Kristin Dwyer, MD, MPH
Fellow in Emergency Ultrasound, BWH
PGY 6
Emergency medicine (EM) is a new specialty here, and many
general practitioners (GPs) continue to staff the emergency room due to inadequate
number of fully trained EM specialists. However, some GPs, who have been
practicing clinically for many years, have now entered the emergency medicine
residency alongside new graduates.
I am working in the emergency department (ED), running the
residency ultrasound rotation. So far, I have had two residents per day on the
rotation. They each rotate for one month through ultrasound training. We join
rounds in the morning, and identify patients who may benefit clinically from a
bedside ultrasound. We spend 8 hours a
day ultrasounding patients in the emergency department and communicating all
our findings through the patient chart, and directly to the clinical team. We are fortunate in that our machines are
functioning well, and we have adequate supplies of ultrasound gel.
This week we had a woman who had been waiting for three days
for a cat scan of her abdomen to look for appendicitis. Cat scans are not performed here until
families can pay upfront for the test, and even then it is not uncommon for it
to take days to occur. We were able to
locate her appendix on bedside ultrasound and diagnose her with appendicitis at
no cost.
Bedside Ultrasound Teaching with Residents: CHUK |
We have also been working on ultrasound guided procedural
skills, in particular peripheral ultrasound venous access. This week we came in
and a patient with DKA, who was acidemic, hypokalemic and very ill appearing,
had waited overnight all night with no interventions, treatments or medication
because the overnight team had been unable to gain peripheral access. The
residents were able to use bedside ultrasound to obtain a peripheral IV line
and the patient ended up doing very well, and was discharged home 2 days later.
While there have been some IRB delays with the research project I am planning to help out with here, I have been able to do some advanced lung ultrasound training for those individuals who will be working on the project in preparation of IRB approval.
I look forward to the second half of my rotation where I will continue to do ultrasound training with a new group of residents, and I will be giving some lectures during department conference day.
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