Obsessed With Ultrasound

1. Tell us how and why you became interested in ultrasound?
During my Emergency Medicine at Mayo Clinic, I gained exposure to point-of-care ultrasound (POCUS) for procedural guidance. I was immediately drawn to the hands-on and technical aspects of using ultrasound, and began advancing my use for diagnostic shihpurposes. After a few cases of diagnosing acute pathology at the bedside (AAA, free fluid, and DVT to name a few), I was hooked! Following residency, I decided to expand my ultrasound training and pursued an Emergency Ultrasound Fellowship at Yale, while also working toward obtaining my Registered Diagnostic Medical Sonographer (RDMS) certification. Ever since I’ve adopted a liberal use of POCUS in my clinical practice, I can say without a doubt that it’s made me a better Emergency Physician, and I can’t imagine practicing without it!

2. Talk about your role as Program Director of the Emergency Ultrasound Fellowship Program at The Scarborough Hospital in Toronto.
I’m thrilled to be able to bring the skills that I’ve learned during my own EUS Fellowship training to the Emergency Medicine community in Toronto! Our team built the Fellowship Program from the ground up, and our Department went all in with the purchase of 4 additional new ultrasound machines and QPath software for archiving. I’m truly proud of what we’ve accomplished. It certainly helps that I have an extremely supportive Department Chair and 2 amazing fellows this year!

3. What prompted the writing of your book Ultrasound for the Win!?
When trying to learn more about ultrasound myself during residency, I found that there was a void in high-yield POCUS books geared toward Emergency Physicians. I found that the few textbooks that were available, while informative, could be quite dense and intimidating to read. So I decided to develop a book that I, myself, and I believe most Emergency Physicians, would appreciate — a case-based interactive and easy-to-read format that’s clinically relevant to our daily practice. It’s a book that a medical student or resident interested in POCUS can easily read and reference during an Emergency Medicine rotation.

4. What’s one thing you learned about yourself through the writing/editing process?
It’s made me realize just how obsessed I am with ultrasound! Writing and putting together the book was hard work, but also enjoyable and extremely satisfying! Seeing these real cases compiled one after another really highlights the potentially life-saving role of POCUS in medicine, and the profound difference it can make in improving patient care and outcomes.

5. What advice would you offer medical students when it comes to ultrasound?
Scan many and scan often—it’s simple; the more you practice POCUS, the better you will be at it! Also, don’t be afraid to take initiative in your own education—while some attendings may not be comfortable enough with POCUS to teach it to you, don’t let that be a deterrent to your own learning. There’s a plethora of resources available online, including Matt & Mike’s Ultrasound Podcast and Academic Life in Emergency Medicine that you can reference!

How did you become interested in ultrasound? What are your go-to resources? What book would you like to see written? Share your thoughts and ideas here and on Twitter: @AIUM_Ultrasound.

Jeffrey Shih, MD, RDMS, is an Emergency Physician and author of the book Ultrasound for the Win! Emergency Medicine Cases. He is Program Director of the Emergency Ultrasound Fellowship Program at The Scarborough Hospital in Toronto, Canada, and Lecturer in the Faculty of Medicine at the University of Toronto. He can be reached at jeffrey.shih@utoronto.ca and on Twitter: @jshihmd

Pediatric Emergency Ultrasound: We’ve Come a Long Way, Baby

My first rotation as a pediatric emergency medicine (PEM) fellow was on the adult trauma service. It was 2006 and in West Philadelphia there was no shortage of patients with gun shot wounds, stabbings, and motor vehicle crashes. The trauma surgeons were hard on the surgery trainees, and generally nice to the PEM fellows. We weren’t training to be surgeons on the front line after all. One attending, however, was indiscriminate in his wrath and unbiased in his intent to humiliate.

dreamstime_xs_59669332A few days into the rotation, during a trauma alert, he chose me: “Jennifer, the FAST, do the FAST!” I was completely puzzled and looked at him blankly. This, of course, made him angrier. “Do the FAST exam!”

Unable to admit at the time that I had never heard of the FAST exam, I remained silent. Seeking to avoid any fear, shame, or humiliation that would certainly accompany future traumas, I immediately read everything I could about it, and the surgery fellows taught me at the bedside.

I returned to the children’s hospital wanting to learn more about ultrasound. Unfortunately, at the time, no one in PEM knew much about it. In fact, none of my colleagues or mentors had any experience with it. I sought guidance from my general emergency medicine colleagues next door who welcomed me and trained me as one of their own.

In time, I proposed a research study in the pediatric emergency department: point-of-care ultrasound for pediatric soft tissue infections. At the time, the radiology faculty weren’t keen on this. They were unaware of non-radiologists using ultrasound and didn’t understand why emergency physicians would need to use it. It was a slippery slope, they argued, and might result in indiscriminate and “unregulated” usage. We compromised–I could use ultrasound in the emergency department solely for research purposes. The machine, literally under lock and key, was off limits to anyone but those involved in the study.

As I found out, my experience was not unique. Many of my PEM colleagues around the country faced similar obstacles from specialists outside of the emergency department. Point-of-care ultrasound at that time was simply not the standard of care.

Nearly a decade later, I practice in a very different climate. Point-of-care ultrasound is a mainstay in my patient care practice; and I now have the support (and collaboration) of my radiology colleagues and others outside of emergency medicine.

More broadly, PEM ultrasound is a recognized subspecialty. Notably:

  • There are approximately 10 dedicated 1-year fellowships in pediatric point-of-care ultrasound.
  • Pediatric point-of-care ultrasound is part of the American Board of Pediatrics core content for pediatric emergency medicine fellowship training, and has been incorporated into the PEM subspecialty board examination.
  • Landmark publications include the American Academy of Pediatrics Policy Statement and Technical Report for PEM point-of-care ultrasound.
  • There is a PEM ultrasound international organization (www.p2network.com).
  • AIUM invited me to write this blog.

We certainly have come a long way.

Do you have a similar ultrasound story? What other areas have come a long way when it comes to ultrasound? What areas are poised to be next? Comment below or let us know on Twitter: @AIUM_Ultrasound.

Jennifer R. Marin, MD, MSc, is Director of Emergency Ultrasound in the Division of Pediatric Emergency Medicine as well as Quality Director, Point-of-Care Ultrasound at Children’s Hospital of Pittsburgh of UPMC.