FCCU

Overview

Dr Deepak Govil

Course Mentor

Fellowship in Critical Care Ultrasound (FCCU) has been conceptualized to cater the need of uniform training and expertise in point-of-care ultrasound. This online, on-site course will try to fill the lacunae that exists due to absence of a structured course and supervised training in India till date. The Fellowship has been formulated in a way to cover all relevant topics and competencies needed for head-to-toe evaluation of a critically ill patient. The course is meant for intensivist, anesthesiologists, pulmonologists, emergency physicians and anyone who looks after critically ill (adult) patients. This one-year fellowship will give you ample confidence to practice POCUS more efficiently in your clinic

Registration Details

Registration to Fellowship

Online
Batch 1 Start Date of Registration- 1st Jan (LIMITED TO FIRST 30 REGISTRATIONS PER BATCH)
Batch 2 Start date of Registration- 1st July (LIMITED TO FIRST 30 REGISTRATIONS PER BATCH)
Rs 25000 + GST Registration (includes one time certification fee, does not include workshop fee)
Repeat certification fee Rs 10000 +GST
Registration is valid for 3 years

Curriculum

Physics of Ultrasonography

Principles of USG waves, doppler
Various modes of USG and doppler
Sonographic textures

Understanding the machine, probes and utility

Machine: parts, handling, disinfection and storage
Transducers: Frequencies, usage
Soft skills with the machine
Optimization of USG image

Assessment of airway by USG

Indications
Probe selection and rationale
Patient position
Assessment of floor of mouth, hyoid bone, thyroid gland and cartilage, cricoid cartilage, cricothyroid membrane and tracheal rings (both longitudinal and transverse)
Tracheal deviation
Prandial status
Key recommendations and limitations

Airway related procedures

Endotracheal intubation
Cricothyroidotomy
Percutaneous tracheostomy

Understanding basic lung USG

Indications
Patient position, probe selection and various zones
Description of A lines, B lines, Z lines and E lines
Description of lung pulse
Description of lung point
Key recommendations and limitations

Identifying the pathologies: I

Pleural effusion, Pneumothorax, Consolidation and Atelectasis
Differentiating between consolidation, collapse and atelectasis, pulmonary edema, Blue protocol

Identifying the pathologies: II

In depth description of ARDS by USG
USG based lung recruitment and derecruitment in ARDS

The diaphragm by USG

Indications, probe selection, patient position
Diaphragm movement, thickening, excursion
Key recommendations and pitfalls

Basics of Echocardiography

Probe selection and patient position
Various movements of probe
Various views and structures
Correlation with cardiac cycle
Key recommendations and pitfalls

Echocardiography: looking at the chambers

All chambers – normal, measurements, dilatation
LV – hypertrophy, systolic function and ejection fraction (all methods), diastolic function and grading
RV – systolic function, dysfunction (by TAPSE and TDI)
Key recommendations

Echocardiography: looking within and outside the heart – valves, intracardiac mass and pericardium

Valves – stenosis, regurgitation and gradients and Pulmonary artery hypertension
Intracardiac mass
Pericardium – effusion, tamponade and pericardiocentesis
Key recommendations

Fluid responsiveness by Echocardiography

Assessment for fluid responsiveness by IVC, LVOT VTI, Carotid doppler
Key recommendations and pitfalls
FALLS protocol

DVT and Venous thromboembolism

Assessment for DVT
Echo findings in pulmonary embolism
Key recommendations and limitations

Role of echocardiography during cardiac arrest

Probe position
Identification of various causes (hypovolemia, pericardial tamponade, pneumothorax, embolism)
Endotracheal tube position
Protocols - FATE, FEER and SESAME
ACLS recommendations and limitations

eFAST examination

Indications and probe selection
Various views of eFAST and structures
Key recommendation

Anatomy and pathology of Intraabdominal organs

Sonoanatomy of Liver, GB, Kidney, Spleen and Urinary Bladder
Liver: Echotexture, IHBRD, abscess and mass
GB: Cholecystitis (calculous and acalculous), GB stone, perforation, dilated CBD
Spleen: infarct and abscess
Renals: CMD, Hydronephrosis and grading, cyst and masses
Bladder: Foleys bulb, distended bladder and stone
Bowel: ileus, peristalsis and pneumoperitoneum
Fluid: ascitic fluid
Key recommendations and pitfalls

Invasive abdominal procedures

Paracentesis, Abscess drainage (Liver and Spleen), Percutaneous cholecystostomy, Suprapubic catheterization

USG of Aorta

Indications and Probe selection
Normal thoracic and abdominal aorta and branches
Intraabdominal vessels: celiac trunk, splenic vessels and SMA
Aortic aneurysm and dissection
Key recommendations and pitfalls

Ocular ultrasonography including Optic nerve

Indications and probe selection
Patient position and probe soft skills
Normal sonoanatomy and structures
Retinal detachment, vitreous hemorrhage and lens dislocation
Pupillary reaction and measurement
Optic nerve sheath assessment and ICP correlation
Key recommendation and pitfalls

Assessment of midline shift and transcranial doppler assessment

Indications, probe and software selection
Third ventricle and midline shift
TCD: various views
TCD: trans temporal view – structures and vessels
TCD: PSV, EDV, MSV, PI and ICP correlation
TCD in brain death, stroke and vasospasm
Key recommendations and pitfalls

USG guided venous and arterial cannulation

USG guided cannulation of IJV (transverse, longitudinal and oblique approach), Subclavian (supraclavicular and infraclavicular), Axillary vein and Femoral (longitudinal and transverse)
Cannulation of arteries including radial artery
Key recommendations and pitfalls

Competencies

POCUS – KNOBOLOGY

Is able to enumerate the fundamental principles of ultrasound
Is able to demonstrate in-depth understanding of the parts and functioning of machine and probe.
Is able to identify and enumerate the indications and limitations of different transducers: Linear, curved array and phased array.
Is able to enumerate the physics of various modes of ultrasound – B mode, M mode and Color flow and Doppler. Is able to identify and differentiate between continuous and pulse wave Doppler.
Is able to demonstrate disinfection of probes, appropriate storage of probes and maintenance of USG machine.
Is able to demonstrate soft skills with probe, viz :- Slide / Pivot / Rotate / Fan / Heel pressure / In-plane / Out of plane / Deep / Superficial / Cranial / Caudal / Coronal / Sagittal
Is able to demonstrate and discuss various sonographic echotextures, viz:- Anechoic / Hyperechoic / Hypoechoic
Is able to demonstrate the ability to optimize an ultrasound image by utilizing various adjustments on the machine, viz :- Gain / Frequency / Brightness / Depth
Is able to demonstrate complete asepsis, while performing ultrasound guided procedures
Is able to save images and clips for demonstrations and future review

POCUS – AIRWAY

Is able to enumerate the indications of Airway ultrasound
Is able to rationalize the probe selection and patient position
Is able to demonstrate sonoanatomy in transverse approach
- Identifies floor of mouth
- Identifies thyroid and cricoid cartilage
- Identifies thyroid gland with isthmus
- Identifies tracheal rings and deviation of trachea
- Identifies vocal cord movement and palsy
Is able to demonstrate sonoanatomy in longitudinal approach
- Identifies tracheal rings
- Identifies cricoid and thyroid cartilage
- Identifies cricothyroid membrane
Is able to assess prandial status by gastric ultrasound
Is able to correctly identify endotracheal and esophageal intubation
Is able to guide cricothyroidotomy by appropriate demonstration of structures
Is able to guide percutaneous tracheostomy by appropriate demonstration of structures
Is able to enumerate the key recommendations

POCUS – LUNG PART I

Is able to demonstrate assessment of correct endotracheal intubation
Is able to understand & demonstrate various sonographic signs to diagnose pneumothorax, consolidation, atelectasis, pulmonary edema and ARDS
Is able to understand & demonstrate various sonographic signs to diagnose pleural effusion
Is able to correctly demonstrate the technique of ultrasound guided drainage of pleural effusion
Is able to correctly demonstrate the technique of ultrasound guided assessment of lung recruitment and derecruitment
Is able to enumerate the key recommendations
Is able to enumerate the stepwise approach for a patient with acute respiratory distress (BLUE protocol)
Is able to enumerate the stepwise approach of assessment by lung ultrasound for a patient with acute circulatory failure and is able to formulate fluid therapy(FALLS protocol)

POCUS – DIAPHRAGM

Is able to enumerate the indications of ultrasound use for diaphragm assessment
Is able to rationalize probe selection
Is able to demonstrate correct probe position for diaphragm assessment
Is able to enumerate & demonstrate normal & abnormal patterns of diaphragm movement, diaphragmatic excursion and contractility
Is able to enumerate the key recommendations

POCUS – CARDIAC PART I

Is able to understand the probe selection & knobology
Is able to demonstrate & identify structures in various echocardiographic views, viz:-
- Parasternal long view
- Parasternal short axis view at level of mitral valve, papillary muscles, apex and base
- Apical 3, 4 and 5 chamber views
- Sub-xiphoid heart and ivc views
- Suprasternal view (optional)
Is able to enumerate pitfalls of all views
Is able to demonstrate the tricks to generate a good image in all views
Is able to correlate various phases of cardiac cycle with ECG (optional)
Is able to demonstrate various chamber measurements and identify chamber dilatations
Is able to enumerate the key recommendations

POCUS – CARDIAC PART II

Is able to enumerate various techniques to assess left ventricular systolic function
Is able to demonstrate fractional shortening, fractional area change method of assessing LV systolic function
Is able to calculate ejection fraction
Is able to demonstrate assessment of left ventricular diastolic function, various grades of left ventricular diastolic dysfunction
Is able to demonstrate techniques to calculate right heart systolic function
Is able to enumerate the assessment of pulmonary artery hypertension by both TR and PR jet
Is able to demonstrate technique of IVC assessment and pitfalls
Is able to identify the regional wall motion abnormalities and the culprit vessel
Is able to identify pericardial effusion and pericardial tamponade. Is able to differentiate pericardial effusion from pleural effusion
Is able to guide sonographic pericardiocentesis
Is able to enumerate the key recommendations

POCUS – CARDIAC PART III

Is able to calculate stroke volume by VTI technique
Is able to demonstrate PLR assessment by VTI
Is able to calculate cardiac output by echocardiography
Assessment of volume responsiveness by LVOT VTI, Carotid doppler, IVC and SVC sonography (SVC sonography – optional)
Is able to perform 2D and Doppler evaluation of gross valvular lesions & their gradient
Is able to identify intracardiac mass
Is able to demonstrate the technique of TPI insertion under ultrasound guidance
Is able to enumerate the key recommendations
Is able to enumerate the stepwise approach for a patient with undifferentiated shock (RUSH protocol)

POCUS – eFAST SCAN

Is able to enumerate the indications of eFAST scan
Is able to rationalize the probe selection and patient position
Is able to demonstrate and identify structures in right upper quadrant, left upper quadrant, pelvic view, sub-xiphoid, para sternal long axis and thoracic views and enumerate the significance
Is able to enumerate the key recommendations
Is able to enumerate the utility of eFAST scan in trauma

POCUS – ABDOMEN ADVANCED

Is able to identify and demonstrate normal and abnormal sonoanatomy of liver
- Able to identify altered liver echotexture, liver abscess, liver mass, dilated IHBR
Is able to identify and demonstrate normal and abnormal sonoanatomy of gall bladder
- Able to identify cholelithiasis, GB perforation, acute cholecystitis (both calculous and acalculous), Dilated CBD (optional)
Is able to identify and demonstrate normal and abnormal sonoanatomy of spleen
- Able to identify splenic abscess, splenic infarct
Is able to identify and demonstrate normal and abnormal sonoanatomy of kidney
- Able to identify nephrolithiasis, grades of hydronephrosis, renal cyst, renal mass
Is able to identify and demonstrate normal and abnormal sonoanatomy of urinary bladder
- Able to identify foleys bulb, distended bladder, bladder stone, bladder mass
Is able to identify and demonstrate normal and abnormal sonoanatomy of bowel
- Able to identify ileus, pneumoperitoneum
Is able to demonstrate the technique of liver abscess drainage (optional) and cholecystostomy (optional)
Is able to demonstrate the technique of peritoneal fluid drainage, suprapubic catheterization
Is able to enumerate the key recommendations

POCUS – AORTA

Is able to describe the anatomy of aorta
Is able to rationalize the probe selection and patient position
Is able to demonstrate and identify thoracic and abdominal aorta in various views
Is able identify pathological findings
- Thoracic aorta aneurysm, abdominal aorta aneurysm, aortic dissection
Is able to demonstrate and identify abdominal vasculature viz:- SMA, Celiac trunk and Splenic vessels
Is able to enumerate the pitfalls in aortic scanning
Is able to enumerate the key recommendations

POCUS – OPTIC

Is able to enumerate the indications of Optic ultrasound
Is able to rationalize the probe selection, patient position
Is able to demonstrate technique of probe position
Is able to demonstrate and identify structures in normal anatomy
Is able to demonstrate & measure optic nerve sheath diameter and interpret the findings
Is able to demonstrate and identify pathologies
- Retinal detachment, vitreous hemorrhage, lens dislocation, papilledema
Is able to demonstrate pupillary assessment
Is able to enumerate the pitfalls
Is able to enumerate the key recommendations

POCUS – TRANSCRANIAL DOPPLER and BRAIN SONOGRAPHY (Optional)

Is able to describe the principle of TCD and enumerate the indications
Is able to rationalize the probe selection and patient position
Is able to enumerate the various windows for TCD
Is able to demonstrate trans-temporal view and trans-foraminal view (optional) of TCD & identify structures
Is able to demonstrate MCA, ACA and PCA
Is able to interpret Doppler findings – Peak systolic flow, End diastolic flow, PI
Is able to enumerate and demonstrate abnormal TCD findings
- Stroke, head injury, SAH & Vasospasm, brain death
Is able to demonstrate midline shift on brain USG
Is able to enumerate the pitfalls
Is able to enumerate the key recommendations

POCUS – VENOUS THROMBO-EMBOLISM

Is able to rationalize the probe selection
Is able to demonstrate upper and lower limb venous sonoanatomy & patient position
Is able to demonstrate techniques of assessment of venous thrombosis
- Compression ultrasound, distal augmentation, colour Doppler, pulse wave doppler
Is able to demonstrate the ECHO findings in pulmonary embolism
- RA & RV dilatation, Paradoxical septum, McConnell sign, D Shaped LV, 60-60 sign
Is able to demonstrate TAPSE & enumerate the significance
Is able to enumerate the DVT algorithm
Is able to enumerate the pitfalls
Is able to enumerate the key recommendations

POCUS – VASCULAR ACCESS

Is able to rationalize the probe selection
Is able to demonstrate the technique of internal jugular vein cannulation in transverse, longitudinal and oblique approach
Is able to demonstrate the technique of infraclavicular and supraclavicular approach of subclavian vein / axillary vein cannulation in longitudinal approach
Is able to demonstrate the technique of femoral vein cannulation in transverse & longitudinal approach
Is able to demonstrate the technique of PICC line cannulation in longitudinal approach
Is able to demonstrate the technique of peripheral venous cannulation
Is able to demonstrate the technique of arterial cannulation
Is able to enumerate the pitfalls
Is able to enumerate the tips to perform a successful cannulation
Is able to enumerate the key recommendations

POCUS – ECHO in CARDIAC ARREST

Is able to perform and identify the cause of cardiac arrest (Pericardial tamponade, pulmonary thromboembolism, pneumothorax, hypovolemia)
Is able to differentiate pulseless electrical activity from false electro-mechanical dissociation
Is able to demonstrate correct position of endotracheal tube
Is able to enumerate the step wise approach of the role of transthoracic ECHO in a patient with cardiac arrest (FATE, FEER and SESAME protocol)
Is able to enumerate the pitfalls
Is able to enumerate the key recommendations