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   CONSIDER THE PROBE/REGIONAL ANESTHESIA REMIX:  FOREARM BLOCKS (Courtesy Dr. Joseph Koes) Another great review from our very own Dr. Koes on utilizing regional anesthesia in the forearm.  Whether it is a complicated hand laceration, a boxer's fracture needing reduction, or a large abscess, consider utilizing a nerve block to alleviate your patient's discomfort.   Enjoy and remember next shift to CONSIDER THE PROBE!
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Utilizing POCUS can be an invaluable tool in reaching the diagnosis of acute pulmonary embolism in a timely manner.  The esteemed PGY-4, Dr. Caleb Scarth presents the following lecture on echo findings suggestive of pulmonary embolism.  Enjoy!


CONSIDER THE PROBE: CXR? WHY BOTHER...POCUS THAT PNA! (Courtesy Dr. Larissa Unruh) Now the following topic is extremely close to my heart.  Lung US is well studied in both adult and pediatric patients and has excellent test characteristics for the diagnosis of Pneumonia (AND Bronchiolitis!!!). Dr. Unruh takes us through the following case of a man who clinically had PNA and was actually HYPOXIC, requiring O2.  He had a single CXR that was read by the attending radiologist as negative...leaving us with a patient with a new oxygen requirement with a normal CXR. Thank goodness Dr. Unruh CONSIDERED THE PROBE!  She takes us through the following (REAL LIFE) case and some of the basic sonographic findings for PNA.  Make sure that you never catch yourself signing a patient out "we ruled out pneumonia with a CXR" (!ESPECIALLY A SINGLE VIEW!).  US is more much more sensitive than any single view CXR for detecting a consolidation.  Though like all things US, the more places you look, t


CONSIDER THE PROBE: CHOROIDAL WT%? (Courtesy Dr. Katia Johnston) Just when you think you finally are getting a solid grip on opthalmalogic (spellcheck?) point-of-care ultrasound findings you have a case like Dr. Katia Johnston recently had, and you begin to question everything.  While Retinal Detachments (RD), Posterior Vitreous Detachments (PVD), and Vitreous Hemorrhage (VH) are all quite common findings (in our ED at least), Dr. Johnston picked up on a less common diagnosis based off her abnormal POCUS.  Even if you don't know what you are looking at (which may or may not have been the case for Katia and myself...), it is important to recognize the presence of a clear abnormality.  In this case, the POCUS findings led to a same-day diagnosis of a quite rare but vision-threatening diagnosis.  Most importantly, the patient ended up with a huge improvement in their outcome based on the early initiation of treatment.  Tune in to the following lecture, courtesy of Dr. Johnston and rem


 Consider the Probe: US Findings of CRAO (CREDIT DR. THAKKAR) While most of us have grown (somewhat) comfortable utilizing POCUS to delineate Retinal Detachments from Vitreous Pathology (detachment vs hemorrhage), who knew that our favorite bedside tool could help point us in the direction of another "can't miss" diagnosis.  Dr. Thakkar explains the POCUS findings seen with Central Retinal Arterial Occlusions.  Enjoy and remember the next time you are on shift to CONSIDER THE PROBE... Special thanks to Dr. Pankthi Thakkar.

CONSIDER THE PROBE: Dynamic US for Paracentesis (Credit Dr. Hollingsworth)

While Paracentesis is a common enough procedure in the emergency department (for either diagnostic or therapeutic purposes), we must remember that LOW RISK does NOT = NO RISK.  In the literature ~ 1 % of paracentesis result in severe hemorrhage requiring transfusion or even operative intervention.  There is even risk of death.  While it has become standard of care to utilize static US-guidance to "find the best pocket," remember that you can also consider utilizing real-time US guidance to guide your needle.  Dr. Hollingsworth reviews a case where he utilized US-guidance to successfully perform a paracentesis. Resulting in an important diagnosis of first-time spontaneous bacterial peritonitis!   And remember, next time you are on shift to always CONSIDER THE PROBE!

Consider the Probe: An Introduction to Regional Anesthesia! (Credit: Dr. Joseph Koes)

During a time where we are becoming more and more cognizant (sp?) of the dangers of chronic opiate use, we should be considering all available tools when addressing our patients' pain.  Dr. Joseph Koes presents a series on regional anesthesia including an introduction to regional anesthesia, a review of forearm blocks, and a review of thoracic blocks.   Enjoy the following lecture with much more to come from the good Dr. Koes... Like what you see? Maybe consider a fourth-year Ultrasound elective...