Trick of the Trade: TRUST ultrasound confirmation of pediatric endotracheal tube placement

Following intubation the confirmation of endotracheal tube placement and depth is essential. While dynamic etCO2 monitoring has revolutionized the confirmation of endotracheal placement, there are still several circumstances in which this modality may be misleading (e.g. prolonged arrest, severe status asthmaticus/PE/pulmonary edema, etCO2 detector contamination with drugs/gastric contents). Additionally, EtCO2 detectors cannot confirm appropriate endotracheal tube depth, leading to delayed recognition of mainstem placement.

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By Mark Tessaro, MD|2021-01-05T14:02:20-08:00Apr 21, 2015|Pediatrics, Ultrasound|

4 Pitfalls of Bedside Ultrasonography During First Trimester Pregnancy

One of the more common indications for the use of bedside ultrasound (US) is to evaluate patients who present to the emergency department (ED) with pain or bleeding during the first trimester of pregnancy. When performing this study, providers should be aware of several potential pitfalls that pose significant risk to both the patient and the provider.

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By Brian Bauerband, MD|2019-02-19T18:51:28-08:00Apr 13, 2015|Expert Peer Reviewed (Clinical), Ob/Gyn, Ultrasound|

Ultrasound For The Win Case – 46F with Abdominal Pain #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 46-year-old woman presents with history of right-sided abdominal pain and vomiting.

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By Jeffrey Shih, MD, RDMS|2017-07-19T00:07:32-07:00Apr 6, 2015|Gastrointestinal, Ultrasound, Ultrasound for the Win|

Author Insight: Ultrasonography versus CT for suspected nephrolithiasis | NEJM

Are you getting a CT or bedside ultrasound as your first-line diagnostic approach to patients with undifferentiated abdominal or flank pain in whom you suspect kidney stones? In a landmark 15-center, multidisciplinary study published in the New England Journal of Medicine in September 2014, Dr. Rebecca Smith-Bindman (UCSF Department of Radiology) and her research team looked at exactly this question for emergency department patients. In the paper, “Ultrasonography versus CT for suspected nephrolithiasis,” Dr. Smith-Bindman and Dr. Ralph Wang (UCSF Department of Emergency Medicine) kindly joined us on a quick discussion about her paper.

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By Michelle Lin, MD|2018-10-28T21:23:26-07:00Mar 24, 2015|Genitourinary, Radiology, Ultrasound|

PV Card: Focused Deep Vein Thrombosis (DVT) Ultrasound

Deep 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.

PV Card: Focused DVT Ultrasound Assessment

Adapted from [1, 2]

References

Kline J, O’Malley P, Tayal V, Snead G, Mitchell A. Emergency clinician-performed compression ultrasonography for deep venous thrombosis of the lower extremity. Ann Emerg Med. 2008;52(4):437-445. [PubMed]
Bernardi E, Camporese G, Büller H, et al. Serial 2-point ultrasonography plus D-dimer vs whole-leg color-coded Doppler ultrasonography for diagnosing suspected symptomatic deep vein thrombosis: a randomized controlled trial. JAMA. 2008;300(14):1653-1659. [PubMed]

By Scott Kobner|2021-10-05T12:54:30-07:00Mar 11, 2015|ALiEM Cards, Cardiovascular, Ultrasound|

PV Card: Focused 1st Trimester Pregnancy Transvaginal Ultrasound

Early 1st trimester pregnancies can be challenging to risk stratify when patient present with bleeding or pain. The pregnancy may be still too early for transabdominal ultrasonography, which was covered in last week’s PV card. The same authors, Drs. Matt Lipton, Mike Mallon, and Mike Stone provide a great bedside clinical reference tool on performing the focused transvaginal ultrasound in pregnancy.

PV: Focused 1st Trimester Pregnancy Transvaginal Ultrasound

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Adapted from [1, 2]

References

Tayal V, Cohen H, Norton H. Outcome of patients with an indeterminate emergency department first-trimester pelvic ultrasound to rule out ectopic pregnancy. Acad Emerg Med. 2004;11(9):912-917. [PubMed]
Wang R, Reynolds T, West H, et al. Use of a β-hCG discriminatory zone with bedside pelvic ultrasonography. Ann Emerg Med. 2011;58(1):12-20. [PubMed]

By Scott Kobner|2021-10-05T12:59:40-07:00Mar 4, 2015|ALiEM Cards, Ob/Gyn, Ultrasound|

Ultrasound for Verification of Endotracheal Tube Location

In patients undergoing emergent tracheal intubation, there is currently no universally accepted gold-standard test to confirm the location of the endotracheal tube (ETT).¹ End-tidal carbon dioxide (CO2) detection is the best of the tests that are routinely utilized to confirm ETT placement, however, it has been shown to have an error rate as high as 1/10 for proper determination of ETT location in emergency intubations.² As a result, multiple modalities are necessary to confirm ETT location, which can delay mechanical ventilation and other treatments. The lack of a single, reliable test to confirm ETT placement can potentially lead to confusion regarding the location of the tube. This confusion can result in both unrecognized esophageal intubations (“false positive”), as well as successful tracheal intubations that are subsequently removed (“false negative”), subjecting the patient to further unnecessary attempts at airway management. Both scenarios can lead to disastrous consequences.

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By Mark Favot, MD|2021-01-05T13:56:52-08:00Mar 2, 2015|Critical Care/ Resus, Expert Peer Reviewed (Clinical), Ultrasound|

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