SAEM Clinical Image Series: Knee Pain

knee

A fifty-six-year-old male with a past medical history of legal blindness and remote right quadricep tendon rupture presents to the emergency department via emergency medical services (EMS) after a mechanical fall, complaining of left knee pain. According to the patient, he is in his regular state of health and was walking with his cane when he had a mechanical fall on the sidewalk after tripping on an unknown object and falling onto his left knee.

The patient did not hit his head, did not lose consciousness, and has no head, neck, or back pain. The patient states that he fell directly onto his knee and felt a popping upon hitting the ground, and remembers all events surrounding the incident. The patient was not ambulatory prior to coming to the emergency department.

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IDEA Series: Big Screen Ultrasound in Resuscitation Bays

Bedside ultrasound (US) often plays a crucial role in medical and trauma resuscitations in the emergency department (ED) [1]. Performing and interpreting bedside US studies such as the Extended Focused Assessment with Sonography for Trauma (E-FAST) during traumas or echocardiography during medical resuscitations are key skills for emergency medicine residents to learn during their training and adopt into clinical practice [2]. During trauma resuscitations timely and efficient dissemination of critical information is paramount. Information obtained via bedside US can be critical in determining further clinical actions (need for urgent thoracostomy for a pneumothorax, need for urgent exploratory laparotomy in a hypotensive patient with free fluid in the abdomen, etc.) through shared decision making between ED and trauma teams [3]. Information obtained via bedside US, however, is often difficult to convey during resuscitations given crowded rooms, simultaneous interventions, and limited viewing of the US screen. For ED and trauma providers wishing to better understand the utility of bedside US during resuscitations and how this powerful tool can change clinical management, a clearly visualized representation of what is displayed on the US screen could provide an ideal learning opportunity.

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By |2020-07-17T10:35:07-07:00Jul 24, 2020|IDEA series, Medical Education, Ultrasound|

ALiEMU New Course: Pediatric Ultrasound-Guided Peripheral IV Access

ALiEMU peripheral IV access pediatric EM ultrasoundDid you know that the ALiEMU learning management platform has courses in addition to the AIR Series? We just published the third installment of the pediatric point-of-care ultrasound (POCUS) series, which focuses on peripheral IV access using ultrasonography. Do you use the traditional transverse, transverse with dynamic needle tip visualization, or longitudinal ultrasound technique?

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By |2020-04-27T14:42:47-07:00May 10, 2020|ALiEMU, Pediatrics, Ultrasound|

Gaining the Diagnosis of Vitreous Hemorrhage with Ultrasound

A 54 year-old male presents to the emergency department with an eye complaint. The patient works as a cook and while cleaning the grill several hours ago felt something fly into his eye. He did not immediately feel pain, but notes blurred vision and an increasing pressure-like sensation in his left eye. He describes his left-sided blurred vision as a haziness, like cobwebs over his eye. He has been able to open his eye and keep it open without difficulty.

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By |2020-01-29T15:55:48-08:00Jan 31, 2020|Ophthalmology, Ultrasound|

Ultrasound for the Win! 3-year-old with abdominal pain #US4TW

ultrasound for the win intussusception

A 3-year-old Hispanic female with no significant past medical or surgical history presents to the Emergency Department with her mother for a 3 day history of crampy abdominal pain, intermittent bloody diarrhea and fever. There has been no recent travel, admissions, or antibiotic use. Her older sister reports similar symptoms, which have resolved. The patient saw her pediatrician the day prior, who recommended supportive care including oral rehydration.

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By |2019-11-19T01:47:58-08:00Dec 4, 2019|Pediatrics, Ultrasound, Ultrasound for the Win|

Trick of the Trade: Save the Ultrasound Probe Cable

You need to perform an ultrasound on your patient. You walk up to the ultrasound and upon grabbing the machine, you notice it’s stuck! You look down and realize the ultrasound probe cable (particularly the linear probe) is impeding the wheel from rolling. You push the machine back, pick the cable up off the floor and off you go to scan to find that the probe is not working. As you try to figure out why it’s not working, you realize that the cable is exposed after repeated damage from the countless times the wheels on the machine rolled over the cable. Let’s prevent this from happening!

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By |2019-09-28T08:29:44-07:00Oct 4, 2019|Tricks of the Trade, Ultrasound|

Techniques for Ultrasound-Guided IV Placement

Y junction access

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 |2019-09-19T17:39:55-07:00Sep 19, 2019|Ultrasound|
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