Bio

Bio


Sarah R. Williams, MD, FACEP is the Associate Program Director for the Emergency Medicine Residency and oversees the educational curriculum for the residents. She has been on faculty at Stanford since 2000 and has the rank of Clinical Associate Professor. Sarah went to Cal as an undergrad (Go Bears!) and then started drinking the Stanford cool-aid, going to medical school here, the EM residency from 1997-2000, and the chief residency in 2000-2001. During 2000-2001 Sarah also developed version 1 of the EM Ultrasound Fellowship and was its inaugural fellow, and then went on to become the founding director of the EM Ultrasound Program at Stanford.

Dr. Williams also has a strong interest in medical education and leadership, and has been working hard with the residency program since 2000. She has worn all of the "hats" of residency leadership: Chief Resident, Assistant Program Director (APD), Associate PD, and Acting PD when the PD is away. Sarah has also been active in helping coordinate and run several CME programs, including our national conference and developing a new series of interdisciplinary ultrasound CME courses. Sarah has both practical real-world experience in education as well as completing the ACEP Teaching Fellowship and is currently completing a Masters Program in Health Professions Education (while continuing to work at Stanford full-time).

Sarah's areas of expertise are medical education, leadership in emergency medicine, and emergency ultrasound. Sarah also understands the challenges of combining an active academic career with family; she is a wife and mom of three school-aged boys. She was also the first member of her family to go to college and gets how hard the system can be... Sarah is happy to collaborate with colleagues with anything related to any of the above interests.

Clinical Focus


  • Emergency Ultrasound
  • Emergency Medicine
  • Medical Education

Academic Appointments


Administrative Appointments


  • Associate Residency Director, Stanford/Kaiser Emergency Medicine Residency (2011 - Present)
  • Assistant Residency Director, Stanford/Kaiser Emergency Medicine Residency (2007 - Present)
  • Fellowship Director, Emergency Medicine Ultrasound, Stanford Division of Emergency Medicine (2004 - Present)
  • Director, Emergency Medicine Ultrasound Program, Stanford Division of Emergency Medicine (2002 - Present)
  • National Board Examiner, American Board of Emergency Medicine (2010 - Present)
  • Course Director "21st Century Medicine: Utilizing Point-of-Care Ultrasound", Stanford School of Medicine (2012 - Present)
  • Course Director, "Xtreme Emergency Medicine" National CME Course, Stanford Division of Emergency Medicine (2006 - Present)
  • Faculty, Monthly Medical Student/Rotating Housestaff Education Series, Stanford Division of Emergency Medicine (2006 - Present)
  • Faculty, Surgery 220 (Introduction to Emergency Medicine), Stanford School of Medicine (2001 - Present)
  • Faculty, POM (Practice of Medicine), previously Surgery 221, Stanford School of Medicine (2000 - Present)
  • Representative, Stanford/Kaiser Emergency Medicine Residency Program, Council of Residency Directors (National) (2005 - Present)
  • Faculty, Emergency Medicine, Stanford Division of Emergency Medicine (2000 - Present)

Honors & Awards


  • Bedside Teacher of the Year Award, Stanford Division of Emergency Medicine (2005)
  • Bedside Teacher of the Quarter Award, Stanford Division of Emergency Medicine (2008, 2004)
  • Elected, Board of Directors, California Chapter of the American College of Emergency Physicians (2006)
  • Elected, President, California Emergency Medicine Residents Association (1999-2000)
  • Award for Outstanding Commitment to Academic Endeavors and Research, 1997-2000, Stanford/Kaiser Emergency Medicine Residency Program (2000)
  • Chief Resident Appreciation Award, Stanford/Kaiser Emergency Medicine Residency Program (2001)
  • 1st place, "Most Outstanding Senior Officer" in State of California, California Cadet Corps, California National Guard (1986)

Professional Education


  • Residency:Stanford University School of Medicine (2000) CA
  • Internship:Stanford University School of Medicine (1998) CA
  • Board Certification: Emergency Medicine, American Board of Emergency Medicine (2003)
  • Medical Education:Stanford University School of Medicine (1997) CA
  • Fellowship, Stanford/Kaiser, Emergency Medicine Ultrasound (2001)
  • Chief Resident, Stanford/Kaiser, Emergency Medicine (2001)
  • Residency, Stanford/Kaiser, Emergency Medicine (2000)
  • MD, Stanford School of Medicine, Medicine (1997)
  • BA, U.C. Berkeley, Biology and Psychology double major (1991)

Research & Scholarship

Current Research and Scholarly Interests


Investigating applications of clinician-performed point-of-care ultrasound for emergency and critical care patients.

Teaching

2013-14 Courses


Publications

Journal Articles


  • Confirmation of endotracheal intubation using color-Doppler ultrasound. 2nd World Congress in Emergency and Critical Care Ultrasound, Abstract Book, 2006. Abstract 4 Williams SR, Wu T, Jeffrey B, Angelotti T, Auerbach PS
  • Pitfalls in the Use of Ocular Ultrasound for Evaluation of Acute Vision Loss. journal of emergency medicine Schott, M. L., Pierog, J. E., Williams, S. R. 2013; 44 (6): 1136-1139

    Abstract

    Retinal detachment is a true medical emergency. It is a time-critical, vision-threatening disease often first evaluated in the Emergency Department (ED). Diagnosis can be extremely challenging and confused with other ocular pathology. Several entities can mimic retinal detachment, including posterior vitreous detachment and vitreous hemorrhage. Ocular ultrasound can assist the emergency physician in evaluating intraocular pathology, and it is especially useful in situations where fundoscopic examination is technically difficult or impossible. Accurate and rapid diagnosis of retinal detachment can lead to urgent consultation and increase the likelihood of timely vision-sparing treatment.This case demonstrates both the utility of ocular ultrasound in the accurate and timely diagnosis of retinal detachment and potential pitfalls in the evaluation of intraocular pathology in the ED.A 38-year-old woman presented with acute onset of bilateral visual loss that was concerning for retinal detachment. Rapid evaluation of the intraocular space was performed using bedside ocular ultrasound. Bedside ocular ultrasound correctly diagnosed retinal detachment in the right eye. Posterior vitreous detachment in the left eye was incorrectly diagnosed as retinal detachment.This case illustrates the importance of bedside ocular ultrasound and highlights some of the pitfalls that can occur when evaluating for retinal detachment. Following is a discussion regarding methods to distinguish retinal detachment from vitreous hemorrhage and posterior vitreous detachment.

    View details for DOI 10.1016/j.jemermed.2012.11.079

    View details for PubMedID 23522956

  • FOCUSED CARDIAC ULTRASOUND TRAINING: HOW MUCH IS ENOUGH? JOURNAL OF EMERGENCY MEDICINE Chisholm, C. B., Dodge, W. R., Balise, R. R., Williams, S. R., Gharahbaghian, L., Beraud, A. 2013; 44 (4): 818-822

    Abstract

    Focused transthoracic echocardiography (F-TTE) is an important tool to assess hemodynamically unstable patients in the Emergency Department. Although its scope has been defined by the American College of Emergency Physicians, more research is needed to define an optimal F-TTE training program, including assessment of proficiency.The goal of this study was to determine the effectiveness of current standards in post-residency training to reach proficiency in F-TTE.Fourteen staff Emergency Physicians were enrolled in a standardized teaching curriculum specifically designed to meet the 2008 American College of Emergency Physicians' guidelines for general ultrasound training applied to echocardiography. This training program consisted of 6 h of didactics and 6 h of scanning training, followed by independent scanning over a 5-month period. Acquisition of echocardiographic knowledge was assessed by an online pre- and post-test. At the conclusion of the study, a hands-on skills test assessed the trainees' ability to perform and interpret F-TTE.Ninety percent of trainees passed the written post-test. Two views, the parasternal long and short axis, were easily obtainable, regardless of the level of training or the number of ultrasounds completed. Other views were more difficult to master, but strong trends toward increased competency were evident after 10 h of mixed didactic and scanning training and > 45 ultrasounds.A short, 12-h didactic training in F-TTE provided proficiency in image interpretation and in obtaining adequate images from the parasternal window. More extensive training is needed to master the apical and subcostal windows in a timely manner.

    View details for DOI 10.1016/j.jemermed.2012.07.092

    View details for Web of Science ID 000317282000024

    View details for PubMedID 23351569

  • Developing and Assessing Initiatives Designed to Improve Clinical Teaching Performance ACADEMIC EMERGENCY MEDICINE Khandelwal, S., Bernard, A. W., Wald, D. A., Manthey, D. E., Fisher, J., Ankel, F., Williams, S. R., Szyld, D., Riddle, J., Ericsson, K. A. 2012; 19 (12): 1350-1353

    View details for DOI 10.1111/acem.12029

    View details for Web of Science ID 000312740100007

  • USE OF CADAVER MODELS IN POINT-OF-CARE EMERGENCY ULTRASOUND EDUCATION FOR DIAGNOSTIC APPLICATIONS JOURNAL OF EMERGENCY MEDICINE Zaia, B. E., Briese, B., Williams, S. R., Gharahbaghian, L. 2012; 43 (4): 683-691

    Abstract

    As the use of bedside emergency ultrasound (US) increases, so does the need for effective US education.To determine 1) what pathology can be reliably simulated and identified by US in human cadavers, and 2) feasibility of using cadavers to improve the comfort of emergency medicine (EM) residents with specific US applications.This descriptive, cross-sectional survey study assessed utility of cadaver simulation to train EM residents in diagnostic US. First, the following pathologies were simulated in a cadaver: orbital foreign body (FB), retrobulbar (RB) hematoma, bone fracture, joint effusion, and pleural effusion. Second, we assessed residents' change in comfort level with US after using this cadaver model. Residents were surveyed regarding their comfort level with various US applications. After brief didactic sessions on the study's US applications, participants attempted to identify the simulated pathology using US. A post-lab survey assessed for change in comfort level after the training.Orbital FB, RB hematoma, bone fracture, joint effusion, and pleural effusion were readily modeled in a cadaver in ways typical of a live patient. Twenty-two residents completed the pre- and post-lab surveys. After training with cadavers, residents' comfort improved significantly for orbital FB and RB hematoma (mean increase 1.6, p<0.001), bone fracture (mean increase 2.12, p<0.001), and joint effusion (1.6, p<0.001); 100% of residents reported that they found US education using cadavers helpful.Cadavers can simulate orbital FB, RB hematoma, bone fracture, joint effusion, and pleural effusion, and in our center improved the comfort of residents in identifying all but pleural effusion.

    View details for DOI 10.1016/j.jemermed.2012.01.057

    View details for Web of Science ID 000309576700044

    View details for PubMedID 22504086

  • D-Dimer Is Not Elevated in Asymptomatic High Altitude Climbers after Descent to 5340 m: The Mount Everest Deep Venous Thrombosis Study (Ev-DVT) HIGH ALTITUDE MEDICINE & BIOLOGY Zafren, K., Feldman, J., Becker, R. J., Williams, S. R., Weiss, E. A., Deloughery, T. 2011; 12 (3): 223-227

    Abstract

    We performed this study to determine the prevalence of elevated D-dimer, a marker for deep venous thrombosis (DVT), in asymptomatic high altitude climbers. On-site personnel enrolled a convenience sample of climbers at Mt. Everest Base Camp (Nepal), elevation 5340?m (17,500?ft), during a single spring climbing season. Subjects were enrolled after descent to base camp from higher elevation. The subjects completed a questionnaire to evaluate their risk factors for DVT. We then performed a D-dimer test in asymptomatic individuals. If the D-dimer test was negative, DVT was considered ruled out. Ultrasound was available to perform lower-extremity compression ultrasounds to evaluate for DVT in case the D-dimer was positive. We enrolled 76 high altitude climbers. None had a positive D-dimer test. The absence of positive D-dimer tests suggests a low prevalence of DVT in asymptomatic high altitude climbers.

    View details for DOI 10.1089/ham.2010.1101

    View details for Web of Science ID 000295406200005

    View details for PubMedID 21962065

  • Acetazolamide fails to decrease pulmonary artery pressure at high altitude in partially acclimatized humans HIGH ALTITUDE MEDICINE & BIOLOGY Basnyat, B., Hargrove, J., Holck, P. S., Srivastav, S., Alekh, K., Ghimire, L. V., Pandey, K., Griffiths, A., Shankar, R., Kaul, K., Paudyal, A., Stasiuk, D., Basnyat, R., Davis, C., Southard, A., Robinson, C., Shandley, T., Johnson, D. W., Zafren, K., Williams, S., Weiss, E. A., Farrar, J. J., Swenson, E. R. 2008; 9 (3): 209-216

    Abstract

    In this randomized, double-blind placebo controlled trial our objectives were to determine if acetazolamide is capable of preventing high altitude pulmonary edema (HAPE) in trekkers traveling between 4250 m (Pheriche)\4350 m (Dingboche) and 5000 m (Lobuje) in Nepal; to determine if acetazolamide decreases pulmonary artery systolic pressures (PASP) at high altitude; and to determine if there is an association with PASP and signs and symptoms of HAPE. Participants received either acetazolamide 250 mg PO BID or placebo at Pheriche\Dingboche and were reassessed in Lobuje. The Lake Louise Consensus Criteria were used for the diagnosis of HAPE, and cardiac ultrasonography was used to measure the velocity of tricuspid regurgitation and estimate PASP. Complete measurements were performed on 339 of the 364 subjects (164 in the placebo group, 175 in the acetazolamide group). No cases of HAPE were observed in either study group nor were differences in the signs and symptoms of HAPE found between the two groups. Mean PASP values did not differ significantly between the acetazolamide and placebo groups (31.3 and 32.6 mmHg, respectively). An increasing number of signs and symptoms of HAPE was associated with elevated PASP (p < 0.01). The efficacy of acetazolamide against acute mountain sickness, however, was significant with a 21.9% incidence in the placebo group compared to 10.2 % in the acetazolamide group (p < 0.01). Given the lack of cases of HAPE in either group, we can draw no conclusions about the efficacy of acetazolamide in preventing HAPE, but the absence of effect on PASP suggests that any effect may be minor possibly owing to partial acclimatization during the trek up to 4200 m.

    View details for DOI 10.1089/ham.2007.1073

    View details for Web of Science ID 000259759600004

    View details for PubMedID 18800957

  • Airway Ultrasound: Confirming Endotracheal Intubation with Color Doppler Ultrasound Academic Emergency Medicine Williams SR, Gharahbaghian L, Wu T, Goodwin T, Harter K, Angelotti T, Jeffrey RB, Auerbach P 2008; May (abstract)
  • Ultrasonographic diagnosis of retinal detachment in the emergency department Ann Emerg Med. Lewin MR, Williams SR, Ahuja Y 2005; 45 (1): 97-8
  • Drug storage and stability (revised), Paul S. Auerbach, editor Wilderness Medicine, Management of Wilderness and Environmental Emergencies, 5th edition Williams SR, Nix D, Patel K 2007
  • Regional vs systemic antivenom administration in the treatment of snake venom poisoning in a rabbit model: A pilot study WILDERNESS & ENVIRONMENTAL MEDICINE Norris, R. L., Dery, R., Johnson, C., Williams, S., Rose, K., Young, L., McDougal, L. R., Bouley, D., Oehlert, J., Thompson, R. C. 2003; 14 (4): 231-235

    Abstract

    To develop a model that compares 2 different routes of antivenom administration (standard intravenous [IV] administration vs regional administration below a tourniquet) to assess their ability to limit muscle necrosis in a rabbit model of rattlesnake venom poisoning.New Zealand white rabbits were randomly assigned to 4 groups. All animals underwent general anesthesia and were then injected intramuscularly (IM) with a sublethal dose of western diamond-back rattlesnake (Crotalus atrox) venom in the right thigh and a similar volume of normal saline (NS) control in the left thigh. Thirty minutes later, standard treatment group animals (n = 4) received 1 vial of reconstituted Antivenin (Crotalidae) Polyvalent (ACP) and 10 mL of NS through an ear vein. Experimental treatment group animals (n = 4) had their lower extremities exsanguinated and isolated by arterial tourniquets. One vial of ACP was then given through a distal IV in the envenomed extremity, and 10 mL of NS was given through an IV in the sham extremity. Tourniquets were removed 30 minutes later. Positive control group animals (n = 2) similarly had their lower extremities exsanguinated and isolated by tourniquets. They then received 10 mL of NS through distal IVs in each lower extremity. Tourniquets were again removed after 30 minutes. Negative control group animals (n = 2) received 2 doses of NS only (10 mL each) through an ear vein. Serum creatinine phosphokinase (CPK) levels were drawn at baseline and 48 hours following venom injection. At 48 hours, the animals were injected with technetium pyrophosphate. Two hours later, they were euthanized, and the lower extremities were scanned to determine levels of radionucleotide uptake in envenomed muscles compared to contralateral sham-injected muscles. The anterior thigh muscle groups were then removed, fixed, stained, sectioned, and analyzed in a blinded fashion by a veterinary pathologist for muscle necrosis grading.There was no evidence of statistically significant differences in changes in serum CPK levels (from baseline to 48 hours), technetium pyrophosphate uptake ratios (right leg/left leg), or muscle necrosis indices in any 2-group analysis.Results of this pilot study do not suggest any beneficial effect of ACP, in the dose and routes used, in limiting local muscle necrosis following IM rattlesnake venom poisoning in the rabbit model.

    View details for Web of Science ID 000187753100005

    View details for PubMedID 14719857

  • Please see full list of publications on attached CV (1992-present). (Under photo above) Williams SR 1992

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