ED ultrasound

Letters

CJEM 1999;1(3):162

To the editor:

I wish to address comments made by Drs. Ducharme and McPhee in the July issue of CJEM.^1,2 Their comments on the use of ED ultrasound (ED U/S) seem to reflect common misconceptions about this important diagnostic tool. These doctors suggest that the amount of training required to perform ED U/S is prohibitive and that, to meet the requirements of the Canadian Association of Radiologists, a great deal of EM residency time would have to be reallocated. This might be true if the purpose of such exams was to delineate specific pathologies or disease processes. But ED U/S exams were never intended to be definitive evaluations, which are far too time intensive to be practical in the busy ED setting. On the contrary, ED U/S is meant to provide rapid answers to specific questions, such as: Is there free fluid in the abdomen of this trauma patient? Is there an intrauterine pregnancy in this woman with suspected ectopic? and Does this hypotensive patient have an abdominal aortic aneurysm?

To avoid confusing ED U/S with the comprehensive exams carried out in the radiology suite, I propose that we refer to the former as EMERGENT scans.³ Emergent scans are performed by Emergency physicians, are Medically indicated, occur in the Emergency department, are Rapid, Goal directed, Evidence-based, Not difficult and will decrease Time to diagnosis. Less training time is required to master EMERGENT scans. The Society of Academic Emergency Medicine recommends only 40 hours of didactic teaching and by 150 clinically-indicated examinations.⁴ This could easily be accomplished during a 5-year EM residency and might even be possible within the CCFP(EM) curriculum.

Importantly, the recognition of the EMERGENT scan as distinct from the definitive radiology U/S should facilitate a more open dialogue with our radiology colleagues. Perhaps if radiologists realized that EMERGENT scans are not a threat to their incomes, then a more collegial interaction could occur.

Jeffrey Sankoff, MD Fellow
Critical Care Medicine
Royal Victoria Hospital
Jewish General Hospital
McGill University
Montreal, Que.
jsanko@po-box.mcgill.ca

References

1. Ducharme J. Ultrasound in the emergency department [controversy]. CJEM 1999;1(2):119-20.
2. McPhee D. A radiologist’s perspective [controversy]. CJEM 1999;1(2):123-4.
3. Sankoff J. Resident education: making a case for training residents to perform and interpret bedside sonographic examinations. Ann Emerg Med 1999;34:105-8.
4. Lanoix R. Credentialing issues in emergency ultrasonography. Emerg Med Clin North Am 1997;15:913-20.