Ultrasound guidance has undeniably revolutionized IV access and is an incredibly useful skill for the ED physician. The following are by no means a comprehensive guide to the procedure but rather 10 tips for small changes that are often overlooked and can make a huge difference. If you have trained with ultrasound guided IV’s and feel comfortable already with your own style, this may not be as helpful for you. For the medical students, interns, and perhaps "less young attendings" that did not have a vascular probe attached to their hip during residency, read on!
Modern immunizations in conjunction with better CT imaging has likely led to declining need for lumbar puncture in the emergency department to evaluate for meningitis and subarachnoid hemorrhage. This may contribute to physician discomfort with the procedure and lower likelihood of first attempt success. This study evaluated whether the addition of ultrasound guidance could increase first attempt success on infant lumbar puncture in the Emergency Department.
Anatomic landmarks followed by a "blind" stick is currently the standard practice for performing bedside lumbar punctures, but with increasing use and ease of ultrasound, could we one day see lumbar punctures follow in the footsteps of central line placement?
You evaluate a patient complaining of acute onset of dyspnea with hypotension and hypoxia. You immediately consider the diagnosis of acute massive pulmonary embolism, but despite your best efforts can't get good cardiac windows on bedside ultrasound. Should you administer thrombolytics? Heparin? Send the shocky patient for a CT? Today Dr. Simpkins goes through the steps to perform 2-point compression ultrasound of the lower extremity to evaluate for DVT, an easy and rapid bedside test that may allow for indrect but more rapid diagnosis of acute, massive pulmonary embolism.
In this video, Cooper Emergency Medicine Residency graduate and current ultrasound fellow at Hennepin County Mark Robidoux demonstrates a few tips and tricks to quickly become a pro in ultrasound guided angiocath insertion (with a little help from Cooper Assistant to the Program Director and volunteer pincushion Rich Byrne)
Answer: False. Infants present with non-bilious vomiting
Diagnosis: Pyloric Stenosis
Pathology: Pyloric stenosis is hypertrophy and hyperplasia of the pylorus with a multifactorial inheritance in families. The incidence is 5/1000 births in males and 2/1000 births in females. It is therefore more common in males; it is also more common in first-born infants, and in Caucasian infants.
Case: A six week-old previously healthy, term infant via vaginal birth is brought to pediatric ED for repeated episodes of vomiting over a one week period. Vomiting occurs 20-30 min following every episode of feeding and is described as projectile. Parents note decreased urine output over the past two days. Patient is noted to be hungry following vomiting episodes
This post aims to shine a light on a possibly emerging use of bedside ultrasound. While this is far from being recommended as a viable method of intubation during RSI in an Emergency Department, knowledge that ongoing research evaluating the use of ultrasound-guided tracheal intubation (UGTI) exists can only serve to enhance one's understanding of the progression of ultrasound in medicine.