SBO and Ultrasound: Genie in a bottle?

SBO you say? 6-infinity hours until dispo?! Sometimes it feels like you want to just rub a lamp and all your dispo decisions would be granted! Maybe it can!? Enter SBO and ultrasound! What are you looking for on US? (Westafer & Faust 2015)   [Chao & Gharahbaghian] [Chao & Gharahbaghian] [Avila UOTW#20] Dilated loops of bowelRead more

Pigtail Catheters: Almost as cute as this guy

Chest tubes hurt…I imagine. And the few times I’ve done them (x2) I’ve wondered couldn’t that person have just gotten a pigtail?! What does the literature say? Voisin et al 2014 asked if large pneumothoraces (>2-3cm from the lung apex) could be evaluated as outpatients with pigtail catheters. Findings They looked at 132 patients with primaryRead more

Reexpansion Pulmonary Edema: Do-Gooders Beware

This case was brought to my attention by the wonderful Sam Schuberg. Impressively he drained a large pleural effusion in the ED offering his patient “Upstairs Care Downstairs”.   He then brought to my attention that when draining a large amount of fluid be weary of… REEXPANSION PULMONARY EDEMA or RPE!  [picture from Tariq &Read more

Peripheral Vasopressors: The Good, The Bad, and The Ugly

First thing that probably comes to mind when you hear peripheral vasopressors is “when is this patient getting a central line (CVC)?” or “COWBOYS!” because as ED docs that is what we are and how else to express that best than sticking things in places they shouldn’t be?!  Like… Peripheral Vasopressors (VM)!!   Why don’tRead more

“Twice As Nice”: Dual Sequential Defibrillation

    The Stats: 350,000 out-of hospital cardiac arrests (OHCA)/209,000 in hospital cardiac arrests (IHCA) each year (2016) Majority of cases have a primary cardiac etiology with vfib as presenting rhythm So SHOCK IT!…..Survival Rate: OHCA 12%/IHCA 24.8 Enters Dual Sequential Defibrillation (DSD) Research previously conducted in animals. In 1986 Chang et al showed that DSDRead more

On Not Crackin Dat Chest

This Sept 2015 Annals of Surgery article made a splash when it first came out a year ago, and it came up again yesterday in conference. Here’s a refresher. FAST ultrasound examination as a predictor of outcomes after resuscitative thoracotomy: a prospective evaluation” by Inabi et al. Inabi and company looked at 187 traumatic arrestsRead more

Tap dat obese belly

We do a lot of diagnostic taps at our shop. People need to take better care of their livers. Here’s a tip for your next tap. I recently encountered a very obese cirrhotic patient who required a diagnostic tap. He had several very deep pockets that were amenable for tapping on bedside ultrasound. The problem wasRead more

Tap dat joint…with Methylene Blue

Today, instead of talking about tapping a joint to pull fluid out, we’re going to talk about tapping a joint to put fluid in. Methylene blue, in fact. The methylene blue joint injection test is a fast and simple bedside test that can be performed in the ED to assess joint capsule integrity in periarticularRead more

Point-of-care ultrasound diagnosis of intravascular air after lower extremity intraossesous access When you come across peripheral intravascular air, take steps to minimize further entrainment of air and migration of air to the heart and lungs.Read more

(De) Winter is coming

  A middle-aged man presented to the ED with chest pain for the past 2 hours. This is his EKG. What’s your next move?       If you look at the anterior leads, you’ll notice upsloping ST depressions and tall, symmetric, prominent t waves. This pattern is known as De Winter’s T wave pattern.Read more