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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

In case you haven’t gotten to this month’s EM:RAP, there’s a really great segment on an important ED procedure that we definitely don’t do enough of in the ED: the nerve block. The section discusses the femoral nerve block and how to perform a fascia iliaca compartment block (the “3-in-1” block)–which hits 3 major nervesRead more

You’re working in RESUS, and you get a notification for hypotension. He’s a 65 year old male noted to be hypotensive to 70/40 by EMS. On arrival, he’s altered and unable to provide any history, and EMS doesn’t have much more information. You don’t see any signs of trauma. Your attending suggests performing a RUSHRead more

Traditionally, central line placement in the subclavian vein (SCV) involves a landmark-based approach in which the needle is guided under the clavicle. For the U/S lovers, there is an alternative approach to the subclavian in which the sono may be utilized: the supraclavicular subclavian. Anatomy: The goal is to cannulate the SCV just lateral toRead more

Surgical resident X: “We have to get the chest X-ray before we go to CT.” EM resident Y: “Honestly, [surgical colleague X], I don’t think we do. The FAST didn’t have any evidence of pneumothorax, so I think we’re safe to proceed to the CT scanner rather than wait for X-ray right now.” Surgical residentRead more

Clinical Question – What’s a systematic approach you can use to improve your Echo? Case – 66 M with IDDM, HTN, and obesity presents to Resus in septic shock. He is intubated for hypoxemic respiratory failure, and remains persistently hypotensive despite a fluid-challenge and 15 mcgs of levophed. You slap on the probe to evaluate his EF. Here’sRead more

Inspired by the mysterious and salacious Jon Mishoe. Trying to explain ultrasound via text just won’t work. Instead I will attempt to describe various ultrasound concepts and possibilities and I encourage you to grab ultrasound faculty for hands-on demonstrations if the clinical scenario is appropriate. Given the small amount of subcutaneous tissue and small surfaceRead more

The Interscalene Block So, you want to provide local anesthesia to the patient with a broken clavicle or a dislocated shoulder. Maybe there’s a proximal / mid-humeral fracture or an injury over the deltoid. Whatever your needs may be, the interscalene block is an option for targeted anesthesia in the upper extremity to knock out partsRead more

Today’s lower extremity block is going to be the posterior tibial nerve. The sensory distribution should be helpful for things like foreign bodies that need to be taken out of the foot.     Anatomy – The largest of the five nerves at the level of the ankle, the posterior tibial nerve is posterior toRead more

“Trust, but verify” -Ronald Reagan   Why would you need ultrasound for tube confirmation? You can confirm placement with direct visualization (sometimes video laryngoscopy), use end tidal CO2, look for color change on colorimetric capnography, listen for bilateral breath sounds, check pulse oximetry, and look for fogging in the tube. In most cases, these methodsRead more