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.
Need a quick refresher course on how to do an ultrasound-guided ear block or ankle arthrocentesis? I recently found out about Drs. Andrew Herring and Arun Nagdev’s Highland Emergency Ultrasound website and thought it was a great resource to share with others in the EM world. The website has easy-to-follow pictorial instructions of anatomic landmarks, probe placement, and ultrasound images of the most common blocks and other procedures.
To provide a resource for evidence-based Emergency Medical education, this list of must-read landmark articles was created to supplement the Emergency Medicine (EM) internship year of training. There are 52 articles so that one article can be read at leisure each week of the year. I searched national databases and polled faculty at the University of Washington to identify articles that faculty would expect any EM resident to be familiar with or that they felt were practice-changing in EM. Articles were selected for the final list based on the quality of study design, sample size, and relevance for EM residents.
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.
The CaseA 500-pound morbidly obese male presents to your ED complaining of mild shortness of breath and palpitations. A quick ECG shows SVT with a rate of 160 bpm. His BP is in the 130s systolic, and he is otherwise stable. You know you have a bit of time. Meanwhile, the nurses begin searching for veins to start an IV…
A patient comes into your department with an obvious shoulder dislocation. You know you can easily reduce the shoulder and have the patient discharged before the orthopedic consultant calls back. But what if there is a fracture? Do you need to get that plain film before popping it back into place?
Patients with hypotension or shock have high mortality rates, and traditional physical exam techniques can be misleading. Diagnosis and initial care must be accurate and prompt to optimize patient care. Ultrasound is ideal for the evaluation of critically ill patients in shock, and ACEP guidelines now delineate a new category of ultrasound (US)– “resuscitative.” Bedside US allows for direct visualization of pathology and differentiation of shock states.
The RUSH Protocol was first introduced in 2006 by Weingart SD et al, and later published in 2009. It was designed to be a rapid and easy to perform US protocol (<2 minutes) by most emergency physicians.