Visual Diagnosis Case from JEM. Bret and Ted discuss a case of appendicitis confirmed with ultrasound after CT was not conclusive.
X-Ray Stinks #1: Finger Injury
In this new series we will highlight cases where ultrasound proved more useful than x-ray.
A seven year old boy presented with distal phalanx pain, tenderness after a fall.
The following x-ray was performed:
What is your diagnosis? Can ultrasound help? How would you perform an ultrasound on such a superficial structure?
The following ultrasound of the distal finger was performed (probe marker towards fingertip):
What is your diagnosis now? Continue reading
Bret Nelson recently filmed a webinar on critical care ultrasound at Gulfcoast Ultrasound Institute in Florida. He discussed evaluation of the hypotensive patient, incorporating Scott Weingart’s RUSH exam as well as other literature on acute assessment of the heart, IVC, FAST exam, and pleura.
Information on the webinar is available at Gulfcoast.
References for a variety of hypotension evaluations are included below, as well as a few screenshots from the webinar!
- UHP protocol
- Rose JS et al, Am J Emerg Med 2001 (PMID: 11447518)
- Trinity Protocol
- Bahner D, JDMS 2002
- RCT of ultrasound in hypotension
- Jones AE et al, Crit Care Med 2004 (PMID: 15286547)
- FATE: Focused Assessed Transthoracic Echocardiography
- Jensen et al, Eur J Anaesthesiol 2004 (PMID: 15595582)
- FEER: Focused Echocardiographic Evaluation in Resuscitation
- Breitkreutz et al, Crit Care Med 2007 (PMID: 17446774)
- CAUSE: Cardiac Arrest Ultrasound Exam
- Hernandez et al, Resuscitation 2008 (PMID: 17822831)
- RUSH: Rapid Ultrasound in Shock and Hypotension
- Weingart et al, emCrit.org 2008, EMedHome 2009
- ACES: Abdominal and Cardiac Evaluation with Sonography in Shock
- Atkinson et al, Emerg Med J 2009 (PMID: 19164614)
- RUSH: Rapid Ultrasound in Shock
- Perera P et al, Emerg Med Clin N Am 2010 (PMID: 19945597)
The Emergency and Critical Care community will no doubt benefit from this new journal. The Critical Ultrasound Journal is the official publication of the international ultrasound group WINFOCUS (world interactive network focused on critical ultrasound) . It is new this year, but they are already into their third issue. Headed by Mike Blaivas, the pediatric and neonatology section is edited by none other than our own Jim Tsung.
We are pleased to present our annual critical care ultrasound pre-conference course at the Clinical Decision Making in Emergency Medicine symposium in Ponte Vedra, Florida on June 23. Each year this intensive, hands on course features ultrasound faculty from across the country working in small groups with live models and plenty of hands-on scanning time.
Highlights of the four-hour course include:
- Cardiac ultrasound
- Thoracic ultrasound
- Ultrasound for venous access
- Assessment of the hypotensive patient
Faculty for this year’s course include:
- Bret Nelson, MD, RDMS (course director)
- Phillip Andrus, MD
- Petra Duran, MD
- Daniel Duque, MD, RDMS
- Joe Wood, MD, JD, RDMS
This full day course on May 10th saw a packed audience of peds EM fellows from all over New York City. Hosted by the faculty of the emergency ultrasound division from Maimonides Medical Center, as well as renowned guest speakers Dr. Paul Sierzenski and our very own Dr. James Tsung.
Participants were treated to a day of informative lectures covering:
- basics in bedside ultrasound
- lung ultrasound
- cardiac ultrasound
- pediatric ultrasound (intussusception, pyloric stenosis, appendicitis)
- pelvic ultrasound
- soft tissue ultrasound
The latter part of the afternoon was spent hands-on with various cool portable ultrasound machinery and volunteer models. Of course, no full day event can be complete without food to give everyone pause for catching up and camaraderie.