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

Interscalene Nerve Block – Knockout That Upper Extremity

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

Lower Extremity Nerve Block: The Posterior Tibial Nerve

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

Lower Extremity Nerve Block: The Sural Nerve

  The next three series in the SinaiEM pearls will be on nerve blocks of the foot. Today is going to cover the sural nerve block which should anesthetize the area depicted by the cross-hatched area in the figure.   As a terminal branch of the sciatic nerve, the sural nerve innervates the lateral portionRead more

Use ultrasound for confirmation of endotracheal tube intubation!

“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

Try ultrasound for your next lumbar puncture!

“Nobody travels on the road to success without a puncture or two.” -Navjot Singh Sidhu   Ultrasound can assist in determining the best site for lumbar puncture. Here is how to do it!   1. Palpate for the superior iliac spine as you would for any lumbar puncture, and find the approximate area of L3-L4Read more

US-Guided Femoral Nerve Block for Hip Fracture

In light of a recent patient in our ED with a femoral neck fracture…   Rather than dose and re-dose opioids, consider an US-guided femoral nerve block for safer, longer, and more effective analgesia [1-3].   Courtesy of Robert J. Strony DO, RDMS, RVT via    FN: femoral nerve, SFA: superficial femoral artery, DFA:Read more

Ultrasound Water Bath

After pulling in a spectacular toe-tapping sideline-hugging outstretched 30-yard bomb just milliseconds before a crushing hit by multiple defenders (a Pearl unto itself), one of our own right-handed residents came down the next day with redness, swelling, and pain to the dorsal aspect of his right hand’s third metacarpophalangeal joint. A heated discussion in theRead more

2015 Peds Ultrasound CME course

Over forty participants joined Sinai faculty Jim Tsung, Ee Tay, Bret Nelson, Joshua Guttman, Jacob Goertz, Turan Saul, Jenny Sanders, Kimberly Kahne, Michelle Vazquez, Joe Sorravit, and Rupi Mudan. Course Directors Ee Tay and Joshua Guttman organized great didactic content and lost of hands-on training (HOT) with pediatric models. Participants from many pediatric and acuteRead more

Improving left upper quadrant view

Many clinicians are challenged when evaluating patients for perisplenic fluid as part of the FAST or RUSH examination. Here are some common problems and how to fix them. Fix probe location Make sure you are holding the probe in a longitudinal view, probe marker towards the patient’s head. Place the probe just above the costal margin,Read more