New Powerpoints

I have uploaded the new version of the FAST lecture- new and improved with more pictures and video! Stay turned for the version with lecture attached...

The Ultrasound Guided Vascular Access PowerPoint is also uploaded for your viewing pleasure. It has a lecture attached to it, so let me know if it fails to play for you...still trying to debug the system.

ENJOY!!!!

New Catheters Are In!

The new 2.5" 18G IV catheters are in for use in deep brachial/basilic lines. They are located in my box in the ED attending office in ECC. In order to get them stocked in the pyxis we will have to prove that we use them frequently, so please place a patient stick and reason for use on the form on top of the box when using the catheter.

Just to get an idea of their size and length, see the picture above. The IV to the left is a normal IV used by the nurses to place a peripheral IV, the middle catheter is the traditional "long" catheter that we currently stock in the pyxis. The catheter on the right is the new longer one.

It will certainly help with those patients who have a lot of SubQ tissue between the skin and the vein. Please let me know if there are any problems. Good Luck!

Case #1: "I Can't Breathe!"

A 80 year old lady presents to the ED with complains of shortness of breath gradually increasing over the course of a week. She denies cough, fever or chest pain. She admits to dyspnea on exertion, orthopnea and PND severe enough to keep her sleeping upright. Her PMH is significant for hypertension only. Physical Exam demonstrates decreased breath sounds on the left, without crackles or wheezing. She appears in mild respiratory distress and her POx is 95% on 3L NC O2. Her CXR demonstrates complete white out of the left side. How can you determine if this is caused by atelectesis versus effusion?

Ultrasound can be used to interrogate the pleural cavity as part of the Extended FAST exam (E-FAST). The probe is placed in the coronal position in the UQ (side depends on the affected area) with the probe indicator to the patient's head. Any time you see black on the cranial side of the diaphragm (no mirror artifact visible) then there is fluid in the pleural cavity.





Notice the diaphragm at the right side of the screen and the lung fluttering within a large pleural effusion every time she breathes.

Welcome to Emergency Ultrasound!

Keep an eye on this site as we will be posting cases and slide shows on emergency ultrasound education.