USSST

Campbelltown ED

US Special Skills Term

By the end of the 6-month placement, the trainee should,

LO1.  Be able to list, describe and discuss theoretical principles related to:

  • Clinical Governance 
  • Ultrasonography Physics
  • Instrumentation and Knobology
  • Ultrasonography disinfection and hygiene standards
  • Point of Care Abdominal Aorta Ultrasonography
  • Extended Focused Abdominal Sonography in Trauma
  • Focused Echocardiography in Life Support
  • Point of Care Lung Ultrasonography
  • Procedural Guidance related to Emergency Medicine
  • Proximal DVT Ultrasonography
  • Biliary Ultrasonography
  • Renal Tract Ultrasonography
  • Early Pregnancy (Viability scan)
  • Bowel Ultrasonography
  • Ocular Ultrasonography
  • Musculoskeletal and Soft Tissue Ultrasonography
  • Integration of ultrasonography in shock and hypotension (RUSH Protocol)

LO2. Have logged more than 400 proctored scans, as per ACEM or equivalent standards i.e., ASUM (CCPU), ULA including:

  • At least 15 accurate AAA scans and 3 positive for aneurysm.
  • At least 25 accurate E-FAST scans and 5 positive i.e., Pneumothorax, Pericardial / Pleural / Intra-peritoneal free fluid.
  • At least 25 accurate FELS scans with at least 5 performed in shock, peri-arrest or arrest patients. At least 2 cases of PE, pericardial effusion, shock and LVF. Review of at least another 25 scans.
  • At least 25 accurate Basic Lung scans with 5 positive i.e., Pneumothorax, PE, Pleural effusion, Interstitial syndrome, Pneumonia.
  • At least 25 ultrasound guided procedures of adequate mix and at least 3 out-of-plane and 3 in-plane
  • At least 15 accurate proximal DVT scans with 3 positive for DVT (thrombus, non-compressible vein)
  • At least 25 accurate early pregnancy viability scans with 10 intrauterine pregnancies, 5 viable, and 3 abnormal
  • At least 25 accurate biliary scans with at least 50% showing CBD measurement, 5 showing gallstones, and 2 demonstrating CBD dilatation
  • At least 25 accurate renal scans with 5 demonstrating hydronephrosis, hydroureter or calculi
  • At least 25 accurate bowel scans with 5 demonstrating appendicitis, 5 demonstrating diverticulitis and 5 demonstrating bowel obstruction
  • Exposure to ocular, musculoskeletal and testis / ovary ultrasonography, and ultrasound related to advanced airway management

LO3. Be able to demonstrate competency in the following core scans, in accordance with ACEM or equivalent standards i.e., ASUM (CCPU), ULA:

  • Abdominal Aorta Ultrasonography
  • Extended Focused Abdominal Sonography in Trauma
  • Focused Echocardiography in Life Support
  • Basic Lung Ultrasonography
  • Procedural Guidance
    • PIVC insertion (in-plane, out-of-plane)
    • CVL insertion
    • Arterial line insertion
    • Pleural drain insertion
    • Basic regional anaesthesia techniques
    • Abdominal paracentesis
    • Arthrocentesis
    • Abscess incision and drainage
    • Soft tissue foreign body removal

LO4. Be progressing towards demonstrating competency in the following advanced scans, in accordance with ACEM or equivalent standards i.e., ASUM (CCPU), ULA:

  • Proximal DVT Ultrasonography
  • Biliary Ultrasonography
  • Renal Tract Ultrasonography
  • Early Pregnancy viability scan
  • Bowel Ultrasonography

LO5. Have completed a distinct project in Ultrasound in ED, including an audit, survey or chart review, every 3-months, and present the findings at M&M.

LO6. Have completed additional administrative aspects, i.e. machine maintenance, QA/QI, teaching, research, IT infrastructure and interdepartmental meetings, related to focused ultrasound services in the department.

LO7. Have also completed 2x ITA assessments (1x every 3-months) and a learning development plan.

The following LOAs clearly outline and describe how trainees will achieve each of the LOs during the 6-month placement.

LOA 1 – Learning Development Plan & Theoretical Knowledge

Expected to be completed within the first week of placement: 

  • Orientation to term
  • Develop Learning Development Plan (Template in OneDrive Folder)
  • Understand Roles & Responsibilities

Learning Development Plan

  • Template in OneDrive Folder
  • Add meetings with supervisor
  • Add completion dates for course, ACEM policy review and online modules
  • Add completion dates for proctored scans, procedural competencies and assessments
  • Add ACEM Mandated Projects and Administrative Requirements and completion dates

Expected to be completed within the first 2-months of placement:

  • Review ACEM Policies and enter date of completion into LDP
  • Understand ACEM and ASUM credentialing requirements
  • If interested, register with ASUM, enroll in CCPU and complete physics module
  • Complete online learning modules (ACEM / Core)

Qualified Course

  • Qualified course i.e., Sono-Town, RPA Critical Care Sonography, AIU, ASMI
  • Completed prior to commencement of term or within 3-months of commencement

Online Textbooks and Resources

  • A collection of online textbooks and resources are available to assist you with your placement. See Resources tab.

LOA 2 – Proctored Scans & Logbook

ACEM requires you to have completed and logged at least 400 proctored scans over 6-months.

You will be required to log your scans in the Campbelltown E-logbook. This allows trainees to log scans at the bedside using their phone. Logged scans can then be extrapolated into an excel spreadsheet which you can add to your CV and submit to ACEM / ASUM for credentialing purposes.

The number of scans and pathologies can be found in the ‘Learning Outcomes’ and ‘Curriculum’ tabs.

We expect you to have achieved the following:

  • At least 50% core scans by 3-months
  • At least 50% advanced scans by 4-months
  • 100% core scans and at least 75% advanced scans by 6-months

ACEM / ASUM credentialing

  • Information and credentialing requirements for different institutions can be found in the ‘Credentialing’ tab.
  • All proctored scans should be clinically indicated and compared to a gold standard.
  • All proctored scans should be logged in your E-logbook and completed milestones entered into your LDP.

LOA 3 and LOA 4 – Assessments & Credentialing

Assessment Forms

  • We will be using the ASUM CCPU assessment forms to assist you with obtaining CCPU in addition to recognition via ACEM pathway.
  • Found in OneDrive Folder

Complete 2x Formative and 1x Summative Assessment for the following scans:

  • AAA
  • EFAST
  • Basic Lung
  • FELS
  • Procedural Guidance
  • Proximal DVT
  • Renal Tract
  • Biliary
  • Early Pregnancy Viability Scan
  • Bowel

Formative Assessments expected to be completed at:

  • 1st formative assessment at 2-months
  • 2nd formative assessment at 4-months

Summative Assessment

  • Performed on or within completion of required number of proctored scans

LDP

  • Update LDP with dates of completion throughout placement

LOA 5 – ACEM Mandated Projects

Mandated projects which need to be completed by the end of the placement include:

  • 1x audit, survey or chart review every 3-months
  • Findings presented at M&M

Examples for subject matter 

  • Machine maintenance, disinfection and hygiene
  • % images labelled and reviewed
  • %images transferred and stored securely
  • % images comparison to gold standard
  • % scans reported in patient notes
  • FIB / SAPB KPIs compared to national standards (training, credentialing, performed, time, complications)
  • % credentialed staff in department
  • % ACEM members completed ACEM modules

The CLUS and US committee members will assist you with this process.

An activity log and dates of completion should be entered into your LDP.

More information can be found under ACEM Mandated Projects and Administrative requirements tab.

LOA 6 – ACEM Administrative Requirements

Administrative requirements which need to be completed by the end of the placement

You are required to complete at least 2 additional administrative aspects of focused ultrasound in the department. At Campbelltown this includes:

Clinical Governance

  • Weekly machine maintenance, hygiene, disinfection and equipment stocking.
  • Transfer, review, store and archive images every 2-weeks.

Scholarship & Teaching

  • Facilitate at least 4x sessions
    • Medical students, JMOs, Nurses – Vascular access
    • Registrars – Procedural Guidance & POCUS
  • Develop and distribute US case of the month (at least 4)
  • Attend Sono-Town as participant or faculty member if qualified course completed

Research

  • Involvement in 1x research project and present findings (Department, ACEM ASM)
  • Perform literature review and present findings at journal club (FACEMs / Registrars)

Quality Assurance and Quality Improvement

  • Involvement in at least 1x QA / QI project (development of a model of care / policy / clinical business rule)
  • Present audit / survey/ chart review findings at M&M
  • Participation in interdepartmental meetings
  • Facilitate credentialing for other trainees / nurses
  • Participation in currency and maintenance of IT infrastructure (Sono-Town online material, EMR reporting templates, Education website US tab)

    The CLUS and US committee members will assist you with this process.

    An activity log and completion dates should be entered into your LDP.

    More information can be found under ACEM Mandated Projects and Administrative requirements tab.

    LOA 7 – ACEM Term Requirements

    ITA

    • You will complete 1x ITA every 3-months with the CLUS +/- DEMTs.

    Learning Development Plan (LDP)

    You will develop and complete a LDP demonstrating

    • Meetings with supervisor
    • Completion of required online learning modules
    • Logged proctored scans
    • Completed assessments
    • Completed mandated projects
    • Completed administrative requirements

    This will be signed by the CLUS, in addition to an excel spreadsheet of your logbook, which will then be submitted to ACEM +/- ASUM.

    Overview

    During your placement with us, the following curriculum will be covered through:

    • Orientation to placement
    • Completion of a qualified course
    • Review of ACEM Policies and Guidelines
    • Completion of online learning modules
    • Review of the literature
    • Performing and logging proctored scans
    • Reviewing scans with the CLUS
    • Completion of Formative and Summative Assessments
    • Participation in ACEM mandated projects
    • Participation in ACEM administrative requirements
    • Completion of ITAs
    • Development and completion of a learning development plan

    Curriculum

    1. Emergency Medicine College Recommendations

    1. ACEM Policies
    2. ACEP Policies

    2. Core Principles of POCUS

    1. Clinical Governance
    2. Physics related to ultrasound
    3. Instrumentation & Knobology

    3. Core ACEM POCUS Modules

    1. Abdominal aorta
    2. Extended focused abdominal sonography in trauma (E-FAST)
    3. Focused echocardiography in life support (FELS)
    4. Basic lung sonography
    5. Procedural guidance

    4. Advanced POCUS Modules

    1. Proximal DVT Ultrasonography
    2. Biliary Ultrasonography
    3. Renal Tract Ultrasonography
    4. Early Pregnancy Viability Scan
    5. Bowel Ultrasonography
    6. Ultrasonography in Shock and Hypotension (RUSH protocol)
    7. Ultrasonography in Advanced Airway Management
    8. Ocular sonography in Emergency Medicine
    9. Musculoskeletal Ultrasonography
    10. Soft Tissue Ultrasonography
    11. Ovary and Testis Ultrasonography

    5. ACEM Mandated Projects and Administrative Requirements

    TOPICS

    1. EMERGENCY COLLEGE RECOMMENDATIONS

    Our program and curriculum aligns with the following ACEM and ACEP policies. 

    ACEM Policies

    ACEP Policies

    2. Core Principles of POCUS

    1. Clinical Governance

    1. Credentialing, Training and Education
    2. Image storage and review
    3. Machine maintenance and Equipment stock
    4. Hygiene and Disinfection
    5. Research
    6. Quality assurance
    7. Quality improvement

    2. Physics

    1. Piezoelectric effect
    2. Wave characteristics (cycle, frequency, period, wavelength, amplitude)
    3. Echogenicity
    4. Image resolution
    5. Attenuation
    6. Doppler effect
    7. Impedance
    8. Artefacts
      1. Reverberation
      2. Side lobe
      3. Mirror
      4. Shadowing
      5. Enhancement
      6. Ring down
    9. Bio-effects

        3. Instrumentation & Knobology

        1. Transducer types and selection
        2. Transducer manipulation
        3. Focus
        4. Gain
        5. Time gain compensation
        6. Orientation
        7. Scan planes
        8. Image measurement
        9. Labelling and Reporting
          • Patient details (Surname, MRN, DOB)
          • Type of scan
          • Indication
          • Trainee Initials and Qualifications
          • Supervisor initials and Qualifications
          • Machine used
          • Adequacy of views / images
          • Labelling i.e., RUQ, LUQ, Pelvis
          • Specific measurements e.g., CRL, FHR, GSD
          • Findings
            • Normal
            • Abnormal
            • Indeterminate
          • Provisional diagnosis and recommendations based on findings
          • Confirmed diagnosis (comparison to gold standard)
          • Supervisor comments

        3. ACEM Core POCUS Modules

        1. Abdominal Aorta

        1. Indications
        2. Evidence
        3. Advantages / Disadvantages compared to other modalities
        4. Limitations / Artefacts / Pitfalls
        5. Patient Position
        6. Image acquisition, optimisation and interpretation
        7. Superficial and sonographic anatomy
          1. Abdominal aorta, associated main branches and bifurcation
          2. IVC
          3. Vertebral bodies
        8. Clinical algorithm and integration
          1. Pulsatile mass
          2. Haemodynamically unstable patient
          3. Abdomen / Back / Flank pain + Age >50
        9. Pathologies
          1. Thrombus
          2. Abdominal aortic aneurysm
          3. Aortic dissection
          4. Endograft leak
        10. Reporting
          • As per 2.3.9
        11. Minimum imaging set (labelled, still or video)
          1. Transverse and Longitudinal Planes
          2. Measurements of maximum diameter in both planes
          3. Proximal, Mid and Distal Measurements
          4. View of bifurcation

        2. Extended Focused Abdominal Scan in Trauma

        1. Indications
        2. Evidence
        3. Advantages / Disadvantages compared to other modalities
        4. Limitations / Artefacts / Pitfalls
        5. Patient Position
        6. Image acquisition, optimisation and interpretation
        7. Superficial and sonographic anatomy
          1. Liver
          2. Kidneys
          3. Diaphragm / Lung bases
          4. Pleural line
          5. Ribs
          6. Spleen
          7. Bladder
          8. Uterus
          9. Pericardium
        8. Clinical algorithm and integration
          1. Blunt vs Penetrating Trauma
          2. Trauma CT vs OT
          3. Shock / Peri-arrest / Arrest
          4. Pelvic Pain + Vaginal bleeding
        9. Pathologies
          1. Haemopericardium
          2. Haemothorax
          3. Haemoperitoneum
          4. Pneumothorax
        10. Reporting
          • As per 2.3.9
        11. Minimum imaging set (labelled, still or video)
          1. RUQ (Hepatorenal space and Caudal tip of Liver)
          2. Right lung views (Parasternal, Right diaphragm / lung base)
          3. LUQ (Splenorenal space and Inferior tip of Spleen)
          4. Left lung views (Parasternal, Left diaphragm / lung base)
          5. Rectovesical / Rectouterine space (Transverse and Longitudinal)
          6. Subcostal pericardial window

        3. Focused Echocardiography in Life Support

        1. Indications
        2. Evidence
        3. Advantages / Disadvantages compared to other modalities
        4. Limitations / Artefacts / Pitfalls
        5. Patient Position
        6. Image acquisition, optimisation and interpretation
        7. Superficial and sonographic anatomy
          1. Cardiac chambers
          2. Cardiac valves
          3. Great vessels
          4. Pericardium
          5. Lung
        8. Clinical algorithm and integration
          1. Shock / Peri arrest / Cardiac arrest
          2. Chest pain / SOB
        9. Pathologies
          1. Pericardial effusion and tamponade
          2. Abnormalities of LV size / systolic function
          3. Abnormalities of RV size / systolic function
          4. Volume status estimation
        10. Reporting
          • As per 2.3.9
        11. Minimum imaging set (labelled, still or video)
          1. Windows (Parasternal, Apical, Subcostal)
          2. Basic Views (PLAX, PSAX, A4C, S4C)
          3. Extended Views (IVC, Aorta, Lungs)
          4. Valve and Haemodynamic assessment

        4. Lung Ultrasonography

        1. Indications
        2. Evidence
        3. Advantages / Disadvantages compared to other modalities
        4. Limitations / Artefacts / Pitfalls
        5. Patient Position
        6. Image acquisition, optimisation and interpretation
        7. Superficial and sonographic anatomy
          1. Diaphragm and lung curtain
          2. Ribs, intercostal space and pleural line
          3. Lung sliding
          4. Lung pulse
          5. Comet tail and other artefacts
        8. Clinical algorithm and integration
          1. SOB / Chest Pain
          2. Pneumonia
          3. Interstitial syndrome
          4. Cardiogenic pulmonary oedema
          5. Lung fibrosis
          6. Pneumothorax
          7. Pleural effusion
        9. Pathologies
          1. Normal lung
          2. Absent lung sliding and how to differentiate causes
          3. Focal B lines
          4. Diffuse B lines
          5. Consolidation
          6. Pleural effusion
        10. Reporting
          • As per 2.3.9
        11. Minimum imaging set (labelled, still or video)
          1. Right (Upper, Middle, Lower Lobes)
          2. Left (Upper, Middle, Lower Lobes)
          3. Labelled per local protocol / Volpicelli / Lichtenstein

        5. Procedural Guidance

        1. Indications & Contraindications
        2. Complications & Risk Mitigation Strategies
        3. Preparation (Space, Staff, Stuff)
        4. Methods (indirect, direct) and Advantages / Disadvantages
        5. Probe Hygiene / Disinfection and Aseptic Technique
        6. Patient Position
        7. Image acquisition, optimisation and interpretation
        8. Superficial and sonographic anatomy
          1. Neurovascular structures
          2. Fluid
          3. Foreign bodies
          4. Thrombus / Valves
        9. Procedural Steps
        10. Post-procedure Care
        11. Reporting
          • Patient ID
          • Operator ID
          • Indications
          • Consent process
          • Time of procedure
          • Aseptic technique
          • Method of US guidance
          • Plane of needle insertion
          • Number of passes
          • Guidewire removed intact and time (seldinger procedures)
          • Complications
          • Post procedure care
        12. Procedures
          1. PIVC insertion (in-plane, out-of-plane)
          2. CVL insertion (in-plane, out-of-plane)
          3. Arterial line insertion (in-plane, out-of-plane)
          4. Thoracocentesis / Pleural drain insertion
          5. Abdominal paracentesis / drain insertion
          6. Arthocentesis (in-plane)
          7. Basic regional anaesthesia techniques (in-plane)
          8. Soft tissue foreign body removal
          9. Abscess incision and drainage
        13. Minimum imaging set (labelled, still or video)
          1. Pre-scan
          2. In-plane OR Out-of-plane

        4. Advanced POCUS Modules

        1. Proximal DVT

        1. Indications
        2. Evidence
        3. Advantages / Disadvantages compared to other modalities
        4. Limitations / Artefacts / Pitfalls
        5. Patient Position
        6. Image acquisition, optimisation and interpretation
        7. Superficial and sonographic anatomy
          1. CFV
          2. SFJ
          3. FV
          4. DFV
          5. PPV
          6. DPV
          7. Compression
          8. Augmentation
        8. Clinical algorithm and integration
          1. Unilateral leg swelling / pain
          2. Shock / Arrest
          3. Dyspnoea
        9. Pathologies
          1. Thrombus
          2. Incompressibility
          3. Lack of respiratory variation
        10. Reporting
          • As per 2.3.9
        11. Minimum imaging set (labelled, still or video)
          1. Longitudinal view of CFV (Spectral doppler)
          2. Compression at CFV, SFJ, FV, DFV, PPV, DPV

        2. Biliary

        1. Indications
        2. Evidence
        3. Advantages / Disadvantages compared to other modalities
        4. Limitations / Artefacts / Pitfalls
        5. Patient Position
        6. Image acquisition, optimisation and interpretation
        7. Superficial and sonographic anatomy
          1. Liver
          2. Gallbladder
          3. Common bile duct
          4. Pancreas
        8. Clinical algorithm and integration
          1. RUQ / Epigastric pain
          2. Jaundice
        9. Pathologies
          1. Cholelithiasis
          2. Cholecystitis (GBWT >3mm, PCF, Murphy’s positive)
          3. Choledocholithiasis (CBD >6mm or >10mm post cholecystectomy)
          4. Pancreatitis
        10. Reporting
          • As per 2.3.9
        11. Minimum imaging set (labelled, still or video)
          1. Transverse and Longitudinal Gallbladder
          2. AP Gallbladder wall thickness
          3. CBD inner diameter measurement

        3. Renal Tract

        1. Indications
        2. Evidence
        3. Advantages / Disadvantages compared to other modalities
        4. Limitations / Artefacts / Pitfalls
        5. Patient Position
        6. Image acquisition, optimisation and interpretation
        7. Superficial and sonographic anatomy
          1. Kidney
          2. Renal sinus
          3. Renal medulla
          4. Proximal ureter
          5. Bladder
        8. Clinical algorithm and integration
          1. Flank / Lower abdominal pain
          2. Haematuria
        9. Pathologies
          1. Hydronephrosis
          2. Hydroureter
          3. Calculus
          4. Bladder distention
          5. Absent ureteric jet
        10. Reporting
          • As per 2.3.9
        11. Minimum imaging set (labelled, still or video)
          1. Longitudinal and Transverse view of both kidneys
          2. Longitudinal and Transverse measurements
          3. Longitudinal and Transverse views of bladder
          4. Bladder volume

        4. Early Pregnancy Viability Scan

        1. Indications
        2. Evidence
        3. Advantages / Disadvantages compared to other modalities
        4. Limitations / Artefacts / Pitfalls
        5. Patient Position
        6. Image acquisition, optimisation and interpretation
        7. Superficial and sonographic anatomy
          1. Rectouterine space (POD)
          2. Uterus
          3. Adnexa and Ovaries
          4. Bladder
          5. Iliac vessels
          6. Gestational sac
          7. Yolk sac
          8. Foetal pole
          9. Foetal heart beat and rate
        8. Clinical algorithm and integration
          1. Bleeding in early pregnancy
          2. Pelvic / Abdominal pain in early pregnancy
          3. Shock in female of child bearing age
        9. Pathologies
          1. Normal intrauterine pregnancy
          2. Ectopic pregnancy
          3. Non viable IUP
          4. Molar pregnancy
          5. OHS
        10. Reporting
          • As per 2.3.9
        11. Minimum imaging set (labelled, still or video)
          1. Transverse and Longitudinal view of uterus
          2. CRL measurement
          3. FHR (M-mode)
          4. FAST if FF in POD

        5. Bowel

        1. Indications
        2. Evidence
        3. Advantages / Disadvantages compared to other modalities
        4. Limitations / Artefacts / Pitfalls
        5. Patient Position
        6. Image acquisition, optimisation and interpretation
        7. Superficial and sonographic anatomy
          1. Large bowel
          2. Small bowel
          3. Appendix
        8. Clinical algorithm and integration
          1. Abdominal pain
          2. Abdominal distention
        9. Pathologies
          1. Bowel obstruction
          2. Appendicits
          3. Diverticulitis
          4. Hernia
          5. Paediatric intussception / Pyloric stenosis
        10. Reporting
          • As per 2.3.9
        11. Minimum imaging set (labelled, still or video)
          1. RIF – Appendix trans and long. Measurements. Compressibility. Peri appendiceal fat stranding / FF. Appendicolith.
          2. LIF – Dimensions of bowel. Fat stranding, FF and bowel wall thickening
          3. Sweep – Bowel loop measurements and compressibility. Peristalsis / Reverse peristalsis

        6. Ultrasonography in shock and hypotension

        1. Indications
        2. Limitations
        3. Pearls / Pitfalls
        4. Image acquisition, optimisation and interpretation
        5. Integration into clinical algorithm
          1. RUSH Protocol
        6. Pathology
        7. Reporting
          1. As per 2.3.9

        7. Ultrasonography in advanced airway management

        1. Indications
        2. Limitations
        3. Pearls / Pitfalls
        4. Image acquisition, optimisation and interpretation
        5. Superficial and sonographic anatomy
          1. Cricothyroid membrane
          2. Cricoid cartilage
          3. Thyroid cartilage
          4. Tracheal rings
          5. Tongue
        6. Integration into clinical algorithm
        7. Pathologies
          1. Floor of mouth / tongue swelling
          2. Oesophageal intubation

        8. Ocular Sonography in Emergency Medicine

        1. Indications
        2. Artefacts / Limitations
        3. Pearls / Pitfalls
        4. Patient position
        5. Image acquisition, optimisation and interpretation
        6. Superficial and sonographic anatomy
          1. Anterior segment
          2. Iris
          3. Lens
          4. Posterior segment
          5. Retina
        7. Integration into clinical algorithm
          1. Painless vision loss
          2. Painful vision loss
          3. Ocular foreign body
        8. Pathologies
          1. Retinal detachment
          2. Vitreous detachment
          3. Vitreous haemorrhage
          4. Globe rupture
          5. Lens dislocation
          6. Foreign body

        9. Musculoskeletal Sonography

        1. Evidence
        2. Indications
        3. Advantages / Disadvantages compared to other modalities
        4. Limitations / Artefacts / Pitfalls
        5. Patient Position
        6. Image acquisition, optimisation and interpretation
        7. Superficial and sonographic anatomy
          1. Surface landmarks
          2. Bone
          3. Joint
          4. Fluid / Fracture Line / Disruption of alignment
        8. Clinical Algorithm and Integration
          1. Paediatric Limp
          2. Orthopaedic injury
        9. Pathologies
          1. Paediatric Hip Effusion
          2. Fracture
          3. Dislocation
        10. Reporting
          1. As per 2.3.9

        10. Soft Tissue Sonography

        1. Image acquisition, optimisation and interpretation
        2. Indication and Pathology
          1. Foreign body identification and removal
          2. Abscess analysis and drainage

        11. Ovary and Testis

        ACEM Mandated Projects

        • You are required to complete a distinct project in the use of ultrasound in ED. These can include a survey, audit or chart review. At Campbelltown ED, you will be expected to complete the following and present your findings at M&M:
          • At least 1x survey, audit or chart review every 3-months
        • You are also expected to experience and be involved in at least 2 additional administrative aspects of focused ultrasound service in the department. At Campbelltown ED you will be expected to
          • Clinical Governance: Perform weekly machine maintenance, hygiene and disinfection, and equipment stocking.
          • Quality Assurance: Transfer, review store and archive images every 2 weeks. Participate in credentialing other trainees. Participate in maintenance of IT infrastructure. Attend interdepartmental ultrasound meetings.
          • Quality Improvement: Participate in 1 policy / model of care / clinical business rule development. Attend interdepartmental ultrasound meetings. Present at M&M.
          • Scholarship and Teaching: Present at least 4 teaching sessions. Complete online learning modules. Develop and distribute US Case of the Month (at least 4).
          • Research: Participate in 1 research project. Present findings at registrar / FACEM journal club. Develop an abstract and present it as a poster at ACEM ASM
          • Courses: Complete Sono-Town or equivalent qualified course. Participate as faculty on Sono-Town.

          Clinical Supervision & Learning Development Plan

          • Meet with the CLUS at the beginning of placement and complete placement orientation
          • Develop a learning development plan and submit it at the end of the placement
            • A copy of your LDP template can be found in your folder on the OneDrive
            • You and the CLUS will develop your plan at the start of the placement
            • Add to this plan throughout your placement
            • Your signed plan will be submitted to ACEM at the end of the placement
          • The plan consists of the following
            • A list of educational sessions delivered and/or attended
            • A list of supervisor meetings
            • Any other related activities (QA, QI)
            • A copy of any research or project(s) performed
          • Meet with the CLUS weekly (proctored scans, discuss and review cases)
          • Complete a mid-term and end-of-term ITA

          Courses, Modules and Credentialing

          • Complete a qualified course i.e., Sono-Town, prior to commencing term or within the first 3-months
          • Review ACEM and ACEP policies
          • Complete online learning modules
            • Campbelltown ED – Xporte Orientation and Image labelling / transfer
            • Core Fundamental Modules
            • ACEM Modules (TBC)
          • Complete expected number of proctored scans and log these in the CTN ED E-Logbook
          • Complete 2x Formative assessments and 1x Summative assessment for required scans (see LOA 3 and LOA 4).
          • Obtain competency in the core ACEM modules and progress towards competency in advanced modules

          Clinical & Staff Training

          • Assist clinical staff with POCUS (performing and interpreting scans)
          • Assist clinical staff with vascular access and procedures
          • Supervise junior members of staff as part of credentialing process
            • POCUS (AAA, E-FAST, FELS, Lung)
            • Procedural guidance (PIVC, CVL, Arterial line insertion and FIB / SAPB)

          Research

          • Participate in local research related to POCUS
          • Present research findings (Teaching, ACEM ASM)
          • Add articles to OneDrive Folder

          Scholarship & Teaching

          • Plan and facilitate at least 4x teaching sessions for med students, JMOs, registrars and nurses
          • Develop and distribute at least 4x US Case of the Month
          • Participate as faculty at Sono-Town
          • Add presentations and other resources to OneDrive Folder

            Governance

            • Report any equipment faults to CLUS and biomed
            • Stock US basket (20G 1.88 inch IVC, Avius Probe Cover, US Gel, Clinell)
            • Medical Record Storage
              • Transfer images fortnightly to share drive
              • Clear storage following successful transfer
            • Perform an audit, survey or chart review every 3-months, and present findings at M&M
            • Complete a QA / QI project
            • Participate in interdepartmental meetings
            • Participate in policy / MOC development
            • Assist with maintenance and currency of IT infrastructure
              • Sono-Town online material
              • US section of education website
              • SST OneDrive Folder
              • Reporting templates
            • Add to OneDrive Folder

            Mandated Project

            You are required to complete a distinct project in the use of ultrasound in ED. These can include a survey, audit or chart review.

            At Campbelltown ED, we want you to do more than the bare minimum and therefore you will be expected to complete at least 1 of the following every 3-months and present your findings at M&M:

            • Survey
            • Audit
            • Chart review

              Administrative Requirements

              You are also expected to have experience and be involved in at least 2 additional administrative aspects of focused ultrasound service in the department. We want you to get the most out of the term and expect you to:

              • Clinical governance (machine maintenance, IT infrastructure)
              • Quality improvement and assurance
              • Scholarship and teaching
              • Research
              • Interdepartmental meetings

              Other Requirements

              In Training Assessment (ITA)

              • You will complete 1x ITA every 3-months with the CLUS +/- DEMTs

              Learning Development Plan (LDP)

              You will develop and complete a LDP demonstrating

              • Meetings with supervisor
              • Completion of required online learning modules
              • Logged proctored scans
              • Completed assessments
              • Completed mandated projects
              • Completed administrative requirements

              ACEM Requirements for Competency

              Educational Program

              • Trainee completes online module / course
              • Program must substantively cover the topics as outline in ACEM Policy G25

              E-FAST

              • Minimum 25 accurate scans
              • 50% clinically indicated
              • At least 5 positive for either intraperitoneal, pleural or pericardial fluid, or pneumothorax
              • 50% of logbook cases can be completed in the non clinical environment (e.g., simulators, courses)

              AAA

              • Minimum 15 accurate scans
              • 50% clinically indicated
              • At least 3 demonstrate an aneurysm
              • 50% of logbook cases can be completed in the non clinical environment (e.g., simulators, courses)

              Basic Lung

              • Minimum 25 accurate scans
              • 50% clinically indicated
              • At least 5 demonstrate significant pathology (e.g., pneumothorax, effusion, pneumonia, interstitial syndrome)
              • 50% of logbook cases can be completed in the non clinical environment (e.g., simulators, courses)

              Focused Echo in Life Support

              • Minimum 25 accurate scans
              • At least 5 clinically indicated (shock / peri arrest / arrest)
              • At least 5 performed under direct supervision (sonologist)
              • Evidence of review of further 25 scans
              • The total 50 scans must include at least 2 cases of pericardial effusion, RV failure / massive PE, hypovolaemia / distributive shock and LV failure
              • 50% of logbook cases can be completed in the non clinical environment (e.g., simulators, courses)

              Procedural Guidance

              • Perform 25 successful needle guided procedures on patients
              • Should include a mix of procedures
              • 6 directly supervised procedures must be performed
              • At lease 3 out-of-plane and 3 in-plane procedures directly supervised
              • Up to 3 of the supervised procedures can be performed on a phantom, but cannot include formative or summative assessments

              Assessments

              • For each module, 2 Formative and 1 Summative assessments are required
              • Assessments must be completed by a recognised sonologist
                • CCPU in ultrasound module
                • DDU
                • FRANZCR or equivalent
                • Post graduate qualification in ultrasound (PTEeXAM, ASCeXAM, GDCLINUS, GCCLINUS)
                • In the case of echo, higher echocardiography is required (PTEeXAM, ASCeXAM, GDCLINUS, GCCLINUS, DDU)
              • During assessments, trainees must be able to
                • Acquire adequate ultrasound images or all appropriate anatomical structures,
                • Identify any relevant artefacts or pathology present,
                • Recognise an inadequate scan, and
                • Demonstrate an understanding of the indications and limitations of ultrasound examination for the condition in question
              • Once the trainee has accrued the required number of proctored scans and completed the required assessments, they will be considered credentialed for the appropriate US module

              ASUM Requirements for Certificate in Clinician Performed Ultrasound (CCPU)

              Click Here for more information

              Campbelltown Emergency Department

              OneDrive Folder

              • Learning Development Plan Template
              • Staff Specialist Qualifications
              • Formative & Summative Assessment Forms
              • POCUS Cheat Sheets
              • POCUS Reporting Templates
              • POCUS EBM Articles
              • POCUS Guidelines
              • Archive – Learning Development Plans
              • Archive – Case of the Month
              • Archive – Journal Club
              • Archive – Audit / Survey / Chart Review
              • Archive – Research and Abstracts
              • PDF Textbooks
                • Fox, C. Atlas of Emergency Ultrasound
                • Soni, N. Point-of-Care Ultrasound
                • Connolly, J. Emergency Point-of-Care Ultrasound
                • Noble, V. Manual of Emergency and Critical Care Ultrasound
                • Ma, J. Ma and Mateer’s Emergency Ultrasound
                • McCaffery, J. Emergency Point-of-Care Ultrasound Made Easy
                • Rumack, C. Diagnostic Ultrasound
                • Hoskins, P. Diagnostic Ultrasound Physics and Equipment

              ACEM Website

              ACEP Website

              UTEC Online Modules

              • UTEC (register an account and access modules with UTEC key)

              Sono-Guide Modules

              Online Textbooks

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              Image Libraries