Point-of-care ultrasound (PoCUS) has become an essential skill that emergency medicine (EM) residents learn during their training . Accordingly, most EM programs schedule a block early in residency dedicated to obtaining and interpreting high-quality PoCUS images. Likewise, the ability to efficiently diagnose and manage acute cardiovascular pathologies is a critical aspect of EM, and most EM residents also rotate on a cardiology service to develop these skills. Despite evidence that PoCUS improves the ability of both cardiologists and non-cardiologists to quickly diagnose cardiac disease at the bedside, integration of this relatively novel technology on cardiology services is often limited by lack of PoCUS availability as well as lack of a convenient platform to share recorded images . Equipping EM residents on cardiology rotations with a portable, handheld ultrasound (US) system (Figure 1. Philips Lumify handheld US system with tablet) can enhance the learning of echocardiography acquisition and interpretation while simultaneously providing cardiology teams with clinically actionable information . In addition to improving patient care, performing and interpreting PoCUS from the lens of a cardiologist is a simple yet innovative way to solidify the skills that are crucial to becoming an excellent bedside echocardiographer.
Bedside ultrasound (US) often plays a crucial role in medical and trauma resuscitations in the emergency department (ED) . Performing and interpreting bedside US studies such as the Extended Focused Assessment with Sonography for Trauma (E-FAST) during traumas or echocardiography during medical resuscitations are key skills for emergency medicine residents to learn during their training and adopt into clinical practice . During trauma resuscitations timely and efficient dissemination of critical information is paramount. Information obtained via bedside US can be critical in determining further clinical actions (need for urgent thoracostomy for a pneumothorax, need for urgent exploratory laparotomy in a hypotensive patient with free fluid in the abdomen, etc.) through shared decision making between ED and trauma teams . Information obtained via bedside US, however, is often difficult to convey during resuscitations given crowded rooms, simultaneous interventions, and limited viewing of the US screen. For ED and trauma providers wishing to better understand the utility of bedside US during resuscitations and how this powerful tool can change clinical management, a clearly visualized representation of what is displayed on the US screen could provide an ideal learning opportunity.
A 70-year-old female with no past medical history was hit by a motor vehicle while crossing the street. She experienced no head strike or loss of consciousness, however she was unable to ambulate at the scene, and upon arrival to the ED, complained of left knee pain. The emergency physician noted moderate swelling on exam with intact skin and distal pulses. She was tender to palpation over the proximal tibia. Portable 2-view radiographs were obtained and interpreted as “no acute fracture.” On repeat examination, however, the patient continued to have pain and was now unable to bear weight on the affected extremity. Is there a role for point-of-care ultrasound (POCUS) in this situation?
Patients with 5th metacarpal fractures (commonly termed “boxer’s fracture”) are frequently treated in the emergency department (ED) with closed reduction and splinting. Obtaining analgesia and a successful closed reduction can often be challenging without procedural sedation. Severe swelling can make a hematoma block difficult, often resulting in inadequate analgesia. An ultrasound-guided ulnar nerve block provides a simple method to facilitate pain relief and allow for improved fracture site manipulation.
It’s 3 am in the middle of your busy night shift and you begin your evaluation of a 65 year-old woman with diabetes with several hours of unilateral flashes of light in her left eye. Her visual fields seem normal, but you are unable to see her fundus with your direct ophthalmoscope. Luckily, you remembered the teaching from your ultrasound rotation during residency.
All the years of ultrasound training in residency has paid off. You found the large pericardial effusion in the hypotensive patient who is still alive, but looks sick. You are a star! The only problem was that you never performed a pericardiocentesis in an awake patient. The cardiology fellow is at home sleeping and/or the closest receiving hospital is about 1 hour away. Now what?
Dr. Arun Nagdev reviews how to do an ultrasound guided pericardiocentesis as part of this new, ongoing series of advanced ultrasound tips for emergency physicians.