Western Mass Emergency Ultrasound
Welcome EM Residents!
Here you will find all the information your need for your Emergency Ultrasound Rotation.
Please read of all the following sections on this page before your first day.
Helpful links are located to the right.
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Menu:
Welcome:
Welcome to the Emergency Ultrasound Rotation at Baystate Medical Center! Your coordinator is Carla Sterling, MD.
If you have difficulty with the website or accessing any of the documents or links, please email michele.schroeder@bhs.org and we will look into the issue.
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You should have received a welcome email from us, please save the email as it contains the contact emails for the fellows and ultrasound faculty.
Preparation:
Please try to watch all of the videos at www.emergencyultrasoundteaching.com - This site teaches the cardiac ultrasound differently, so for cardiac, watch the video at https://www.youtube.com/watch?v=E8QjRlvlfNg. You should watch these videos before the start of the rotation. Please try to find time to watch each video a SECOND time during week 2 or 3, you get more out of the videos after you have practiced a little.
Scanning Expectations:
During this month, you are expected to practice and obtain competency in the basic emergency applications of ultrasound. Like any other rotation, you are expected to be working 40 hours a week (including conference times). Most rotators do 9am to 5pm on weekdays, however, the times you are scanning are up to you- if you would rather do night shifts or evening shifts, or come in on a weekend day instead of a weekday, that is perfectly fine, HOWEVER, you must be present during the times the fellows and/or attendings designate to scan with you during the week.
At the end of each week, you will be expected to have completed a certain number of each type of scan, with an overall goal of 25 of each scan by the end of the month (please see “Ultrasound Rotation Goal Numbers 4-Week Version”. For those of you with a vacation during the block, please use “Ultrasound Rotation Goal Numbers 3-Week Version”. For each type of study, there are a set of minimum views which MUST be obtained in order to get credit for credentialing. Please see the cheat sheet “Image View Requirements”.
You are required to scan with each fellow for at least 2 hours a week. The fellows are required to do a certain number of hours on their own for their fellowship requirements, therefore the fellows will be putting in parentheses on their scanning blocks on the EM Ultrasound Calendar the 2 hour block that they are expecting you to be scanning with them (see screenshot below). If there is nothing in parentheses, they do not have a planned scanning session with you that day. If the fellows are in the department to do their own scanning for the fellowship, they are available to answer the occasional question or help with a scan, but please limit interruptions- they have certain obligations to the fellowship that they are responsible for. They have been given the dates that you are unavailable, however, if there is scanning shift that you will NOT be able to attend, please email the fellows ASAP and CC Dr. Sterling on the email). Be sure to check the schedule EVERY DAY, as changes in the scanning shifts may change throughout the month.
You also have access to the ultrasound faculty's schedule, so if you prefer to scan when one of us is working you can do so.
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You may also be scanning with an Ultrasound Faculty Attending during your rotation. Again, if you are unable to attend these sessions please email the attending ASAP and CC Dr. Sterling on the email, as the attendings are often coming in solely for the purpose of scanning with you.
There may be other ultrasound-related appointments on the schedule. If you are expected to be there, it will say “ROTATORS. If not (e.g. for a division meeting), it will not say “with rotators”. You are only expected to go to the sessions that say “ROTATORS”. You are expected to go to all Ultrasound Conferences as well.
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Screenshot example of scanning calendar
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You are not required to scan on the weekends, however, you are welcome to do so if you want some week time off.
PLEASE LOG IN AND OUT OF YOUR PAGERS, SO PEOPLE KNOW WHEN YOU ARE AVAILABLE FOR ULTRASOUNDS.
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These are members of the ultrasound division and/or non-division members who are ultrasound fellowship trained.. Feel free to seek them our for help when you are on shift.
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Ultrasound Division:
Gavin Budhram (Emergency Ultrasound Division Director) gavin.budhram@baystatehealth.org
Jeff Dan (Associate Division Director, Associate Fellowship Director) jeffrey.dan@baystatehealth.org
Julien Ginsberg-Peltz (Pediatric Emergency Ultrasound)
Michele Schroeder (Ultrasound Fellowship Director) michele.schroeder@baystatehealth.org
Carla Sterling (Ultrasound Rotation Education Coordinator) sterling.carla@gmail.com
Zach Testo zachary.testo@baystatehealth.org
Nadia Villarroel (Ultrasound Research)
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Ultrasound Fellowship Trained:
Tala Elia
Elizabeth Schoenfeld
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This year (2023 - 2024), we have three ultrasound fellows who also act as Assistant Ultrasound Rotation Education Coordinators
Danielle Aston
Luca Tomasi
Michael Zampi
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Conferences:
Ultrasound conference dates are posted to the Ultrasound Calendar. They usually occur on the 2nd and 4th Thursdays of the month from 11am to 3pm. If you double click on the blue box labeled “UItrasound Conference” on the calendar, a list of the topics and assignments for that week will appear. You are expected to attend all conferences unless they fall on one of your clinic or academic days.
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Conferences may be either in-person or remotely via zoom- this should be detailed on the Ultrasound Calendar. If you are unsure if you need to be there in person or not, please email Michele Schroeder at michele.schroeder@baystatehealth.org.
Presentations:
You will be expected to give a 10-20 minute case during conference. Check the Ultrasound Calendar to see which conference you will be presenting at. It does not have to be a groundbreaking issue - it can be as simple as differentiating cellulitis from abscess using ultrasound. The idea is to use a question or case you have had during your first 2 weeks and do a literature search to answer that question. Please make sure you know how to get ultrasound clips off Ultralinq - we can help you. You can also refer to the document “Ultralinq Exporting Images and Clips”. Please make sure you use at least 3 articles in answering your question - this is supposed to be an evidence-based talk. Feel free to ask us about it. Please work out computer glitches before your presentations, we can help.
Journal Club:
Ultrasound Journal Club is every other month at one of the faculty's homes in the evening. Dinner will be provided. A journal club may or may not fall during your rotation, please check the Ultrasound Calendar. You will be emailed the journal article that you are responsible for reviewing. You do not need to do a powerpoint presentation, but you will be verbally reviewing the article. Please see “Journal Club Lit Review Guide” to help you in organizing your review of the article if needed.
Curriculum:
The month will be split up into 4 blocks of curriculum (or 3 if you have a vacation week). Please see "Curriculum".
Each week you will be expected to read the assigned chapters in Ma & Mateer’s Emergency Ultrasound. The book is available in a digital version by going to Kindle Cloud Reader on your web browser. The login name is “baystateemultrasound@gmail.com” and the password is “Ultrasound1”. PLEASE DO NOT DOWNLOAD THE KINDLE EDITION TO YOUR DEVICE, AS THERE IS A LIMIT TO THE NUMBER OF TIMES THIS CAN BE DONE. PLEASE ONLY READ THE BOOK IN THE KINDLE CLOUD READER THROUGH A WEB BROWSER. I can also give you a hard copy version of the book if you prefer.
Scanning patients:
When you first come in to the ED, go to each pod and let the residents, PA’s, and/or attendings know you are ultrasounding and to page or cortext you if they have any scans they need done. If there are no scans needed by residents, look at the FirstNet tracking board for likely candidates (abdominal pain, chest pain, SOB). Make sure to check with both the resident or attending AND the patient to get permission to do these types of “educational” ultrasounds. You can often do more than one study on each patient, for example, it is easy to get a FAST, renal, gallbladder, and transabdominal pelvic all on one patient with abdominal pain. Patients that you are scanning will often ask you about test results, diagnoses, and plans. DO NOT TELL THE PATIENT ANY OF THIS INFORMATION!. Tell the patient you are only there to perform the ultrasound, but you will let their primary doctor know that they are requesting an update.
When scanning a patient, you must enter the patient’s first and last names, MR number, and DOB. You also need to enter your Ultralinq username into the “Reading Dr” or "Performing Physician" field (for most of you this is your first initial and last name, e.g. for John Doe, it would be jdoe).
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Label your scans liberally (e.g. PSL for parasternal long, CBD for common bile duct, etc).
For the most part, video clips are preferred to still images, as still images can be hard to interpret (exceptions include whenever you’re measuring something, just save images of those).
Sometimes the machines’ storage gets filled up, and when that happens the machine may ask you if you want to “delete archived items”. ALWAYS SAY NO, ONLY ULTRASOUND DEPARTMENT FACULTY OR FELLOWS SHOULD BE CLEARING THE MACHINES. If the machines are full, or the images aren’t crossing over to ultralinq, the best thing to do is email all of us in the ultrasound department, and the first one of us who is next in the department will address the issue.
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It is a good idea to keep track of your scans yourself. You can print a log here. This way, you can make sure you know which exams to duplicate. Also, occasionally there is a glitch with the online image storage system, so if images or lost, you have a records of the ones you did. Lastly, the log can make it easier when you go to fill out the Ultralinq worksheets.
PLEASE MAKE SURE TO LEAVE AT LEAST ONE MACHINE IN EACH POD FOR OTHER PEOPLE TO USE.
Billing and Documentation:
If a resident requests that you perform an ultrasound, ask them if they would like you to bill for the study and write a note in FirstNet. NEVER bill for a study until you have confirmed that the requesting attending or resident wants you to. If you are scanning with a fellow, you can forward the note to them to sign (IF THAT’S OK WITH BOTH THE REQUESTING ATTENDING/RESIDENT AND THE FELLOW). See “Billing and Documentation” for instructions on how to order the scan and write the note in FirstNet. ALL scans that you do as part of patient care (those that are not purely educational) during your ultrasound month should be reviewed by either the resident or attending; providers should NOT be basing patient care on your scans unless they have personally reviewed the images with you. If you have ANY concerns that your images are not of sufficient quality to make a reliable clinical decision, please let the provider know and they can decide whether they want to repeat the scans themselves. If you have ANY concerns about the way providers are using your scans please let Dr. Sterling know IMMEDIATELY, so it can be addressed in a timely manner. If you are doing a scan purely for educational reasons, and you discover an “incidental” finding, YOU MUST NOTIFY THE RESIDENT OR ATTENDING CARING FOR THE PATIENT.
Submitting scans for credentialing:
During your orientation we will go over how to use Ultralinq, which is the online image storing and documentation system. You can also refer to the document “Ultralinq General Instructions”. You do NOT need to log your ultrasounds in New Innovations. All the credentialing for our residency is done through Ultralinq.
In addition to scans that you perform yourself, you can submit for review scans done as a group by the ultrasound rotators - for example, if you are scanning with a fellow and another rotator, only one physician’s name can be entered into the machine for each patient. Keep the pt’s MRN or patient sticker, and log in to Ultralinq to duplicate the exam so that you can submit it for credentialing as well. See “How to Duplicate Exams” for instructions on how to duplicate studies. HOWEVER, AT LEAST 50% OF YOUR SUBMITTED SCANS FOR THE MONTH NEED TO BE PERFORMED BY YOU PERSONALLY. You will be required to submit a certain number of scans each week through Ultralinq which will then be reviewed by the fellows and/or faculty. Keep up with logging your scans - "read" your scans and fill out the worksheets EVERY DAY so you don’t get behind, and so you get feedback in a timely manner.
The fellows and/or attendings will be reviewing scans submitted for credentialing. You will sometimes received feedback on your scans sent to the email account that you used when we set up your ultralinq accounts. When you received these emails, click on the link and scroll to the bottom of the worksheet where the person who over-read your exam will put in comments about issues they had with your study. It will also say whether or not you received credit for the ultrasound. If you have questions for the reviewer, you can't reply to the email from Ultralinq. Just forward the Ultralinq email to the reviewer along with your question.
Every now and then, there’s a glitch with the cloud-based image storage and the images aren’t transmitted to Ultralinq. If you notice that no studies are crossing over, or if there is a problem with a specific machine, please email the fellow and/or Dr. Sterling so we can take care of the problem as soon as possible.
***Ultralinq is not smart enough to give you credit for each leg when you do a DVT study or for each eye when you do an ocular study. Therefore, in order to get credit for both legs and both eyes, duplicate the study and fill one worksheet out for the left and one for the right.
Monitoring your credentialing progress:
Once your scan has been approved for credit, it will show up on Ultralinq under the tab “Credentialing Progress”. You can check your progress from time to time to see which of the studies you need more of. Just remember that only those studies that have been reviewed and approved by the fellows or attendings will show up under Credentialing Progress, so there may be a few days’ lag between when you’ve submitted them for review, and when they show up under your Credentialing Progress tab.
Keeping a log of all your scans will give you a more current idea of your numbers. You can also sort your scans on ultralinq by exam type, so if you want to know how many cardiac exams you have done, for example, you can sort by just cardiac exams.
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Machine Stocking and Care:
During your rotation you will be responsible for keeping the machines stocked. There should be diagram and list of items taped up in room 1406 (the airway cart room, in the hall across from pod C). You can also refer to the “Ultrasound Cart Stocking Guide”.
You will also be responsible for making sure the machines are kept clean. Ideally, the providers will clean the machines after use, but they need a routine cleaning of gel and other materials off the probes, machine, and base. This should be done at least every week, but during the rest of the week when you grab a machine to use, please take a moment to clean it if needed.
We hope you have a great rotation, feel free to contact us with any issues or questions!
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