We know Jim Tsung can ultrasound anything, but in the peds world we all need to beef up our lung ultrasounds because more and more evidence is piling up to support the use of ultrasound to diagnose pediatric pneumonia. A recent meta-analysis of 1510 patients showed that lung ultrasound had a sensitivity of 95.5% (93.6-97.1) and […]

Consider inhaled nitric oxide in massive PE and watch for upcoming literature. Massive PE elevates pulmonary vascular resistance leading to right ventricular failure, hypoxemia, and cardiogenic shock. Inhaled nitric oxide selectively dilates pulmonary vasculature and has antiplatelet activity. Prior case series show improvements in oxygenation and hemodynamic variables within minutes of starting iNO. How does iNO help? […]

Ever been annoyed when you try to admit a liver patient and the MAR requests that you perform a diagnostic tap prior to admission? Here is the data behind why we perform diagnostic paracentesis in the ED. Bottom line: performing diagnostic paracentesis in hospitalized patients early is associated with improved mortality.  There are a few important […]

Try an interscalene block! It anesthetizes C5-7 and is used in shoulder surgery- surely that is good enough for a measly little reduction. Studies in the ED have shown decreased time in the ED and good anesthesia for shoulder reduction. Here is how: Place patient in supine position Using the linear ultrasound probe oriented like […]

Don’t want to read more? Here is the summary: There are a bunch of studies coming out looking at risk stratification for Aortic Dissection (AD). On chest pain patients check for focal sensory/motor neurologic deficit, pulse deficit and hypotension and look for widening of the mediastinum on CXR. Aortic dissection detection score + d-dimer can […]