Blog

E-point Septal Separation in the Patient with Congestive Heart Failure

Perhaps never explained so clearly, Cisewki and Alerhand’s article on EPSS is a wonderful read. Bottom line to remember: EPSS > 7 mm was 87% sensitive and 75% specific at identifying reduced EF (<50%).  This is the cutoff generally used to point to an abnormal EF (but isn’t it all about stroke volume, really?)Read more

Awake Intubation Topicalization

Compiled from a variety of sources from #FOAMed (specifically, NYSORA and the ACCRAC podcast) and inspired by morning report today with Taryn and Tina, here is a quick and dirty rundown for awake intubation. Firstly, we should be considering this method when the two Venn diagrams of “anatomically challenging” and “enthusiastically cooperative” overlap in theRead more

SonoSweden 2015

Bret Nelson and Felipe Teran took part in an incredible conference just outside of Stockholm, Sweden. Over one hundred participants and twenty faculty attended this sold-out conference at the Hasseludden Yasuragi Japanese spa . Among the luminaries were Matt Dawson and Mike Mallin (from the Ultrasound Podcast), lung ultrasound queen Vicki Noble, Mike Lambert andRead more

You Put in a Femoral Tlc, You Dirty Dog Didn’t You!

@JoePinero Every critical care physician scoffs at the idea of placing a femoral central line, but are they correct? Do femoral central lines actually cause more infections than other sites?Read more

2014 Emergency and Critical Care Ultrasound CME Course

The Mount Sinai Department of Emergency Medicine hosted its annual ultrasound CME conference on April 25. Faculty, fellows, nurses and PAs from a number of institutions and specialties took part in our tenth annual course. The course was directed by Bret Nelson, MD who introduced ultrasound physics and machine controls, followed by lectures on assessment of  airway and breathing (JimRead more

SonoSweden 2014 course

At the end of January, Bret Nelson joined an incredible team of international a faculty for the largest SonoSweden course to date. Course director Christofer Muhr hosted this unique, intensive hands-on conference at the scenic Yasuragi hotel in Stockholm, Sweden. Over thirty faculty and one hundred participants took part in this three-day course. Among the facultyRead more

Papilledema and the Crescent Sign

  What’s abnormal in this image?   Here’s a hint.  Here is an example of normal.   When evaluating for possible elevation in intracranial pressure, it has been shown that optic nerve sheath diameter (ONSD) measurements correlate with elevated intracranial pressures.(1,2)  The optic nerve attaches to the globe posteriorly and is wrapped in a sheath thatRead 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

Intubation devices

Many new developments in ultrasound were demonstrated at the ACEP conference in Denver this week. Since airway management rivals ultrasound as my academic interest, I’d like to focus for a moment on an intubating device I saw demonstrated at an ultrasound vendor booth.  I’ve seen lots of organs on my ultrasound screen- hearts, gallbladders, eyeballs, prostates. I’ve even seen airway structures, but notRead 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