University of North Carolina at Chapel Hill Ultrasound Program focuses on bedside education, research and improving patient care. Point of Care Ultrasound (POCUS) has been shown to expedite diagnosis of life-threatening disease, increase patient satisfaction, decrease ED length of stay, lower healthcare cost, and, most importantly, save lives. POCUS is a required skill of graduating EM residents.
As a resident at UNC, you will become an expert in not only image acquisition and interpretation, but will also know how to incorporate your findings into your clinical decision making. At UNC, POCUS plays an important role in our clinical practice. The vast majority of faculty are credentialed in POCUS. The Emergency Department has a unique ability to link bedside sonographic images to the patient’s medical record simply by placing an order. Throughout the hospital and in our consulting services, ultrasound is well known and respected. It is frequently a game changer for patient management and simplifies conversations amongst surgeons, interventional cardiologists to obstetricians and ophthalmologists. All images obtained are reviewed by ultrasound faculty for quality assurance and feedback is provided.
PGY1 US Education
You are first introduced to POCUS during orientation. There is a daylong US bootcamp, taught by faculty and residents! During this session, you will be taught FAST, RUSH, Undifferentiated abdominal pain and IV access. This allows for basic skills so that you can start using US on day 1 of your internship.
The main purpose of the required elective is to learn, practice, and review all applications for emergency US. This is done by attending our weekly US scanning shifts, US QA review, and US lectures/workshops You will also come to scan independently in the ED while one of the US faculty are on shift for supervision. During your intern year, you will spend a total of 4 weeks dedicated to US during which time you will:
- Refine your basic skills and learn DVT, Early Pregnancy, Soft Tissue/Musculoskeletal and Procedural US.
- Complete a formal video training educational program (EMsono)
- Develop an US interesting case presentation and Journal Watch review
- Participate in US quality assurance sessions with the US faculty
This rotation provides a solid framework on which to build during your second and third years. POCUS is routinely used in all the clinical settings at UNC, Wake Med and Hillsborough hospitals.
There are monthly didactic and hands-on sessions throughout the year on basic ultrasound applications but also on secondary applications such as ophthalmic exams, DVT screening, and ultrasound-guided procedures.
There is an US concentration for junior/senior residents that has defined roles and responsibilities for student/resident US education, supervised US scanning, monthly US journal watch presentations, and research initiatives. Those in the US concentration are also responsible for organizing the annual UNC Sonogames! This entails resident teams tackling US questions that test fund of knowledge and sonographic skills!
We have participated in the annual SAEM sonogames for the past three years, and have made into the final rounds each year!
The US team:
Daniel Park MD – Associate Director of the UNC US program
Christopher Howarth MD – Clinical Manager of the Adult EM US program
Danny Migliaccio MD – Head of Emergency Ultrasound Education
Jonathan Dobin MD – 2018-19 Resident Ultrasound Director
We are extraordinarily proud of the sonographic skills that our residents acquire during the course of training. Each intern will log nearly 100 scans during the first year, all of which are reviewed and feedback provided to encourage excellence and accuracy in image acquisition and interpretation. The foundation is set for competency in clinical practice. Those interested in pursuing fellowship training will be highly competitive from our comprehensive US program. The 2018 US chief will begin his fellowship at Virginia Commonwealth University this year!
Bedside US is used by to diagnose countless emergent medical conditions such as pericardial tamponade, pneumothorax, ectopic pregnancy, intraabdominal hemorrhage, and retinal detachment…to name a few. We also use bedside US for procedural guidance to maximize patient safety and prevent complications. Procedures include line placement, thoracentesis, paracentesis, abscess drainage, lumbar puncture, nerve blocks, and foreign body removal.
ED Ultrasound Applications
Musculoskeletal (MSK) Ultrasound
Bladder Volume Ultrasound
Soft Tissue Ultrasound
Advanced Ultrasound Applications
Right Lower Quadrant Ultrasound for Appendicitis
Bowel Ultrasound – Bowel Obstruction, Intussusception, Pyloric Stenosis
Links/list of recent US publications:
- Pediatric Abdominal Bedside Ultrasound, A Comprehensive Guide to Making the Diagnosis, Part 1.Fender, K. Park, D., Migliaccio, D. Pediatric Emergency Medicine Reports, 23(7).
- A 54-year-old male with abdominal pain secondary to superior mesenteric artery dissection.Teeter, W., Migliaccio, D. Stahmer, S. (Nov 2017). Visual Journal of Emergency Medicine
- A 61-year-old male with undifferentiated hypotension (IVC mass). Palomba, K., Migliaccio, D. (Oct 2017). Visual Journal of Emergency Medicine
- A 44-year-old male with cardiac amyloidosis.Saleeby, J., Migliaccio, D. (Oct 2017). Visual Journal of Emergency Medicine
- 63 year old man with chest pain and shortness of breath. Stahmer S, Stenberg R. In: Weinstock MB, Klauer KM, Weingart SD, Henry GL. Bouncebacks! Critical Care. Columbus, OH: Anadem Publishing; 2019.