Mount Sinai Emergency Medicine Ultrasound

Finally- a little recognition! We were named one of the top 50 continuing medical education blogs by Nurse E.D.U.
Although there is no mention that they were listed in any particular order, we will consider ourselves in the top 20 of that list since that’s where we fell.
Today, Nurse E.D.U.
Tomorrrow, The Huffington Post!

Another beautiful sunny day. Although some people left for early flights back home, there was still some life left in the conference on Saturday.

Notable events included:

Sinai’s own Henrietta Rosenberg, MD, hosting a meet-the-professor session on sonography of the infant hip

EM/Critical Care track session on the ultrasound evaluation of dyspnea, featuring Anthony Dean, Paul Sierzenski, Vicki Noble, David Bahner, and Jim Tsung.

Scientific session on Emergency Sonography research in the afternoon

Just Images- cardiac ultrasound in the ED and ICU, including contributions by Chris Moore, Alexander Levitov, Jim Tsung, and Erika Kube.

San Diego 2010 Final Thoughts:

Bret:

The Transcranial Doppler session was great. The best part of the AIUM conferences for me is learning something new and getting outside of my comfort zone. The faculty for the TCD course made the technique look easy. Although you can’t hope to master a new clinical skill in an afternoon, I was inspired to learn more about this technique and how it could impact care in the ED.

Zsolt Garami, director of the TCD Center at Methodist Hospital in Houston, demonstrated the perfect blend of knowledge, technique, wit, and sarcasm to make for a fantastic experience!

Phil:

The Just Images sessions were really useful. Lots of great cases, and an excellent video of a pupillary reflex from Chris Moore.

Jim:

The coolest thing I saw was in one of the OB sessions- a 4D/3D plus real-time movie of an ultrasound guided needle sampling of fetal blood cells from an umbilical cord floating in the amniotic sac.  That was pretty cool- and the future for ultrasound guided procedures.

Another great day for the Emergency and Critical Care track.

8:15 head and neck US

9:45 Emergency and Critical Care Community of Practice meeting

Michael Blaivas was at the helm as the new Chair of the EM/CC community of practice. Bret Nelson was elected the incoming Secretary, and thus took notes. Apparently poor handwriting and the inability to touch type were not obstacles in the selection process.

11:00 clinical sonography – emergency sonography

1:30  transcranial Doppler session

This was an excellent session, with great hands-on instruction by experienced and enthusiastic instructors. They made everything look easy.

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Thursday was a great day for the EM/Crit Care track.

Not sure what happened in the AM – I was on a plane – not on a boat – on a plane!

The hands-on vascular access course was held in the afternoon.  The opening lecture covering short and long axis approaches by Jason Nomura was an excellent example of clear, concise presentation of complicated information.  Clearly, Jason has mastered the zen of well…presentation zen.  I’m sure no one in that room had a hard time remembering the importance of distinguishing the tip of the needle from the shaft after his talk.

The day ended with a Just Images session presented by Anthony Dean and Chris Moore titled “Patients in Shock.” Fascinating clips of patients with pulmonary embolism, atrial myxoma, tamponade, dissection, and more.

Mount Sinai’s Director of Pediatric Radiology, Henrietta Rosenberg presented data on the use of ultrasound in pediatric hip evaluations this afternoon as well.

As the ultrasound fellow, I have the privilege of scanning with the ultrasound faculty, all of our residents and all of our non-ultrasound faculty.  It is so refreshing to have such a variety to work with.  At times, the non-ultrasound faculty will bring issues to light that neither residents nor ultrasound faculty would.
On my most recent scanning shift, one of our faculty ended every encounter with a reassurance for the patient that “absolutely everything is normal.  Your heart is entirely normal.  All of your organs are normal.  You will live forever.”  The patients laughed and appreciated his humor, but each time, a little part of me died.  As soon as he stepped out of the room, I followed up with “Yes, Dr. X is a riot.  However, you should know that the ultrasound study we are doing today is limited and really looking to answer very focused questions.  This is not a comprehensive exam.”

Being scanned can be reassuring to patients.  You are taking the time to do  something that they don’t normally have done by their PMD, but your patients’ report of the results of the studies can be misconstrued by the patients themselves, their family, their providers, your colleagues in the ED, OB, Radiology.  So, when you are scanning your patients and you have answered your very focused questions for yourself, please, please save the humor for the next thought and let your patients know that this is not a comprehensive ultrasound, but a study designed only to answer very focused questions”.