Summary: The EUP presents educational insight into different ultrasound techniques and possibilities. Take your emergency medicine practice to a new level today!
What we do matters. Our bedside ultrasound often changes management and saves lives. So why are we calling our scans “informal”? We might not always say that outright, but I frequently hear our residents and staff call a radiology or cardiology performed ultrasound a “formal” scan, implying that what we do is informal. I have nothing but respect for the vast knowledge and experience that our consultant colleagues bring to the table, but what we do is also “formal”, albeit its usually a limited exam compared to the comprehensive scans they do. While pondering on this, I decided that I might be able to convince people that what I do at the bedside is formal….by performing ultrasounds whilst wearing the most formal attire I could buy off of Amazon. I was fortunate enough to be joined by Nik Theyyunni, Rob Huang and Creagh Boulger at GLUC (Great Lakes Ultrasound Consortium) a few months ago in Cincinnati, and they were nice enough to sit down with me and record our thoughts. You can definitely hear the audio podcast, but make sure to check out the Youtube page to see us in our whole get-up. Interested in an online ultrasound fellowship? Check out the Ultrasound Leadership Academy!Interested in an in-person fellowship, check out the University of Kentucky’s Ultrasound Fellowship!
Over the past year there has been a small bit of controversy regarding the best way to make sure that we aren’t causing iatrogenic infections when placing ultrasound-guided IV’s. To be honest, I took it for granted that tegaderms should be used when we do this potentially life-saving procedure. Recent posts from ALiEM and EMRAP made me question the utility of these adhesive barriers. After much research, it turns out that tegaderms are probably perfectly fine to use. In this podcast, Dallas Holladay, Michael Gottlieb and I sit down to talk about our interpretation of the literature behind using tegaderms for ultrasound-guided IV’s. Check it out! If you’re interested in an online ultrasound fellowship, check out the Ultrasound Leadership Academy
While preparing for a recent grand rounds lecture, I uncovered something rather interesting: The fact that the RV can enlarge during cardiac arrest independently of the presence of a pulmonary embolism. It turns out that the data showing RV enlargement as a marker of a pulmonary embolism is actually mostly extrapolated from alive patients (in which it has been shown to be a pretty good marker of submassive and massive PE). There is very minimal data on RV enlargement in arrest in humans, but there are some animal studies that suggest that the RV enlarges in many causes of arrest, including hypoxia and arrhythmias. Check out the podcast, and the summary of the literature on the PDF below:
The last day of Bendfest 2019 was bittersweet. I was a phenomenal day of education, idea exchanges and friendship, but also it was the last day. In this summary, I sit down with Justin Cook to talk about his top tips for being a master of the ultrasound-guided vascular access, and I give you a sneak peek of Patrick Ockerse’s phenomenal talk on ultrasound in cardiac arrest. Check it out! Check out our other ventures: www.ultrasoundleadershipacademy.com – Online ultrasound fellowship www.5minsono.com – Short videos on how to perform exams www.ultrasoundGEL.org – Audio ultrasound journal club www.ultrasoundoftheweek.com/tools – If you want to learn to create content, definitely check this out.
Day 2 of Bendfest 2019 is drifting further in the past, but that doesn’t mean we can’t relive it! In this interview summary, Jacob sits down with Creagh Boulger and Jenn Cotton and they talk about ultrasound in shock and pregnancy. Here are the salient points: Creagh Boulger (Ultrasound in Shock) Mnemonics can be helpful, but not every patient needs the same exam every time. First step for Dr. Boulger: Is it the pump (cardiac contractility) and/or is it the pipes (Preload)? Other things can cause shock that aren’t in the typical hypotensive algorithm (Gallbladder, Soft tissue, etc) Jenn Cotton (Pregnancy) Don’t get tricked by the hCG! You can have ruptured ectopics at hCG = 0. Additionally, viable pregnancies with hCG levels above the “discriminatory zone” and not visualized on US can still be viable Our job is to RULE IN uterine pregnancies, not RULE OUT ectopics. Fertility treatments increase risk of heterotopic ultrasounds Don’t be scared of performing a transvaginal ultrasound. Day 3’s summary will be out soon!If you’re interested in an online ultrasound fellowship, check out www.ultrasoundleadershipacademy.com
Dr. Chris Fox is one of the trailblazers in integrating ultrasound into medical school education. This week, I got the opportunity to interview him and hear a bit of his story, get some tips and talk about the 7th Annual World Congress of Ultrasound in Medical Education. If you want to see a video of the interview, check out our youtube page! Interested in an online ultrasound fellowship? Check out ultrasoundleadershipacademy.com
A few weeks ago we had a wonderful time in Bend, Oregon during Bendfest 2019. We got some mountain biking in, some hiking in, some river floating in and ate some great food! We wanted to share the choicest pearls from our phenomenal lecturers on some of the topics they covered. Check out the summary of day 1! Peter Weimersheimer (Cardiac): Find the beating thing first. Use lots of gel, and lot of pressure to get your view. Get your ultrasound beam parallel with the heart. Start your exam with your patient in the left lateral decubitus position. Do one maneuver at a time (rotate, fan, rock, etc). Start with the probe at the clavicle/sternal interface, slide down until you see the heart. You don’t always need all the 4 views of the heart. If ventricle is round, subtle hand rotations will fix. #1 point – Just use bedside echo. Ben Smith (Aorta, renal) If you think you see mild hydro, use color flow to differentiate between mild hydro and prominent renal vessels Scan from the back; the ribs are farther away from each other back there so may get better windows. We aren’t good at finding the actual ureteral stone, but were pretty good at hydro For getting past bowel gas when looking at the aorta – start up high where there is less gas (epigastric). Then when you come up on gas, use other hand to apply steady pressure (often 30-60 seconds). Use curvilinear probe, hurts less than the phased array. Transhepatic view of aorta – not bad for aneurysm, but not great for dissection We are good at looking at the aorta as long as we can actually see the aorta. Research that show great accuracy of bedside sonographic aorta exam only included studies where the aorta... Read More
This week, we had the pleasure of sitting down with Patrick Ockerse, MD at Bendfest 2019, a 3 day ultrasound event in Bend, Oregon. Dr. Ockerse is the ultrasound director at the University of Utah in Salt Lake City, Utah and part of his job is to review ultrasound images performed in his emergency department. Mike was formerly the ultrasound director in Utah and Jacob has a very similar job as the ultrasound director at the University of Kentucky in Lexington, Ky. This week, we sit down and talk about the errors we most commonly see when performing our image review sessions. Here are some tips: Basics: Depth – Make sure that the image you’re trying to see is as big as you can make it. Don’t have any wasted space in your clips or images. Gain – Make sure your image is bright enough. But don’t over gain! Exam type – If you’re doing a FAST exam, don’t scan in the “lung” setting. Video clips – Be conscientious of the clips and images you take. Focus on the thing you want to record and record a long enough clip of it, but also don’t record multiple clips of subpar exams. Specific exams: DVT – Make sure that the vein you’re evaluating is actually a deep vein. Deep veins paired, while superficial veins may be solitary. Also, don’t confuse a lymph node for a DVT. FAST exam – Slow sweeps of the regions your evaluating. Fast sweeps can miss subtle fluid collections. Don’t forget to look at the inferior pole of the kidney/caudal tip of the liver interface on the right side. Be careful with the seminal vesicles in the pelvis. Intrauterine pregnancy (IUP) – Make sure that gestational sac is actually inside the uterus. Thorax – Make sure to... Read More
We love talking about super advanced ultrasound applications, but its important to make sure we understand the basics. Soft tissue ultrasound probably has a greater effect on patient dispositions and treatment than most of our other ultrasound applications due to the sheer volume of soft tissue infections we see. I recently (virtually) sat down with Jenn Cotton and discussed a technique she developed with Mike Prats for evaluating hand infections. If you need a review on how to evaluate soft tissue infections on ultrasound, check out the 5 Minute Sono abscess vs cellulitis 2019 update video and the 5 Minute Sono necrotizing soft tissue infection 2019 update and if you want to see a video on how to perform the technique we discuss with Jenn, check out our youtube page Interested in an online ultrasound fellowship? Check out the Ultrasound Leadership Academy
Sometimes we have to get back to our basics and just, make sure we’re holding the probe correctly. This is especially relevant considering we all have new residents this month (It is July, after all!). In this podcast, Cian McDermott sits down with Jacob to discuss his tips for how to hold the probe and how to position yourself to get your best images. Jacob’s favorite tip? Don’t treat the probe like a dirty sock. Check out the podcast to learn more! Interested in an online ultrasound fellowship? Check out http://ultrasoundleadershipacademy.com/
Is Skynet around the corner? Remember Terminator? That was set in 2029, 10 years away. Maybe that’s a little dramatic, but AI, artificial intelligence, is already present in daily medicine and we’re starting to see it in point of care ultrasound as well. In this episode Jacob sits down with Srikar Adhikari, man, myth, legend of POCUS and they wax extensionally about AI in point of care ultrasound. Education, feedback, accuracy, and the future of AI in POCUS. Join us and learn something instead of letting the computers learn it for you. Want to come scan with us in Bend, Oregon? Go to Bendfest19.com Want to participate in an online ultrasound fellowship? Check out ultrasoundleadershipacademy.com
This week Mike and Jacob sit down and talk about their thoughts on current point of care machines, including the cart based machines, the laptop machines, and the tablet/phone ultra-portable machines. A lot of the discussion right now is regarding Butterfly and its utility in patient care scenarios. If you want more on the comparison between the Butterfly Is and the Philip Lumify machine, check out this podcast we did a few weeks ago. Also, if you would like to see my review on the new GE Venue Go machine, check out the youtube page. If you want hands-on time with us and some great didactics this coming July, check out Bendfest 2019! Interested in an online ultrasound fellowship? Check out the ULA!
During Castlefest we had the honor of sitting down with Anand Swaminathan to hear his thoughts on learning and utilizing ultrasound even if you didn’t necessarily learn it in residency. Check it out! If you want to come hang out with us in Bend, Oregon, go to Bendfest19.com. Want to come free of charge courtesy of G.E.? Email us to tell us why you think you deserve it. Want to participate in a year long online fellowship? Go to Ultrasoundleadershipacademy.com.
The LAST DAY of Castlefest 2019 was a great one (as were all of the other days). Check out day 4’s summary: Jimmy Fair: Diastology: Consider approaching diastology as binary; does your patient have elevated left atrial pressure or not? If you want a more in-depth summary, watch: Diastology part 1, Diastology part 2 Cardiac arrest: Concentrate on getting windows during your 10 second pulse check, save clips, then interpret the image during compressions. Unless if you have TEE. Then just leave it in there and get continuous monitoring. RUSH: It’s not a law that you have to do every part of the RUSH exam in all your hypotensive patients. Peter Weimersheimer: Pelvic Ultrasound: If you can get the answer with transabdominal US, you don’t necessarily need to go for the endocavitary probe TEE: Why learn this if I get good TTE views during arrest? Answer: Because you often can’t. Also, some tips on how to start a TEE program. Here’s the Link to Annals of Emergency Medicine article on TEE and cardiac arrest (that Mike Mallin was second author on) Claire Heslop: Volume responsiveness is defined as the ability of a patient to increase their cardiac output with fluids. Best way to tell with US: VTI. Although carotid flow time is an up-and-comer. Bendfest 2019 is coming soon! Spots are filling quickly, reserve your spot today! Interested in an online ultrasound fellowship? Go to ultrasoundleadershipacademy.com
Day 3 was nearly a full Mike Stone/Justin Cook day with a little Mike Mallin sprinkled in there. We did all things nerve blocks and MSK. .Check out the podcast for our in-depth post-day interview with them. Stay tuned for day 4!