Category Archives: SonoExtras

SonoCase: 75 year old coming in unresponsive…

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This case highlights an example of how bedside ultrasound can save a life. Period.

It was 330pm. The ring down from EMS was helpful; we knew the equipment we needed to get ready prior to arrival. “75 year old female, last seen normal at 2pm by family found unresponsive on the carpeted ground of her bedroom, O2 sat 94% and placed on 100% non-rebreather (NRB), shallow breaths at 12/min, weak carotid pulses with one IV access and fluids running, HR 120, blood pressure 60/p, ETA 5 minutes.” Intubation equipment, central access kit, arterial line set-up, and ultrasound machine – ready. Upon arrival, EMS states they have no advanced directive (aka full code until proven otherwise – to social worker: “please let us know when family arrives.”

In the ED… Continue reading →

SonoCase: “My back hurts, I just need a med refill.” Yeah, except….

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This case scares me. Truly. We have all had patients with this chief complaint, maybe on a weekly, if not daily, basis. You know the one – guy comes in, says he has been diagnosed with …. lets see, its usually “herniated disk”, “muscle strain”, “sciatica”, or he may throw out a term that gets more of your attention like “stenosis”, but usually it’s just “I have a bad back” and now on narcotics (because there’s just no other way – ugh!) and just needs a refill. He may even have an empty bottle in hand. He just might ask for the medicine by name : “Norco 10s work really well, but my doctor put me on Oxycontin now. Can you give me enough for a month?” Response: “uh… No.” But I digress…..lets go to our crazy-scary case…

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SonoLinks: new links to awesome US educational sites/texts/apps

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Since the last installment of SonoLinks, there have been several more awesome US related websites/links that 1) I have found in my search for more, 2) are new ones that just came on to the horizon or 3) I totally forgot to add before – – –  They are all free! They are all listed on our Blogroll (scroll down, on the right of the screen) that we keep updated. If anyone knows of any other great sites, send them on over!

SonoCloud – a new and excellent website for free and easy visualization, downloading, uploading, and learning of US clips and images – by Matt & Mike (of Ultrasound Podcast) and Mike Stone (current ACEP US Section President). Can you say A-W-E-S-O-M-E! You can help fill up their library of clips by downloading your own on there too.

WikiSpaces to De-identify/Crop/Edit your image/Clip – thanks to Ben Smith for creating and sharing! A great way to post/share your stills and clips without violating HIPAA by cropping out the MRN/patient name. A simple way to keep you out of HIPAA jail.

EchoBasics – Mereles, a cardiologist from Paraguay, has an excellent website of all things cardiac echo, from basic to advanced evaluations, including explanations and clips, and even 3D and 4D clips! very cool.

ICU Sonography – along the same lines as above, there are a couple sites that are worth mentioning for ICU Sonography: Beth Israel’s website and Stanford’s website. Great review/images of critical care US and echo/IVC.

Yale’s Atlas of Echo – a complete site of everything you need to know about cardiac echo

Neuraxiom – A great website for US guided regional nerve blocks!

Sonic Nerve Blocks – another excellent website by Sanjay Sinha, an anesthesiologist at the University of Connecticut, to review all US guided nerve blocks

EFSUMB – free US textbook reviewing US applications (and includes resource limited US utilization and HIV related views)

Partners in Health book – an excellent manual for US use in resource poor/limited settings by Sachita Shah et al.

SonoWorld – an all-inclusive website that has cases, lectures, images, and articles

Ultrasound Village – another all-inclusive site with from our colleagues in Australia filled with lectures, images, and quizzes!

Qstream – a great free way to test your US skills through email question and answers by Sam Ko.

Other organizations that deserve mention in addition to ACEP include:  SAEM (who have narrated lectures),  AIUM (which is an organizer of the UltrasoundFirst project), WFUMB, and WINFOCUS

Emergency US Fellowships – in the time of application review, I thought I would send out the link for those interested in applying for emergency US fellowships

Emergency US Research articles – Chip Schmier does a GREAT job in sending out the new US related research articles every month; allows us to feel “in the know” when our colleagues ask us questions about it.

And… a website for free medical education testing and media sharing using a social networking and incentive paradigm: GMEP  – Global Medical Education Project – as you can see SonoSpot has already created a folder and adding to it with US images of all applications.

SonoInterview by Medscape: A Radiologist’s perspective on the topic of point-of-care Ultrasound

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In case anyone out in the Sono world was wondering what friends we have out there in Radiology, include this guy on the list… someone who understands what is best for patient care, how bedside US can save lives, and how every specialty has the capability and patient population to help their patients through this tool.

Handheld Units Shift Ultrasonography From a Diagnostic to a Clinical Evaluation Tool, Broadening Its Appeal

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SonoReview: US-guided Interscalene nerve blocks

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Hope you had a Happy 4th! To all those who received patients with an upper extremity that has been burned, fractured, or blown away from all the “legal” fireworks foreplay……

Pain control. Two words. Patient satisfaction. Two more words. Physician satisfaction. Two MORE words. Nerve blocks are the new procedural sedation for many painful procedures we do in the ED. Takes much less resources and time, and provides immediate pain control for however long your anesthetic will work without concern for respiratory distress, hypotension, hypoxia, and… well… death. So why dont we do it more? Well, in a prior post, we have discussed the ins & outs for performing US guided nerve blocks with the help of some of my colleagues, some of whom are mentioned below.

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SonoStudy: Survival potential – US evaluating cardiac motion during traumatic cardiac arrest… AND an assessment of the literature

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An interesting study in the July issue of the Journal of Trauma and Acute Care Surgery (see full article here) discussing the utility of bedside ultrasound during traumatic cardiac arrest. For anyone who works at a trauma center, or who just so happens to receive a patient dropped off by a friend on the driveway of the ED (we have all had that happen), or who received a patient by ambulance who is in cardiac arrest at a non-trauma center to soon find evidence of trauma upon exposure of the patient….. this study is quite relevant when it comes to survival potential and how bedside ultrasound may help. What they say….

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SonoFiler: Profiling Dr. Michael Stone

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It is with great pleasure that this SonoFiler edition – profiling leaders in bedside ultrasound –  is none other than “The Prez”, “The Holy Stone”, “The Mikester” (as we like to call him) – Dr. Mike Stone, current President of the ACEP US Section, and best described as “husband and dad” as he puts it. His nickname is simply, Stone –  “because it’s my name and let’s face it, sounds cool.” It does have a nice ring to it! Kind of like Cher, Madonna, Sly….ok, maybe a bit more important to the world than that. So, lets talk a bit about Stone… Continue reading →

SonoTip and Trick: “See” the eye better…Hey ‘bright’ eyes: no pain, no ‘GAIN’!!

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Ok, so the “no pain, no gain” doesn’t really make too much sense as the point of this tip and trick is for better visualization of the eyeball : INCREASE THE GAIN! Puts a whole new meaning to the term “Bright eyes.” When you have a patient with painful or painless vision loss, unilateral visual field deficit, trauma to the eye, or if you have a suspicion of a foreign body in the globe – increase the gain – yup, that’s right. Even though the eye is filled with fluid, and fluid is the lover of ultrasound allowing better visualization of structures deep to it on the screen, it can be difficult to visualize WITHIN that fluid filled structure. Lets see some examples: Continue reading →

SonoCase: 72 yr old, woke up with “funny” vision… What’s up with that eye?!

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One of my good friends and colleagues, Dr. Graham Walker, emailed me the other day with a “booya, check it out”-type of email that he knows I love and cherish. He made the diagnosis quickly with the help of his bedside US study.

72 year old male with a history of hypertension, high cholesterol and on antibiotics for a foot infection – – stating he woke up and his vision was “funny” – Continue reading →

SonoApp: Lung Ultrasound… Be fine with B lines!

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So you get a patient with shortness of breath, and you have no idea what the reason is…. but they can’t lie flat and the Xray tech is busy with the trauma. Lung US can help you – but that’s weird, right? Air is supposed to be the enemy of ultrasound with gas scatter artifact making what you want to see very hard. Well, believe it or not, with the lung, ultrasound will turn into your go-to tool for quick evaluation. There has been a study that has described a methodical approach to this, the RADIUS study, and one of the key elements of this is evaluating artifact. Yup, that’s right, ARTIFACT…. Continue reading →