you to rule out key emergent diagnoses (AAA, hemoperitoneum) at the bedside. Emergency ultrasounds are designed to answer a specific yes/no question (is this patient going down the pipes because of pericardial tamponade or not?) and are not intended to duplicate or replace formal ultrasound studies.

Having said that, ultrasound is useful, but is not the end-all, be-all of your clinical skills. An ultrasound probe does not entitle you to shut off your brain (i.e. you'd still better watch where you're pointing that needle). It's just like central lines. You must know how to do them, as in certain situations they can be a lifesaver, but they're just another tool in the shed at the end of the day.

 

[Ceez]

ultrasound is awesome. have picked up a few gallbladder and kidney stones myself. what a great tool once you learn how to use it properly

 

[USCDiver]

ultrasound is awesome. have picked up a few gallbladder and kidney stones myself. what a great tool once you learn how to use it properly

Picking up gallstones and kidney stones is essentially worthless because many people have either or both kinds of stones asymptomatically. It's the gallbladder wall thickening, common bile duct dilation, hydronephrosis etc that you have to be able to pick up to make the scan diagnostic. This is one of the big limitations of EM U/S; either the equipment isn't powerful enough to get good images (Sonosite) or the operator is too inexperienced.

And I beg to differ with Radiohead. In order to 'pick up some extra pocket change' from doing an ultrasound, you'll have to be credentialled to acquire and interpret images by your hospital. Without formal U/S training and the blessing of the radiology department (HA!) you aren't going to get either. Sure it's helpful in screening people in the department and moving the meat (no more waiting for the rads department to do/read the scan), which will secondarily allow you to see more patients. But it's doubtful you will be able to charge for you scans.

 

[Radiohead]

And I beg to differ with Radiohead. In order to 'pick up some extra pocket change' from doing an ultrasound, you'll have to be credentialled to acquire and interpret images by your hospital. Without formal U/S training and the blessing of the radiology department (HA!) you aren't going to get either. Sure it's helpful in screening people in the department and moving the meat (no more waiting for the rads department to do/read the scan), which will secondarily allow you to see more patients. But it's doubtful you will be able to charge for you scans.

Yes you are correct. Getting "credentialed" is much different than satisfying your residency U/S requirement. But, I would like to tell you about a faculty member who left our institution to go into private practice. He was not U/S fellowship trained, but was "credentialed" and now makes >400,000 because the hospital he works at, and radiology, let him bill for his ultrasounds. Now, you are correct in the fact that Radiology usually has a firm grip on having the sole right on U/S billing, but that is changing with the ever increasing skills that EM docs will possess.