This past weekend, our first ever weekend Point of Care Ultrasound Crash Course was a success! The focus of this session was on cardiac ultrasound evaluation and procedural skills. Topics covered included 1. Tips and techniques to obtain “gold standard” cardiac Echo views, taught by Cardiac Echo Sonographers 2. Understanding pulsed wave and continuous wave doppler in the evaluation of valve function, 3. POCUS guided intravascular volume assessments, 4. Navigating central line access kits as well as simulated central line placement.
Thank you to our sonographers Megan and Julia for their teaching and expertise! Shout out also to Cardiology Fellow Thomas Prohaska, ultrasound afficionados Dan Sweeney and Milla Kviatkovsy, and our current and future CMRs for this wonderful teaching session.
Dominic Picetti, one of our amazing R2s, presented a case of a young man who presented with abdominal pain, moderate increase in liver enzymes, and possible new ascites. We reviewed a systematic approach to abdominal pain by reminding ourselves to consider each quadrant, the epigastrum, the pelvis as well as referred symptoms from the thorax (CHF, ACS, pneumonia ect, esophageal conditions). Then one of our fantastic Hepatologists Dr. Yuko Kono reviewed indications for different types of imaging to examine the Right Upper Quadrant. We recommended starting with an Ultrasound with doppler for this patient and then considering CT Abdomen with contrast if the initial ultrasound is equivocal. MRI with MRCP should be considered to gather information on the biliary system and Triple Phase Abdominal CT may be helpful in patients with chronic liver disease.
This patient’s imaging revealed right hepatic vein thrombosis consistent with Budd Chiari Syndrome!
YAY Friday School! This Friday, Dr. Dan Sweeney (PCCM) and our awesome PCCM fellows (Mazen Odish, Jacob Bailey, Erica Lin, Jeff Barry) taught us how to perform a FAST exam, and how image the aorta, the IVC, the femoral and popliteal veins to look for DVT. We practiced on a simulator, and on LIVE models, including a very nice volunteer with Polycystic Kidney Disease.
Our residents then participated in a workshop facilitated by our multi-disciplinary Palliative Care team and members of the HEAR (Healer Evaluation Assessment and Referral) program (including Rachel Accardi, Courtney Sanchez, Chris Onderdunk, Dr. Maria Tiamson-Kassab) on how to lead a debrief following a difficult patient event. Critical leadership skills and part of our RACE (Resident As Clinician Educator) Curriculum!
I want to take this opportunity to stress that if any of you are struggling with the impact of a difficult patient encounter, a loss or medical error, I urge you to seek help to process this important event. Being a physician is an incredibly rewarding, but also difficult job! The program is here to support and help you. You can also come to any of the chief residents, or program leadership with your concerns about yourself or your colleagues. I promise they will be addressed with sensitivity and confidentiality. I have included some resources below for the Healer Education Assessment and Referral (HEAR) Program.