Emergency Ultrasound and Procedural Skills
Domain focus
The Emergency Ultrasound and Procedural Skills domain tests image acquisition, interpretation, and safe procedural technique. The board emphasizes anatomy, pitfalls, and ultrasound-guided decision-making.
Core rules
- FAST: pericardial, perihepatic (Morison's pouch), perisplenic, pelvic views; fluid appears anechoic.
- eFAST adds lung sliding and pleural views for pneumothorax.
- Cardiac: subxiphoid view for effusion; tamponade shows RA/RV collapse.
- Lung: B-lines suggest interstitial edema; absent sliding suggests pneumothorax.
- Procedural: consent, sterile technique, landmark review, ultrasound guidance, confirm placement.
- Central line: avoid infection; confirm with ultrasound or pressure transduction; chest X-ray for pneumothorax.
Worked example
A hypotensive trauma patient has a positive FAST with fluid in Morison's pouch. Reasoning: in unstable trauma, a positive FAST is an indication for laparotomy, not CT. Ultrasound answers a binary question-free fluid yes/no-and the clinical condition determines the next step.
Traps
Do not overinterpret artifacts, forget to scan the pelvis, or assume a negative FAST excludes injury. Do not use ultrasound to delay definitive care in an unstable patient.