Tap that? VP Shunts & their complications

CSF shunts – these are the most common pediatric neurosurgery procedure done in the United States. While very common, these also have the highest rate of neurosurgical complications. About 50% fail within the first year, and the median survival of a shunt is usually 8-10 years, so a patient can expect 2-3 shunt revisions over the course of 20 years. 

Put down that FOBT

“The HgB has dropped, have you checked a guaic?” How many times have you checked a FOBT in your workup for anemia? Let’s take a look at what FOBT is supposed to be used for. FOBT is a visual stool assay in which heme in th…

Painless Foley insertion

A 57yo M presents with new onset urinary retention for 3 days. The triage nurse attempts to place a foley catheter but is unable to pass it. Bedside ultrasound confirms a distended bladder. The patient is now complaining of urethral discomf…

Troubleshooting PEG tubes

A patient is sent from nursing home at 10pm for a non-functioning PEG tube. He has a prior history of stroke with L sided weakness and is now bedbound at baseline. He has stable vitals, no abdominal tenderness, and is otherwise well appeari…

Median and Ulnar Nerve Blocks

Injuries to the hands are a frequent complaint in the emergency department. When the injury isn’t limited to a single digit, or involves larger areas of the hand such as a burn or deep laceration, a nerve block can be an effective opt…

Oops…is that part important?

There you were, minding your own business when EMS brings you a sick-as-can-be patient, intubated in the field for who knows what. Someone gets overzealous with their trauma shears and cuts off the pilot balloon on the endotracheal tube. Th…

Improving left upper quadrant view

Many clinicians are challenged when evaluating patients for perisplenic fluid as part of the FAST or RUSH examination. Here are some common problems and how to fix them. Fix probe location Make sure you are holding the probe in a longitudi…

Ultrasound Zen

To image something which moves, you must remain still. To image something which is still, you must move. If you think on this long enough, the point is self-evident and requires no explanation. Or, just see some examples below. We are prett…

September 2022