Lung Ultrasound Pitfalls

Thoracic sonography is one of the most rapidly growing areas of emergency and critical care ultrasound. One very important emerging indication is to assess for lung consolidation. The characteristic appearance of consolidated lung is very sensitive and specific for pneumonia, but novices should heed some important pitfalls in making the diagnosis. Special thanks to JimRead more

Bubble test

We already know it is helpful to use ultrasound to guide placement of central venous catheters. How can we use ultrasound to help confirm proper placement of an internal jugular catheter? There are several methods which have been described: Visualize the needle entering the vein (optimally in the long axis) Visualize the guide wire in the veinRead more

Presentations-slide sorter view

We mostly focus on ultrasound here, but a large part of what we do is information exchange, adult education, and the like. We give a lot of presentations, and many of our faculty are interested in the art of speaking, the aesthetics of presentation design, and adult education. So from time to time we’ll postRead more

Straight Suture Safety

Hopefully you are using ultrasound to guide your insertion of central venous catheters. Once they are in, you still have to suture them at some point. Straight suture needles are often used to secure arterial and venous catheters to the skin. These types of suture needles have been demonstrated to be more dangerous than curvedRead more

Top ultrasound scanning tips

Welcome new interns across the land! You will be receiving lots and lots of advice from many sources, so I’d like to pour some ultrasound scanning tips into the information deluge. Most of these tips were posted here at a few years ago, yet they are so classic they they still ring true! TheseRead more

Subxiphoid window

The subxiphoid four chamber view is commonly used in cardiac assessments and the FAST exam and for many is the initial “go-to” view of the heart. Difficulty obtaining this window can frustrate novice and seasoned operators, and there are a few tips which can help optimize the view. It’s called SUB-xiphoid for a reason. Don’t jam theRead more

Left upper quadrant fluid

One common source of confusion or false positives in the FAST exam is the assessment of the left upper quadrant. We’ve already covered some tips on improving your view of the spleen. This post will illustrate how the stomach can mimic free fluid to the unprepared. The first image shows a perisplenic (left upper quadrant)Read more


Finding the right angle is critical to optimal imaging. In fact ‘right angle’ or perpendicular imaging is the best way to get a clear image. At 90 degrees, many more sound beams reflect back to the transducer than at more shallow angles. In addition, the ultrasound energy is more spread out when it connects toRead more

Pupillary Light Reflex

We’ve all seen ultrasound augment the physical examination and even allow for assessments we could not otherwise accomplish at the bedside. One great example is the use of ultrasound to check the pupillary light reflex. If you are wondering why a pen light would not suffice for this physical examination standby, you have never encounteredRead more

Spleen Tips

Hippocrates, Galen, and a host of classical physicians wrote extensively on the spleen and its maladies. As I’m sure you recall, the spleen is tasked with the metabolism of black bile. Failure of the spleen to clear this fluid leads to melancholia. Fast forward to now, and we also seek black fluid near the spleen.Read more