Techniques for Ultrasound-Guided IV Placement

Imagine a busy evening shift interrupted by the news that the unstable dialysis patient still has no access. Begrudgingly, you drag the ultrasound into the patient’s room. Buried beneath a layer of muscle, a tiny vein lurks below an intimidating artery with a nerve nestled close by. Making matters worse, the patient is becoming increasingly more frustrated. “This always happens. I told them not to remove my last PICC line,” he notes. The use of ultrasound-guided IV improves successful cannulation and decreases complications, but cases like this have caused many emergency providers to resent, even fear, this basic procedure.^1–4 Below, we provide additional techniques to increase your success and to avoid the risks associated with central line placement.

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By Kimon Ioannides, MD|2019-09-19T17:39:55-07:00Sep 19, 2019|Ultrasound|

EMRad: Can’t Miss Elbow Injuries

Have you ever been working a shift at 3 am and wondered, “Am I missing something? I’ll just splint and instruct the patient to follow up with their PCP in 1 week.” This is a reasonable approach, especially if you’re concerned there could be a fracture. But we can do better. Enter the “Can’t Miss” series: a series organized by body part that will help identify injuries that ideally should not be missed. This list is not meant to be comprehensive review of each body part, but rather to highlight and improve your sensitivity for these potentially catastrophic injuries. To begin: “Can’t Miss” adult elbow injuries.

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By Stephen Villa, MD|2020-05-14T22:36:36-07:00Sep 16, 2019|EMRad, Orthopedic, Radiology, Trauma|

EMRad: Radiologic Approach to the Traumatic Elbow

Radiology teaching during medical school is variable, ranging from informal teaching to required clerkships.¹ Many of us likely received an approach to a chest x-ray, but approaches to other studies may or may not have not been taught. We can do better! Enter EMRad, a series aimed at providing approaches and improving interpretation of commonly ordered radiology studies in the emergency department. When applicable, it will provide pertinent measurements specific to management, and offer a framework for when to get an additional view, if appropriate. To begin: the elbow.

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By Stephen Villa, MD|2020-05-14T22:36:46-07:00Sep 16, 2019|EMRad, Orthopedic, Radiology, Trauma|

SAEM Clinical Image Series: Hip Pain

$hip pain anterior inferior iliac spine fracture$

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Chief complaint: Left hip pain

History of Present Illness: A healthy right leg-dominant 13-year-old male athlete presents with left hip pain after kicking a soccer ball.

He states that he kicked the ball awkwardly and experienced hip pain immediately afterwards. He did not feel a pop or cracking sensation but could not stand after the kick and fell to the ground. He can ambulate but only with significant pain.

He now has 8/10 sharp, non-radiating left hip pain that is worse with movement, weight-bearing and palpation.

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By Louis Yu, MD MA|2019-09-09T17:23:16-07:00Sep 9, 2019|Emergency Medicine, Orthopedic, SAEM Clinical Images, Ultrasound|

SplintER Series: Ankle and Foot Pain in a Child

A 10-year-old female dancer presents with sub-acute onset pain located in her lateral ankle and foot without any history of significant trauma. She has had similar pain occasionally over the past 6 months. Pain is worse while dancing and now has difficulty putting on her shoe. You obtain a foot x-ray and see the adjacent image (photo credit).

What is the most likely diagnosis, differential diagnosis, and appropriate management plan?

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By William Denq, MD CAQ-SM|2019-09-09T13:56:11-07:00Sep 4, 2019|Expert Peer Reviewed (Clinical), Orthopedic, SplintER|

SAEM Clinical Image Series: Foreign Body Ingestion

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Chief complaint: Foreign Body Ingestion

History of Present Illness:

A 4-year-old male presents to the Pediatric ED for evaluation of swallowed foreign body.

The mother reports the patient was at his grandmother’s house playing near a cabinet when they witnessed him put a small unknown object in his mouth and swallow. Family denies vomiting, difficulty breathing, change in behavior, abdominal pain, or any additional symptoms at this time.

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By Brett Berliner, MD|2019-09-03T11:18:06-07:00Sep 2, 2019|Gastrointestinal, SAEM Clinical Images, Tox & Medications|

SAEM Clinical Image Series: Young Woman with a Headache

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Chief complaint: Headaches for 1 year

History of Present Illness: A 31-year-old woman with no significant past history presents with a dull headache.

She notes the headache is generalized, has been almost daily for a year and is worsened by bending over. She denies nausea, vomiting, photophobia, trauma, seizures, focal weakness, numbness, or vision change. Acetaminophen and ibuprofen provide only mild, short-acting relief. She takes oral birth control and her periods have been normal.

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By Walter L Green, MD|2019-09-03T11:17:34-07:00Sep 2, 2019|Neurology, Ophthalmology, SAEM Clinical Images|