Introduction

Point-of-care ultrasound (POCUS) has achieved broad acceptance across many medical specialties over the past few years. Despite this progress, significant challenges surrounding the achievement of both competency and certification in POCUS remain among both trainees and practicing physicians.

The landscape of training and competency in POCUS cannot be understood without a firm grasp on the nomenclature that has been adopted thus far. For POCUS performed in critically ill patients, critical care ultrasound (CCUS) is the appropriate umbrella term, spanning the two main branches of critical care echocardiography (CCE) and general critical care ultrasound (GCCUS). Critical care echocardiography itself is divided into basic (BCCE) and advanced (ACCE) skill sets. A basic-level provider should be able to generate and interpret basic transthoracic assessment, as well as to perform basic GCCUS examinations. So essential to the modern practice of critical care medicine, BCCE and GCCUS have been endorsed as a core skill for all critical care providers by the worldwide critical care community and benefit from a growing evidence base. As with other essential skills (bronchoscopy, central venous access, airway management), there is general agreement that BCCE and GCCUS should be taught under local expert supervision during fellowship training. Importantly, formal certification for BCCE and GCCUS has been deemed unnecessary both internationally and by the unanimous consensus of Canadian CCUS experts, a position endorsed by the Canadian Critical Care Society in 2013.

Goals and Objectives

• Acquire basic critical care echocardiography (BCCE) and general ultrasound (GCCUS) images
• Interpret BCCE and GCCUS images
• Integrate sonographic findings in the clinical-decision making of critically ill patients
• Describe differences and peculiarities of BCCE compared to advanced critical care echocardiography (ACCE)
• Describe pitfalls and limitations of basic POCUS applications

The curriculum will focus on BASIC POCUS applications (BCCE and GCCUS), including:

• Basic echocardiography
• Lung ultrasound
• Diaphragmatic ultrasound
• Airway ultrasound
• Basic vascular ultrasound (venous and arterial)
• Abdominal (FAST and other basic applications)
• Procedural ultrasound

For each application, the curriculum will focus on (I-AIM Framework):

1. Indications (I) for the examination (“what clinical question are we trying to answer by using this specific ultrasound modality?”)
2. Image acquisition (A) techniques (patient position, probe and protocol selection, image acquisition and optimisation)
3. Logical stepwise approach to image interpretation [1) assessment of image quality and adequacy for interpretation; 2) establishment of the presence or absence of suspected findings; 3) interpretation of findings according to clinical context – e.g., vasoactive agent, mechanical ventilation; 4) generation of an ultrasonographic differential diagnosis; 5) progression to further scanning if needed, including utilization of other POCUS applications]
4. Integration (I) in medical decision making (POCUS seen as only one piece of the diagnostic puzzle, with multiple possible effects on the pretest diagnostic hypothesis: 1) support and confirmation; 2) deception; 3) inconsequentiality (not supporting but not changing the hypothesis/plan); 4) complete change in the pretest diagnosis)
5. Identification, analysis and management (M) of limitations and pitfalls associated with focused, non-comprehensive studies performed by non-experts (when to call for help; when not to trust ultrasound findings).

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Get in Touch

BASIC.CCUS@gmail.com

Alberto Goffi – alberto.goffi@unityhealth.to

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IDCCM & ANESTHESIA BASIC Ultrasound Curriculum – All rights reserved