A UCSF Fresno Department of Emergency Medicine point-of-care ultrasound fellowship, developed in collaboration with Community Regional Medical Center, enables patients in the emergency department to be quickly assessed, receive a diagnosis at the bedside, and begin treatment sooner.
Point-of-care ultrasound is a longstanding tool in emergency medicine, and basic instruction in its core applications is part of the Emergency Medicine residency curriculum. However, the UCSF Fresno Advanced Emergency Medicine Ultrasonography Fellowship trains physicians as experts in advanced uses of the technology.
“Not only do we become experts in image acquisition, but also in image interpretation for point-of-care ultrasound,” said Stephen Haight, MD, UCSF Fresno’s Ultrasonography Fellowship director.
UCSF Fresno’s one-year fellowship at Community Regional, the primary clinical partner for UCSF Fresno, offers a wide range of point-of-care ultrasound experiences at the only Level 1 trauma center between Sacramento and Los Angeles.
Point-of-care imaging is common for many complaints, among them abdominal pain, nausea, and vomiting. Abdominal pain can be caused by gallstones, for example, and imaging can detect stones, as well as other conditions, Haight said. “If we observe some shadowing, we’d look for signs of inflammation, such as thickening of the gallbladder wall. We would look for fluid around the gallbladder, as well as gas in the wall or something that would indicate a very severe infection.”
Importantly, imaging results are available in a few minutes and can be entered into the patient’s electronic medical chart, allowing them to be viewed by other physicians, including surgeons, should surgery be advised. Community Regional bought a state-of-the-art ultrasound machine that incorporates artificial intelligence (AI) features, enabling even faster diagnosis and lifesaving measurements when a patient is in immediate danger, Haight said.
Ultrasounds of the heart are also commonly used to detect life-threatening conditions, such as fluid around the heart, evidence of heart failure, or dysfunction of the right side of the heart, which may indicate a pulmonary embolism or a clot in the lungs. “And those findings can sometimes really dictate the next steps in management and help you guide your therapy to what the patient needs right away,” he said.
Point-of-care ultrasound helps streamline patient flow in the emergency department, said Danielle Campagne, MD, FACEP, who is UCSF Fresno’s chief of Emergency Medicine and holds the Gene W. Kallsen, MD, Endowed Chair in Emergency Medicine. Campagne utilized funding from the endowed chair to aid in the development of the fellowship.
“As our emergency department gets busier, it is good to be able to offer ultrasound at the bedside, and the hospital has purchased software so the results of the ultrasound can be uploaded into the patient’s chart, and the specialist or consultant can see the images right away,” she said.
As more physicians receive advanced training, Campagne sees an increasing number of applications for ultrasound. “It is becoming like a core competency for EM doctors,” she said. “We tease that in 20 years, that ultrasound is going to be like the stethoscope.”