Thorax, Trachea, and Lung Ultrasonography in Emergency and Critical Care Medicine: Assessment of an Objective Structured Training Concept

Table 1

Course structure of THOLUUSE.

Program number and time limit	Lecture, case presentation, or HOT^a	Content and key messages
1 (15 min)	Reasons for thorax, trachea, and lung ultrasonography in emergency and critical care medicine	Introduction, context, advantages, and disadvantages of chest ultrasound in emergency and critical care medicine
2 (15 min)	Sonoanatomy of the thorax, trachea, and lung	Brief physics of US, probes, chest wall and organ anatomy, general remarks on B-mode of structures, basic windows and artifacts, and impact on views of artificial ventilation
3 + 4 (10 min + 5 each)	Two related clinical case presentations from the emergency department (incl. 10 min discussion)	Authentic clinical example, well prepared with original US sequences, relevant PLE, and rib/sternal fracture
5 (20 + 10 min)	US of PLE: phenomena and artifacts (incl. 10 min discussion)	Repetition of basic windows and artifacts, B-Mode, and appearance and differential diagnosis of hypoechogenic findings (pulmonary embolism, fluids, chest hematoma, and lung contusion)
(90 min)	HOT-1	Practical training with instructors and models
6 (15 min)	US of trachea, cartilages, and cricoids: sonogram and artifacts	Air artifacts, reverberation, and procedural ultrasound use within percutaneous dilatational tracheotomy
7 (20 + 10 min)	US of pneumothorax: sonogram and artifacts (incl. 10 min discussion)	Views of air artifacts, reverberation, loss of pleural sliding and comet tails, lung pulse, and understanding M-mode sonograms
8 (15 min)	Standardized sequence of lung ultrasonography	How to quickly examine a patient with suspected PLE or PTX. Algorithm training with practical relevance for time sensitive scenarios.
9 + 10 (10 min + 5 each)	Two related clinical case presentations from intensive care medicine (incl. 10 min discussion)	Physiology of lung US in intensive care medicine, postprocedural (insertion of central line), postcardiotomy PTX despite tube drain
(90 min)	HOT-2	Practical training with instructors and models

aLectures and cases all included a brief discussion; all major artifacts were taught in a clinical context. Lectures were followed by hands-on trainings (HOT).
PLE: pleural effusion; PTX: pneumothorax; US: ultrasound examination.