GMED 5000

Internal Medicine Clerkship - Ultrasound

Introduction

The Internal Medicine Clerkship Ultrasound requirements aim to provide clinically relevant education on how to use point-of-care ultrasound (POCUS) during your Internal Medicine clerkship. The ultrasound requirements are designed to give you a deeper understanding of some of the concepts taught during the clerkship through the experience of ultrasound.

Ultrasound provides an excellent way for you to understand the heart function and pathophysiology. Many of the patients you will encounter on your Internal Medicine clerkship will have pathology such as hypertension or coronary artery disease which will affect the heart. By imaging the heart, you can correlate the ultrasound findings with that of the EKG and physical exam.

QUICK LINKS:

MCG C/O 2027 Clerkship Ultrasound Orientation Email Ultrasound Image Link FAQ

Educational Ultrasound Informed Patient Consent  GMED US Image and Case Info Upload Link

 

HOW TO DOWNLOAD IMAGES FROM MACHINES OTHER THAN LUMIFY 

Philips Sparq     Sonosite     GE    Cart-Based Ultrasound

LEARNING OBJECTIVES

At the end of this module, you will be able to:

• Acquire cardiac images (Subcostal 4-Chamber, PSLA, and Apical 4-Chamber) of the heart and a lung image of the lung sliding sign with limited assistance.
• Interpret the findings of heart and lung ultrasound images on actual patients and mock case scenarios. 
• Integrate the findings of heart and lung ultrasound images in the care plan of actual patients and mock case scenarios.

Cardiac Windows and Anatomy    THORACIC ULTRASOUND- HOW TO READ A CHEST ULTRASOUND    Bedside Cardiac Ultrasound Applications

TO DO

Complete the following quizzes (includes patient consent attestation, image upload, and mock case scenario questions) prior to the end of your IM clerkship rotation by submitting 3 separate quizzes in this D2L course by the noted due dates.

Quiz 1    Quiz 2    Quiz 3

You will receive feedback on your images by email after they are graded. Quizzes must be completed by due dates.

WHAT DOES THE INTERNAL MEDICINE CLERKSHIP ULTRASOUND IMAGE REQUIREMENT INCLUDE?

The Internal Medicine Clerkship Ultrasound requirement consists of acquiring cardiac and lung images as follows: 

• There are 3 traditional windows (views) of the heart: the subcostal, parasternal and apical windows. The key point for you is that while each of these windows are important for you to be familiar with, it is more important for you to be able to identify the structures of the heart and assess how they correlate to the EKG and physical exam findings. The key structures to identify are the left ventricle, interventricular septum, and the mitral valve. As you become comfortable assessing these structures, evaluating the relative size of the chambers and the flow across the valves using color Doppler will help you achieve a more advanced understanding of the heart.  
• The Subcostal 4-Chamber (Subxyphoid) heart image includes the left lobe of the liver, all 4 chambers of the heart, and visualization of the pericardium.
• The Parasternal Long Axis (PSLA) heart view includes the left ventricle, left atrium, mitral valve, aortic valve, ascending aorta, and the right ventricle.
• The Apical 4-Chamber heart view is taken from the apex of the heart and includes all 4 chambers of the heart.
• The Lung view to assess for pneumothorax is acquired in the longitudinal plane on the anterior chest on either side of the sternum.

WHAT SHOULD THE IMAGES FOR THE INTERNAL MEDICINE CLERKSHIP ULTRASOUND REQUIREMENT LOOK LIKE?

DO I NEED TO DOCUMENT INFORMED CONSENT FOR THE PATIENT BEFORE I BEGIN THE EDUCATIONAL ULTRASOUND?

Yes, you will need to ask your preceptor and the patient if you can perform an educational ultrasound for your IM Clerkship Ultrasound requirement. Once the patient has agreed to be scanned, you will need to explain the procedure to them and include the following aspects:

• Ultrasound has no known adverse side effects and it uses sound waves to visualize structures
• The patient will not be charged for the educational ultrasound (They may have an additional ultrasound for clinical reasons for which they will be charged)
• The student will touch their chest wall and abdomen with the transducer on their body with possibly cold gel and cool, gloved hands to obtain the images
• The lights in the room may be dimmed for better visualization of the images
• Results from the educational ultrasound will not be included in their chart or patient care decisions
• If any type of problem is detected, the student will inform their preceptor and the preceptor will direct the next steps 

After reviewing this information with the patient, the student will ask the patient to type their name and sign the Educational Ultrasound Informed Patient Consent. Images will NOT be accepted for the requirement if the patient does not complete this consent.

WHAT DOES THE IM CLERKSHIP ULTRASOUND REQUIREMENT QUIZ INCLUDE?

The IM Clerkship Ultrasound Requirement Quiz includes:

• Attestation question that you and your patient completed an "Educational Ultrasound Informed Patient Consent" prior to scanning your patient
• Attestation question that you have submitted your images and case information through the provided link
• Acquiring three sets of images for submission on three different patients
• IM ultrasound content and case questions

WHAT IF I HAVE TROUBLE OBTAINING PATIENTS FOR IMAGING, IDENTIFYING EQUIPMENT TO USE, OR HAVE TROUBLE UPLOADING IMAGES?

Contact Katie Comeaux at kcomeaux@augusta.edu or call 706-721-5695

ADDITIONAL RESOURCES:         

CUSE YOUTUBE CHANNEL   Clinical US EBOOK  Clinical US ibook download  Interactive cases  Making Healthcare Safer