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.