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Emergency ultrasound is an integral part of the clinical, educational and research mission of the Department of Emergency Medicine. Since 1997, emergency ultrasound has been used for resuscitation, trauma evaluation, AAA recognition and detection of first trimester pregnancy complications, abdominal, near field, and procedural applications. Multiple research studies have been performed on the topic of emergency ultrasound in our department. The Department of Emergency Medicine firmly believes that ultrasound is one of the bedside tools the emergency physician should master to properly evaluate patients during emergency care. Within the Department of Emergency Medicine, the Division of Emergency Ultrasound has been created with the addition of additional faculty and the maturation of the emergency ultrasound fellowship.

Clinical Care
The department has four ultrasound machines that are in continual use. All have extensive Doppler and digital capability. The annual volume of emergency ultrasounds performed has grown each year to an annual ultrasound procedure census of 6000 per year. The attending physicians are credentialed and a quality assurance program audits every ultrasound that is performed. Ultrasound is used extensively for resuscitation (both non-traumatic and traumatic), pregnancy, abdominal evaluation, cardiovascular evaluation, soft-tissue, musculoskeletal, ocular, and for procedural guidance.

Director of Emergency Ultrasound
The director of emergency ultrasound is Vivek Tayal, MD, an emergency physician with extensive clinical and academic experience with ultrasound. Dr. Tayal served as the chair of the ACEP section on emergency ultrasound from 2000 - 2001 and 2008 - 2009. He is also active nationally with the SAEM ultrasound interest group and AIUM. He is the ACEP liaison to the AIUM .

The director of the ultrasound fellowship is Anthony Weekes, MD, an emergency medicine physician whose certifications in ultrasonography include echocardiography. His special interests are the critical care applications of emergency ultrasonography.

Margaret Lewis, MD is the Director of Ultrasound in Undergraduate Medical Education at Carolinas Medical Center/ Charlotte Campus of UNC School of Medicine. She completed her ultrasound fellowship at Carolinas Medical Center in 2012 and stayed on as faculty. She has since developed a longitudinal ultrasound curriculum for the third year medical students at CMC as well as a fourth year medical school rotation in point of care ultrasound. She has presented abstracts regarding her work in development of ultrasound curricula at national meetings. Dr. Lewis has lectured on emergency ultrasound applications nationally and has worked with Dr. Weekes and Dr. Tayal to develop Code Ultrasound, a multidisciplinary critical care ultrasound course. Her interests include ultrasound education, undergraduate medical education, critical care ultrasound and pediatric ultrasound applications.

A one-year emergency ultrasound fellowship was started five years ago. The fellowship follows the ACEP Emergency US Guidelines, and participating in the website and application process. The ultrasound fellow is expected to be: involved in clinical ultrasound research; get extensive experience with ultrasound program development and maintenance, especially quality assurance; and develop strong teaching skills and an extensive knowledge base through group didactic sessions, bedside teaching of learners and supervised scan sessions with 'ultrasound' faculty.

Drs. Tayal and Weekes have lectured extensively on emergency ultrasound both regionally, nationally and internationally.

Residency Training 
Residency training in emergency ultrasound is incorporated into the daily didactics lecture series and clinical rotation of the emergency department. Emergency medicine residents use ultrasound during their clinical evaluation of patients in the ED. In addition, there are specific PGY-1 rotations involving emergency ultrasound as well as a PGY-3 elective.

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.

  Contact Information

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

Emergency Ultrasound Fellowship (1 year)
Department of Emergency Medicine
Attn: Anthony J. Weekes, MD
Medical Education Bldg., 3rd floor
1000 Blythe Boulevard
Charlotte, NC 28203
Email Anthony Weekes

Current and past fellows:

Laura Oh
Medical School:  University of Michigan

Jordan Chanler-Berat
Medical School:  New York Medical College

Sam Ghali
Medical School: American University of the Caribbean 

David Johnson
Medical School: UNC Irvine

Margaret Lewis
Medical School: MUSC

Dale Quirke
Medical School:  University of Cincinnati

Heather Tassone
Medical School:  College of Osteopathic Med. of the Pacific

Krishnaraj Jayarama
Medical School:  New York College of Osteopathic Maedcine of Nyit

Casey Glass
Medical School: Pennsylvania State

Gregory Snead
Medical School:  UCLA

Manoj Pariyadath
Medical School:  MUSC