Mount Sinai Emergency Medicine Ultrasound

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 Wednesday, June 20. 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.

The course is held at the beautiful and historic Ponte Vedra Inn and Club.

Please visit here for Registration information

Highlights of the four-hour course include:

1. Cardiac ultrasound
2. Thoracic ultrasound
3. Ultrasound for venous access
4. Assessment of the hypotensive patient

Faculty for this year’s course include:

• Bret Nelson, MD, RDMS (course director)
• Petra Duran, MD
• Joseph Wood, MD, JD, RDMS

Probe Manipulation – Rotation from Sinai EM Ultrasound on Vimeo.

How do you obtain that nice long image of the peripheral blood vessel for a longitudinal approach? It is easy to say ‘rotate the probe 90 degrees from the transverse view,’ but there are many subtleties to probe rotation. Many times when we rotate the probe, we do not get the desired longitudinal view, but rather the vessel is seen in part, or obliquely sectioned. Also, the vessel may appear on the left side of the screen or the right side and further fine rotation often makes the vessel disappear. How do we correct for this?

The trick is to understand the many different axes of probe rotation. See the video for an example of :

(i) probe rotation along an axis that goes through the proximal end of the probe (incorrect)

(ii) probe rotation along an axis through the distal end of the probe (incorrect)

(iii) CORRECT probe rotation along an axis through the central portion of the probe (through the transducer wire)

In order to move from a transverse to longitudinal view of a blood vessel without losing track of it, you must:

1. Visualize the vessel in the center of the screen (thus, directly beneath the center of the probe)
2. Rotate the probe on its CENTRAL axis (through the wire)
3. Watch as the vessel transitions from a circle (transverse) to an ellipse (oblique) to two parallel lines (longitudinal)

Go try this on a phantom and with some practice, everyone can get that nice elongated view of the vessel.

The annual Sinai PA Conference took place on 9/12/2009. The division of Emergency Ultrasound ran a course on peripheral line placement under ultrasound.

Attendees were enthusiastic and placed angiocaths under ultrasound guidance using our vessel phantoms. In fact, some were so eager that they were absolutely covered in gel by the end of the conference. Next year we will remember to bring towels.