Trick of the Trade: Squeeze test for confirmation of IO placement

IO needlesVenipuncture is the most common invasive procedure performed in the emergency department 1 , likely due to the fact that the vast majority of our laboratory evaluations require blood and many of our life saving interventions require access to the patient’s systemic circulation. Most of the time emergency department staff are able to perform this procedure easily, but occasionally you find that your patient is the dreaded “difficult stick”. Literature suggests that the landmark technique is successful on the initial venipuncture 74-77% of the time. 2–5  Success rates rise after multiple attempts, but what happens when you don’t have the luxury of time? What happens when your patient will die if you don’t get life saving medications into their circulation promptly?  There are a few options when you can’t get IV access through traditional means, among them external jugular vein cannulation, central line, ultrasound-guided IV, and the intraosseous lines (IO).6 However, when managing the crashing patient, a wise decision is to use the quickest option, which is often the IO.

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Ultrasound For The Win! Case – 101M with Altered Mental Status #US4TW

Welcome to another ultrasound-based case, part of the “Ultrasound For The Win” (#US4TW) Case Series. In this peer-reviewed case series, we focus on real clinical cases where bedside ultrasound changed management or aided in diagnoses. In this case, a 101-year-old man presents after being found down with altered mental status.

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PV Card: Focused Deep Vein Thrombosis (DVT) Ultrasound

ultrasound dvtDeep vein thrombosis (DVT) is always a consideration when patients with asymmetric lower extremity swelling. Why is one leg. Two-point focused DVT ultrasonography of the femoral and popliteal veins can be incredibly useful in the Emergency Department when trying to narrow the differential diagnosis. Drs. Margaret Greenwood-Ericksen, Joshua Rempell, and Mike Stone provide a clear, image-based clinical reference tool on this ultrasound technique.

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2017-08-03T00:20:25-07:00

PV Card: Focused Echocardiography Ultrasound

Screen Shot 2014-12-31 at 1.06.33 PMSo many great information can be gleaned from a focused echocardiogram in Emergency Department patients. What views are you obtaining? What is the importance of the e-point septal separation (EPSS) and how to measure this? Drs. Jimmy Fair, Mike Mallon, and Mike Stone provide a terrific step-by-step image-based guide to these questions that you can use at the bedside as a refresher.

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2017-08-03T00:20:42-07:00

PV Card: Pericarditis – Diagnosis and Treatment Recommendations

pericarditisWhen the topic of pericarditis is mentioned, the classic electrocardiogram (ECG) findings of diffuse ST elevation and PR depression are often the focus of discussion. What about the criteria for diagnosis, the 3-prong approach to treatment, and contraindications to colchicine? These are the great questions answered by Dr. Chris Bond (@socmobem) in this PV card, which summarize 3 key papers by Imazio et al from the New England Journal of Medicine, Archives of Internal Medicine, and Circulation.

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2019-01-11T15:26:03-07:00

US4TW Case: 39F with Chest Pain

Welcome to another ultrasound-based case, part of the “Ultrasound For The Win!” (#US4TW) Case Series. In this peer-reviewed case series, we focus on a real clinical case where bedside ultrasound changed the management or aided in the diagnosis. In this case, a 39-year-old female with history of lupus presents with chest pain.

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US4TW Case: 74F with Right Arm Tingling | Ultrasound for the Win series

Welcome to another ultrasound-based case, part of the “Ultrasound For The Win!” (#US4TW) Case Series. In this peer-reviewed case series, we focus on real clinical cases where bedside ultrasound changed management or aided in diagnoses. In today’s case, a 74-year-old woman presents to the Emergency Department with painful right arm paresthesias.

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2017-07-19T00:08:52-07:00