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Emergency Ultrasound

The Ultrasound Division in the Department of Emergency Medicine has led point-of-care ultrasound in Atrium Health since 1996, with system-wide leadership in adopting, incorporating into practice, credentialing, continuing medical education, graduate medical education, undergraduate medical education, nursing, military, resuscitation and diagnostic care pathways, and other ultrasound programs. Our physicians have become national and international leaders on the topic of clinical, point-of-care emergency ultrasound, and utilize ultrasound in care daily.

Emergency point-of-care ultrasound is an integral subspecialty at Carolinas Medical Center. Founded by Dr. Tayal in 1996, emergency POC ultrasound has been used for resuscitative, diagnostic, and procedural applications. With over 15,000 ultrasounds done per year, ultrasound is part of the daily care in the CMC ED.   In addition, our ultrasound division has a long history of performing ground-breaking and meaningful research on various topics in Emergency Ultrasound.. The Department of Emergency Medicine firmly supports ultrasound as one of the bedside tools the emergency physician should master to properly evaluate patients during emergency care. We utilize all the 2016 ACEP US applications, with several evolving uses of TEE, volume imaging, and US guided nerve blocks. Within the Department of Emergency Medicine, the Division of Emergency Ultrasound has expanded with the addition of ultrasound fellowship-trained faculty and the maturation of the emergency ultrasound fellowship. The CMC ED was one of the first EDs in the United States accredited by the ACEP Clinical Ultrasound Accreditation Program (CUAP). The US Division leads POC education, credentialing, research, and practice across the health system.

Operations and Clinical Care

Director of Operations – Vitaliy Belyshev, MD
The department has >11 ultrasound machines that are in continual use.  Each machine is capable of extensive imaging techniques such as doppler with a wide array of probe types.  All are networked for automated wireless image/clip transmission and allow for offsite viewing using QPATH cloud-based storage. The volume of emergency ultrasounds performed has grown each year to an annual ultrasound procedure census of 15,000 per year. The attending physicians are credentialed, and a quality assurance program audits every ultrasound performed in the ED. Ultrasound is used extensively for resuscitation (both non-traumatic and traumatic), pregnancy, abdominal evaluation, cardiovascular evaluation, soft-tissue, musculoskeletal, ocular, biliary, urinary tract, DVT, bowel, and for procedural guidance in both adults and our pediatric application. Recent additions to our armamentarium including advanced nerve blocks including Fascia Iliaca, ESP, and brachial plexus blocks. Further advanced imaging modalities such as volume flow, spectral tracking, and TEE are being incorporated. Quality assurance is built into daily EM care and the US division’s workflow.

Educational Programs

We teach across the medical educational spectrum including US fellowship, EM residents, medical students, community and faculty physician, advanced practice providers, military medics, nurses, and rotators from other departments.

Fellowship Training

Director – Denise Fraga, MD
The US fellowship was initiated in 2005 by Dr. Tayal. In 2008 when Dr. Weekes CMC as fellowship director. In 2019, Denise Fraga, MD became the US Fellowship Director.  Our US Division offers a one-year postgraduate Ultrasound fellowship that meets the new ABEM EUFAC Emergency Medicine Clinical Ultrasonography Accreditation criteria (pending the accreditation initiation).  The ultrasound fellow is expected to be involved in clinical ultrasound research, obtain extensive experience with ultrasound program development and maintenance with special attention to quality assurance, and develop strong teaching skills. The fellow will develop an extensive knowledge base through group didactic sessions, bedside teaching of learners and supervised scan sessions with 'ultrasound' faculty.  Our fellowship features advanced ultrasound applications, teaching ultrasound at all levels, ultrasound research, and ultrasound experience in other clinical and imaging department such as Cardiology and Anesthesia.  In addition, the US fellow is active junior faculty attending physician with shifts in both the Adult and Pediatric Emergency Care areas. Clinically, the fellow exclusively works at the CMC Main campus as an academic attending. The CMC Emergency Department has over 100,000 annual visits and serves as a referral center for trauma, cardiac arrest, stroke, MI, medical resuscitation, and pediatric emergencies.  An active simulation center offers ultrasound simulators as well.

Residency Training

Director of EM Residency Training - Vivek Tayal, MD
Director of EM PGY3 Elective – Vitaliy Belyshev, MD
CMC EM Ultrasound Residency training started in 1997, and has been a primary mission of the US Division. Beginning with the orientation US intern course, US is incorporated into residency training from day One. The ultrasound training throughout residency includes a dedicated month of US in the PGY1 year with online didactics and hands-on scanning shifts with ultrasound faculty. PGY years 2 and 3 feature integrated US goals and a PGY-3 US elective. EM residents are expected to meet and complete quality EM US examinations that meet the ACEP Ultrasound Guidelines and pass an end of residency US test.  As EM residents use ultrasound during their clinical evaluation of patients in the ED, residents naturally become teachers and leaders in the department and other rotations as they assume more responsibility during the residency.  In addition, many residents also participate in the international opportunities in Tanzania and Guatemala to teach and use ultrasound in international settings.

Director, Medical School Education – Margaret Lewis, MD
Led by Dr. Margaret Lewis and in collaboration with UNC Charlotte, our medical education program includes a US curriculum as part of the Continuous Longitudinal Integrated Curriculum for the MS3 and MS4 year students. Through didactics and hands-on scan labs, the curriculum exposes students to the basics of bedside point of care ultrasound. Our students have represented UNC at SonoSlam each year and continuously rank the ultrasound program as one of the top reasons they choose the Charlotte Campus. As Atrium Health associates with Wake Forest University School of Medicine, we are excited to continue to integrate ultrasound education for students choosing the Charlotte campus for their 3rd and 4th year.

Pediatric Emergency Ultrasound

Director, Pediatric Emergency Ultrasound – Lindsey Chaudoin, MD
Pediatric emergency ultrasound is fully integrated in the emergency ultrasound program.  Residents and fellows have pediatric specific ultrasound didactics and hands-on training by fellowship-trained ultrasound faculty. Ultrasound is used in pediatric resuscitation and diagnosis routinely, with the same credentialing process for faculty as with adult patients. With a focus on best practices, throughput, and education, ultrasound research is ongoing in our department to optimize care for our pediatric population.

US Research

Director, Emergency Emergencies – Anthony Weekes, MD
Our division’s research in ultrasound has covered the spectrum of point of care clinical application and procedures. Our division faculty are actively involved in clinical and educational ultrasound research.  Faculty have collaborated on regional research projects including the REASON trial (cardiac ultrasound in cardiac arrest). Our former ultrasound fellowship director, Anthony Weekes, MD MSc  is now the director of Emergency Medicine Research Division.

 

US Faculty

Vivek Tayal, MD, FACEP, FAIUM
Dr. Tayal is a graduate of the University of Virginia (BA), Medical College of Virginia (MD) and the emergency medicine residency at Carolinas Medical Center in 1989. Vivek served as chairman of the Department of Emergency Medicine at Wilford Hall Medical Center, San Antonio, Texas, where he was involved with EM education as a faculty member of the Joint Military Medical Centers Emergency Medicine Residency (1989-92),, research director and ultrasound program initiation with an ATL Ultramark 4. Dr. Tayal joined the CMC faculty in the fall of 1993, and he serves as Chief of the Division of Emergency, Point-of-Care Ultrasound in the CMC.  He is a Professor of Emergency Medicine in the Department of Emergency Medicine with faculty appointment in the Department of Surgery/Division of Trauma and Surgical Critical Care. In addition to the Ultrasound division, he directs departmental quality assessment activities for the CMC EM department.  He has been active nationally in the ACEP Emergency Ultrasound Section (Chair 2000-2001, 2007-2008), SAEM Ultrasound Interest Group/Academy, AIUM Emergency Ultrasound Section and been involved with the majority of POC US issues in Emergency Medicine during the last 20 years.  He contributed to the ACEP US Imaging Compendium, the ACEP Standard Reporting Guidelines, and multiple other statements and policies.   He served on the ABEM Clinical Ultrasonography Task Force looking at subspecialty development.  He was the lead author of the ACEP Emergency Ultrasound Guidelines (2001, 2008, 2016). He served on the AIUM Board (2017-2019), and he serves on the Clinical Ultrasound Accreditation Program board as Chair.  He teaches nationally for the Emergency Ultrasound Course. He has also served for 10 years on the NCCEP Board, serving as President in 2006.   He also completed a Health Policy Fellowship in the office of Emergency Care Coordination Center in HHS in 2009-2010.   He is author of the textbook Ultrasound Program Management published by Springer in 2018. He is a reviewer for over 10 national medical journals, and published over 50 refereed articles, letters, and chapters. His academic interests include new avenues in ultrasonography, resuscitation, quality improvement and health policy.

Anthony Weekes, MD, FACEP
Dr. Weekes graduated from the Albert Einstein College of Medicine and Jacobi Medical Center’s EM residency program in New York. He teaches emergency ultrasound at regional, national and international conferences and was the director of the emergency ultrasound fellowship at CMC for 11 years.  After obtaining the Master of Science degree in Clinical Research at Drexel University, he became the director of the emergency medicine research division.  His clinical research interests involve echocardiography, pulmonary embolism and critical care. He has been the regional director of multi-center investigations into the role of cardiac ultrasound in cardiac arrest resuscitation, directs the multi-center Pulmonary Embolism Short Term Clinical Outcomes Registry and serves as an investigator and research advisory board member for the Code Pulmonary Embolism program at Atrium Health. 

Margaret Lewis, MD, FACEP
Associate Professor of Emergency Medicine
Dr. Lewis received her BS in Chemical Engineering from the University of South Carolina in 2002. She completed medical school in 2008 and Emergency Medicine residency in 2011, both at the Medical University of South Carolina. After years in Charleston, Dr. Lewis moved to Charlotte for an Emergency Ultrasound Fellowship at Carolinas Medical Center which she completed in 2012 and then joined CMC as ultrasound faculty.  Dr. Lewis currently directs ultrasound education for the Charlotte Branch of UNC School of Medicine as well as continuing ultrasound education. Dr. Lewis has other roles in undergraduate medical education including working with UNC to oversee the fourth year of medical school at Charlotte and running the Transition to Residency course. Her focuses include ultrasound in medical student education, resident education, and gaming in education. Her ultrasound interests include ultrasound education, critical care applications, and pediatric applications.

Denis Fraga, MD, MPA
Dr. Fraga grew up along the Texas-Mexico border in McAllen, Texas. She received her undergraduate degree in biochemistry from Notre Dame, her medical degree from the University of Texas Medical School at Houston, and a master of public policy degree from the University of Texas at Austin - LBJ School of Public Affairs.  She completed her emergency medicine training at the University of Maryland and an ultrasound fellowship at Vanderbilt.  Dr. Fraga is also the EM Ultrasound Fellowship Director.  Her academic interests include ultrasound guided regional anesthesia and teaching ultrasound in resource limited areas.  Dr. Fraga has worked internationally in Colombia, Rwanda, Lesotho, Guyana, and Guatemala.  She continues to travel regularly to Guatemala to teach ultrasound.

Lindsey Chaudoin, MD
Dr. Chaudoin received her undergraduate degree from Wake Forest University, and after a year on the West Coast, returned to attend medical school at the University of Alabama at Birmingham. She completed her pediatric residency, a chief resident year, pediatric emergency fellowship and an ultrasound fellowship at Columbia University at Morgan Stanley Children's Hospital. Dr. Chaudoin worked in New York for the next five years until her family outgrew New York City and decided to relocate south. Dr. Chaudoin is board certified in pediatrics and pediatric emergency medicine. Her interests in emergency ultrasound include education and streamlining care.

Vitaliy Belyshev, MD
Assistant Professor of Emergency Medicine
Dr. Belyshev received his BS in Physics at the University of Massachusetts in 2009 and his medical degree from the University of Massachusetts Medical School in 2015. During medical school, he spent a year living in Germany studying local EMS systems. He completed his Emergency Medicine residency at Christiana Care Health System in Newark, Delaware in 2018. After residency, he joined CMC for an ultrasound fellowship where he continued to develop a passion for teaching and ultrasound. Apart from ultrasound, his area of interests includes public policy, emerging technologies and administration.

Graduates of Emergency Ultrasound Fellowship

 2005-2006   Manoj Pariyadath, MD 
 2006-2007   Greg Snead, MD
 2007-2008   Casey Glass, MD 
 2008-2009   Krishnaraj Jayarama, DO
 2009-2010   Heather Tassone, DO
 2010-2011   Dale Quirke, MD
 2011-2012   Margaret Lewis, MD
 2012-2013   David Johnson, MD 
 2013-2014   Sama Ghali, MD
 2014-2015   Jordan Chanler-Berat, MD 
 2015-2016   Laura Oh, MD
 2017-2018   DeVaughn Peace, MD
 2018-2019   Vitaliy Belyshev, MD
 2019-2020   Patrick Lam, MD 
Research and Publication
Research has also been a focus of our ultrasound program, specifically into resuscitation, both non-traumatic and trauma and first trimester pregnancy. Some examples include:

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Weekes AJ, Lewiss RE. Ultrasound in Resuscitation, Clinical Emergency Radiology, Cambridge University Press

Weekes AJ, Zapata R, Napolitano, A. Symptomatic Hypotension-Emergency Department Diagnosis, Management and the Role of Bedside Sonography, Emergency Medicine Practice- An Evidenced Based Approach to Emergency Medicine November 2007.

Lewiss RE, Weekes AJ. Advances in Pediatric Emergency Ultrasound: Procedural Applications in the Adolescent and Child as an Aid to Diagnosis of Traumatic Conditions. Ped Emerg Med Rep 2005; 9: 105-116.

Weekes AJ, Lewiss RE. Advances in Pediatric Ultrasound. Part 1: Focused Applications in the Adolescent Female with Abdominal Pain and the Male with Testicular Pain.Ped Emerg Med Rep 2004; 4: 37-52.

Weekes AJ, Lewiss RE. Advances in Pediatric Ultrasound. Part 2: Focused Applications for Cardiac, Abdominal and Renal Complaints. Ped Emerg Med Rep 2004; 5: 53-64.

Prospective study of 2D uniplanar versus 3D cardiac ultrasound for emergency cardiac ultrasound (SAEM) Annual Meeting, New Orleans 2009.

Tayal VS, Moore CL, Rose GA. Cardiac. In: Ma OJ, Mateer JR, editors. Emergency Ultrasound. New York : McGraw-Hill, 2003: 89-128.

ACEP (policy). Contributors: Tayal V, Blaivas M, Mandavia D, Stahmer SA, Cardenas E, Dean AJ, Rose JS, Cook TP, Heller M, Pattavina C, Bromley M. Emergency Ultrasound Guidelines - 2001. Annals of Emergency Medicine. 2001;10.

Moore CL, Rose GA, Tayal VS, Sullivan DM, Arrowood JA, Kline JA. Determination of Left Ventricular Function by Emergency Physician Echocardiography of Hypotensive Patients. Academic Emergency Medicine.

Heller MB, Mandavia D, Tayal VS, Cardenas EE, Lambert MJ, Mateer J, Melanson SW, Peimann NP, Plummer DW, Stahmer SA. Residency Training in Emergency Ultrasound: Fulfilling the Mandate. Academic Emergency Medicine. 2002; 9: 835-839.

Tayal VS, Graf CD, Gibbs MA. Prospective Study of Accuracy and Outcome of Emergency Ultrasound for AAA over 2 years. Academic Emergency Medicine. 2003;10:1-5.

Jones AE, Mason PE, Tayal VS, Gibbs MA. Sonographic Intraperitoneal Fluid in Patients with Pelvic Fracture: Two Cases of Traumatic Intraperitoneal Bladder Rupture. Journal of Emergency Medicine. 2003

Tayal VS, Kline JA. Emergent Echocardiographic Detection of Pericardial Effusion in Patients with Hemodynamic Collapse. Resuscitation. 2003;59:315-318.

Tayal VS, Beatty MA, Marx JA, Tomaszewski CA , Thomason MH. FAST (Focused Assessment With Sonography in Trauma) Accurate for Cardiac and Intraperitoneal Injury in Penetrating Anterior Chest Trauma. J Ultrasound Med. 2004; 23:467-472.

Jones AE, Tayal VS, Sullivan DM, Kline JA. Randomized Controlled Trial of Immediate vs. Delayed Goal-directed Ultrasound to Identify the Etiology of Nontraumatic Hypotension in Emergency Department Patients. Critical Care Med. 2004; 32: 1703-1708.

Tayal V, Cohen H., Norton HJ. Outcome of Patients with an Indeterminate Emergency Department First-Trimester Pelvic Ultrasound to Rule Out Ectopic Pregnancy. Academic Emergency Medicine. 2004;11:912-917.

Hoffenberg S, Tayal V, Dean A, Quick G, Cardenas E, Bromley M. Emergency Ultrasound Coding and Reimbursement. ACEP Ultrasound Section.

Tayal V, Kline JA. Emergent Echocardiographic Detection of Pericardial Effusion in Patients with Hemodynamic Collapse. (Abstract) Submitted to SAEM Annual 1999 Meeting in Boston , MA , May 1999.

Tayal V, Oakes JL, Tomaszewski CA, Marx JA, Thomason MH. Trauma Ultrasound in Splenic Injury: Which View is Most Sensitive? (Abstract) Presented at SAEM Annual 1999 Meeting in Boston , MA , May 1999.

Mahon KD, Tomaszeski CA, Tayal V. Emergency Department Presentation of Serum Confirmed GHB Ingestions (Abstract) Presented at the SAEM Annual 1999 Meeting in Boston, MA, May 1999.

Tayal V, Beatty MB, Marx JA, Tomaszewski CA , Thomason MH. FAST Accurate for Cardiac and Intraperitoneal Injury in Penetrating Chest Trauma. Academic Emergency Medicine. 2000;7: (Abstract) Presented to SAEM Annual 2000 Meeting in San Francisco , CA , May 2000.

Moore CL, Rose GA, Tayal VS, Sullivan DM, Arrowood JA, Kline JA. Determination of Left Ventricular Function by Emergency Physician Echocardiography of Hypotensive Patients. Academic Emergency Medicine

Tayal V, Gibbs M. Letter to the Editor: Misguided Residency Questions (AEM October 1999. Academic Emergency Medicine. 2000;7:220-221.

Backus CL, Pratt BL, Gibbs M, Tayal V, Heniford BH, Sing RF. Focused Assessment with Sonography of the Trauma Patient. Submitted to ACS Annual Meeting 2000.

Rose J, Mandavia D., Tayal V, Blaivis M, Physician Sonography Training Competency AJR. 2001. 176;813-4.

Tayal VS, Graf CD, Gibbs M. Prospective Study of Accuracy and Utility of Emergency Ultrasound for AAA over a Two-Year Period. Academic Emergency Medicine. 2002; 9:541 (presented at the SAEM Annual 2002 Meeting in St. Louis ).

Flanders C. Tayal V. Outcome Analysis of an Emergency Physician Pelvic Ultrasound Protocol to Rule Out Ectopic Pregnancy: A One-Year Review at an Urban Emergency Department. CMC 2002 Resident Academic Day. June 13, 2002 . AIUM annual meeting June 2003, Montreal , Canada .

Foster T, Tayal V, Saunders T, Norton J. Emergency Ultrasound Optic Nerve Sheath Measurement to Detect Increased Pressure in Head Injury Patients: Preliminary Study of Interobserver Variability in Normal Human Subjects. Academic Emergency Medicine. 2003; 10: 487-488. Accepted at SAEM annual meeting May 2003, Boston MA and AIUM annual meeting June 2003, Montreal CA .

Hasan N, Tayal V. Ultrasound Changes Emergency Physician Management Of Cellulitis. Academic Emergency Medicine. 2003;10:426-427 Accepted at SAEM annual meeting May 2003, Boston MA and AIUM annual meeting June 2003, Montreal CA .

Romognuolo L, Tayal V, Tomaszewski C, Norton J, Saunders T. Optic Sheath Nerve Diameter in Normal Human Subjects in the Supine, Trendelenburg, and Reverse Trendelenburg positions. Presented at the ACEP Research Forum 2003.

Kothari R, Tayal V, Wade RA, Marx JA. An Interdepartmental Protocol of Transvaginal US for Ectopic Pregnancy: Effect on Length of Stay and Safety. CMC 2000 Resident Academic Day.

Moore CA , Tayal V. Molar Pregnancy: A Component of the First-Trimester Emergency Ultrasound Protocol to Confirm Intrauterine Pregnancy. CMC 2001 Resident Academic Day.

LaCharite D, Tayal V, Gibbs M, Colucciello S, Marx J, Thomason M, Jacobs D. The Use of Trendelenberg Positioning in the Determination of Hemoperitoneum by Abdominal Ultrasound in Blunt Abdominal Trauma. CMC 2001 Resident Academic Day.

Tayal V , Nielsen A, Jones A, Kellam J, Thomason M, Norton HJ. Accuracy of Trauma Ultrasound in Major Pelvic Injury. Acad Emerg Med. 2004;11: 579. Presented at 2004 AIUM annual meeting, Phoenix , AZ and 2004 SAEM annual meeting, Orlando , FL.

Cohen H. Tayal V. Outcome of Patients with an Initially Indeterminate EM Pelvic Ultrasound to Evaluate for Intrauterine Pregnancy.

Nicks B. Tayal V. Emergency Ultrasound Evaluation of Symptomatic Non-Traumatic Pleural Effusions Accepted for presentation at ACEP Research Forum 2004.

Grady M, Runyon M, Weekes A, Hogg M, Chaudoin, LT. Comparison of Ultrasound Marked vs Standard Lumbar Puncture Success in Infants. Accepted for publication, pending date. Pediatr Emerg Care 2020.

 

Halm BM, Leone TA, Chaudoin LT, McKinley KW, Ruzal-Shapiro C, Franke AA, Tsze DS. Evaluation of Ventricle Size Measurements in Infants by Pediatric Emergency Medicine Physicians. Pediatr Emerg Care. 2018 June 5.

 

Halm, BM, Chaudoin, LT: Diagnosis of a Posterior Fracture Dislocation of the Medial Clavicle in an Adolescent With Point-of-Care Ultrasound. Pediatr Emerg Care. 2017 Apr 18.

 

Marin JR, Abo AM, Arroyo AC, Doniger SJ, Fischer JW, Rempell R, Gary B, Holmes JF, Kessler DO, Lam SH, Levine MC, Levy JA, Murray A, Ng L,

Noble VE, Ramirez-Schrempp D, Riley DC, Saul T, Shah V, Sivitz AB, Tay ET, Teng D, Chaudoin L, Tsung JW, Vieira RL, Vitberg YM, Lewiss RE. Pediatric emergency medicine point-of-care ultrasound:summary of the evidence. Criti Ultrasound J. 2016 Dec 8.

 

Tilt  L, Kessler DO. Rapid evaluation of an inguinal mass in a female infant using point-of-care ultrasound. Pediatr Emerg Care. 2014 May;30(5):366-7

 

Contact Information

Emergency Ultrasound Division
Department of Emergency Medicine
Attn: Vivek Tayal, MD
Medical Education Bldg., 3rd floor
1000 Blythe Boulevard
Charlotte, NC 28203
704-355-7205
Email Vivek Tayal

Emergency Ultrasound Fellowship (1 year)
Department of Emergency Medicine
Attn: Denise Fraga, MD
Medical Education Bldg., 3rd floor
1000 Blythe Boulevard
Charlotte, NC 28203
704-355-3181
Email Denise Fraga

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