About William Shyy, MD

Director of Emergency Ultrasound, Parnassus Heights
Co-Director of Emergency Ultrasound Fellowship
Co-Chair High Risk Hawaii Conference
Assistant Clinical Professor
Department of Emergency Medicine
University of California, San Francisco

Fascia iliaca nerve block: A hip fracture best-practice

fascia iliaca nerve block hip fracture

An 82-year-old woman presents with left hip pain after a mechanical fall while cleaning the kitchen floor. When EMS arrived, the left leg was foreshortened and externally rotated. The paramedics administered 10 mg of IV morphine, but she is still writhing in pain on arrival. The AP pelvic x-ray demonstrates a left femoral neck fracture (arrow). You consider performing a fascia iliaca nerve block for better pain control.

(more…)
2019-09-09T13:55:18-07:00

Update on the ED Management of Intracranial Hemorrhage: Not All Head Bleeds Are the Same

management of intracranial hemorrhageRobust and comprehensive studies now support specific management guidelines for patients presenting with different intracranial hemorrhages (ICH). From the Emergency Department perspective, the primary dilemmas involve specific blood pressure goals and whether seizure prophylaxis with phenytoin is necessary. The Brain Trauma Foundation provides an excellent summary of the current guidelines.1

(more…)

2017-09-05T14:53:30-07:00

Trick of the Trade: Ultrasound for Pedal Pulse Identification and ABI

ultrasound for pedal pulse PT The Problem: A patient is rolled in to your ED by EMS with extremity trauma. You’re rightfully concerned about possible vascular injury to an upper or lower extremity, but you can’t palpate a dorsalis pedis (DP) or posterior tibialis (PT) pulse! You spend minutes, whisking the doppler probe, attempting to hear a waveform in a busy ED. Unfortunately you can’t seem to hear the “whoosh,” making accurate it nearly impossible for you to measure ankle-brachial indices (ABI). 1–3

(more…)