Emergency Ultrasound

Division of Emergency & Critical Care Ultrasound

Over the past three decades, the clinical applications of ultrasound by emergency physicians has greatly expanded. Emergency Physicians have adopted ultrasound to advance the timely and accurate evaluation and treatment of the acute patient. In 2001 the first emergency medicine ultrasound training and credentialing guidelines was published. It is a broadly written document that divides ultrasound into abdominal, pelvic and cardiac applications, and describes the many uses of ultrasound in emergency practice. Since this landmark publication, the American College of Emergency Physicians (ACEP) has mandated that performance and interpretation of ultrasound imaging is included in emergency medicine residency training.

In 2006, UMDNJ-RWJMS Department of Emergency Medicine and Robert Wood Johnson University Hospital purchased it’s first ultrasound machine and began training emergency physicians to perform and interpret point of care ultrasound studies. In accordance with the revised ACEP training guidelines and the 2010 CORD consensus statement we have divided the training we offer our students, residents and physicians into the following:

Life-saving applications:
• Aorta
• Cardiac
• Pelvic
• Vascular Access

Time-saving applications:
• Renal
• Gallbladder
• Scrotal
• Soft tissue
• Ocular

Over the last several years our physicians have made a tremendous impact on patient care. Examples includebut are not limited to:

  • Approximately 70 US guided peripheral venous lines inserted per month (reduced number of blind attempts, less central lines).
  • Rapid identification of ruptured ectopic pregnancy and aortic aneurysms leading to immediate surgical consultation and operative intervention.
  • Rapid identification of traumatic intra-abdominal / pericardial hemorrhage and pneumothorax leading to immediate activation of trauma alert pathway.
  • Utilization in cardiac arrest to identify absence of cardiac activity and/or reversible causes for arrest in order to guide resuscitative efforts.
  • Utilization in undifferentiated hypotension and hypoxia to rapidly identify etiology, guide resuscitative efforts and enable better utilization of resources.

In 2010 we introduced a web based image archival system that has substantially improved the QA process. The images are sent wireless from machines in the ER to a server and can then be viewed from any computer in and outside the hospital. All information is encrypted and therefore HIPPA compliant. Images can be reviewed and feedback can be given to providers within seconds of when the scans are performed. We are one of the first emergency ultrasound programs in the country to begin using a workflow solution like this. This technology also allows us to accurately track data for research and resident teaching purposes.

We currently offer a four week emergency ultrasound elective for fourth year medical students and incorporate emergency ultrasound in the core emergency medicine clerkship. In addition, our Emergency Medicine residents take a one month ultrasound rotation during their first year of training. Our residents acquire all ultrasound training in the Emergency Department by our faculty. Heavy emphasis is placed on mastering all of the life-saving applications by the end of their intern year.