ultrafest.org – have to give props to the creator of my US itch, Dr. Chris Fox at UCI (my prior stomping grounds for EM residency) for his hugely successful med stud US course – over 200 students!! May 20, 2012 – Chris, Im looking forward to getting some pics from that! Wish I could have been there!
Crazy case I saw recently… 38 yo female who came to the ED for vaginal bleeding that was unrelenting for 6 months, not changed with repeated PO hormonal treatment by PCP, and “I just want an answer.” Stable vitals, no sx of anemia, she was not tender on exam and pelvic was unremarkable except for some blood. In my efforts to simply appease her as I wasnt going to do much more, I did a Transabdominal Pelvic US (sagittal view shown below). Once I saw this, I started to pay more attention (of course, it should have been the other way around, but thats just my skeptical self). I asked her about weight loss (she had 15 pounds loss in 6 months (already a pretty petite girl) and no significant family history, but I realized when speaking to her for more time that she kept having an intermittent dry cough every now and again. I asked her about it, and she thought it was allergies “and I just dont think i got over that cold from a month ago.” Pretty sad case -CXR showed mets…..”platinum” scan done, admitted to Medicine, biopsy/onc/chemo underway… shows the importance of TA Pelvis for not just the 1st trimester pregnancy VB/abd pain evaluations. Continue reading
Very Cool illustration page of US for epidurals for my anesthesiology friends by Dr. Chris Mitchell as described by the Broome Docs blog!
For all the moms out there on Mother’s day! And for all who know me well, you know the baby will be dancin’ to Party Rock! If an expectant mom comes in with pelvic pain or vaginal bleeding, check for fetal dancing: Continue reading
Zonare’s faster software and improved image resolution:http://www.zonare.co.uk/products/
Phillips new Clearvue for improved Echocardiography:http://www.healthcare.philips.com/us_en/products/ultrasound/systems/clearvue550/
If the XR tech is busy with the traumas, its the overnight shift where resources are limited, and you just intubated someone who didnt have great breath sounds or O2 sat to begin with – and want to assess if the ETT is in the trachea – cool way to do it. Linear probe. transverse over the trachea at the jugular notch. You will see the the trachea as an arched hyperechoic (bright linear) structure with tracheal rings coming down from it. With the ETT in the trachea, a shadow of the tube over the trachea will be seen, but that may be tough to see at times, so you can put the color doppler box over it and do a little – wiggle wiggle wiggle wiggle wiggle, yeah – of the ETT – a color ray will spike down from the trachea.
Very cool review article on the evaluation of the short of breath patient by bedside US…. the RADIUS study – strong name, if I do say so myself…
http://www.scribd.com/doc/93314237/The-Rapid-Assessment-of-Dyspnea-With-Ultrasound-RADiUS
MSK ultrasound – truly the wave of the future, and current extensive use amongst sports medicine docs who have no XRay machines on the field, and also for disaster and international uses. Someone once said “Problems are to the mind what exercise is the the muscle.” I knew thats why my head hurt during the most recent 49ers playoff game, but I bet their joints were much more sore. Ever wonder what tendonitis looks like on US? Easy and quick diagnosis. Continue reading
THIS is truly my fav when it come to US applications. If you ever show this to any group of students or other learners, the entre room responds with , “Oooooooh, Awwwww.” You can see pupillary constriction by angling the probe upward to get a coronal view of the eye and shining a light on the eye – or the opposite eye. Or, you can decrease your depth and have the linear probe directly on the eyelid in transverse view while the patient looks upward. You will see the linear muscle layers which will constrict when a light is shined in the opposite eye (as seen below) … Pretty cool stuff, I tell ya….
“The Eye is the window to the soul”…. or something like that…. but I actually think that ultrasound comes pretty darn close to being that window – or at least being the key to the door. Orbital US is super cool. People talk about the orbital pathology that you can assess all the time, but what is also amazing is being able to assess normal anatomy and physiology of the eye – like extra-ocular movements (by using the linear high frequency probe and a tegaderm with gel over the orbit, have the patient move their eye left and right – along the plane of the probe – then rotate the probe 90 degrees and have them move their eye up and down).
SonoSpot: Topics in Bedside Ultrasound 