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.
A 25-year-old medical student comes in with a muffled voice, sore throat and trismus. You look at the back of her throat and you see the uvula deviated to the right. You astutely diagnosed a peritonsillar abscess (PTA). You consider aspirating and want to check for tips on how to successfully do this.
Dr. Michelle Lin and Dr. Demian Szyld have created great guides for the common and important emergency medicine procedure of draining a PTA (laryngoscope lighting and spinal needle for aspiration; ultrasound localization and spinal needle guard; avoiding awkward one-handed needle aspiration). This update reviews these tricks as well as some additional techniques for optimal success in draining a PTA, while avoiding the ultimate feared complication of puncturing the carotid artery.
Chief Complaint: Chest pain
History of Present Illness: An 89-year-old female with a past medical history of coronary artery disease and with recent admission for myocardial infarction that was medically managed, presented with chest pain and shortness of breath. She reports worsening midsternal chest pain that occasionally radiates to her back and right arm since discharge.
Our ALiEMU learning management system, which currently houses the AIR series, Capsules series, and In-Training Exam Prep courses, is ready to slowly open the doors to welcome external authors with high quality content. We are thrilled to welcome a UCSF-sponsored pediatric emergency medicine (EM) point of care ultrasonography (POCUS) series, led by Dr. Margaret Lin. The first course is on the intussusception scan, filled with multiple ultrasound scans showing normal variants and two different types of intussusception.(more…)
How many times have you told a patient “The gel will be cold?” How many times have you watched a patient retract from the transducer because of the cold gel? How about a pediatric patient? Could warm gel improve your rate of clinically successful scans? It seems easy enough to install gel warmers alongside our ultrasound machines. But, should we do this?Read more
As the use of point-of-care ultrasound expands in emergency medicine, phantoms offer an attractive training solution for new learners and continuing education. Unfortunately, commercially available products are expensive and likely cost-prohibitive for individual practitioners to purchase. Luckily, there are a number of quality, low cost do-it-yourself (DIY) models published in journals and on the Internet. To help you navigate your options, I have created a compendium of DIY ultrasound models relevant to emergency medicine. The models are divided by system or application with a cost estimate for each model, if provided, as well as a list of materials and a short description. Links are provided for further reading.(more…)
The following ultrasound video was obtained in a hypotensive 23 year-old man with a history of drug abuse. What drug of abuse when used chronically is most likely to lead to this ultrasound finding in an otherwise healthy patient?