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As emergency physicians are looking at handheld devices as alternatives to the traditional, cart-based systems, concerns center around whether they are forsaking image quality for a lower price point and whether the handheld can be trusted for medical decision making. We aimed to determine the feasibility of using a handheld ultrasound device in place of a cart-based system during the evaluation of trauma patients using the Focused Assessment with Sonography for Trauma (FAST) examination. This was a prospective study of adult trauma patients who received a FAST examination as part of their evaluation. A FAST examination was performed using a cart-based machine and a handheld device. The results of the examinations were compared with computed tomography imaging. Images obtained from both ultrasound devices were reviewed by an expert for image quality. A total of 62 patients were enrolled in the study. The mean (SD) time to perform a FAST examination using the handheld device was 307.3 (65.3) s, which was significantly less (p = 0.002) than the 336.1 (86.8) s with the cart-based machine. There was strong agreement between the examination results of the handheld and cart-based devices and between the handheld and computed tomography. Image quality scores obtained with the handheld device were lower than those from the cart-based system. Most operators and reviewers agreed that the images obtained from the handheld were adequate for medical decision making. Data support that it is feasible to use the handheld ultrasound device for evaluation of the trauma patient in place of the cart-based system. [ABSTRACT FROM AUTHOR]

Objectives: Emergency ultrasound (EUS) is a critical component of emergency medicine (EM) resident education. Currently, there is no consensus list of competencies for EUS training, and graduating residents have varying levels of skill and comfort. The objective of this study was to define a widely accepted comprehensive list of EUS competencies for graduating EM residents through a modified Delphi method. Methods: We developed a list of EUS applications through a comprehensive literature search, the American College of Emergency Physicians list of core EUS benchmarks, and the Council of Emergency Medicine Residency-Academy of Emergency Ultrasound consensus document. We assembled a multi-institutional expert panel including 15 faculty members from diverse practice environments and geographical regions. The panel voted on the list of competencies through two rounds of a modified Delphi process using a modified Likert scale (1 = not at all important, 5 = very important) to determine levels of agreement for each application--with revisions occurring between the two rounds. High agreement for consensus was set at >80%. Results: Fifteen of 15 panelists completed the first-round survey (100%) that included 359 topics related to EUS. After the first round, 195 applications achieved high agreement, four applications achieved medium agreement, and 164 applications achieved low agreement. After the discussion, we removed three questions and added 13 questions. Fifteen of 15 panelists completed the second round of the survey (100%) with 209 of the 369 applications achieving consensus. Conclusion: Our final list represents expert opinion on EUS competencies for graduating EM residents. We hope to use this consensus list to implement a more consistent EUS curriculum for graduating EM residents and to standardize EUS training across EM residency programs. [ABSTRACT FROM AUTHOR]

BACKGROUND: Traditionally performed using a subxiphoid approach, the increasing use of point-of- care ultrasound in the emergency department has made other approaches (parasternal and apical) for pericardiocentesis viable. The aim of this study is to identify the ideal approach for emergency-physician-performed ultrasound-guided pericardiocentesis as determined by ultrasound image quality, distance from surface to pericardial fluid, and likely obstructions or complications. METHODS: A retrospective review of point-of-care cardiac ultrasound examinations was performed in two urban academic emergency departments for the presence of pericardial eff usions. The images were reviewed for technical quality, distance of eff usion from skin surface, and predicted complications. RESULTS: A total of 166 pericardial effusions were identified during the study period. The mean skin-to-pericardial fluid distance was 5.6 cm (95% confi dence interval [95% CI] 5.2-6.0 cm) for the subxiphoid views, which was signifi cantly greater than that for the parasternal (2.7 cm [95% CI 2.5-2.8 cm], P<0.001) and apical (2.5 cm [95% CI 2.3-2.7 cm], P<0.001) views. The subxiphoid view had the highest predicted complication rate at 79.7% (95% CI 71.5%-86.4%), which was significantly greater than the apical (31.9%; 95% CI 21.4%-44.0%, P<0.001) and parasternal (20.2%; 95% CI 12.8%-29.5%, P<0.001) views. CONCLUSIONS: Our results suggest that complication rates with pericardiocentesis will be lower via the parasternal or apical approach compared to the subxiphoid approach. The distance from skin to fl uid collection is the least in both of these views. [ABSTRACT FROM AUTHOR]

Introduction: As physician-performed point-of-care ultrasound (POCUS) becomes more prevalent in the evaluation of patients presenting with various complaints in the emergency department (ED), one application that is significantly less used is breast ultrasound. This study evaluates the utility of POCUS for the assessment of patients with breast complaints who present to the ED and the impact of POCUS on medical decision-making and patient management in the ED. Methods: This was a retrospective review of ED patients presenting with breast symptoms who received a POCUS examination. An ED POCUS database was reviewed for breast POCUS examinations. We then reviewed electronic health records for demographic characteristics, history, physical examination findings, ED course, additional imaging studies, and impact of the POCUS study on patient care and disposition. Results: We included a total of 40 subjects (36 females, 4 males) in the final analysis. Most common presenting symptoms were breast pain (57.5%) and a palpable mass (37.5%). "Cobblestoning," ie, dense bumpy appearance, was the most common finding on breast POCUS, seen in 50% of the patients. Simple fluid collections were found in 37.5% of patients. Conclusion: Our study findings illustrate the utility of POCUS in the evaluation of a variety of breast complaints in the ED. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study was to evaluate the performance of a handheld ultrasound device for difficult peripheral intravenous (PIV) access performed by nurses and paramedics in the emergency department (ED). Methods: This was a retrospective review at an academic medical center. Participants were ED nurses and paramedics with competence in ultrasound‐guided PIV placement. Participants were asked to log their use of the handheld device when used on patients deemed to have "difficult" access and complete a questionnaire, which consisted of items related to the effectiveness and ease of use of the device. Data were collected over the course of 1 year. An electronic medical record review was performed to track the success rates and the occurrence of any associated complications throughout the hospital stay. Results: Nurses and paramedics logged a total of 483 cases in which PIV access was attempted with the handheld ultrasound device. Ninety‐two percent (95% confidence interval [CI], 89%–94%) of the ultrasound‐guided PIV lines attempted were placed successfully. Eighty‐four percent (95% CI, 80%–87%) of the lines were placed successfully on the first attempt. In most cases (396 of 483 [82%]), no complications associated with the PIV occurred. A total of 429 questionnaires were completed over the study period. Most of the operators (84%; 95% CI, 80%–87%) stated that the handheld device was adequate to perform ultrasound‐guided PIV access. Conclusions: The handheld ultrasound device performed well in terms of usability and reliability for PIV access. [ABSTRACT FROM AUTHOR]

Objectives: Prior literature has demonstrated incongruities among faculty evaluation of male and female residents' procedural competency during residency training. There are no known studies investigating gender differences in the assessment of procedural skills among emergency medicine (EM) residents, such as those required by ultrasound. The objective of this study was to determine if there are significant gender differences in ultrasound milestone evaluations during EM residency training. Methods: We used a stratified, random cluster sample of Accreditation Council for Graduate Medical Education (ACGME) EM residency programs to conduct a longitudinal, retrospective cohort analysis of resident ultrasound milestone evaluation data. Milestone evaluation data were collected from a total of 16 ACGME‐accredited EM residency programs representing a 4‐year period. We stratified milestone data by resident gender, date of evaluation, resident postgraduate year, and cohort (residents with the same starting date). Results: A total of 2,554 ultrasound milestone evaluations were collected from 1,187 EM residents (750 men [62.8%] and 444 women [37.1%]) by 104 faculty members during the study period. There was no significant overall difference in mean milestone score between female and male residents [mean difference = 0.01 (95% confidence interval {CI} = −0.04 to 0.05)]. There were no significant differences between female and male residents' mean milestone scores at the first (baseline) PGY1 evaluation (mean difference = −0.04 [95% CI = −0.09 to 0.003)] or at the final evaluation during PGY3 (mean difference = 0.02 [95% CI = −0.03 to 0.06)]. Conclusions: Despite prior studies suggesting gender bias in the evaluation of procedural competency during residency training, our study indicates that there were no significant gender‐related differences in the ultrasound milestone evaluations among EM residents within training programs throughout the United States. [ABSTRACT FROM AUTHOR]

Objectives: To determine the feasibility of integrating pre-intubation ultrasound into airway course and assess emergency medicine (EM) residents' confidence and comfort level in using ultrasound for pre-intubation hemodynamic stabilization and identifying cricothyroid membrane after the training session. Materials and methods: This is a retrospective study. Pre-intubation ultrasound training was delivered with the following ultrasound components (didactics and hands-on sessions using human models) to EM residents: (1) sonoanatomy and scanning technique to identify cricothyroid membrane and (2) pre-intubation echocardiography for recognition of acute right ventricular failure and pre-intubation hemodynamic stabilization. Results: A total of 56 EM residents participated in this study. Only 21% [95% confidence interval (CI), 10-31%] reported using ultrasound for pre-intubation hemodynamic stabilization. After the training session, 89% (95% CI, 81-97%) reported that ultrasound-based teaching increased their knowledge of pre-intubation hemodynamic stabilization compared with traditional teaching methods. On a scale of 1 (low) through 10 (high), the average comfort level for integrating ultrasound findings into medical decision making for pre-intubation hemodynamic stabilization was 6.8 (95% CI, 6.3-7.3). Seventy-nine percent (95% CI, 68-89%) reported that focused training in airway ultrasound is adequate to identify cricothyroid membrane. On a scale of 1 (low) through 10 (high), the average confidence level for identifying cricothyroid membrane using ultrasound was 6.6 (95% CI, 6.1-7.1). Conclusion: At our institution, we successfully integrated pre-intubation ultrasound into an airway course. Emergency medicine residents had a moderate level of comfort and confidence level using ultrasound for pre-intubation hemodynamic stabilization and identifying cricothyroid membrane after the training session. [ABSTRACT FROM AUTHOR]

Aim: Regional anesthesia with ultrasound-guidance is an excellent option for pain control if nerves are adequately visualized. Gender, body mass index (BMI), history of diabetes, neck and forearm circumference may affect echotexture and visualization. This study evaluates patient characteristics for their ability to predict the echogenicity or visibility of upper extremity peripheral nerves.Material and Methods: This is a prospective observational study. A convenience sample of adult emergency department patients were enrolled. Gender, BMI, history of diabetes, neck circumference and arm circumference were recorded. Sonographic images of the brachial plexus at interscalene and supraclavicular levels, the median, the radial and ulnar nerves were recorded. Three reviewers independently graded the echogenicity and visibility using subjective scales.Results: 395 peripheral nerves were included. Nerves of the forearm (median, ulnar, radial nerves) were found to be more echogenic (OR=9.3; 95% CI: 5.7, 15.3) and visible (OR=10.0; 6.3, 16.0) than more proximal nerves (brachial plexus at interscalene and supraclavicular levels). Gender, BMI, and history of diabetes mellitus were not significantly related to nerve visibility (p=0.9, 0.2, 0.2, respectively) or echogenicity (p=0.3, 0.8, 0.3). Neck circumference was not related to visibility or echogenicity of proximal nerves. Increased forearm circumference improved echogenicity (OR=1.25; 1.09, 1.43) but not visibility of forearm nerves.Conclusions: Gender, BMI and presence of diabetes were not related to echogenicity or visibility of upper extremity nerves. Increasing forearm circumference was associated with increased echogenicity of the adjacent nerves, but not visibility. Neck circumference was not associated with either nerve visibility or echogenicity of brachial plexus nerve bundles. [ABSTRACT FROM AUTHOR]

Study Objective: There is significant overlap between the symptoms of patients presenting with retinal detachment (RD) and posterior vitreous detachment (PVD). Urgency to obtain consultation and treatment are dependent on the ability to accurately distinguish these two conditions. The objective of this study was to determine the ability of emergency physicians to differentiate RDs from PVDs using point-of-care (POC) ocular ultrasound.Methods: Single blinded cross-sectional study at an academic medical center. Emergency physicians with varying ultrasound experience completed a brief tutorial on the sonographic findings of RD and PVD. Thirty POC ocular ultrasound clips obtained from ED patients with ocular symptoms were presented to emergency physicians. The sonographic findings in these clips were in agreement with the final diagnosis made by consultant ophthalmologists. There were 14 ultrasound videos showing PVD, 13 videos showing RD, and 3 normal ocular ultrasound videos. The subjects independently reviewed POC ocular ultrasound video clips and submitted their final interpretations.Results: A total of 390 ocular video clips were reviewed by 13 emergency physicians. Overall, physicians were able to accurately diagnose the presence of a RD 74.6% (95%CI, 69.8-79.4) of the time, PVD 85.7% (95%CI, 77.6-93.8) of the time, and normal ultrasounds 94.9% (95%CI 87.3-100.0) of the time. There was no statistically significant relationship between correct diagnoses for ocular abnormalities or normal ultrasound images and number of previous ocular ultrasounds performed by emergency physicians.Conclusion: Emergency physicians were modestly accurate in distinguishing RD from PVD on POC ultrasound. [ABSTRACT FROM AUTHOR]

Background: Arthrocentesis of the ankle and elbow and brachial plexus nerve blocks are infrequently performed procedures; however, clinicians in specialties such as emergency medicine are required to be proficient in these procedures in the event of emergent or urgent necessity. Objectives: The objective of this study was to create, implement, and assess a fresh cadaver-based educational model to help resident physicians learn how to perform ultrasound-guided arthrocentesis of the ankle and elbow and ultrasound-guided regional nerve blocks. Methods: This was a single-center cross-sectional study conducted at an academic medical center. After a brief didactic session, 26 emergency medicine residents with varying levels of clinical and ultrasound experience rotated through 4 fresh cadaver-based stations. The objective of each station was to understand the sonographic anatomy and to perform ultrasound-guided arthrocentesis or regional nerve block with hands-on feedback from ultrasound fellows and faculty. Participants were subsequently asked to complete a questionnaire which evaluated participants' experience level, opinions, and procedural confidence regarding the 4 stations. Results: A total of 26 residents participated in this study. All 26 residents agreed that the cadaver model (compared with clinical anatomy) was realistic regarding ultrasound quality of the joint space, ultrasound quality of the joint effusion, ultrasound quality of nerves, tissue density, needle guidance, and artifacts. Finally, there was a statistically significant difference between mean scores for pre-simulation and post-simulation session participant procedural confidence for all 4 procedures. Conclusions: This fresh cadaver-based ultrasound-guided educational model was an engaging and well-received opportunity for residents to gain proficiency and statistically significant confidence in procedures which are uncommonly performed in clinical settings. [ABSTRACT FROM AUTHOR]

Objectives The objective of this study is to describe a simple, replicable method to create neck models for the purpose of education and practice of ultrasound (US) identification of anatomic landmarks for cricothyrotomy. The second objective is to assess the model's capability in training emergency medicine (EM) residents in the US identification of anatomic landmarks for cricothyrotomy. Methods This is a cross-sectional study using a convenience sample of EM residents. Participants were taught to identify the thyroid cartilage, the cricothyroid membrane (CTM), and the cricoid cartilage using US. After an instructional period, participants performed a US examination on gel models designed to overly a live, human neck simulating various scenarios: thin neck, thick neck, anterior neck hematoma, and subcutaneous emphysema. Residents were asked to identify the thyroid cartilage, the CTM, and the cricoid cartilage as quickly as possible. The mean time to successful identification was reported in seconds. Following the scanning session, participants were asked to complete a post-survey. After the session, the video recordings were reviewed by an emergency US fellowship-trained physician to assess the visuomotor skills of each participant. Results A total of 42 residents participated in the study. Ninety-three percent (32/42; 95% CI 80.3% - 98.2%) of residents were able to obtain an optimal sagittal or parasagittal sonographic view of the anterior airway landmarks. Of these residents, 21.4% (9/42; 95% CI 11.5% - 36.2%) required minimal assistance with the initial probe placement. The visuomotor scores were recorded for each participant. Results of the pearson correlation indicated that there was a significant positive relationship between the residents' year in training with their visuomotor score (r(40) = .41, p = .007). When scanning the thin neck, 90.5% (38/42; 95% CI 77.4% - 96.8%) of residents were able to successfully identify the landmarks. The median time to completion was 27 seconds. When scanning the subcutaneous air model, 88.1% (37/42; 95% CI 74.5% - 95.3%) of residents were able to successfully identify the landmarks. The median time to completion was 26 seconds. When scanning the neck with the fluid collection 95.2% (40/42; 95% CI 83.4% - 99.5%) of residents were able to successfully identify the landmarks with a median time of 20 seconds for identification. When scanning the thick neck model, 73.8% (31/42; 95% CI 58.8% - 84.8%) of residents were able to successfully identify the landmarks taking a median time of 26 seconds. After the training session, 76.2% of residents reported that they felt either "confident" or "extremely confident" in identifying the CTM using US. Conclusion The novel anterior neck gel models used in this study were found to be adequate for training EM residents in the US identification of anterior neck anatomy. Residents were successfully trained in identifying the important anterior neck landmarks that are useful when predicting a difficult anterior airway and planning for surgical cricothyrotomy. Residents overall felt that the models simulated the appropriate anatomic scenarios. The majority felt confident in identifying the CTM using US., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Acuña et al.)

Background: The objective of this study is to investigate gender differences in the percentage of men and women who have completed an Emergency Ultrasound (EUS) fellowship over a four-year period. Secondary objectives of this study include evaluation of the career paths and accomplishments of women who have recently completed an EUS fellowship. We will also be assessing program characteristics as reported by the program directors., Methods: This was an online survey of all EUS fellowship programs in the United States. Programs were excluded if they were not in existence before July 2020. The survey took place between September 16, 2021, and December 5, 2021. The study was approved by the appropriate institutional review board. Emergency Ultrasound fellowship programs and their respective program directors were identified from a list of participating programs created by the Society of Clinical Ultrasound Fellowships. The survey questions were divided into the following categories: program demographics, questions regarding the program's recent fellowship classes, and questions relating to the program director's perspective on gender and fellowship., Results: This study utilized a convenience sample, from a roster of 109 programs, with a response rate of 67% by program directors. There was no significant difference in the percentage of men and women who have completed an EUS fellowship over a four-year period. No graduates who identified as transgender or non-binary/gender non-conform were reported. The majority of female fellows (65%) completed a research/scholarly project during their fellowship year (65%) and have held or currently hold a leadership position at their institution (60.3%). When program directors were asked if they felt women were equally represented in EUS fellowship programs, 24 (34.3%) respondents said yes, 18 (25.7%) said no, and 28 (40%) were not sure. When asked if they felt there were barriers that specifically prevented women from pursuing a fellowship, 28 (40%) said yes, 24 (34.3%) said no, and 18 (25.7%) were not sure., Conclusion: There does not exist a significant difference in the percentage of males and females who have completed an EUS fellowship over a four-year period. Completion of an EUS fellowship may provide women the opportunity to participate in research and receive awards for their accomplishments. It may also serve as a pipeline to academic medicine and leadership roles., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Acuña et al.)

Introduction: Pott's puffy tumor (PPT) is a rare clinical disease characterized by forehead swelling from a subperiosteal abscess coupled with frontal bone osteomyelitis. It is often associated with severe complications and poor outcomes if left undiagnosed; thus, rapid recognition is crucial. Point-of-care ultrasound (POCUS) may provide an alternative pathway to diagnosis. It can be performed rapidly at the bedside and assist in early screening of patients, identifying those with high suspicion for PPT and prioritizing imaging and consultation., Case Report: A 59-yghb ar-old-male presented to the emergency department for evaluation of a "lump" on his forehead. He recently had a bifrontal craniotomy to de-bulk a polyp burden in an effort to manage his recurrent sinusitis. To further characterize the mass, a POCUS examination was performed by the treating emergency physician. The examination found a subcutaneous, hypoechoic fluid collection extending superficially along the frontal bone. A discontinuity in the surface of the frontal bone was visualized through which the collection appeared to extend. Given the heightened concern for PPT based on the POCUS examination findings, otolaryngology service was consulted and the patient was admitted for further imaging and treatment., Conclusion: Pott's puffy tumor is a rare diagnosis that has the potential for life-threatening complications. Timely diagnosis is imperative. Point-of-care ultrasound can easily be used to help identify patients with suspicion for PPT in the acute care setting and influence patient management with regard to obtaining further imaging and plans for early consultation.

Introduction: Cephalohematomas generally do not pose a significant risk to the patient and resolve spontaneously. Conversely, a subgaleal hematoma is a rare but more serious condition. While it may be challenging to make this diagnostic distinction based on a physical examination alone, the findings that differentiate these two conditions can be appreciated on point-of-care ultrasound (POCUS). We describe two pediatric patient cases where POCUS was used to distinguish between a subgaleal hematoma and a cephalohematoma., Case Reports: We describe one case of a 14-month-old male brought to the pediatric emergency department (PED) with concern for head injury. A POCUS examination revealed a large fluid collection that did not cross the sagittal suture. Thus, the hematoma was more consistent with a cephalohematoma and less compatible with a subgaleal hematoma. Given these findings, further emergent imaging was deferred in the PED and the patient was kept for observation. In the second case an 8-week-old male presented with suspected swelling over the right parietal region. A POCUS examination was performed, which demonstrated an extensive, simple fluid collection that extended across the suture line, making it more concerning for a subgaleal hematoma. Given the heightened suspicion for a subgaleal hematoma, the patient was admitted for further imaging and evaluation., Conclusion: Point-of-care ultrasound can be used to help differentiate between a subgaleal hematoma and a cephalohematoma to risk-stratify patients and determine the need for further imaging.

Objectives: Prior literature has demonstrated incongruities among faculty evaluation of male and female residents' procedural competency during residency training. There are no known studies investigating gender differences in the assessment of procedural skills among emergency medicine (EM) residents, such as those required by ultrasound. The objective of this study was to determine if there are significant gender differences in ultrasound milestone evaluations during EM residency training., Methods: We used a stratified, random cluster sample of Accreditation Council for Graduate Medical Education (ACGME) EM residency programs to conduct a longitudinal, retrospective cohort analysis of resident ultrasound milestone evaluation data. Milestone evaluation data were collected from a total of 16 ACGME-accredited EM residency programs representing a 4-year period. We stratified milestone data by resident gender, date of evaluation, resident postgraduate year, and cohort (residents with the same starting date)., Results: A total of 2,554 ultrasound milestone evaluations were collected from 1,187 EM residents (750 men [62.8%] and 444 women [37.1%]) by 104 faculty members during the study period. There was no significant overall difference in mean milestone score between female and male residents [mean difference = 0.01 (95% confidence interval {CI} = -0.04 to 0.05)]. There were no significant differences between female and male residents' mean milestone scores at the first (baseline) PGY1 evaluation (mean difference = -0.04 [95% CI = -0.09 to 0.003)] or at the final evaluation during PGY3 (mean difference = 0.02 [95% CI = -0.03 to 0.06)]., Conclusions: Despite prior studies suggesting gender bias in the evaluation of procedural competency during residency training, our study indicates that there were no significant gender-related differences in the ultrasound milestone evaluations among EM residents within training programs throughout the United States., (© 2019 by the Society for Academic Emergency Medicine.)

Competing Interests: The authors have disclosed that they do not have any potential conflicts of interest.

Objectives: Prior literature suggests that incongruities between male and female resident's procedural competency may be explained by gender bias during the evaluation process. There are no known studies investigating gender differences in the assessment of ultrasound-based procedural skills among emergency medicine (EM) residents. The purpose of this study was to evaluate for gender differences in ultrasound milestone assessments among EM residents. Methods: This is a retrospective study including EM residents. Milestone assessment data were collected from a total of 3 Accreditation Council for Graduate Medical Education (ACGME) EM residency programs representing a 3-year period The outcome measures included mean milestone levels, milestone levels at baseline and graduation and differences in milestone achievement between female and male EM residents. An unpaired Student's t -test was used to compare milestone scores between female and male residents. Results: A total of 456 ultrasound milestone evaluations were collected from 91 EM residents (34 females [37%] and 57 males [63%]). No significant differences were noted in the overall mean milestone level between females (2.3±0.6) and males (2.2±0.6) ( P =0.387). There were no significant differences noted in the ultrasound milestone level between females (0.8±0.6) and males (0.7±0.7) at baseline ( P =0.754). Although it did not reach statistical significance ( P =0.197), the increase in the mean ultrasound milestone level from baseline to graduation was greater in males (3.4±0.7) compared to females (3.1±0.7). Conclusion: Overall, there were no statistically significant differences in the mean ultrasound milestone levels between females and males. The rate of ultrasound milestone level achievement during EM residency training at our institution had a slight tendency to be higher for males than females in the observed residency programs; however, this also did not reach statistical significance. Possible gender bias while evaluating ultrasound milestone levels needs to be further studied on a larger scale., Competing Interests: The authors report no conflicts of interest in this work.

Introduction  Ultrasound-guided peripheral nerve blocks (USGPNB) are performed by various specialists and are excellent, non-addicting pain control techniques. Alternative pain management approaches are needed to combat opiate abuse. Medical students should be aware of alternative pain management therapies before they begin clinical practice. Objective  Our objective was to determine if medical students can identify peripheral nerves under ultrasound and perform a USGPNB after a one-day hands-on training session. Methods  This was a cross-sectional study at an academic medical center. The study participants were third-year medical students with minimal prior ultrasound experience. Students were given an introductory lecture highlighting the opiate epidemic and benefits of USGPNB prior to the workshop. The one-day hands-on educational workshop consisted of learning basic sonographic anatomy, indications for USGPNB, and practicing needle guidance under ultrasound guidance. After the educational workshop, students' procedural competency was assessed by ultrasound-trained emergency medicine clinicians. Results  A total of 94 participants were included in this study. The average pre-test score was 68.4% (95% confidence interval [CI]; 65.4% to 71.4%). After the one-day educational workshop, the post-test score was 92.8% (95% CI; 90.8% to 94.8%). The average hands-on evaluation score was 84.4% (95% CI; 81.6% to 87.3%). All students agreed that this educational session is a good start to learning about USGPNB, and they felt comfortable identifying the peripheral nerves using ultrasound. On a confidence scale of one (low) through 10 (high), 83% (95% CI; 75.9% to 90.15%) rated their confidence as ≥6. All except one student either agreed that this educational session helped them understand how USGPNB could be integrated into acute pain management. The majority (84% [95% CI; 77% to 91%]) agreed that the session will change how they manage patients' acute pain in their future medical practice. Conclusion  Medical students can learn the sonographic anatomy of peripheral nerves and techniques of USGPNB after a one-day educational session., Competing Interests: The authors have declared that no competing interests exist.

Introduction The objectives of this study were to determine if a multimodular introductory ultrasound course improved emergency medicine intern confidence in performing a point-of-care ultrasound and if our educational objectives could be met with our chosen structure. Methods This is a prospective, observational study evaluating three consecutive incoming emergency medicine residency classes from three residency programs. A one-day introductory ultrasound course was delivered. The course consisted of 1) flipped classroom didactics, 2) in-person, case-based interactive teaching sessions, and 3) check-listed, goal-driven, hands-on instruction. Results Over three years, 73 residents participated in this study. There was no significant difference in performance on the written test (p = 0.54) or the skills assessment (p = 0.16) between years. Performance on the written pre-test was not a predictor of performance on the skills test (R 2  = 0.028; p = 0.19). Prior to training, residents were most confident in performing a focused assessment with sonography for trauma examination (median confidence 5.5 (interquartile range (IQR): 3 - 7) on a 10-point Likert scale where 1 represents low confidence and 10 represents high confidence). They reported the lowest confidence in performing a cardiac ultrasound (3 (IQR: 2 - 6)). Following training, residents reported increased confidence with all applications (p < 0.001). Eighty-five percent (confidence interval (CI): 73, 92) of residents agreed that the online ultrasound lectures effectively teach point-of-care ultrasound applications and 98% (CI: 88, 100) agreed that case-based interactive sessions helped them understand how ultrasound changes the management of acutely ill patients. Conclusions A written test of knowledge regarding the use of point-of-care ultrasound does not correlate with procedural skills at the start of residency, suggesting that teaching and evaluation of both types of skills are necessary. Following a multimodular introductory ultrasound course, residents showed increased confidence in performing the seven basic ultrasound applications. Residents reported that an asynchronous curriculum and case-based interactive sessions met the learning objectives and effectively taught point-of-care ultrasound applications., Competing Interests: The authors have declared that no competing interests exist.