When assessing patients with difficult peripheral venous access it is often helpful to look in the medial upper arm. Here, the brachial artery (A) and veins (V) are predictably located between the biceps and brachialis muscles. The median nerve (N) resides there as well.
Here’s a plate from Grey’s Anatomy for some perspective:
So how can you tell which is which? Apply pressure slowly and watch for movement.
- The veins will collapse
- The artery will pulsate
- The nerve will do nothing
Lots of inspiring speakers at today’s academic retreat. I had ten minutes to give my opinion on how to give a great talk, and referred to a few great books to help:
My opinion? Craft a powerful message and find the best tools at your disposal to convey it. Easy!
The Mount SinaiÂ DepartmentÂ of Emergency Medicine hosted its annual ultrasound CME conference on April 25.Â Faculty, fellows, nurses and PAs from a number of institutions and specialties took part in our tenth annualÂ course.
The course was directed by Bret Nelson, MD who introducedÂ ultrasound physics and machine controls, followed by lectures on assessment ofÂ airway and breathing (Jim Tsung, MD, MPH), cardiovascular ultrasoundÂ (JenniferÂ Huang, DO), trauma evaluationÂ (Phil Andrus, MD) and procedure guidance (Amy Sanghvi, MD).
After lunch an intensive hands-on session with live models, task simulators and sim cases rounded out the experience.
Spectacular rounds this week lead by Sahar Ahmad of Stonybrook and hosted by Pierre at BI.
Sahar gave a great presentation on her didactic program for the critical care fellows at Stonybrook. Â She then presented a series of discussion inducing cases. Â Carl Kaplan (of Stonybrook not RUSH) presented an interesting case of ONSD ultrasound for hydrocephalus. Â Sam Parnia gave a presentation on the cardiopulmonary resuscitation research being done at Stonybrook on cerebral oximetry.
Some of the articles (with pmid and link) that came up in discussion were:
- The Lung US Consensus Recommendations:Â 22392031
- Copetti ARDS vs Pulmonary Edema:Â 18442425
- NASA MRI Optic Nerve sheath: 22416248
- Louis Eisen Optic Nerve sheath: 21519957
- Flawed Pediatric Optic nerve sheath article 19167786Â
- re “reverse” FALLS protocol – Vicki Noble’s on bline resolution at dialysisÂ 19188552
See you next time.