TURBO!!!

We now have a new M-Turbo Ultrasound machine for each area of the ED: ECC, Flexcare and Peds.

Each machine cover is a different color to help us differentiate them. Please continue to save all your images and do a report for each patient scan, otherwise I will not know if your diagnosis using those images was correct. This is an essential part of the QA process and I can't give you credit for the exam unless you can prove you know what to make of the image! Please note that the "How to save images" cards are attached to each of the machines if you forget how to use them. As always, please let me know if you have any questions or problems!

Case #2: "I fell and my belly hurts"

25 year-old female presents to the ED after slipping on water in her kitchen and falling to the ground yesterday. She denies loss of consciousness, but complains of abdominal pain and began vaginal spotting today. She states that she is 8 weeks pregnant confirmed by her primary doctor. This is her first pregnancy and has been receiving prenatal care, but has not had her first ultrasound as of yet. She denies chest pain, headache, nausea, vomiting or extremity pain.

Physical exam reveals a diffusely tender to palpation abdomen, without other signs of trauma. Pelvic exam is positive for scant blood in the vaginal vault, but a thick closed os and no cervical motion tenderness or adenexal masses palpable.

Labs included a normal CBC and a quantitative Bhcg of 61,410.

The resident performs a transabdominal bedside ultrasound and sees the following:

What is the diagnosis?

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.