Paucis Verbis: Cardiac tamponade or just an effusion?

cardiac_tamponadeWhat is a cardiac tamponade? It is a clinical state where pericardial fluid causes hemodynamic compromise. With bedside ultrasonography in most Emergency Departments now, it’s relatively easy to detect a pericardial effusion.

But what we more want to know in the immediate setting is: Is this cardiac tamponade?

You can look for RA systolic or RV diastolic collapse. What if it’s equivocal? How good is the clinical exam and EKG in ruling out a tamponade?

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By |2019-01-28T22:41:46-08:00Jul 8, 2011|ALiEM Cards, Cardiovascular, Ultrasound|

Tricks of the Trade: Ultrasound workshop setup

 
Ultrasound

Have you ever been to an ultrasound workshop where each small group of attendees huddles around the small ultrasound display? Personally I think the 3 people closest to the display really see the images well. This tends to exclude the other participants.

Last week, I hosted (my first!) ultrasound workshop for the UCSF Alumni CME Conference where I showed peri-retired UCSF alumni from various specialties about the future of bedside ultrasonography. I equated it to the 21st century stethoscope. Thanks to my star team of ultrasonographers: Dr. Asaravala, Flores, Miss, Lenaghan, and Wilson.

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By |2016-11-11T18:54:22-08:00May 11, 2011|Tricks of the Trade, Ultrasound|

Trick of the Trade: Check pupillary constriction with ultrasound

SwollenEyeIn some trauma patients with head and face trauma, you will need to check their pupillary response to light. Severe periorbital and eyelid swelling, however, make this difficult. You want to minimize multiple attempts to retract the eyelids because of the risk of a ruptured globe. What’s a minimally painful and traumatic way to check for pupillary constriction?

By |2019-01-28T22:50:28-08:00Apr 6, 2011|Ophthalmology, Tricks of the Trade, Ultrasound|

Trick of the Trade: Ultrasound-guided supraclavicular central line

SupraclavicularPositionsmEmergency physicians are procedural experts in central venous access. The subclavian vein is the best site for such access, because it has been shown to have the lowest rate of iatrogenic infections and deep venous clots

Bedside ultrasonography has really revolutionized how we obtain vascular access over the past 10 years. Identifying the subclavian vein using ultrasonography, however, is still technically challenging. The vein is located just posterior to the clavicle, which often gets in the way of the linear transducer. 

By |2016-11-11T19:00:20-08:00Nov 10, 2010|Tricks of the Trade, Ultrasound|

Trick of the trade: I got ultrasound gel in my eye!

OcularUltrasoundProbeBedside ultrasonography is increasingly being used in the ED to examine the eye. For instance, it can be used to detect a retinal detachment, vitreous hemorrhage, and high intracranial pressure. The technique involves applying ultrasound gel on the patient’s closed eyelid. A generous amount of gel should be used to minimize the amount of direct pressure applied on the patient’s eye by the ultrasound probe.

Sometimes, however, no matter how careful you and the patient are, some gel accidentally contacts the eye itself.

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By |2019-01-28T23:23:16-08:00Sep 15, 2010|Tricks of the Trade, Ultrasound|
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