POCUS

Program Overview

The Department of Anesthesiology and Pain Medicine offers a Perioperative Point-of-Care Ultrasound Anesthesia Fellowship Training Program at The Ottawa Hospital. The Ottawa Hospital is a tertiary care centre in the National Capital Region.

The purpose of this fellowship is to prepare the fellow for a career of leadership in point-of-care ultrasound at local, regional, national, and international levels. After completion of the fellowship, the fellow will have acquired the skills necessary to lead a successful perioperative point-of-care ultrasound program at their local institution.

It is important to note that the trainee has to prioritize clinically indicated ultrasound examinations, where intervention may be required, over educational scans.

 

Goals and Objectives

 By the end of the fellowship, the trainee will be able to meet the following objectives:

 

Medical Expert

  • Understand the basic and advanced knobology of the ultrasound machine.
  • Demonstrate understanding and proficiency with the use of various probe types including curvilinear, phased, linear and transesophageal.
  • Demonstrate proper ultrasound technique including probe manipulation and image optimization.
  • Apply ultrasound findings in clinical management of patients in perioperative setting.
  • Demonstrate proficiency in image generation and interpretation in the following areas:

 

A - Cardiac scan (performance and interpretation of 100 focused transthoracic echocardiographic examinations and 50 focused transesophageal echocardiographic will be required)

 

Examinations including assessment of the following:

  • Major aortic pathology (dissection, aneurysmal dilatation & atheroma)
  • Left ventricular systolic function (global assessment of LV function & assessment of ejection fraction using fractional shortening, fractional area change, and Simpson’s Index)
  • Right ventricular function and PE diagnosis (RV size, RV function, measurement of RVSP using the TR CWD & identification of the common echocardiographic manifestations of PE)
  • Pericardial space (assess for effusion, differentiate between pericardial and pleural effusion & identify the echocardiographic manifestations of hemodynamic tamponade physiology)
  • Fluid status assessment (IVC size and variation with spontaneous respiration, LV stroke volume and the velocity time integral)
  • Major valvular dysfunction (identify and assess significant valvular stenosis & regurgitation)

 

B - Lung scan (performance and interpretation of 50 lung ultrasound examinations will be required)

 

Examinations must include identification of the following:

  • Identify the diaphragm and assess its movement with respiration.
  • Identify the pleural line and assess for sliding pleura
  • Identify the presence or absence of "A" lines (pleural reverberation artifact)
  • Identify the presence or absence of "B" lines (interstitial alveolar pattern)
  • Demonstrate the “curtain sign”
  • Use M mode to assess for the “seashore sign"
  • Use grayscale and / or M Mode to identify pleural effusion, consolidation and pneumothorax.
  • Use the US to assess the type and volume of pleural effusion.

 

C – Abdominal/FAST scan (performance and interpretation of 30 abdominal ultrasound examinations will be required)

 

Examinations must identify the following: Presence or absence of free fluid space in:

  • Hepato -renal recess
  • Spleno-renal recess,
  • Recto-vesical or utero-vesical space
  • Pericardial space

 

D – Gastric Scan (performance and interpretation of 30 gastric scans will be required)

 

Examinations must identify the following:

  • The antrum of the stomach in the short axis view (supine and R lateral)
  • Assessment of gastric volume in emergency surgery

 

E– Airway Scan (performance and interpretation of 30 airway scans will be required)

 

Examinations must identify the following:

  • The upper airway (including distinguishing features between the trachea and the esophagus)
  • The cricothyroid membrane in the short and long axis

 

F-Ultrasound guided vascular access (performance and interpretation for 30 vascular scans for the purpose of obtaining vascular access)

 

The objectives will be to:

  • Understand the rationale for the use of ultrasound to aid in central venous, peripheral venous, or arterial access procedures.
  • To localize the appropriate anatomic site and surrounding structures, check vessel patency and check venous compressibility.
  • To use the ultrasound dynamically, either in-plane or out-of-plane, and to visualize needle entry into the vessel.
  • To choose the appropriate type, gauge, and length of the catheter used.             
  • To use ultrasound to ensure appropriate intraluminal placement.

 

G- Elective (optional) self-directed learning rotation:

 

It is an instructional strategy where the fellow, with guidance from the supervisors, decide what and how he/she will learn. The overall concept is that the fellow takes ownership of his/her learning.

This approach will be applied to one block (4 weeks) in which the fellow will choose one of the following PoCUS areas to get competency.

 

  • U/S guided neuraxial block
  • U/S guided nerve block (2 nerve blocks only)

 

The faculty may give general learning goals. The fellow would then work with the faculty to decide the scope of the project, length of time, and the end result that would demonstrate his/her learning.

 

Communicator

 

  • Converse effectively and sensitively with patients and their families.
  • Discuss the indications for ultrasound examination and obtain informed consent.
  • After consulting with the attending, provide a brief report to the surgical and anesthesia teams involved in the perioperative patient care
  • Demonstrate useful communication skills when teaching ultrasound skills to others

 

Collaborator

 

  • Work effectively as part of a healthcare team.
  • Collaborate with other specialties to incorporate bedside ultrasound into routine patient care.
  • Develop and lead educational workshops for various health-care groups including physicians, nurses and respiratory therapists.

 

Participate as an instructor for ongoing ultrasound training activities including:

 

  • Undergraduate: basic US training workshops
  • Postgraduate:  introductory ultrasound course for Anesthesia residents
  • Faculty development ultrasound workshops

 

Manager

 

  • Demonstrate proper documentation and archiving of ultrasound scans.
  • Regularly perform Quality Assurance review of archived scans and complete relevant worksheets/logbook.
  • Manage scan time efficiently to avoid delay in patient management.
  • Demonstrate proper care of the ultrasound equipment.

 

Health Advocate

 

  • Act as an advocate for individual patients in the Anesthesiology department.
  • Understand the importance of access to emergency ultrasound devices for all resuscitation and management of acute perioperative hemodynamic instability.
  • Advocate for increased point-of-care ultrasound resources for the Anesthesiology department and TOH in general.

 

Scholar

 

  • Present at biweekly Continuing Medical Education Ultrasound / Echo rounds for the staff and residents.
  • Critically evaluate the literature as it pertains to the emergency ultrasound.
  • Act as a mentor for trainees pursuing academic work in point-of-care ultrasound.
  • Develop the capacity to create a comprehensive POCUS training curriculum for  trainees (residents & medical students) .
  • Present the results of the academic project at a scientific meeting.

 

Professional

 

  • Be sensitive to any discomfort caused by ultrasound scans, especially when performing training scans or when scanning volunteers.
  • Adhere to the code of ethics of the TOH.
  • Treat patients and colleagues with respect.
  • Be responsible, reliable, remain calm and organized in stressful or emergency situations.

 

Key Faculty

 

 

 Applications

 uOttawa Admissions Website

For more details about application requirements, please visit our Fellowship Application Instructions page.

 

Contact Us

Dr. Colleen McFaul
Dr. Elizabeth Miller
Perioperative POCUS Anesthesia Fellowship Leads

Mrs. Kelsey Rice
Fellowship Program Coordinator
Department of Anesthesiology and Pain Medicine
Email: krice@toh.ca

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