POCUS Learning Modules

MODULE 12:  Emergency Medicine US

Curriculum Location: TCH Urgent Care/Emergency Medicine Rotation / Total Time: 2 hour

For this and all other modules, you are welcome and encouraged to take notes as helpful to you in your Ultrasound/POCUS for Family Medicine Evernote Notebook, found here. 

Learning Module Objectives:

  1. Synthesize previously learned ultrasound scan competencies by describing (and observing and/or applying as the rotation allows) common validated emergency medicine protocols of eFAST (Extended Focused Assessment with Sonography for Trauma) and RUSH (Rapid Ultrasound for Shock and Hypotension).

  2. Utilize ultrasound to evaluate the lower extremity for proximal deep vein thrombosis.

eFAST Scan (Time: 30 minutes)

  1. Background Case: A 30 year old female is brought in by family to your rural clinic following a bike accident approximately 20 minutes ago. She complains of mild headache and mild abdominal pain. She does not recall details clearly regarding the mechanism of her landing, but does recall swerving to dodge a dog and then losing control just prior to wrecking. She was not wearing a helmet. A neighbor saw the accident from a distance and ran to help. He states she was unconsciousness for approximately 2 minutes and has had no emesis. She appears tired but lucid. VS show a HR 110, BP 110/70, GCS=15. She has a small laceration on her frontal parietal skull that requires suturing, but there are no skull deformities/step-offs or exposure of the galea. She has mild abdominal tenderness in the LUQ with ecchymosis in the left flank. By Canadian Head CT Rules, she does not need a Head CT, but you wonder if you should transfer her to an ER for surgical evaluation of her abdomen. You decide to use the eFAST Protocol to inform your decision. What is eFAST used for? How is it used? Would use of POCUS affect management?

  2. Assignments:

    1. First, read through this ACEP summary of eFAST scan. Be sure to understand the big picture of the key views and approaches to each; take time to understand each picture and click on video links. Also, reference this Evernote and consider adding your own notes to it.

    2. Next, watch the first video in Dr Perera’s Soundbytes FAST scan series, RUQ (5 minutes). It is recommended, but not required, that you watch the other video’s as well: 1) RUQ; 2) RUQ Abnormal; 3) LUQ; 4) Suprapubic

RUSH (Rapid Ultrasound for Shock and Hypotension) Protocol:

  1. Background Case: A 65 year old male with a PMH of smoking, COPD, CAD, and no primary care in the last 5 years, presents to the E.R. after his spouse called 911 when she found him lying in the kitchen, confused, diaphoretic, and slightly short of breath. On exam, his vital signs include: T 99.5F, HR 110, RR 24, BP 85/55, SaO2 94%. You start IV fluids, and sepsis and cardiac protocols. How can POCUS be used to augment your physical exam and rule-out additional causes of hypotension/shock?

  2. The RUSH Protocol utilizes ultrasound to provide extra information for the evaluation of the hypotensive patient. While many of our POCUS modules involve watching video, RUSH involves cobbling together many of the other POCUS skills you’ve learned elsewhere. The article by Seif et al published in 2012 provides an excellent, well-organized summary of the RUSH protocol with superb pictures. Please read this article in its entirety. (And here’s the link to the Evernote on RUSH for future reference.)

DVT Scan (Time: 30 minutes)

  1. Background Case: PENDING

    1. Introduction: Read this Case Summary and accompanying Case Questions for a brief example of how POCUS applies to family medicine regarding 2-zone compression DVT ultrasound.

    2. Case description:

    3. Case Questions:

  2. Assignments:

    1. PENDING

    2. In the meantime, here are a few links you may find helpful:

      1. USC (6m): https://www.youtube.com/watch?v=M0JmjOOg10M

      2. SonoInternist (15m) https://www.youtube.com/watch?v=T4laNiWFdJM&t=11s

      3. iUSC (13m – OPTIONAL) https://www.youtube.com/watch?v=0czlSbmYvFc

      4. https://www.youtube.com/watch?v=0czlSbmYvFc&t=7s

Module QUIZ (No quiz yet; Yer off the hook!) (Time: 10 minutes)

  • Congratulations on completing the module. Please click HERE to take your Module Quiz and provide Module feedback.