Total Immersion in Ultrasound

Tony Joseph, MD
Resident in Emergency Medicine at PHS
PGY 3

Just started off our first week at Mbarara Regional Referral Hospital (MRRH) in Southwestern Uganda! Led by PURE co-founder, Dr. Trish Henwood, this team welcomes back Drs. Katie O’Brien (Kaiser Sacramento), Dave Mackenzie (Maine Med) & Newman (Penn) and brought in some new crew members: Dr. Elizabeth Hall (Penn), Simone Schriger, and me – Tony Joseph from Brigham/Mass General.

We hit the ground running with a full week of ultrasound training sessions for the OB midwives, house staff interns/residents, and surgical staff. Within a single day, physician trainees went from not knowing where the power button on the machine was to identifying subtle fluid stripes in Morison’s pouch and distinguishing free fluid fake outs in the pelvis from real pathology. Seminal vesicles will fool them no more!

Dr. Peter (surgical resident) was able to quickly utilize the knowledge and skills he gained on a Friday after he found himself on call in Accidents & Emergency on Sunday. 

A trauma patient presented with abdominal pain after a motorcycle crash, the FAST was positive for free fluid in the abdomen concerning for hemorrhage. The patient was taking to the operation theatre immediately and found to have a grade IV splenic laceration. Point-of-care ultrasound making a difference off the bat!

Many of the intern trainees quickly realized the power of ultrasound and started asking about other applications such as vascular access and hydronephrosis. With this level of interest, we expect their bedside scanning skills to take off quickly.

Meanwhile, the OB midwives and attendings who had received training on our last visit, showcased their wonderful OB ultrasound skills that they have been using all year long! Several 2nd & 3rd trimester pregnant patients from clinic volunteered to be scanned and the local staff correctly made biometry measurements to date the pregnancies.

We are also preparing for a trauma course in early February along with coordinating trauma surgeon, Dr. Deepika Nehra. Now that the physicians are getting the FAST exam down, they just have to learn A through E. 

More to come on that later… 

Back to scanning!