Novel Uses of Ultrasound in Cardiac Arrest

    NextPrevious

    Novel Uses of Ultrasound in Cardiac Arrest

    Question – How can you use ultrasound to figure out the etiology of a cardiac arrest?

    Much of the buzz surrounding ultrasound in cardiac arrest revolves around the intra-arrest echo and TEE. You can also use ultrasound to get some information about the etiology of the arrest. Enter the SESAME Protocol, developed by Daniel Lichtenstein (aka the Lung King).

    The SESAME Protocol is a 5-step method that can be performed in two minutes or less:

    1. Lungs – look for a PTX. Best done after a patient is intubated and being ventilated. Preferably done before several rounds of compressions have happened. Obvious note – the PTX you see may be due to a rib fracture, thus limiting its utility.
    2. Legs – Look for a DVT in the b/l fems – many patients with massive PE may have a concurrent DVT. If present, look for RV dilation. Consider code-dose thrombolytics.
    3. Abdomen – quickly scan the abdomen to look for free fluid. The goal is speed, so while you could do a full FAST, what you’re really interested in is a massive amount of free fluid that can be obviously seen. If you have this, consider hypovolemia and the need to transfuse blood product.
    4. Pericardium – evaluate for pericardial tamponade.
    5. Heart – Evaluate for RV dilation, asystole, echocardiographic evidence of fine VF. Echo windows best done after compressions are stopped.

    Here’s a video of the Lichtenstein demonstrating the SESAME Protocol. I haven’t found any evidence of this protocol being rigorously investigated for effects on cardiac arrest mortality or other patient centered outcomes. Nevertheless, it’s a neat idea.

    Sources:

    1. Lichtenstein et al. 2016 – Critical Care Ultrasound in Cardiac Arrest
    • Welcome! This is the website for the Mount Sinai Emergency Ultrasound Division. It serves as an information resource for residents, fellows, medical students and others seeking information about point-of-care ultrasound. There is a lot ofRead more

    • Bag Mask Ventilation During Intubation

      A few days ago NEJM published the results of an investigation with profound implications for our specialty.  A group of intensivists and anesthesiologists conducted a multicenter, randomized trial conducted in seven ICUs to study theRead more

    • Gastric Emptying for Acute Poisonings

      At the request of department leadership, we will be revisiting methods of gastric decontamination for today’s pearl.  Two methods in particular. Ipecac-induced emesis and gastric lavage are two procedures that we read about in medicalRead more

    • Pacemakers Review pt. 3

      Today we will review complications associated w/ implanted pacemakers that you may encounter in the ED and thus ought to be familiar with. Generally, complications can be divided into two categories: early vs. late EarlyRead more

    • Pacemakers Review Pt. 2

      Cardiac pacing as an intervention can be conceptualized as addressing problems in electrophysiological conduction and/or.  So, for example, if there is a disruption in the electrical continuity between the atrium and the ventricle, a pacerRead more

    • Pacemakers Review Pt. 1

      The pursuit of mastery over cardiovascular emergencies demands a rough familiarity with implanted devices which includes why they get implanted in the first place (indications), how they work, how they malfunction, and how they affectRead more

    • In honor of a rosh review question that I got wrong, lets review Lyme disease!   Lyme disease is caused by the spirochete Boriella burgdorferi, transmitted to humans through tick bites from ixodes ticks. Location:Read more

    • NGT INSERTION

      Your patient has an SBO and has repeated bilious emesis on the side. The surgery team is in the OR and they ask if you can place the nasogastric tube (NGT). Lets review proper NGTRead more

    • No, that’s not an olive. That’s Pyloric Stenosis!

      Inspired by what appears to have been a very interesting day in the Peds ED, lets review a rare but interesting pediatric entity: PYLORIC STENOSIS Background: MC in Males (5:1) & firstborn children (30%) UsuallyRead more

    NextPrevious