o   Knowledge

o   Ultrasound physics

o   Ultrasound safety

o   Creation of 2D M-mode ultrasound images.

o   Principles of continuous wave Doppler, pulsed wave Doppler, color flow Doppler

o   Knobology

o   Artifacts & limitations

o   Hemodynamic calculations

o   Administrative

o   Image recording & storage

o   Reporting findings

o   Medicolegal – responsible level of practice within area of competence

o   Competence in General Critical Care Ultrasound (Adapted from 2009 ACCP & 2015 SCCM guidelines)

o   Pleural ultrasonography

§  Identification of normal anatomy – ribs, pleura, diaphragm, liver, spleen, heart, IVC, pericardium

§  Identification of pleural fluid – floating lung, loculations, pleural vs peritoneal fluid, pleural thickening

o   Lung ultrasonography

§  A-line, B-line, lung point, lung sliding

§  Identification of normal lungs – A-lines with lung sliding

§  Identification of consolidated lung & B-lines

§  Pneumothorax – presence of lung sliding & B-lines; lung point

o   Abdominal ultrasonography

§  Identification of normal anatomy – diaphragm, liver, spleen, GB, kidney, bladder, bowel, uterus, IVC, aorta

§  Intraperitoneal fluid identification

·        Anechoic space, floating bowel, peristalsis, presence of septations, debris, loculations

§  Identification of bladder, qualitative measurement of intravesicular volume

§  Identification of both kidneys, hydronephrosis

o   Vascular ultrasonography

§  Guidance of vascular access – differentiation from artery using compression, pulsed wave Doppler, color flow Doppler, identification of adjacent structures

§  Identification of deep venous thrombosis

o   Competence in Basic critical care echocardiography (Adapted from ACCP, WINFOCUS guidelines)

o   Image acquisition

§  Parasternal long axis

§  Parasternal short axis

§  Apical four-chamber

§  Subcostal four-chamber

§  Subcostal IVC long axis

o   Identification of clinical syndromes

§  Hypovolemia – small LVEDV & RVEDV; small IVC with respirophasic variation

§  LV failure – severe, global LV dysfunction based on parasternal short axis view

§  RV failure – RV dilation, dilated IVC, paradoxical septal motion

§  Tamponade – pericardial effusion, RA/RV diastolic collapse, dilated IVC

o   Advanced Curriculum – additional topics for further study if trainee shows competence in basic techniques

o   Cardiac

§  Transesophageal echocardiography

§  Calculations of stroke volume, regurgitant volume

§  Valvular examination – stenosis, regurgitation

§  Dynamic maneuvers to assess fluid responsiveness

o   Abdominal exam

§  Gallbladder thickening

§  CBD dilation

o   Thoracic

§  Diaphragmatic movement, diaphragmatic thickening

§  Pulmonary edema

§  Identifying additional pulmonary pathologies: abscess, mass, etc.