HCMC NETWORK FEATURE: Emergency Department pioneered in ultrasound use and leads today

by Hennepin Healthcare

Recent dramatic save in Coon Rapids shows benefits of HCMC residency training

Dr. Tom Wyatt and Dr. Eric Haug, graduates of the HCMC Emergency Medicine residency program, recently made clinical headlines with a dramatic save and article in Annals of Emergency Medicine about the first-reported Emergency Department thoracotomy for post-ablation tamponade (see HCMC NETWORK FEATURE: Patient’s chest opened to save life:  MDs credit HCMC medical training).   Crediting skilled teamwork with colleagues at Mercy Hospital for the good outcome, they also emphasized the importance of their HCMC Emergency Medicine residency training, including extensive training in the use of bedside Emergency Department (ED) ultrasound, which was pioneered at HCMC.

Photo 1: First ultrasound machine used in the HCMC Emergency Department

It all began in 1984, when EM faculty physician Dr. Ray Mayron obtained an ultrasound machine from Dr. Richard Asinger in the Department of Cardiology, for use on evenings and weekends (Photo 1).   The machine shown in Photo 1 has a  Sony Rear projection cathode ray TV balanced on top of the control panel and a VCR on the right.   This machine met its death after a positive examination when a life-threatening condition was diagnosed and required rapid action and it was pushed away and fell over.

Dr. Mayron was initially investigating the use of ultrasound for diagnosing cardiac and pericardial abnormalities such as hemopericardium (see Photo 2) and pericardial tamponade, which was the cause of life-threatening obstructive shock in the patient treated by Drs. Wyatt and Haug.

Photo 2: First traumatic hemopericardium ever diagnosed at HCMC

Emergency Department staff and residents were trained in ultrasound use and Drs. Mayron, Gaudio, Plummer, Asinger, and Elsperger co-authored the first clinical journal article on real time ultrasound use in the Emergency Department, published in Annals of Emergency Medicine in 1988.

Bedside ultrasound training continued in the Emergency Department (see Photo 3) and beyond; in the 1990’s, Dr. Dave Plummer taught approximately 2,000 physicians, in the U.S. and abroad, providing didactic and hands-on training.  He assisted approximately 40 Emergency Medicine residency programs to incorporate bedside ultrasound training into their training and co-authored the first ultrasound guidelines published by the American College of Emergency Physicians.

Photo 3: Emergency Department ultrasound use and training in the late 1980's (Dr. Kirk Lufkin, left)

HCMC Emergency Medicine physicians continue to pave the way in applications of bedside ED ultrasound, as well as research and training.  On-site training is provided to residency physicians (see Photos 4 and 5) and to practitioners who come from across the state and region.  A November 2011 HCMC ultrasound course taught by Dr. Rob Reardon and Liberty Caroon and others trained 38 physicians and physician assistants from Iowa, Wisconsin, and Minnesota.

Photo 4: Dr. Rob Reardon training Emergency Medicine residents

Photo 5: Ultrasound images projected onto multiple screens for class instruction

HCMC Emergency Department instruction on bedside ultrasound extends globally, through training provided by Dr. Reardon and others at national and international Conferences (see Photo 6) and online, through  hqmeded.com, the Emergency Department’s educational website (see Photo 7).  There, viewers around the world can view high quality medical education lectures and videos on bedside Emergency Department ultrasound, free of charge.  See the HCMC NETWORK FEATURE for more details on hqmeded.com.

Photo 6: Dr. Reardon teaching at the World Congress on Ultrasound in Medical Education (photo from website, at www.wcume.org)

Photo 7: Screen shot of hqmeded.com Home page