tag:blogger.com,1999:blog-74018936866647938742024-03-12T21:29:24.625-05:00Ultrasound NinjaAnonymoushttp://www.blogger.com/profile/17479264085986945802noreply@blogger.comBlogger57125tag:blogger.com,1999:blog-7401893686664793874.post-82299065758963434772023-06-05T12:18:00.001-05:002023-06-05T12:18:12.446-05:00FELLOW'S CORNER 2nd and 3rd Trimester Pregnancy<p> </p><div class="separator" style="clear: both; text-align: center;"><iframe allowfullscreen="" class="BLOG_video_class" height="266" src="https://www.youtube.com/embed/ACXVDDO0vHQ" width="320" youtube-src-id="ACXVDDO0vHQ"></iframe></div><br /><p></p><p><br /></p><p> Dr. Pfeiffer with a nice review on utility of POCUS for evaluation of 2nd/3rd Trimester pregnancies and their complications. </p><div><br /></div>David Murrayhttp://www.blogger.com/profile/05064067930999854450noreply@blogger.comtag:blogger.com,1999:blog-7401893686664793874.post-89061390961366796732022-03-23T14:25:00.008-05:002023-06-06T10:35:08.177-05:00Consider the Probe: POCUS 4 OCULAR TRAUMA (Courtesy Dr. Cooper)<p> Dr. Cooper gives a nice review of how POCUS is a great tool for the evaluation of acute ocular trauma. US can assist in making a number of critical diagnoses... </p><p>A quick reminder that if globe rupture is being strongly considered, you must be very careful before you perform your POCUS. Some consider US contraindicated in these cases. To be careful, you should strongly consider staining the eye quickly to evaluate for a globe rupture before proceeding with your POCUS...</p><p><br /></p>
<div class="separator" style="clear: both; text-align: center;"><iframe allowfullscreen="" class="BLOG_video_class" height="266" src="https://www.youtube.com/embed/Sac7e1-DKRc" width="320" youtube-src-id="Sac7e1-DKRc"></iframe></div><br /><div style="padding: 56.25% 0px 0px; position: relative; text-align: center;"><br /></div><script src="https://player.vimeo.com/api/player.js"></script>David Murrayhttp://www.blogger.com/profile/05064067930999854450noreply@blogger.comtag:blogger.com,1999:blog-7401893686664793874.post-52736611463563860332021-12-15T15:01:00.001-06:002023-06-06T10:36:03.496-05:00CONSIDER THE PROBE: DELVING INTO THE FAST EXAM (COURTESY Dr. Mansour)<p>The FAST exam is one of the most important POCUS applications for emergency providers to be proficient in. Whether it be to detect the source of hemorrhage in a blunt trauma patient, identify a ruptured ectopic pregnancy, or (recently here at Cook County) diagnose an atraumatic splenic rupture in a patient with active malignancy, this modality can critically affect clinical decision making and patient outcomes.</p><p>Dr. Mansour dives a bit deeper into some of the more recent evidence on where we should be looking for free fluid in the abdomen...</p><div class="separator" style="clear: both; text-align: center;"><iframe allowfullscreen="" class="BLOG_video_class" height="266" src="https://www.youtube.com/embed/ELE6w3To8Ik" width="320" youtube-src-id="ELE6w3To8Ik"></iframe></div><br /><p><br /></p><p><br /></p><p><br /></p><p><br /></p> <div style="padding: 51.24% 0px 0px; position: relative;"><br /></div><script src="https://player.vimeo.com/api/player.js"></script>David Murrayhttp://www.blogger.com/profile/05064067930999854450noreply@blogger.comtag:blogger.com,1999:blog-7401893686664793874.post-17065347372679195132021-10-10T11:41:00.008-05:002023-06-06T10:37:36.308-05:00REGIONAL ANESTHESIA REMIX: TORSO BLOCKS (Courtesy Dr. Koes)<p style="text-align: center;"> <b><span style="font-family: verdana;"><span style="font-size: large;"> </span><span style="font-size: x-large;">REGIONAL ANESTHESIA REMIX: </span></span></b></p><p style="text-align: center;"><span style="font-family: verdana; font-size: large;"><b>TORSO BLOCKS</b></span></p><p style="text-align: center;"><b><span style="font-family: verdana;">(Courtesy Dr. Joseph Koes)</span></b></p><div><p style="text-align: center;"><span style="font-family: verdana;">While many emergency medicine physicians may not be comfortable with regional anesthesia of the torso, it is important to always be looking towards the future and how we can best serve our patients. </span></p><p style="text-align: center;"><span style="font-family: verdana;">Dr. Koes gives a nice review of two important blocks: serratus anterior and erector spinae.</span></p><p style="text-align: center;"><span style="font-family: verdana;">These blocks may prove to be especially helpful in managing a geriatric trauma patient, where IV narcotics may be especially harmful. Enjoy the lecture and remember to always CONSIDER THE PROBE!!!</span></p></div>
<div class="separator" style="clear: both; text-align: center;"><iframe allowfullscreen="" class="BLOG_video_class" height="266" src="https://www.youtube.com/embed/eCKZ1fhv9rE" width="320" youtube-src-id="eCKZ1fhv9rE"></iframe></div><br /><div style="padding: 56.25% 0px 0px; position: relative; text-align: center;"><br /></div><script src="https://player.vimeo.com/api/player.js"></script>David Murrayhttp://www.blogger.com/profile/05064067930999854450noreply@blogger.comtag:blogger.com,1999:blog-7401893686664793874.post-84376992312093641052021-08-11T00:20:00.002-05:002023-06-06T10:38:02.595-05:00FELLOW'S CORNER: Pericardial Effusion, Tamponade, and Pericardiocentesis (Courtesy Dr. Pfeiffer)<p style="text-align: center;"><span style="font-family: verdana;">FELLOW'S CORNER: Pericardial Effusion, Tamponade, and Pericardiocentesis</span></p><p style="text-align: center;"><span style="font-family: verdana;"><br /></span></p><p style="text-align: center;"><span style="font-family: verdana;">Dr. Pfeiffer takes us through a great review of diagnosing a circumferential effusion, identifying tamponade physiology and the safest way to perform what may be a once-in-a career procedure: an emergent pericardiocentesis. (Hint...its Ultrasound Guided...)</span></p><p style="text-align: center;"></p><div class="separator" style="clear: both; text-align: center;"><iframe allowfullscreen="" class="BLOG_video_class" height="266" src="https://www.youtube.com/embed/8sZYrpsJR0U" width="320" youtube-src-id="8sZYrpsJR0U"></iframe></div><br /><span style="font-family: verdana;"><br /></span><p></p><p style="text-align: center;"><span style="font-family: verdana;"><br /></span></p><p style="text-align: center;"><span style="font-family: verdana;"><br /></span></p><p style="text-align: center;"><span style="font-family: verdana;"><br /></span></p><p style="text-align: center;"><span style="font-family: verdana;"><br /></span></p><p style="text-align: center;"><span style="font-family: verdana;"><br /></span></p><p style="text-align: center;"><span style="font-family: verdana;"><br /></span></p><p style="text-align: center;"><span style="font-family: verdana;"> </span></p><script src="https://player.vimeo.com/api/player.js"></script>David Murrayhttp://www.blogger.com/profile/05064067930999854450noreply@blogger.comtag:blogger.com,1999:blog-7401893686664793874.post-82517943553226201052021-07-12T15:48:00.004-05:002023-06-06T10:39:18.053-05:00CONSIDER THE PROBE: McConnell's Sign (Courtesy Dr. Jia)<p style="text-align: center;"><b><span style="font-size: large;">CONSIDER THE PROBE: McConnell's Sign (Courtesy Dr. Jia)</span></b></p><p style="text-align: left;"><span>COVID-10 presented many challenges to emergency departments. Early on, an association between COVID and thrombo-emoblic disease was discovered. As this was a novel infection, there were no evidence-based rules to assist a provider when deciding when to work up a patient with presumed COVID pneumonia for a concurrent thromboembolism. Seems like a great time to CONSIDER THE PROBE!</span></p><p style="text-align: left;">Dr. Jia summarizes a great case where bedside ultrasound detected a McConnell's Sign, helping to diagnose a significant acute pulmonary embolism. He goes on to give a nice review of McConnell's Sign. Enjoy!</p><div class="separator" style="clear: both; text-align: center;"><iframe allowfullscreen="" class="BLOG_video_class" height="266" src="https://www.youtube.com/embed/bn5amhePquc" width="320" youtube-src-id="bn5amhePquc"></iframe></div><br /><p style="text-align: left;"><br /></p><p style="text-align: left;"><br /></p>
\David Murrayhttp://www.blogger.com/profile/05064067930999854450noreply@blogger.comtag:blogger.com,1999:blog-7401893686664793874.post-75558285424470143032021-05-19T11:37:00.003-05:002023-06-06T10:40:18.039-05:00CONSIDER THE PROBE: AN IMPORTANT "CAN'T MISS" DIAGNOSIS DURING FLU SEASON (Courtesy Dr. Debessai)<p>While the past year has been a rather unusual influenza season, most years from December through February in the emergency department we are tripping over patients with "influenza-like illness". While the vast majority of patients do indeed have a fairly benign viral syndrome, there are a few "can't miss' diagnoses that should always be considered. </p><p>Dr. Debessai presents a case where his use of POCUS helped him make an important diagnosis and changed the therapeutic plan as well as the disposition. So next flu season, consider bringing the ultrasound into the room with you when evaluating patients with ILI symptoms...</p><p><br /></p><div class="separator" style="clear: both; text-align: center;"><iframe allowfullscreen="" class="BLOG_video_class" height="266" src="https://www.youtube.com/embed/6YaeiP7h2As" width="320" youtube-src-id="6YaeiP7h2As"></iframe></div><br /><p><br /></p><p><br /></p><p><br /></p>
<div style="padding: 56.25% 0px 0px; position: relative;"><br /></div><script src="https://player.vimeo.com/api/player.js"></script>David Murrayhttp://www.blogger.com/profile/05064067930999854450noreply@blogger.comtag:blogger.com,1999:blog-7401893686664793874.post-527081183056727882021-04-19T19:35:00.005-05:002023-06-06T10:41:07.795-05:00REGIONAL ANESTHESIA REMIX: Sciatic Nerve Block (Courtesy: Dr. Mikell)<p style="text-align: left;"><b style="text-align: center;"><span style="font-family: verdana;"><span style="font-size: large;"> </span><span style="font-size: large;"> </span><span style="font-size: large;"> </span><span style="font-size: x-large;">REGIONAL ANESTHESIA REMIX: </span></span></b></p><p style="text-align: center;"><span style="font-family: verdana; font-size: large;"><b>Sciatic Nerve Block</b></span></p><p style="text-align: center;"><b><span style="font-family: verdana;">(Courtesy Dr. Carlos Mikell)</span></b></p><div><b><span style="font-family: verdana; font-size: medium;"><br /></span></b></div><div><p style="text-align: center;"><span style="font-family: verdana;">Green Team is just more fun when you are blocking out the pain! Dr. Mikell introduces and summarizes the Sciatic Nerve Block, which he utilized to assist in the reduction of a complicated ankle fracture. </span></p><p style="text-align: center;"><span style="font-family: verdana;">Consider this block for your next LE complex laceration, dislocation or fracture; and remember when on shift to always CONSIDER THE PROBE!</span></p><div class="separator" style="clear: both; text-align: center;"><iframe allowfullscreen="" class="BLOG_video_class" height="266" src="https://www.youtube.com/embed/iilVxEK7KS0" width="320" youtube-src-id="iilVxEK7KS0"></iframe></div><br /><p style="text-align: center;"><br /></p></div><br /><br />David Murrayhttp://www.blogger.com/profile/05064067930999854450noreply@blogger.comtag:blogger.com,1999:blog-7401893686664793874.post-682321713216878712021-03-30T20:12:00.002-05:002023-06-06T10:42:36.500-05:00CONSIDERE THE PROBE: Should I give a fluid bolus? (Courtesy: Dr. Aceves)<p> Dr. Aceves tickled my heartstrings with one of my favorite POCUS topics--US-guided resuscitation. Dr. Aceves introduces some (sonographic!) tools to add to your repertoir (sp?) to individualize your resuscitation to the patient in front of you. A nice introduction to utilizing IVC, Carotid flow parameters, and ECHO to help identify which patients may be fluid tolerant (and perhaps even fluid responsive!). This is one of critical care's most difficult questions to answer. While there is no perfect solution or easy answer, these tools may prove helpful in making the decision: will you order another bolus or is it time to start pressors...</p><div class="separator" style="clear: both; text-align: center;"><iframe allowfullscreen="" class="BLOG_video_class" height="266" src="https://www.youtube.com/embed/jbmUShZXs1s" width="320" youtube-src-id="jbmUShZXs1s"></iframe></div><br /><p><br /></p><p><br /></p><p><br /></p><div class="separator" style="clear: both; text-align: center;"><br /></div><br /><p><br /></p>David Murrayhttp://www.blogger.com/profile/05064067930999854450noreply@blogger.comtag:blogger.com,1999:blog-7401893686664793874.post-72948864392088944722021-02-28T22:12:00.005-06:002023-06-06T10:43:36.904-05:00CONSIDER THE PROBE: POCUS4LP (Courtesy: Dr. Dickson)<p style="text-align: center;"> </p><p style="text-align: center;"><b><span style="font-family: verdana;">CONSIDER THE PROBE: POCUS4LP</span></b></p><p style="text-align: center;"><span style="font-family: verdana;">Not all spines were created equal. When you are starting out, Lumbar Puncture can be an intimidating procedure to perform. While some patient's have incredible surface anatomy to guide your procedure, for many others, it is extremely challenging. Dr. Bradley Dickson reviews the techniques of ultrasound-guided lumbar puncture. There is good evidence that utilization of ultrasound improves our overall performance of this procedure (especially in patients with a higher BMI...). </span></p><p style="text-align: center;"><span style="font-family: verdana;">Enjoy and always remember on shift to CONSIDER THE PROBE!</span></p><div class="separator" style="clear: both; text-align: center;"><iframe allowfullscreen="" class="BLOG_video_class" height="266" src="https://www.youtube.com/embed/kfFI5AQ3Sx0" width="320" youtube-src-id="kfFI5AQ3Sx0"></iframe></div><br /><p style="text-align: center;"><br /></p><div class="separator" style="clear: both; text-align: center;"><br /></div><br /><div class="separator" style="clear: both; text-align: center;"><br /></div><br /><p style="text-align: center;"><br /></p>David Murrayhttp://www.blogger.com/profile/05064067930999854450noreply@blogger.comtag:blogger.com,1999:blog-7401893686664793874.post-62118313146807611892021-01-29T15:28:00.005-06:002023-06-06T10:44:18.992-05:00REGIONAL ANESTHESIA REMIX: FOREARM BLOCKS (Courtesy: Dr. Koes)<p style="text-align: center;"> <b style="text-align: center;"><span style="font-family: verdana; font-size: medium;"> CONSIDER THE PROBE/REGIONAL ANESTHESIA REMIX: </span></b></p><p style="text-align: center;"><span style="font-family: verdana; font-size: medium;"><b>FOREARM BLOCKS</b></span></p><p style="text-align: center;"><b><span style="font-family: verdana; font-size: medium;">(Courtesy Dr. Joseph Koes)</span></b></p><div><b><span style="font-family: verdana; font-size: medium;"><br /></span></b></div><div><p style="text-align: center;"><span style="font-family: verdana;">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. </span></p><p style="text-align: center;"><span style="font-family: verdana;">Enjoy and remember next shift to CONSIDER THE PROBE!</span></p><div class="separator" style="clear: both; text-align: center;"><iframe allowfullscreen="" class="BLOG_video_class" height="266" src="https://www.youtube.com/embed/twySKYLWE9k" width="320" youtube-src-id="twySKYLWE9k"></iframe></div><br /><p style="text-align: center;"><br /></p></div>
<br />David Murrayhttp://www.blogger.com/profile/05064067930999854450noreply@blogger.comtag:blogger.com,1999:blog-7401893686664793874.post-72180389531665785612021-01-18T15:25:00.005-06:002023-06-06T10:45:09.383-05:00CONSIDER THE PROBE: POCUS4PE (Courtesy: Dr. Scarth)<p>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!</p><p><br /></p><div class="separator" style="clear: both; text-align: center;"><iframe allowfullscreen="" class="BLOG_video_class" height="266" src="https://www.youtube.com/embed/9eSsX3UtR_s" width="320" youtube-src-id="9eSsX3UtR_s"></iframe></div><br /><p><br /></p><p><br /></p>
<br />David Murrayhttp://www.blogger.com/profile/05064067930999854450noreply@blogger.comtag:blogger.com,1999:blog-7401893686664793874.post-53736863885275073102020-12-30T16:16:00.010-06:002023-06-06T10:45:37.803-05:00CONSIDER THE PROBE: CXR? WHY BOTHER? POCUS THAT PNA! (Courtesy Dr. Unruh)<p style="text-align: left;"><span style="text-align: center;"><span style="font-family: verdana; font-size: medium;">CONSIDER THE PROBE: CXR? WHY BOTHER...POCUS THAT PNA!</span></span></p><p style="text-align: left;"><span style="font-family: verdana; font-size: medium;">(Courtesy Dr. Larissa Unruh)</span></p><p style="text-align: left;"><span style="font-family: verdana; font-size: medium;">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!!!).</span></p><p style="text-align: left;"><span style="font-family: verdana; font-size: medium;">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.</span></p><p style="text-align: left;"><span style="font-family: verdana; font-size: medium;">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, the more sensitive your exam will be...</span></p><p style="text-align: left;"><span style="font-family: verdana; font-size: medium;">Enjoy a great case by Dr. Unruh and ALWAYS CONSIDER THE PROBE when evaluating a hypoxemic/dyspneic patient...</span></p><p style="text-align: left;"><span style="font-family: verdana; font-size: medium;"><br /></span></p><p style="text-align: left;"></p><div class="separator" style="clear: both; text-align: center;"><iframe allowfullscreen="" class="BLOG_video_class" height="266" src="https://www.youtube.com/embed/BK1_b4pe3kQ" width="320" youtube-src-id="BK1_b4pe3kQ"></iframe></div><br /><span style="font-family: verdana; font-size: medium;"><br /></span><p></p><p style="text-align: left;"><span style="font-family: verdana; font-size: medium;"></span></p><div class="separator" style="clear: both; text-align: center;"><br /></div><span style="font-family: verdana; font-size: medium;"><br /><b><br /></b></span><p></p><p style="text-align: left;"><b><span style="font-family: verdana; font-size: medium;"><br /></span></b></p>David Murrayhttp://www.blogger.com/profile/05064067930999854450noreply@blogger.comtag:blogger.com,1999:blog-7401893686664793874.post-79247319187177403672020-10-19T19:19:00.005-05:002023-06-06T10:46:01.789-05:00CONSIDER THE PROBE: CHOROIDAL WT%? (Courtesy Dr. Johnston)<p style="text-align: left;"><span style="font-family: verdana; font-size: large;">CONSIDER THE PROBE: CHOROIDAL WT%?</span></p><p style="text-align: left;"><span style="font-family: verdana; font-size: medium;">(Courtesy Dr. Katia Johnston)</span></p><p style="text-align: left;"><span style="font-family: verdana; font-size: medium;">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. </span></p><p style="text-align: left;"><span style="font-family: verdana; font-size: large;">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 remember always my friends to CONSIDER THE PROBE!</span></p><p style="text-align: left;"></p><div class="separator" style="clear: both; text-align: center;"><iframe allowfullscreen="" class="BLOG_video_class" height="266" src="https://www.youtube.com/embed/ZXtPPRWAt1E" width="320" youtube-src-id="ZXtPPRWAt1E"></iframe></div><br /><span style="font-family: verdana; font-size: medium;"><br /></span><p></p><p style="text-align: left;"><span style="font-family: verdana; font-size: medium;"><br /></span></p><p style="text-align: left;"></p><div class="separator" style="clear: both; text-align: center;"><br /></div><br /><span style="font-family: verdana; font-size: medium;"><br /></span><p></p>David Murrayhttp://www.blogger.com/profile/05064067930999854450noreply@blogger.comtag:blogger.com,1999:blog-7401893686664793874.post-42106354501545852602020-10-05T22:36:00.004-05:002023-06-06T10:46:39.050-05:00CONSIDER THE PROBE: US Findings in CRAO (CREDIT DR. THAKKAR)<p style="text-align: left;"> Consider the Probe: US Findings of CRAO (CREDIT DR. THAKKAR)</p><p style="text-align: center;"><br /></p><p style="text-align: left;">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...</p><p style="text-align: left;"><br /></p><div class="separator" style="clear: both; text-align: center;"><iframe allowfullscreen="" class="BLOG_video_class" height="266" src="https://www.youtube.com/embed/kJ5Q9iqAyLQ" width="320" youtube-src-id="kJ5Q9iqAyLQ"></iframe></div><br /><p style="text-align: left;"><br /></p><div class="separator" style="clear: both; text-align: center;"><br /></div><br /><p style="text-align: left;">Special thanks to Dr. Pankthi Thakkar.</p><p style="text-align: left;"><br /></p>David Murrayhttp://www.blogger.com/profile/05064067930999854450noreply@blogger.comtag:blogger.com,1999:blog-7401893686664793874.post-68726692660984551802020-10-01T16:37:00.006-05:002023-06-06T10:47:05.096-05:00CONSIDER THE PROBE: Dynamic US for Paracentesis (Credit Dr. Hollingsworth)<p style="text-align: left;">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. </p><p style="text-align: left;">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! </p><p style="text-align: left;">And remember, next time you are on shift to always CONSIDER THE PROBE!</p><div class="separator" style="clear: both; text-align: center;"><iframe allowfullscreen="" class="BLOG_video_class" height="266" src="https://www.youtube.com/embed/qxVqMnDxS1w" width="320" youtube-src-id="qxVqMnDxS1w"></iframe></div><br /><p style="text-align: left;"><br /></p><p></p><div class="separator" style="clear: both; text-align: left;"><br /></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><br /></div><br /><p></p>David Murrayhttp://www.blogger.com/profile/05064067930999854450noreply@blogger.comtag:blogger.com,1999:blog-7401893686664793874.post-30364040293635977982020-09-21T20:00:00.006-05:002023-06-06T10:47:27.638-05:00Consider the Probe: An Introduction to Regional Anesthesia! (Credit: Dr. Joseph Koes)<p style="text-align: left;"><span style="font-family: verdana;">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. </span></p><p style="text-align: left;"><span style="font-family: verdana;">Enjoy the following lecture with much more to come from the good Dr. Koes...</span></p><p style="text-align: left;"><span style="font-family: verdana;">Like what you see? Maybe consider a fourth-year Ultrasound elective...</span></p><div class="separator" style="clear: both; text-align: center;"><iframe allowfullscreen="" class="BLOG_video_class" height="266" src="https://www.youtube.com/embed/EkglB8lybyU" width="320" youtube-src-id="EkglB8lybyU"></iframe></div><br /><p><br /></p><p><br /></p><p></p><div style="text-align: center;"> <div class="separator" style="clear: both; text-align: center;"><br /></div><br /><div class="separator" style="clear: both; text-align: center;"><br /></div><br /></div><p></p>David Murrayhttp://www.blogger.com/profile/05064067930999854450noreply@blogger.comtag:blogger.com,1999:blog-7401893686664793874.post-62526202346396284022018-02-10T11:26:00.001-06:002018-02-10T11:26:36.815-06:00Consider the Probe 3: So I've found the effusion, now what?<div class="separator" style="clear: both; text-align: left;">
<span style="background-color: white; color: #444444; font-family: "trebuchet ms" , "trebuchet" , "verdana" , sans-serif; font-size: 12px;">A 74 y/o F with pmhx of metastatic breast cancer, IDDM, HTN presents after a syncopal episode. The patient notes that for the past 2-3 days she has been experiencing some lightheadedness and shortness of breath with exertion. She is presently undergoing chemotherapy (I'd throw in some random chemo drus here, but lets face it, we wouldn't know them anyways...) and radiation. She notes that she hasn't been eating/drinking very well. She denies fever, cough, hemoptysis, leg pain/swelling. She has mild nausea but no abdominal pain.</span></div>
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As you peek up at the monitor, you note that the patient’s <b>HR is ~ 135</b> and her <b>BP is 88/56</b>. Her O2 saturation is 99% and the nurse told you that she was
afebrile. Taking a look at this patient,
she looks ill-appearing and anxious. Her
extremities are cool to touch. You
quickly decide that Room 33 might not be the best place to manage this patient and
that she would be better served in a RESUS station. As you wheel the patient to RESUS, you are
trying to organize a mental game plan. <o:p></o:p></div>
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You grab a quick accucheck (remembering that your pt is an
insulin-dependent diabetic) which comes back normal at 115mg/dL. You are appropriately concerned about this
patient and feel the need to evaluate her for life-threatening pathologies such
as pulmonary embolism, cardiac tamponade, pneumothorax, and large malignant
pleural effusions. Wouldn’t it be nice
if there were a bedside tool that could help you quickly assess the patient for
the aforementioned “can’t miss” diagnoses.
<o:p></o:p></div>
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I think you know where I am going, might be time to…CONSIDER
THE PROBE. I would strongly argue that
for a hemodynamically unstable patient, Point-of-care ultrasound should be the
initial tool utilized to guide workup in a dyspneic patient. You help your RESUS nurse get your patient “plugged in” and
pull in an ultrasound machine to perform a quick ECHO to guide your
decision-making. You grab a couple quick
still images that get you more worried:</div>
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<span style="font-size: 6.0pt; line-height: 107%;"><a href="http://www.emcurious.com/blog-1/2014/10/30/ultrasound-leadership-academy-basic-cardiac">http://www.emcurious.com/blog-1/2014/10/30/ultrasound-leadership-academy-basic-cardiac</a></span><span style="font-size: 6.0pt; line-height: 107%;"><o:p></o:p></span></div>
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<span style="font-size: 6pt;">https://emedicine.medscape.com/article/80602-overview</span></div>
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<a href="https://www.youtube.com/watch?v=_4LmrRKlcd0" style="font-family: "trebuchet ms", trebuchet, verdana, sans-serif; font-size: 12px;"><span style="font-size: 5.0pt; line-height: 107%;">https://www.youtube.com/watch?v=_4LmrRKlcd0</span></a></div>
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Diagnosing a patient with a pericardial effusion is nice,
but what value does it serve us as emergency medicine physicians? In this hypotensive patient with an
impressive pericardial effusion at a quick glance, we need to get moving. GET FLUIDS HANGING (if they aren’t already!) and
then start scurrying around to gather a pericardiocentesis kit or (let’s face
it) perhaps a Cook County makeshift kit (spinal needles tubing, 3 way stop
cock?, get creative…). Prepare yourself
mentally and physically for the prospect that you may need to perform this
rare, life-saving procedure! If you have consultants in-house, GET THEM
INVOLVED! Cardiology should be your
first call, but realize that they may want CardioThoracic surgery involved in this
case.<o:p></o:p></div>
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You have a page out to cardiology, your equipment for an
emergent pericardiocentesis is at the bedside. A 500cc NS bolus is in and the
blood pressure improves to 98/60, HR comes down to 120. You mentally review a recent
ultrasound-college presentation on cardiac tamponade and remember how nice it
is to be succinct but knowledgeable when communicating with your consultants. You go back to the bedside and acquire the
following echo clips so that you might have a more informed discussion with
your consultants. </div>
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Now, to review for a minute.
It doesn’t take too much skill as a bedside sonographer to identify a
pericardial effusion. However, it is
much more difficult to assess for tamponade physiology. Early signs of tamponade physiology include a
<b>Dilated IVC with</b> <b>Right Ventricular Diastolic Collapse. </b>This is easier said then done, especially
when considering that these patients are often tachycardic. <b>Use
Apical 4 chamber, Parasternal long or Subxiphoid and take a 5 second clip. </b>When reviewing these clips, assess the <b>R ventricular free wall</b> during <b>diastole </b>by slowing the clip down to
frame by frame progression. By noting
the activity of the mitral (or tricuspid!) valve, you will be able to more
easily separate SYSTOLE (Mitral/Tricuspid valves closed) from DIASTOLE
(mitral/tricuspid valves open). One really
nice trick is to utilize M-mode in a Parasternal Long View. Drop the M mode “plane” through the mitral
valve (in the same location as we do to calculate an EPSS) and view this plane
over time. You should be more easily
able to identify motion of the R ventricular free wall in relation to the
mitral valve to assess for diastolic collapse as shown below:<o:p></o:p></div>
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The Yellow Circle above
(familiar from measuring EPSS) illustrates the mitral valve snapping open
towards the septal wall (indicating the start of DIASTOLE), while the Blue
rectangle shows the R ventricular free wall collapsing inwards—indicating
tamponade physiology! <o:p></o:p></div>
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After reviewing your bedside
ECHO clips (above), cardiology agrees with your interpretation (R ventricular
diastolic collapse indicating cardiac tamponade) and whisks the poatient off to
the operating room for a pericardiocentesis with CT surgery prepared to perform
a window if the pericardiocentesis fails.
<o:p></o:p></div>
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<b>Take Home Pearls<o:p></o:p></b></div>
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<!--[if !supportLists]--><b>1)<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; font-weight: normal; line-height: normal;"> </span></b><!--[endif]--><b>In a
hypotensive and dyspneic patient, always CONSIDER cardiac tamponade in your
differential diagnosis and then CONSIDER THE PROBE…<o:p></o:p></b></div>
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<!--[if !supportLists]--><b>2)<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; font-weight: normal; line-height: normal;"> </span></b><!--[endif]--><b>Once you
have diagnosed the effusion, use POCUS to assess for IVC dilation with RV free
wall collapse during diastole as indicators of tamponade physiology—and a
patient that is more likely to require urgent vs emergent pericardiocentesis.<o:p></o:p></b></div>
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<!--[if !supportLists]--><b>3)<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; font-weight: normal; line-height: normal;"> </span></b><!--[endif]--><b>Utilizing
M-mode on PSL view may help you to more precisely identify the movement of the
RV free wall during Diastole vs Systole.<o:p></o:p></b></div>
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<!--[if !supportLists]--><b>4)<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; font-weight: normal; line-height: normal;"> </span></b><!--[endif]--><b>Once POCUS
has identified tamponade physiology, prepare yourself (mentally and physically)
to perform a pericardiocentesis while concurrently reaching out to your
consultants.<o:p></o:p></b></div>
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Sources/Links<o:p></o:p></div>
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Nice intro/discussion through
Dr. Avila’s 5 min sono: http://5minsono.com/tamp/<o:p></o:p></div>
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Really awesome/in depth
videocast from Mike/Matt that delves further into tamponade physiology: <a href="http://www.ultrasoundpodcast.com/2013/11/pericardial-tamponade-learn-know-foamed/">http://www.ultrasoundpodcast.com/2013/11/pericardial-tamponade-learn-know-foamed/</a></div>
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<o:p></o:p>Interesting article that
highlights the subtelties of accurately diagnosing subacute tamponade: <a href="http://www.amjmed.com/article/S0002-9343(13)00391-4/pdf">http://www.amjmed.com/article/S0002-9343(13)00391-4/pdf</a><o:p></o:p></div>
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As always check out
Introduction to Bedside Ultrasound Ch: 17 (R Heart Pathology) to review this
topic further: <a href="https://itunes.apple.com/us/book/introduction-to-bedside-ultrasound/id554196012?mt=11"><b>https://itunes.apple.com/us/book/introduction-to-bedside-ultrasound/id554196012?mt=11</b></a><o:p></o:p></div>
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David Murrayhttp://www.blogger.com/profile/05064067930999854450noreply@blogger.comtag:blogger.com,1999:blog-7401893686664793874.post-78739509284210443402017-08-30T21:27:00.001-05:002017-08-30T21:46:53.427-05:00 Consider the Probe Take 2: Coming to Grips with your Fundoscopic Shortcomings....<div class="columns-inner" style="background-color: white; color: #444444; font-family: "Trebuchet MS", Trebuchet, Verdana, sans-serif; font-size: 12px; min-height: 0px;">
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<span style="font-size: 13.2px;">49 y/o M with hx of HTN, HLD, IDDM presents with non-traumatic L-sided painless visual loss. The patient states that several hours prior to presentation he developed blurry vision in his L eye. On quick examination, there are no signs of trauma. Visual acuity is 20/120 on the L and 20/40 on the R with normal intraocular pressures bilaterally. Pupils are briskly reactive without any photophobia or consensual photophobia. The lids, sclera, conjunctivae are grossly normal and there are no corneal defects with fluorescein staining. </span><br />
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Coming out of the room, you are concerned about this sudden-onset blurry vision. You remember a short lecture on visual acuity changes that Dr. Schindlebeck begrudgingly gave you in between his posting about sweater vests on Pinterest. Your differential brings concerning diagnoses including central retinal arterial occlusion (CRAO), central retinal vein occlusion (CRVO), retinal detachment, as well as vitreous hemorrhage. Now, our patient still has some visual acuity in the affected eye which speaks against CRAO (usually profound loss of visual acuity…unable to count fingers, etc.). CRVO is certainly on the differential, but it is usually not a time-sensitive diagnosis to make. That leaves us with retinal detachment vs vitreous hemorrhage. Might be a nice time to CONSIDER THE PROBE!<o:p></o:p><br />
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Brushing up on the basics, ocular US is performed utilizing the high frequency linear probe. ALWAYS make sure you clean the probe prior to examination and use sterile gel packets. You can consider placing a tegaderm over the closed eye to further protect it. Fear not, you will not remove their eye-lashes when ripping the teggy off. Finally, make sure to “brace” your hand on the bridge of the nose or the cheek as to avoid applying too much pressure to your patient’s globe. Using plenty of gel, minimal pressure is needed to visualize both superficial structures (cornea, iris, lens) as well as the posterior chamber as shown below:<br />
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<a href="https://1.bp.blogspot.com/-Ou0NUROyCuc/WadjYPOi-JI/AAAAAAAADEs/OVZCuNnYjkccfSGlOwiXJZk2SIjNIHMSgCLcBGAs/s1600/eye%2Banatomy.jpg" imageanchor="1" style="color: #3d85c6; margin-left: 1em; margin-right: 1em; text-decoration-line: none;"><img border="0" data-original-height="427" data-original-width="315" height="640" src="https://1.bp.blogspot.com/-Ou0NUROyCuc/WadjYPOi-JI/AAAAAAAADEs/OVZCuNnYjkccfSGlOwiXJZk2SIjNIHMSgCLcBGAs/s640/eye%2Banatomy.jpg" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; border: 1px solid rgb(238, 238, 238); box-shadow: rgba(0, 0, 0, 0.1) 1px 1px 5px; padding: 5px; position: relative;" width="470" /></a></div>
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<span style="font-size: 5pt;">(http://www.sonomojo.org/keeping-an-eye-on-intracranial-pressure-detecting-elevated-icp-using-ocular-ultrasound)</span></div>
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It sure beats your non-dilated funduscopic exam. Anyways, let’s say you place the probe over your patient’s affected eye and ascertain the following image:<o:p></o:p><br />
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<a href="https://1.bp.blogspot.com/-tZTlD8a4jLE/WadjcV3BYZI/AAAAAAAADE0/EtTx3aTn1s8fa7QmWVEY4HvCihhxvvvugCLcBGAs/s1600/RD.jpg" imageanchor="1" style="color: #3d85c6; margin-left: 1em; margin-right: 1em; text-decoration-line: none;"><img border="0" data-original-height="360" data-original-width="480" height="300" src="https://1.bp.blogspot.com/-tZTlD8a4jLE/WadjcV3BYZI/AAAAAAAADE0/EtTx3aTn1s8fa7QmWVEY4HvCihhxvvvugCLcBGAs/s400/RD.jpg" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; border: 1px solid rgb(238, 238, 238); box-shadow: rgba(0, 0, 0, 0.1) 1px 1px 5px; padding: 5px; position: relative;" width="400" /></a></div>
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<span style="font-size: 5pt; line-height: 7.13333px;">https://i.ytimg.com/vi/KZIK2-t9jpw/hqdefault.jpg<o:p></o:p></span><br />
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Noting the echogenic (hyperechoic) snake-like structure floating in the vitreous that ORIGINATES from the optic nerve (the optic nerve sheath is the hypoechoic “band” passing posteriorly from the vitreous chamber, see image above for anatomy review)—you are appropriately concerned that your patient may have a retinal detachment and needs urgent ophthalmologic consultation and you put a page out to the on-call resident.<br />
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Lets imagine that your bedside ultrasound of the affected eye had produced the following images/videos:<br />
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<iframe allowfullscreen="true" class="b-hbp-video b-uploaded" frameborder="0" height="266" id="BLOGGER-video-f034947cb685d503-18569" mozallowfullscreen="true" src="https://www.blogger.com/video.g?token=AD6v5dyplZt2JoWtRBFpcXPXyOyulTFTlhzWYXFkoo4mgdd25d9w0A0t9zwoa6fFS1j2_sS2R1kP9qIPz1LlABQ7voIXSDLkgttB9n2qiLqiWBm4d3bo9Vb5H6W3YJOTUbfVttgvGVDF" webkitallowfullscreen="true" width="320"></iframe><a href="rtsp://v7.cache1.googlevideo.com/ChoLENy73wIaEQkD1YW2fJQ08BMYDSANFEgDDA==/0/0/0/video.3gp" style="color: #3d85c6; text-decoration-line: none;" type="video/3gpp"></a></div>
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<a href="https://www.blogger.com/blogger.g?blogID=1567058379713984339" imageanchor="1" style="color: #3d85c6; margin-left: 1em; margin-right: 1em; text-decoration-line: none;"></a></div>
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<a href="https://www.blogger.com/blogger.g?blogID=1567058379713984339" imageanchor="1" style="color: #3d85c6; margin-left: 1em; margin-right: 1em; text-decoration-line: none;"></a></div>
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<a href="https://www.blogger.com/blogger.g?blogID=1567058379713984339" imageanchor="1" style="clear: right; color: #3d85c6; float: right; margin-bottom: 1em; margin-left: 1em; text-decoration-line: none;"></a><a href="https://www.blogger.com/blogger.g?blogID=1567058379713984339" imageanchor="1" style="clear: right; color: #3d85c6; float: right; margin-bottom: 1em; margin-left: 1em; text-decoration-line: none;"></a><a href="https://www.blogger.com/blogger.g?blogID=1567058379713984339" imageanchor="1" style="clear: right; color: #3d85c6; float: right; margin-bottom: 1em; margin-left: 1em; text-decoration-line: none;"></a><a href="https://www.blogger.com/blogger.g?blogID=1567058379713984339" imageanchor="1" style="clear: right; color: #3d85c6; float: right; margin-bottom: 1em; margin-left: 1em; text-decoration-line: none;"></a><a href="https://www.blogger.com/blogger.g?blogID=1567058379713984339" imageanchor="1" style="clear: right; color: #3d85c6; float: right; margin-bottom: 1em; margin-left: 1em; text-decoration-line: none;"></a>You note more globular hyperechoic material that swirls with kinetic maneuvers. There is no “connection” to where the optic nerve originates. Thus, you are less concerned for a retinal detachment and are moving towards a less time-sensitive diagnosis of vitreous hemorrhage. Recognize that sometimes these hemorrhages can be subtle and may require you to adjust your gain (“lighten” your image) to visualize the abnormality. While you still want to provide your patient with a prompt ophthalmology f/u appointment, you recognize that you probably don’t need to page the on-call consultant at 3:30 in the morning for a patient with these findings. <o:p></o:p><br />
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<b>Take it to the next level:</b></h4>
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Like all things, Ocular US takes practice. Fortunately, at Cook County we have an abundance of visual acuity complaints. If you start imaging all of these patients early on, you will develop a good “eye” for normal vs abnormal findings. One “next-level” step to ocular ultrasound involved further interpreting a patient with findings concerning for a retinal detachment to determine whether the macula is involved. It is important to remember that the macula is the part of the retina responsible for “high-acuity” and central vision. So retinal detachments can either involve this important region termed “Mac-Off” (macula detached) or they can spare it “Mac-On.” To assess this, you must be able to localize the macula—it is immediately lateral to the optic nerve and usually inline with the middle of the lens (direct line of vision):<o:p></o:p><br />
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<a href="https://4.bp.blogspot.com/-m8-mivR_IOc/WadjeJtQ_JI/AAAAAAAADE8/RTfn1_AzhCMqOL2jwX_rLLTp4DW_ncgXgCEwYBhgL/s1600/macula.jpg" imageanchor="1" style="color: #3d85c6; margin-left: 1em; margin-right: 1em; text-decoration-line: none;"><img border="0" data-original-height="471" data-original-width="502" height="375" src="https://4.bp.blogspot.com/-m8-mivR_IOc/WadjeJtQ_JI/AAAAAAAADE8/RTfn1_AzhCMqOL2jwX_rLLTp4DW_ncgXgCEwYBhgL/s400/macula.jpg" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; border: 1px solid rgb(238, 238, 238); box-shadow: rgba(0, 0, 0, 0.1) 1px 1px 5px; padding: 5px; position: relative;" width="400" /></a></div>
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<span style="font-size: 5pt; line-height: 7.13333px;">(https://www.ultrasoundoftheweek.com/uotw-12-answer)<o:p></o:p></span><br />
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Now on account of the critical role the macula fulfills, any retinal detachment that spares the macula “Mac-On” requires EMERGENT optho consultation (that’s right, pick up the phone at 4AM…). While patients that have already detached this region “Mac-Off” patients are slightly less time-sensitive and require URGENT follow-up. The subtle difference between these findings is noted in the images below:<o:p></o:p><br />
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<a href="https://1.bp.blogspot.com/-q0aWmy2BW2I/WadjajqqtkI/AAAAAAAADE8/DM5W00ld1pQtBAv0RRblDuXTmY-USDyoACEwYBhgL/s1600/Mac%2Bon%2Bvs%2Boff.jpg" imageanchor="1" style="color: #3d85c6; margin-left: 1em; margin-right: 1em; text-decoration-line: none;"><img border="0" data-original-height="1001" data-original-width="1600" height="400" src="https://1.bp.blogspot.com/-q0aWmy2BW2I/WadjajqqtkI/AAAAAAAADE8/DM5W00ld1pQtBAv0RRblDuXTmY-USDyoACEwYBhgL/s640/Mac%2Bon%2Bvs%2Boff.jpg" style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; border: 1px solid rgb(238, 238, 238); box-shadow: rgba(0, 0, 0, 0.1) 1px 1px 5px; padding: 5px; position: relative;" width="640" /></a></div>
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<b>“Take Home Pearls”</b></h4>
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<b>1) Retinal Detachments appear as a snake-like hyperechoic extension floating in the vitreous that should “originate” from the optic nerve.<o:p></o:p></b><br />
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<b>2) Vitreous hemorrhage appears as less well-defined hyperechoic “globular” debris in the posterior chamber. It may be subtle and you may have to adjust the gain to visualize it. <o:p></o:p></b><br />
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<b>3) Retinal detachments that preserve the macula “Mac- On” require EMERGENT ophthalmologic consultation, while “Mac-Off” detachments are URGENT, but non-EMERGENT. <o:p></o:p></b></div>
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Sources/Links: </h4>
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<b>5 Min Sono Video Retinal Detachment vs Vitreous Hemorrhage</b>: <a href="http://5minsono.com/rdvd/" style="color: #3d85c6; text-decoration-line: none;">http://5minsono.com/rdvd/</a><o:p></o:p><br />
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<b>Chapter 31 on Introduction to Clinical Ultrasound by Matt Dawson and Mike Mallin. Still appears to be free on Itunes. (</b><a href="https://itunes.apple.com/us/book/introduction-to-bedside-ultrasound/id554196012?mt=11" style="color: #3d85c6; text-decoration-line: none;"><b>https://itunes.apple.com/us/book/introduction-to-bedside-ultrasound/id554196012?mt=11</b></a><b>)<o:p></o:p></b></div>
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<b>Random Youtube Video with nice example of “Mac-On” vs Mac-Off” detachment: https://www.youtube.com/watch?v=JijIfSzOG9U</b></div>
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David Murrayhttp://www.blogger.com/profile/05064067930999854450noreply@blogger.comtag:blogger.com,1999:blog-7401893686664793874.post-89889653334190342612017-06-26T10:45:00.004-05:002017-06-26T10:46:31.147-05:00Weekly Fix - Nerve Blocks for Shoulder Reduction<div class="separator" style="clear: both; text-align: left;">
<span style="font-family: "trebuchet ms" , sans-serif; font-size: large;">Read the </span><a href="https://www.ncbi.nlm.nih.gov/pubmed/21883635" style="font-family: "Trebuchet MS", sans-serif; font-size: x-large;" target="_blank">Blaivas paper</a><span style="font-family: "trebuchet ms" , sans-serif; font-size: large;"> on interscalene nerve blocks while listening to the podcast below.</span><span style="font-family: "trebuchet ms" , sans-serif; font-size: large;"> </span><span style="font-family: "trebuchet ms" , sans-serif; font-size: large;">For more FOAMed fun check out the </span><a href="http://www.ultrasoundninja.com/p/nerve-block.html" style="font-family: "Trebuchet MS", sans-serif; font-size: x-large;" target="_blank">Nerve Block</a><span style="font-family: "trebuchet ms" , sans-serif; font-size: large;"> </span><span style="font-family: "trebuchet ms" , sans-serif; font-size: large;">page.</span></div>
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<br />Anonymoushttp://www.blogger.com/profile/14396517962987287151noreply@blogger.comtag:blogger.com,1999:blog-7401893686664793874.post-89633791175250170202017-06-26T10:36:00.002-05:002017-06-26T10:36:38.905-05:00Weekly Fix - More and more biliary fun!<div class="separator" style="clear: both; text-align: left;">
<span style="font-family: "trebuchet ms" , sans-serif; font-size: large;">Read the </span><a href="https://www.ncbi.nlm.nih.gov/pubmed/24126067" style="font-family: "Trebuchet MS", sans-serif; font-size: x-large;" target="_blank">Becker paper</a><span style="font-family: "trebuchet ms" , sans-serif; font-size: large;"> on common bile duct measurement while listening to the podcast below. Then read the </span><a href="https://www.ncbi.nlm.nih.gov/pubmed/24673668" style="font-family: "Trebuchet MS", sans-serif; font-size: x-large;" target="_blank">Gaspari paper</a><span style="font-family: "trebuchet ms" , sans-serif; font-size: large;"> on learning curves in bedside ultrasound while listening to the podcast below. </span><span style="font-family: "trebuchet ms" , sans-serif; font-size: large;">For more FOAMed fun check out the </span><a href="http://www.ultrasoundninja.com/p/biliary-tract.html" style="font-family: "Trebuchet MS", sans-serif; font-size: x-large;" target="_blank">Biliary</a><span style="font-family: "trebuchet ms" , sans-serif; font-size: large;"> </span><span style="font-family: "trebuchet ms" , sans-serif; font-size: large;">page.</span></div>
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<br />Anonymoushttp://www.blogger.com/profile/14396517962987287151noreply@blogger.comtag:blogger.com,1999:blog-7401893686664793874.post-14529997050652305502017-05-26T19:06:00.003-05:002017-05-26T19:10:21.037-05:00Weekly Fix - Where is Mickey?<div class="separator" style="clear: both; text-align: left;">
<span style="font-family: "Trebuchet MS", sans-serif; font-size: large;">Check out the awesome lecture below by EM Intern Dr. Michael Daley. Read the </span><a href="https://www.ncbi.nlm.nih.gov/pubmed/24126067" style="font-family: "Trebuchet MS", sans-serif; font-size: x-large;" target="_blank">Becker paper</a><span style="font-family: "Trebuchet MS", sans-serif; font-size: large;"> on the importance of CBD measurement while listening to the </span><a href="https://soundcloud.com/ultrasoundninja/becker-cbd" style="font-family: "Trebuchet MS", sans-serif; font-size: x-large;" target="_blank">podcast</a><span style="font-family: "Trebuchet MS", sans-serif; font-size: large;">. Read the </span><a href="https://www.ncbi.nlm.nih.gov/pubmed/18439787" style="font-family: "Trebuchet MS", sans-serif; font-size: x-large;" target="_blank">Gaspari paper</a><span style="font-family: "Trebuchet MS", sans-serif; font-size: large;"> on learning curves in biliary US education while listening to the </span><a href="https://soundcloud.com/ultrasoundninja/blehar-gb-learning-curve" style="font-family: "Trebuchet MS", sans-serif; font-size: x-large;" target="_blank">podcast</a><span style="font-family: "Trebuchet MS", sans-serif; font-size: large;">. For more FOAMed fun check out the </span><a href="http://www.ultrasoundninja.com/p/biliary-tract.html" style="font-family: "Trebuchet MS", sans-serif; font-size: x-large;" target="_blank">Biliary</a><span style="font-family: "Trebuchet MS", sans-serif; font-size: large;"> page.</span></div>
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<br />Anonymoushttp://www.blogger.com/profile/14396517962987287151noreply@blogger.comtag:blogger.com,1999:blog-7401893686664793874.post-74894266595034733402017-05-25T13:34:00.001-05:002017-05-25T13:34:04.834-05:00Weekly Fix - Procedures, Procedures, Procedures<div class="separator" style="clear: both; text-align: left;">
<span style="font-family: "trebuchet ms" , sans-serif; font-size: large;">Read the </span><a href="https://www.ncbi.nlm.nih.gov/pubmed/18778380" style="font-family: "Trebuchet MS", sans-serif; font-size: x-large;" target="_blank">Chenkin paper</a><span style="font-family: "trebuchet ms" , sans-serif; font-size: large;"> on procedural education while listening to the podcast below. Then read the </span><a href="https://www.ncbi.nlm.nih.gov/pubmed/24673668" style="font-family: "Trebuchet MS", sans-serif; font-size: x-large;" target="_blank">Peterson paper</a><span style="font-family: "trebuchet ms" , sans-serif; font-size: large;"> on US in LP's while listening to the podcast below. </span><span style="font-family: "trebuchet ms" , sans-serif; font-size: large;">For more FOAMed fun check out the </span><a href="http://www.ultrasoundninja.com/p/procedures.html" style="font-family: "Trebuchet MS", sans-serif; font-size: x-large;" target="_blank">Procedures</a><span style="font-family: "trebuchet ms" , sans-serif; font-size: large;"> </span><span style="font-family: "trebuchet ms" , sans-serif; font-size: large;">page.</span></div>
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<br />Anonymoushttp://www.blogger.com/profile/14396517962987287151noreply@blogger.comtag:blogger.com,1999:blog-7401893686664793874.post-55635800025466193262017-05-25T13:21:00.001-05:002017-05-25T13:24:32.513-05:00Weekly Fix - Airway Ultrasound for Everyone!<div class="separator" style="clear: both; text-align: left;">
<span style="font-family: "trebuchet ms" , sans-serif; font-size: large;">Check out the awesome lecture below by EM Intern Dr. Meghan Mathur. Read the </span><a href="https://www.ncbi.nlm.nih.gov/pubmed/23263648" style="font-family: "Trebuchet MS", sans-serif; font-size: x-large;" target="_blank">Martindale paper</a><span style="font-family: "trebuchet ms" , sans-serif; font-size: large;"> on diagnosing pulmonary edema while listening to the </span><a href="https://soundcloud.com/ultrasoundninja/martindale-diagnosing-pulmonary-edema" style="font-family: "Trebuchet MS", sans-serif; font-size: x-large;" target="_blank">podcast</a><span style="font-family: "trebuchet ms" , sans-serif; font-size: large;">.</span><span style="font-family: "trebuchet ms" , sans-serif; font-size: large;"> For more FOAMed fun check out the </span><a href="http://www.ultrasoundninja.com/p/airway.html" style="font-family: "Trebuchet MS", sans-serif; font-size: x-large;" target="_blank">Airway</a><span style="font-family: "trebuchet ms" , sans-serif; font-size: large;"> page.</span></div>
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<br />Anonymoushttp://www.blogger.com/profile/14396517962987287151noreply@blogger.comtag:blogger.com,1999:blog-7401893686664793874.post-52096786783759904382017-05-05T14:46:00.000-05:002017-05-05T14:46:07.862-05:00Weekly Fix - STONE Study, Take Two!<div class="separator" style="clear: both; text-align: left;">
<span style="font-family: "trebuchet ms" , sans-serif; font-size: large;">Read the </span><a href="https://www.ncbi.nlm.nih.gov/pubmed/26279392" style="font-family: "Trebuchet MS", sans-serif; font-size: x-large;" target="_blank">Fields paper</a><span style="font-family: "trebuchet ms" , sans-serif; font-size: large;"> on renal US in nephrolithiasis while listening to the podcast below. Then read the </span><a href="https://www.ncbi.nlm.nih.gov/pubmed/26747219" style="font-family: "Trebuchet MS", sans-serif; font-size: x-large;" target="_blank">Daniels paper</a><span style="font-family: "trebuchet ms" , sans-serif; font-size: large;"> on the STONE PLUS study while listening to the podcast below. </span><span style="font-family: "trebuchet ms" , sans-serif; font-size: large;">For more FOAMed fun check out the </span><a href="http://www.ultrasoundninja.com/p/urinary-tract.html" style="font-family: "Trebuchet MS", sans-serif; font-size: x-large;" target="_blank">Renal</a><span style="font-family: "trebuchet ms" , sans-serif; font-size: large;"> </span><span style="font-family: "trebuchet ms" , sans-serif; font-size: large;">page.</span></div>
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<br />Anonymoushttp://www.blogger.com/profile/14396517962987287151noreply@blogger.com