Ultrasound-Guided Pericardiocentesis

pericardial tamponade ultrasound pericardiocentesis

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.

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By |2019-08-17T12:49:52-07:00Aug 22, 2013|Cardiovascular, Ultrasound|

Trick of the Trade: The PIPP for deep peripheral IVs in obese patients

SVT_Lead_II-2The Case

A 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…

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By |2016-11-11T19:02:44-08:00Aug 5, 2013|Tricks of the Trade, Ultrasound|

RUSH protocol: Rapid Ultrasound for Shock and Hypotension

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.

How do you perform the RUSH protocol?

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By |2019-09-10T13:38:55-07:00Jun 1, 2013|Cardiovascular, Ultrasound|

Is it time to trash the stethoscope? The age of ultrasound

stethoscopeIs the physical exam a relic of the past, because our tools are relics of a prior era?

It is important to do and teach a thorough physical exam. I cautioned against the overreliance on diagnostic testing in lieu of a physical exam, which can be initially burdensome and prolonged. But perhaps our difficulty with the physical exam is not the exam itself, but the tools that we have at our disposal to perform an exam, rather than the exam itself.

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By |2018-01-30T01:59:00-08:00Mar 15, 2013|Medical Education, Ultrasound|

Teaching internationally: More than just a language barrier

JoshiUltrasound1I recently traveled to San Salvador to help teach a pediatric and adult ultrasound course. The course was well received and it was wonderful traveling around San Salvador.

I wanted to share some of our experiences, and discuss some challenges to educating internationally. More importantly, I want to engage you, the readers to share some of your experiences when educating internationally as well.

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By |2016-11-11T18:43:05-08:00Dec 7, 2012|Medical Education, Ultrasound|