ECHO – Consulting patients, solving problems

Tips for your EM:RAP session!

Tips and Tricks Before You Record:

We want to make this fun and easy so here are some simple tips and tricks to help you prepare.

We know that all of you have a thousand stories to tell but try to think of a rural med case that stood out in some way: Stood out because it was clinically taxing, personally stressful or emotional, or even just plain funny, and that also reflects the particular challenges of working in a rural or resource poor environment.

Make a brief outline of the key points you want to get across (think of how you would prepare a brief case presentation for rounds, or better yet, how you would tell the story to a group of doctors at a party).

Think of descriptors for the story:

The season, the setting, the mood.
How you were feeling (before, during, after the case).
What you were thinking (before, during, after).
Think of the lessons/pearls that you took away from this and that you would like to share.

Sample Questions

Tell us about yourself and the setting of the story:
- Not exact location but “small rural clinic” versus “community hospital on a reservation”
- Time of year
- How far from next level of care
Case
- Set the scene
- Describe the ER that day
- Case overview
- Challenges faced
How you felt
Lessons learned

Cultural Responsiveness in the Development of the Community Health Aide Program (CHAP) | April 18, 2024

Presenter: Carrie Sampson-Samuels (Umatilla), and Jason Butler (Ute/Mojave/Cherokee)

Presenter Bios:

	Jason Arion Butler is an enrolled member of the Ute Tribe of Fort Duchesne, Utah and is also part Mojave and Cherokee. He resides in Gibson, Idaho with his wife of 22 years, children, and grandchild who are all enrolled members of the Shoshone-Bannock Tribes. He graduated from Idaho State University with a Bachelor of Arts in Psychology and earned his Master of Science in Family and Human Development from Arizona State University. He has spent the past 5+ years employed by the Shoshone-Bannock Tribes, Tribal Health and Human Services Department, where he spent time serving as the Recovery Service Coordinator for the Four Directions Treatment Center, the manager for the Community Health Representative program, and recently accepted the position of Behavioral Health Manager. He strives to incorporate Native culture, traditions, morals, and values into the healthcare services provided to Native communities, implementing these practices into his work with the Shoshone-Bannock Tribes and advocating for the reconstruction of healthcare practices nationally. Today he says, “I am loving life and am extremely thankful to have found a career path I love.

	Carrie Sampson-Samuels is an enrolled member of the Confederated Tribes of the Umatilla Indian Reservation located in Eastern Oregon. Carrie has an early background in nursing providing patient care in long term and clinical care settings. Carrie then furthered her education in community health and health studies at Portland State University, later advancing her education in healthcare management at Oregon Health and Sciences University while serving in leadership and executive management for a Tribal health organization as the Community Health Director. Carrie has served Tribes from Oregon to Montana and the Treaty 7 Blackfoot Confederacy in Southern Alberta. As the Community Health Aide Project Director for the Northwest Portland Area Indian Health Board, Carrie has provided leadership, advocacy and project management for expansion for the Behavioral Health Aide and Community Health Aide Program under the umbrella and direction of the Tribal Community Health Provider Project. This work has led to the expansion of Tribal Community Health Providers in Washington, Oregon, and Idaho. Carrie is responsible for leading partnerships with the education institutions, key Tribal partner sites, contract experts and advisory workgroups. This includes development of education infrastructure, education curriculum, recruitment strategies, tools for integration of providers into tribal health organizations, and working with state partners to develop policy and infrastructure for provider reimbursement. Carrie manages and writes multiple grants that support all aspects of this work and provides technical assistance support to the Portland Area CHAP Certification Board. Carrie is the proud mother of 4 daughters and resides on a small ranch on her Tribal homelands.

Presentation Slides: https://www.indiancountryecho.org/wp-content/uploads/2024/04/Cultural-Responsiveness-in-the-Development-of-the-Community-Health-Aide-Program.pdf

Hózhóójík’ehgo Nanitin: Wellness is Decolonization | April 18, 2024

Presenter: YakaiYastai Gorman-Etl (Navajo/Cheyenne)

Presenter Bio:

Yakaiyastai Gorman-Etl (Navajo/Cheyenne), is a Northwest Indian College Alumni, current student of Antioch University, Yakaiyastai Nanabah Gorman-Etl is originally from Steamboat, Arizona of the Navajo and Cheyenne Tribes. The first daughter of eight children to Beverly and Emerson Gorman. Yakaiyastai is a young indigenous scholar, mother and wife who strives to learn more about how to preserve inherent rights for future generations through higher education. Along with learning her foundational traditional knowledge of Navajo teachings, she is self-taught in traditional herbal medicine, holistic healing and food sovereignty. She grew up with a father who was known as a traditional medicine man and a mother who worked for John Hopkins Center for American Indian Health Center as a researcher. Raised in a traditional hogan without running water or electricity, Navajo spoken as their first language and raised with Navajo structural influence. She learned the importance of traditional values, holistic health and knowledge as it connects to sense of place as well as the person, she would become to help her surrounding communities. Currently, she has worked in various capacities of Wellness Coordinator at Northwest Indian College and an Environmental Science Instructor. Having learned the importance of healing and medicine from both spectrums of traditional and western medicine, she utilizes her knowledge to bring equitable health initiatives on behalf of indigenous people through her work as a Behavioral Health Program Coordinator and interim Community Health Program Coordinator.

Presentation Slides: https://www.indiancountryecho.org/wp-content/uploads/2024/04/4_Hozhoojikego-Nanitin-Wellness-is-Decolonization.pdf

Rapid Fire Clinical – OB Emergencies, Urologic | April 18, 2024

Presenter: Christopher Hoover, MD and Constance Liu, MD

Presenter Bios:

	Dr. Liu is a generalist OB/GYN at Gallup Indian Medical Center. In addition to her medical degree, she holds a PhD in Health Policy. Among other publications, she served as the chief editor for the 2019 Oxford University Press book: “50 Studies Every Obstetrician and Gynecologist Should Know.” She has formal training in Quality Improvement processes through the Partners Clinical Process Improvement Leadership Program (CPIP), which she utilized to implement emergency contraception at Massachusetts General Hospital. During her six years at Gallup Indian Medical Center she has primary responsibility for preparing and reporting of metrics related to the delivery of obstetric care, and serves on the Continuing Medical Education committee.

	Dr. Hoover is from Chicago, where he grew up and went to medical school, at Rush University, on Chicago’s diverse West Side. He was trained in Urology at Boston Medical Center in Boston’s beautiful South End neighborhood. Dr. Hoover went on to pursue fellowship training in voiding dysfunction and laser prostate surgery at Beth Israel Deaconess Medical Center. Dr. Hoover is a Board-Certified Urologist, by the American Board of Urology, having achieved this honor in 2018. Dr. Hoover has several peer-reviewed publications, including research studies and medical illustrations. His family is happy to call Gallup home since the end of 2017. In their free time they like to explore New Mexico’s wilderness and go camping. Now that their two girls are growing up, it’s also imperative that we catch Pokemon wherever we go.Dr. Hoover is the only Urologist in McKinley County, New Mexico, and in any of the surrounding counties– it’s just him between Albuquerque and Flagstaff. He’s happy to continue seeing established patients, and is accepting new patients from the entire region. Dr. Hoover believes in communication, candor, and compassion as essential tenets of patient care. Dr. Hoover is an expert in general Urology, male and female voiding dysfunction, kidney stones and kidney stone surgery, BPH and laser prostate surgery, erectile dysfunction, vasectomy, prostate cancer, bladder cancer, kidney cancer, testicular cancer. Many of the procedures he do as a Urologist are done in the office including: cystoscopy, vasectomy, urodynamics, treatment foroveractive bladder, and many others. Please call/text or email and let him and his staff know how they can help you.

Presentation Slides: https://www.indiancountryecho.org/wp-content/uploads/2024/04/Rapid-Fire-Clinical-OB-Emergencies-Urologic-1.pdf

Trauma Systems: Whole Blood | April 18, 2024

Presenter: Jade Nunez, MD

Presenter Bios:

Jade M. Nunez, MD, is an Acute Care Surgeon whose practice is centered on the surgical care of critically-ill and injured patients. He completed his general surgery residency and fellowships in surgical critical care and acute care surgery at Wake Forest Baptist Medical Center in Winston-Salem, NC. An Associate Professor of Surgery at the University of Utah, he serves as Associate Trauma Medical Director and is responsible for performance improvement initiatives. He is also core faculty at the Center for Global Surgery, focusing on building educational programs and surgical capacity in Mongolia.

Presentation Slides: https://www.indiancountryecho.org/wp-content/uploads/2024/04/Whole-Blood-Resuscitation-in-Trauma.pdf

Healthy Longevity in Rural Emergency Medicine | April 18, 2024

Presenter: Eric Wortmann, MD and Corey Detlefs, MD, FACS

Presenter Bios:

	Eric Wortmann, MD is the former Director of Emergency Medicine at Chinle Comprehensive Health Care Facility. Besides patient care, Eric has a deep passion for mentoring aspiring physicians and health care providers. He was the Education Director of Emergency Medicine at Chinle as well as Adjunct Faculty for the US Army teaching Special Forces Medics. He has been a visiting professor of Emergency Medicine in Haiti and has worked in the Dominican Republic since 1989. Eric has a long-time passion as a mid and long-distance running coach. He has lived on Kauai for 30 years. Currently he divides his time between Northern Italy and Hawaii. Recently he was accepted into Doctors without Borders USA and is awaiting his first assignment.

	Corey Detlefs, MD, FACS, is the Trauma Outreach Director and an Associate Professor of Surgery at the University of Arizona College of Medicine – Phoenix

Presenter Slides: https://www.indiancountryecho.org/wp-content/uploads/2024/04/30-Years-in-Emergency-Medicine.pdf

Bronchiolitis – Escalating Respiratory Support and Management Pearls | April 17, 2024

Presenter: Mike Johnson, MD

Presenter Bios:

Dr. Mike Johnson completed his medical degree at the Medical College of Wisconsin in Milwaukee, WI and his residency in pediatrics at the Mayo Clinic in Rochester, MN. He is currently an Associate Professor in the Division of Pediatric Emergency Medicine at the University of Utah. Dr. Johnson´s clinical interests include improving the efficiency and effectiveness of patient care in the Emergency Department and Rapid Treatment Unit at Primary Children’s Hospital and across the Intermountain Health system, especially the care of children with respiratory illness including asthma and bronchiolitis. He serves as the representative of the Primary Children’s Hospital Emergency Department for hospital and system-wide work groups tasked with improving respiratory care. His research focuses on optimizing the care provided to children with severe acute asthma in the emergency department. Currently this work is centered on understanding the effectiveness of intravenous magnesium sulfate for children who are likely to be hospitalized despite other treatment in the emergency department. He works with pediatric emergency medicine physicians and researchers across the United States as a member of the steering committee for the Pediatric Emergency Care Applied Research Network (PECARN) and across the world as a participant in the Pediatric Emergency Research Networks (PERN) to conduct research that improves the lives of children no matter where they seek emergency care. Dr. Johnson cares for patients at Primary Children’s Hospital Emergency Department and Rapid Treatment Unit.

Presentation Slides: https://www.indiancountryecho.org/wp-content/uploads/2024/04/EMRIC-Asthma-and-Bronchiolitis-2024.pdf

Care of the Patient with Cirrhosis | April 17, 2024

Presenter: Rebecca Kim, MD

Presenter Bios:

Rebecca G Kim, MD, MAS, is a transplant and general hepatologist at the University of Utah School of Medicine. She specializes in the care of patients with chronic liver disease, cirrhosis, patients being evaluated for a liver transplant and those who have received a liver transplant. Dr. Kim grew up in Salt Lake, and then traveled around the country for her training. She received her medical degree from the University of Cincinnati College of Medicine and completed her internal medicine residency at the University of California San Diego. She stayed in San Diego for an additional year to work as a Chief Medicine Resident, and then completed her gastroenterology and transplant hepatology fellowships at the University of California San Francisco. Dr. Kim feels passionately about caring for patients with any stage of liver disease and truly enjoys the long-term relationship she gets to build with her patients. She sees patients with viral, genetic, and autoimmune causes of liver disease, and specifically focuses on alcohol-associated liver disease and metabolic dysfunction-associated steatotic liver disease. She is also particularly interested in caring for and conducting research focused on patients with liver disease who also have social needs or unique barriers to healthcare access.

Presentation Slides: https://www.indiancountryecho.org/wp-content/uploads/2024/04/Care-of-the-patient-with-cirrhosis.pdf

Data-driven Quality Improvement Strategies in Low-resource Settings | April 17, 2024

Presenter: Vijay Kannan, MD

Presenter Bio:

Vijay Kannan, MD, is the Director of the Office of Clinical Performance and Health Impact at IHS Headquarters. In this role he oversees the agency’s work on the monitoring and evaluation of clinical care, on academic affairs, on telehealth, and on credentialing and privileging. He previously worked as the Director of the Office of Quality Management for the Phoenix Area (Arizona, Utah, Nevada) IHS. His work there focused on identifying systemic issues in quality of care and addressing them in a context-relevant and data-driven manner. Prior to working for IHS he served as a Technical Officer at the World Health Organization (WHO) Headquarters in Geneva, Switzerland. He worked in the Clinical Services and Systems Unit, where he was the clinical focal point to the Quality Team and worked to develop emergency, surgical, and intensive care capacity in resource-limited settings as well to optimize the integration of care platforms across the care continuum. Before joining WHO, he served as faculty at Harvard Medical School, where his academic focus was on the use of registry-based analytics and applied implementation science methodology for quality improvement. He spent approximately one-third of his time in Africa as a consultant to WHO. He is an emergency physician by training, obtaining his Master’s in Public Health and fellowship in Global Health from the Harvard School of Public Health and Beth Israel Deaconess Medical Center.

Presentation Slides: https://www.indiancountryecho.org/wp-content/uploads/2024/04/OCPHI-Tools-and-Strategies-for-Improving-Emergency-Care.pdf

Showing Up as Yourself | April 17, 2024

Presenter: A’lai Alvarez, MD

Presenter Bio:

Al’ai Alvarez, MD (@alvarezzzy) is a national leader and educator on wellness, diversity, equity, and Inclusion. He is a clinical associate professor of Emergency Medicine (EM) and Well-Being Director at Stanford Emergency Medicine. He co-leads the Human Potential Team and serves as the Stanford EM Physician Wellness Fellowship Director. Dr. Alvarez is the chair of Stanford WellMD’s Physician Wellness Forum and the director of Stanford’s peer-to-peer support for faculty and trainees, the Physician Resource Network (PRN) Support Program. His work focuses on humanizing physician roles as individuals and teams by harnessing the individual human potential in the context of high-performance teams. This includes optimizing the interconnectedness between Process Improvement (Quality and Clinical Operations), Recruitment (Diversity and Representation), and Well-being (Inclusion and Belonging). He is one of the 2021-2022 Faculty Fellows at the Stanford Byers Center for Biodesign. Dr. Alvarez gives several grand rounds and national/international conference lectures and workshops on relevant topics in self-compassion, physician well-being, and high-performance teams, including increasing leadership capacity and mentorship to enhance diversity and inclusion.

Presentation Slides: https://www.indiancountryecho.org/wp-content/uploads/2024/04/Showing-up-as-yourself-emRIC.pdf

Departmental Innovations | April 17, 2024

Presenter: Paul Charlton, MD

Presenter Bio:

Dr. Paul Charlton, MD, MA, works as an emergency medicine physician at the Gallup Indian Medical Center where he currently serves as the emergency department director. He completed medical school at Dartmouth and his residency in Emergency Medicine at the University of Washington/Harborview. Dr. Charlton also holds a master’s degree from Georgetown University in Conflict Resolution, which drives his motivation to improve health care systems to address issues of quality, equity, and social justice. In addition to his clinical contributions, his academic niche is conflict management and health care, for which he holds academic affiliations with several universities focused on this topic. He lives in Gallup, New Mexico, with his wife and two children, and is an active climber and trail runner.

Presentation Slides: https://www.indiancountryecho.org/wp-content/uploads/2024/04/Institutional-Innovations.pdf

How to Care and Help in an Unequal and Unjust World | April 17, 2024

Presenter: Anu Taranath, PhD

Presenter Bio:

Dr. Anu Taranath brings both passion and expertise as a speaker, author, educator, and racial equity consultant. In all her work, she partners with a range of people to deepen conversations on history, harm and healing. A University of Washington Seattle professor for the past 23 years, Dr. Anu knows that the most compelling conversations on race, identity, power, and belonging take place when people feel valued and heard. She has received the Seattle Weekly’s “Best of Seattle” recognition, the University’s Distinguished Teaching Award, and multiple US Fulbright Fellowships to work abroad. As a consultant she has partnered with over 300 clients from National Geographic Society to the Raging Grannies. Her book “Beyond Guilt Trips: Mindful Travel in an Unequal World” was named a Washington State Book Award Finalist, Newsweek’s Future of Travel Winner in Storytelling, and included in Oprah Magazine’s “Best 26 Travel Books of All Times.” Visit www.anutaranath.com to learn more.

Presentation Slides: https://www.indiancountryecho.org/wp-content/uploads/2024/04/How-to-Care-and-Help-in-an-Unequal-and-Unjust-Word.pdf

Poowavie Moppaht and Wovookie: The Medicine Wheel and Smudging | April 17, 2024

Presenter: Larry Cesspooch (Ute)

Presenter Bio:

Larry Cesspooch Ute Filmmaker/Storyteller/Spiritual Leader uses all forms of media to tell his stories, film, music, and lecture. He grew up on the Uintah & Ouray Ute Reservation in Northeastern Utah. Larry maintains a Sweat Lodge and is one of the Spiritual Leaders for his Noohchew Ute people. Larry served as a Radioman 3rd Class in Vietnam with an Air Squadron VRC-50. He used the GI Bill to attend the Institute of American Indian Arts for his associate degree and went onto the Anthropology Film Center for his Bachelor Degree, both in Santa Fe, N.M. Larry returned home to create the “Ute Tribe Audio-Visual Department,” one of the first tribal production groups in the states in ‘79. They produced over 600 films for the Ute Indian Tribe on the culture, language, and history. During his 23-year tenure, Cesspooch also served as the Editor for the “Ute Bulletin” tribal newspaper and was Public Relations Director for the tribe. He served over twelve years as an Utah Humanities Public Square Speaker, presenting “Utah History Through Native Eyes,” as one of his many topics. He is often called on by his tribe to represent their history and their viewpoint. The filmmaker left the tribe in 2002 to create his own production company, “Through Native Eyes Productions.” Many of his films on his YouTube Channel. Webmaster Cesspooch continues to preserve Ute history through UteTube.org the Ute Indian Tribe’s History, Photo, Film & Audio Archives. Eventually the website will have 250 of the cultural films and over 500 photos.

Presentation Slides: https://www.indiancountryecho.org/wp-content/uploads/2024/03/Poowavie-Moppaht-and-Wovookie.pdf

Culture and Health | April 17, 2024

Presenter: Ernest Begay (Navajo)

Presenter Bio:

Ernest Harry Begay is a Traditional Counselor who resides at Rock Point, Arizona. He has been doing ceremonies constantly for 50 years. He has worked as a Traditional Practitioner for 14 years for the Navajo Department of Behavioral Health Services. He worked for 6 years as a Traditional Healer/Counselor for the Indian Health Services (Four Corners Regional Health Center – Red Mesa, Arizona). Presently, he is a Traditional Services Program Manager for the Utah Navajo Health System. He uses the Indigenous Navajo Modality which consists of Self Awareness, Self Respect, Self Help and Self Care. He uses the Navajo Oral Traditions of the Black, Blue, Yellow and White Worlds to heal. He helps people with substance abuse, mental challenges, behavioral disorders, domestic violence and the variety of sicknesses that clinical institutions deal with through allopathic medicine. He uses storytelling, ceremonies and sweat lodge as mechanisms to help people. He is also a traditional educator and presenter on a variety of topics; Parenting, indigenous education, indigenous governance, history, etc.

Presentation Slides: https://www.indiancountryecho.org/wp-content/uploads/2024/04/Achieving-Balance-of-the-Spiritual-Mental-Emotional-and-Physical-Beings.pdf

Managing Substance Use Disorders in the ED | April 17, 2024

Presenter: Erik Anderson, MD

Presenter Bio:

Dr. Erik Anderson, MD, is the Associate Medical Director of the Bridge Program and the Director of Addiction Consult Service in the Division of Addiction Medicine at the Department of Emergency Medicine at the Alameda Health System

Presentation Slides: https://www.indiancountryecho.org/wp-content/uploads/2024/04/Bridging-the-Gap-Updates-in-Substance-Use-Treatment-in-the-ED.pdf

Unpacking Ideas About Identity, Privilege, Power and Ethics of Care | April 17, 2024

Please note recording is not available for this session due to the nature of the workshop.

Presenter: Anu Taranath, PhD

Presenter Bio:

Dr. Anu Taranath brings both passion and expertise as a speaker, author, educator, and racial equity consultant. In all her work, she partners with a range of people to deepen conversations on history, harm and healing. A University of Washington Seattle professor for the past 23 years, Dr. Anu knows that the most compelling conversations on race, identity, power, and belonging take place when people feel valued and heard. She has received the Seattle Weekly’s “Best of Seattle” recognition, the University’s Distinguished Teaching Award, and multiple US Fulbright Fellowships to work abroad. As a consultant she has partnered with over 300 clients from National Geographic Society to the Raging Grannies. Her book “Beyond Guilt Trips: Mindful Travel in an Unequal World” was named a Washington State Book Award Finalist, Newsweek’s Future of Travel Winner in Storytelling, and included in Oprah Magazine’s “Best 26 Travel Books of All Times.” Visit www.anutaranath.com to learn more.

Ultrasound-Guided Regional Anesthesia Lab | April 16, 2024

Please note recordings of the hands-on skills and procedure day labs are not available

Presenter: Patrick Ockerse, MD

Presenter Bio:

Dr. Ockerse is an emergency physician serving the University of Utah and focuses on treatment of emergent conditions at University Hospital. He is a member of the teaching faculty at the University and educates fellows, resident physicians, and medical students. He is the Director of Ultrasound for the Division of Emergency Medicine.

Descrpition: Thank you for attending Ultrasound Guided Regional Anesthesia! This workshop was designed for both intermediate and advanced ultrasound users. The workshop focused on various applications of ultrasound guided regional anesthesia:

Introduction to Ultrasound Guided Regional Anesthesia: Building Blocks for Successful Implementation
Upper Extremity Blocks
Lower Extremity Blocks
Truncal Blocks

In preparation for your workshop, there were several online resources that you may have found helpful in preparing the foundation for ultrasound guided regional anesthesia applications. Please find below a list of resources for each of the hands-on stations.

If you are looking for any additional resources, please reach out!

Ultrasound Guided Regional Anesthesia
https://coreultrasound.com/nb_basics/

http://highlandultrasound.com/med-guide

http://highlandultrasound.com/what-needle

Upper Extremity Blocks
https://coreultrasound.com/ulnar-nerve-block/

https://coreultrasound.com/median-nerve-block/

https://coreultrasound.com/supraclavicular-brachial-plexus-nerve-block/

https://coreultrasound.com/raptir5ms/

Lower Extremity Blocks
https://coreultrasound.com/sciatic-nerve-block/

https://coreultrasound.com/fascia-iliaca-nerve-block/

https://coreultrasound.com/5ms_peng/

Truncal Blocks
https://coreultrasound.com/serratus/

https://coreultrasound.com/transversus-abdominus-plane-nerve-block/

https://coreultrasound.com/lumbaresp/

Advanced Ultrasound Lab | April 16, 2024

Please note recordings of the hands-on skills and procedure day labs are not available

Presenter: Ashley Sullivan, MD

Presenter Bio:

Dr. Sullivan is an emergency physician serving at the Gallup Indian Medical Center.

Description: Thank you for attending Beyond the Basics: Advancing your Point-of-Care Ultrasound Skills! This workshop was designed for both intermediate and advanced ultrasound users. The workshop consisted of several advanced ultrasound applications:

Advanced Cardiac Ultrasound
Critical Care Ultrasound: Your Guide to the Crashing Patient
Deep Dive: Deep Venous Thrombosis
First Trimester OB/GYN
Advanced Ultrasound Guided Procedural Skills

In preparation for your workshop, there were several online resources that you may have found helpful in preparing the foundation for advanced point-of-care ultrasound applications. Please find below a list of resources for each of the hands-on stations.

If you are looking for any additional resources, please reach out!

Advanced Cardiac Ultrasound
https://coreultrasound.com/how-to-obtain-cardiac-windows/

https://coreultrasound.com/basic-cardiac-function/

https://coreultrasound.com/diastology/

Critical Care Ultrasound: Your Guide to the Crashing Patient
https://coreultrasound.com/rush-exam/

https://coreultrasound.com/volume-responsiveness-lvot-vti/

https://coreultrasound.com/pericardial-tamponade/

Deep Dive: Deep Venous Thrombosis
https://coreultrasound.com/dvt/

First Trimester OB/GYN
https://coreultrasound.com/ob-gyn-scanning-technique-5ms/

https://coreultrasound.com/ntrauterine-pregnancy-assessment-5ms/

https://coreultrasound.com/fhr/

https://coreultrasound.com/5ms_gestational_age/

Ultrasound Essentials Lab | April 16, 2024

Please note recordings of the hands-on skills and procedure day labs are not available

Presenter: Jennifer Cotton, MD, RDMS

Presenter Bio:

Dr. Cotton is an emergency physician at the University of Utah. She is also ultrasound faculty for the department of emergency medicine, the director of point of care ultrasound curriculum for the medical school, and the director of clinical ultrasound educator program for faculty. She graduated from medical school at the University of Kentucky College of Medicine. She completed her emergency medicine residency at the Ohio State University. She also completed a fellowship in emergency ultrasound at the University of Utah and the ACEP Teaching Fellowship after that. She has been passionate at ultrasound education since she was a medical student and involved on a national/international level for more than 10 years. She oversees the ultrasound training for more than 500 medical students each year and is involved training residents, fellows, and faculty across the medical center and many disciplines. In addition, she is the ultrasound curriculum director for the Rural, Underserved, and Tribal Point of Care Ultrasound Program where she is involved in ultrasound training for clinicians caring for patients in resource limited settings.

Description: Thank you for attending Introduction to Point-of-Care Ultrasound: Core Applications and Beyond! This workshop was designed for both beginner and intermediate ultrasound users, as well as for all provider types. The workshop had 8 available stations with various core ultrasound applications.

eFAST
Focused Cardiac Ultrasound
Focused Thoracic Ultrasound
Focused Biliary Ultrasound
Introductory Soft Tissue/MSK
Ocular Ultrasound
Ultrasound Guided Nursing Skills
Introduction to Ultrasound Guided Basic Procedures

In preparation for your workshop, there were several online resources that you may have found helpful in preparing the foundation for basic point-of-care ultrasound applications. Please find below a list of resources for each of the hands-on stations.

If you are looking for any additional resources, please reach out!

eFAST
https://coreultrasound.com/knobology/

https://coreultrasound.com/efast/

https://coreultrasound.com/pneumothorax/

Focused Cardiac Ultrasound
https://coreultrasound.com/how-to-obtain-cardiac-windows/

https://coreultrasound.com/basic-cardiac-function/

Focused Thoracic Ultrasound
https://coreultrasound.com/how-to-perform-a-pulmonary-exam/

https://coreultrasound.com/b-lines/

https://coreultrasound.com/pleural-effusions-part-1/

https://coreultrasound.com/pneumothorax/

Focused Biliary Ultrasound
https://coreem.net/core/biliary-ultrasound/

Introductory Soft Tissue/MSK
https://coreultrasound.com/cellulitis-vs-abscess/

https://coreultrasound.com/nsti/

https://coreultrasound.com/msk-basics/

Ocular Ultrasound
https://coreultrasound.com/onsd/

https://coreultrasound.com/vd-rd/

Ultrasound Guided Nursing Skills
https://coreultrasound.com/bladder-volume-measurement/

https://coreultrasound.com/ultrasound-guided-peripheral-iv-access/

https://coreultrasound.com/confirmation-of-central-venous-catheter-placement/

Introduction to Ultrasound Guided Basic Procedures
http://www.emcurious.com/blog-1/2014/12/7/ultrasound-leadership-academy-introduction-to-procedural-ultrasound/

Common Procedure Lab | April 16, 2024

Please note recordings of the hands-on skills and procedure day labs are not available

Presenter: Alisa Anderson, MD

Presenter Bio:

Dr. Anderson is an emergency medicine physician serving at the Northern Navajo Medical Center.

Description for Providers: In this skills lab, participants will have the opportunity for hands on experience with common procedures such as: incision and drainage, arthrocentesis, complex suturing, reductions, slit lamp exams and corneal foreign body removal.

Description for Nursing Staff: This lab is also a part of the *Critical Nursing Skills workshop (including the following topics: ultrasound PIV) and will include a didactic reviewing the anatomy and procedure, as well as time to practice looking at veins with ultrasound, and using ultrasounds to practice on phantom.

In anticipation of the lab, please take a moment to review the following asynchronous learning prior to the event:

I&D with loops
- https://www.youtube.com/watch?v=iSDkvvY3SHc
- https://www.youtube.com/watch?v=df4k085Z-JM
Arthrocentesis/injections
Complicated suturing/local anesthesia
- https://www.youtube.com/watch?v=Akyr4zlBS9E
Reductions
- Wrist
  - https://www.youtube.com/watch?v=kMZmW1SAST0
- Ankle
  - https://www.youtube.com/watch?v=H6Dz566KrcM
  - https://www.youtube.com/watch?v=wMjKrrMhsZE
- Shoulder
  - https://www.youtube.com/watch?v=k_ORI51luFI
  - https://www.youtube.com/watch?v=u2MsnjVNoPM
- Elbow
- Hip
  - https://www.youtube.com/watch?v=wjY_hMcxLGo
  - https://www.youtube.com/watch?v=GKZWG6hEv8o
Slit lamp exams
- https://www.youtube.com/watch?v=7UH4HBKYeJc
Corneal foreign body removal
- https://www.youtube.com/watch?v=ZLo8DDK6pL4

Advanced Airways Lab | April 16, 2024

Please note recordings of the hands-on skills and procedure day labs are not available

Presenter Bio:

Dr. Anderson is an emergency medicine physician serving at the Northern Navajo Medical Center.

Description for Providers: As emergency medicine providers, having the skills to manage difficult airways is crucial in rural settings with limited resources. In this skills lab, we will review various approaches to the difficult airway including cricothyrotomy, awake and fiberoptic intubations, and pediatric needle cricothyrotomy. We will provide hands-on experience and participants will have the opportunity to talk through their worst airway nightmares.

Description for Nursing Staff: This lab is part of the *Critical Nursing Skills workshop (including the following topics: intubation assistance, cricothyrotomy, jet ventilations, and flexible scope intubation) and will provide a general overview of procedures, nursing roles, and identification of instruments.

In anticipation of the lab, please take a moment to review the following asynchronous learning prior to the event:

Cricothyrotomy
- https://youtu.be/luhQWqF2EY4?si=qahMjrpho65h41s6
- https://youtu.be/Q0RVlgwC9rs?si=TLWS JOi8geNERwf
Awake/fiber optic intubation
- https://youtu.be/YBZFIcIDhQw?si=YvIFoyuVZ7z0Ig2G
- https://youtu.be/-Ehjj06HReE?si=HJ-StMTK30V3x43s
Difficult airway
- https://www.youtube.com/watch?v=G1cGrM9nxJo
Peds needle cric/jet ventilation
- https://youtu.be/Rhpiecg748Y?si=7VfleR7q6THx963_
- https://youtu.be/BrpzH5G-VHM?si=73YNe9tYd7xa_jYY
Difficult peds airway
- https://www.youtube.com/watch?v=hbQSEVwpnfA

Critical Care in the ED Lab: Adult and Pediatric Vent Management | April 16, 2024

Please note recordings of the hands-on skills and procedure day labs are not available

Presenter: Hillary Baker, DO

Presenter Bio:

Dr. Baker is an emergency medicine physician serving at the Northern Navajo Medical Center.

Description: Your sick patient needing transfer is boarding in your ED awaiting weather to clear or is 5th on the list for an air medical team. Your rural hospital may or may not have RT or an ICU and likely no intensivists. Sound familiar? In this skills lab, we will focus on the ongoing care of critically ill patients including managing ventilation settings for both adult and pediatric patients. You will have the opportunity to practice central lines and arterial lines as well.

Who should attend this lab? Providers managing critically ill patients in the ED.

In anticipation of the lab, please take a moment to review the following asynchronous learning prior to the event:

Adult ventilation management
- https://www.youtube.com/watch?v=E5uLM41URmE
- https://www.youtube.com/watch?v=yHg_ivGjch4
Pediatric vent management
- https://www.youtube.com/watch?v=ktIG7QHMspE
CVC
- https://www.youtube.com/watch?v=DgQbQSBYeQU
- https://www.youtube.com/watch?v=ukEv7NgH3iQ
Transvenous pacing
- https://www.youtube.com/watch?v=00-T8PcbStE
Arterial lines
- https://www.youtube.com/watch?v=VtoVavr0W9k
- https://www.youtube.com/watch?v=EFnUaYRAdro

Critical and Rare Procedure Lab | April 16, 2024

Please note recordings of the hands-on skills and procedure day labs are not available

Presenter: Hillary Baker, DO

Presenter Bio:

Dr. Baker is an emergency medicine physician serving at the Northern Navajo Medical Center.

Description for Providers: Your sick patient needing transfer is boarding in your ED awaiting weather to clear or is 5th on the list for an air medical team. Your rural hospital may or may not have RT or an ICU and likely no intensivists. Sound familiar? In this skills lab, we will focus on the ongoing care of critically ill patients including managing ventilation settings for both adult and pediatric patients. You will have the opportunity to practice central lines and arterial lines as well.

Description for Nursing Staff: This lab is part of the *Critical Nursing Skills workshop (including the following topics: IO placement, chest tube drain set-up/management, arterial line set-up/management) and will review setup and management of these devices – in less populated areas we have fewer opportunities to practice these skills and can use a periodic refresher.

In anticipation of the lab, please take a moment to review the following asynchronous learning prior to the event:

Tube thoracostomy
- https://youtu.be/BciVkfsi-qc?si=mUjFe_9lygqCzDNp
- https://youtu.be/IdmMR8JxmFo?si=JfZc_G1W_MYLutiF
Burr holes
- https://www.youtube.com/watch?v=QeDQZoeg0RA
Pericardiocentesis
- https://youtu.be/GcoAHYcngEw?si=nBtYA_vRClUHrLsZ
Lateral canthotomy
- https://www.youtube.com/watch?v=tgQaKVGynFA
- https://www.youtube.com/watch?v=bUAagMd_Q8A
Thoracotomy

Emergency Deliveries and Neonatal Resuscitation Lab | April 16, 2024

Please note recordings of the hands-on skills and procedure day labs are not available

Presenter: Alisa Anderson, MD

Presenter Bio:

Dr. Anderson is an emergency medicine physician serving at the Northern Navajo Medical Center.

Description for Providers: Emergency deliveries are rare but high stakes and can include complications no one ever wants to face. In this skills lab, we will focus on managing deliveries in the ED setting without an OB/gyn physician immediately available, including routine deliveries, delivery complications and perimortem c-sections (resuscitative hysterotomy). We will also review neonatal resuscitation and vascular access for neonates including hand-on experience with umbilical vein catheterization.

Description for Nursing Staff: This lab is part of the *Critical Nursing Skills workshop (including the following topics: postpartum hemorrhage, preeclampsia, umbilical IV access) and will provide an overview of these complications, identifying appropriate interventions, and review nursing roles in umbilical IV access and management.

In anticipation of the lab, please take a moment to review the following asynchronous learning prior to the event:

Vaginal deliveries and complications
Perimortem c section
- https://www.youtube.com/watch?v=rdr20ngzA6s
- https://www.youtube.com/watch?v=IwDWv2iyAos
Neonatal resuscitation
- https://www.youtube.com/watch?v=ERTrWGuQ800
UVC
- https://www.youtube.com/watch?v=7_hsLoPDhSM

Indian Health Service Innovations and Future Directions | April 17, 2024

Video coming soon.

Presenter:

Presenter Bio:

Description:

Welcome to the 6th Annual emRIC Gathering | April 17, 2024

Video coming soon.

Presenter:

Presenter Bio:

Description:

Ask a Clinical Question

Indian Country ECHO's clinical team are here to answer your clinical questions, provide consultation and support your team. We will respond within 6 hours during the business day. Please keep any patient information de-identified.

"*" indicates required fields

Tyanne Conner, MS

Northwest Portland Area Indian Health Board
Native BOOST Project Manager

Tyanne Conner, a descendant of settlers from Ireland, England, and Scotland, is the Native Boost Project Manager at the Northwest Portland Area Indian Health Board (NPAIHB). In her free time she enjoys creating all manner of things including watercolor paintings, fiber crafts, and new recipes from garden delights. When she is not at home, she and her wife can be found wandering the beaches and mountains in search of mushrooms, rocks, sticks, and other treasures to incorporate into art projects and recipes.

Supriya Gupta

Great Lakes Inter-Tribal Epidemiology Center

Supriya (she/her) received her MPH in Global Health Epidemiology from the University of Michigan. She serves Tribal communities and urban Indian centers in the Great Lakes regions by providing technical assistance with program evaluation and data analysis.

Stephanie Paz

Tigua Indian from Ysleta del Sur Pueblo
Good Medicine Tribal Public Health Consulting
Lead Consultant

Stephanie Paz is a Tigua Indian from Ysleta del Sur Pueblo. She has a Bachelor of Science in Psychology from The University of Texas at El Paso and a Master of Public Health candidate in Health Behavior and Health Promotion from New Mexico State University. Stephanie has vast experience working in American Indian and Alaska Native health, working with different health boards such as the National Indian Health Board, Albuquerque Area Indian Health Board, and the Northwest Portland Area Indian Health Board. She is currently a Lead Consultant for Good Medicine Tribal Public Health Consulting.

Lana Schenderline

Crow Nation
Rocky Mountain Tribal Leaders Council
Project Coordinator

For the past year, Lana has worked in the Epidemiology department to promote and increase vaccinations for the AI/AN adults who are part of Montana and Wyoming Tribes. Previously, Lana worked as an accounting assistant until taking time off from work to care for her parents. Being a caretaker has given Lana better understanding for the needs of the Elder community.

Shemira Castellanos-Cervantes

CDC Foundation
Tribal Public Health Educator

Shemira Castellanos-Cervantes is a Tribal Public Health Educator working with Rocky Mountain Tribal Leaders Council (RMTLC) from the CDC Foundation. Prior to her current position, Shemira worked as a Case Investigator with RMTLC and assisted Tribes with contact tracing and case investigation. Shemira has been working for the CDC Foundation for over a year now and has been working specifically with Tribal communities. Shemira graduated from Beloit College in 2014 with a Bachelor’s Degree in International Relations and Public Health. In 2018, she graduated from Northwestern University with a Master of Science in Global Health.

Helen Tesfai

Rocky Mountain Tribal Leaders Council
Epidemiology Center Director

Ms. Tesfai has more than 15 years of experience in public health and public health research publications. Her experience is within the areas of epidemiology, quantitative and qualitative surveys, vector control, education, communication, and social marketing.

Danner Peter, MPH

Diné (Navajo)
Northwest Portland Area Indian Health Board
TEC-IVAC Program Manager

Danner has professionally worked in Tribal Health since 2015 and has extensive experience in Indigenous health issues; specific areas include sexual health, harm reduction, research, and infectious disease prevention. He also has a profound love for viruses.

Anna Morgan

Kauffman & Associates
Graphic Designer

Anna Morgan is an award-winning graphic designer with nearly two decades of experience creating materials that are designed with accessibility in mind for a variety of target audiences using an assortment of visual solutions for print, video, and web designs. In addition, Ms. Morgan provides expertise in designing culturally appropriate products concerning issues that affect underserved populations, including suicide prevention, substance misuse, mental and behavioral health, health care, vaccine awareness, and safety.

Tam Lutz

Lummi
Northwest Portland Area Indian Health Board
Maternal Child Health Programs Director
Native BOOST Project Director

Tam Lutz, MPH, MHA, CPST is the Maternal Child Health Programs Director and Native Boost Project Director at the Northwest Portland Area Indian Health Board.

Emily Good Weasel

Oglala Sioux
Great Plains Tribal Epidemiology Center
Epidemiology and Disease Prevention Program Manager

Emily an enrolled member of the Oglala Sioux Tribe. Emily has been working in Public Health for many years in various capacities and over the past four years as the Epidemiology & Disease Prevention Program Manager for the Great Plains Tribal Epidemiology Center.

LaKota Scott, ND

Diné (Navajo)
Northwest Portland Area Indian Health Board
Native BOOST Provider Expert

Lakota Scott is Diné from Arizona. She is a licensed Naturopathic Doctor with a certificate in Natural Childbirth; completed her ND training at the National University of Natural Medicine. She works as an integrative healthcare provider in private practice and as the Native Boost Provider Expert at the Northwest Portland Area Indian Health Board.

Wendee Gardner, DPT, MPH

Stockbridge-Munsee Band of Mohican Indians
Good Medicine Tribal Public Health Consulting
CEO and Founder

Dr. Wendee Gardner, DPT, MPH, a member of the Stockbridge-Munsee Band of Mohican Indians, has spent over a decade working in Indigenous health. Wendee began her career at the Northwest Portland Area Indian Health Board, where she worked with Tribal partners to develop a first-of-its-kind sexual health intervention called Native VOICES. Wendee also headed the Youth Department at the National Indian Health Board, where she directed a health policy fellowship for youth. In 2019, she founded Good Medicine Tribal Public Health Consulting to offer high-quality public health services to Tribal communities, universities, federal agencies, and other allies working to promote Tribal health and healthcare.

Mariah Knox

Alaska Native Tribal Health Consortium
Communication Lead

Mariah has worked to improve the health of Alaska Native (AN) Peoples since 2015. Mariah’s focus areas have included clinical research exploring the uses of motivational interviewing to improve cardiovascular health and smoking cessation rates in adult AN populations, and coordination of activities for the 12 nationwide Tribal Epidemiology Centers. Mariah’s most recent focus is the design and implementation COVID-19 and influenza projects to educate communities and influence messengers on the importance of receiving associated vaccinations.

Tinka Duran

Rosebud Sioux
Great Plains Epidemiology Center
Senior Director

Ms. Tinka Duran received her MPH at the University of Nebraska Medical Center. She serves as the Senior Director for the Great Plains Tribal Epidemiology Center (GPTEC) of the Great Plain Tribal Leaders Health Board (GPTLHB). GPTEC was founded in 2003 as a core component of the GPTLHB. GPTEC’s mission is to provide leadership, technical assistance, support, and advocacy for the 18 tribal nations and communities serviced by the Great Plains Area Indian Health Service in order to achieve our vision of eliminating the disparities in health that currently exist for tribal peoples within the four-state region of South Dakota, North Dakota, Nebraska and Iowa. Ms. Duran is an enrolled member of the Rosebud Sioux Tribe.

Cassandra Querdibitty, PhD, MPH

Seminole/Muscogee
Southern Plains Tribal Health Board
Tribal Epidemiology Center Core Program Manager

Cassandra has a broad background in public health, with specific training in social and behavioral research, program evaluation, spatial analysis, and survey development. As an evaluator or coordinator on several locally and federally funded grants, she participated with Tribal Nations on community-based participatory research studies to foster an equitable partnership characterized by power-sharing, mutual benefit, co-learning, capacity building, and most importantly social action to address public health issues prioritized by the Tribal Nation.

Erin Spain

Southern Plains Tribal Health Board
Epidemiologist

Erin is an epidemiologist that works with Tribes in Oklahoma, Kansas, and Texas through the Oklahoma City Area Tribal Epidemiology Center. Her work with the Tribes includes survey development, program development, data collection, data for grant construction, and technical assistance requests.

Julie Nystrom, BS

Great Lakes Inter-Tribal Epidemiology Center
Communication Lead

Julie has worked professionally in the communications field since 2014. Her career has intentionally focused on positions that intersect with health care, public health, or science-related trades. She is passionate about using health communication to help individuals and communities improve their health and quality of life.

Karin Eagle

Oglala Lakota
Great Plains Epidemiology Center
EDP Program Director

Karin has worked in Public Health information since the COVID-19 pandemic began as Public Information Office for the Oglala Sioux Tribe’s Task Force. She works in vaccine advocacy and promotion through GPTEC with the Great Plains Tribal Leaders Health Board and is creating new materials and training for the Great Plains Region.

Michele Suina, PHD

Cochita Pueblo
Albuquerque Area Tribal Epidemiology Center
Program Director for the Good Health and Wellness in Indian Country Program

Michele is a health educator with over 25 years of experience and chose this pathway to contribute to the vitality of Indigenous peoples and to influence western approaches to public health for Native Americans so tribes can realize their own self-defined health goals. In 2015, Michele graduated from Arizona State University School of Social Transformation with the first Pueblo PhD Justice Studies cohort.

Melissa Fulton, MPH

Inter-Tribal Council of Arizona
Vaccine Epidemiologist

Melissa has 20 years of population health experience specifically in dental health and hygiene. She has served various populations in many countries to achieve quality health through resource accessibility and education.

Emily Davis, MPH

Great Lakes Inter-Tribal Epidemiology Center
Epidemiologist

Emily serves the Tribal communities within the Great Lakes region. This includes supporting efforts to improve the health of Tribal communities through community-based research, partnership development, and technical assistance. Emily received her MPH in Epidemiology through the University of Minnesota. Emily’s areas of expertise are immunizations and health equity.

Success Stories

ECHO – Consulting patients, solving problems

Want to share your own story?

Northwest Portland Area Indian Health Board
Native BOOST Project Manager

Great Lakes Inter-Tribal Epidemiology Center

Tigua Indian from Ysleta del Sur Pueblo
Good Medicine Tribal Public Health Consulting
Lead Consultant

Crow Nation
Rocky Mountain Tribal Leaders Council
Project Coordinator

CDC Foundation
Tribal Public Health Educator

Rocky Mountain Tribal Leaders Council
Epidemiology Center Director

Diné (Navajo)
Northwest Portland Area Indian Health Board
TEC-IVAC Program Manager

Kauffman & Associates
Graphic Designer

Lummi
Northwest Portland Area Indian Health Board
Maternal Child Health Programs Director
Native BOOST Project Director

Oglala Sioux
Great Plains Tribal Epidemiology Center
Epidemiology and Disease Prevention Program Manager

Diné (Navajo)
Northwest Portland Area Indian Health Board
Native BOOST Provider Expert

Stockbridge-Munsee Band of Mohican Indians
Good Medicine Tribal Public Health Consulting
CEO and Founder

Alaska Native Tribal Health Consortium
Communication Lead

Rosebud Sioux
Great Plains Epidemiology Center
Senior Director

Seminole/Muscogee
Southern Plains Tribal Health Board
Tribal Epidemiology Center Core Program Manager

Southern Plains Tribal Health Board
Epidemiologist

Great Lakes Inter-Tribal Epidemiology Center
Communication Lead

Oglala Lakota
Great Plains Epidemiology Center
EDP Program Director

Cochita Pueblo
Albuquerque Area Tribal Epidemiology Center
Program Director for the Good Health and Wellness in Indian Country Program

Inter-Tribal Council of Arizona
Vaccine Epidemiologist

Great Lakes Inter-Tribal Epidemiology Center
Epidemiologist