Ultrasound for Endotracheal Intubation Confirmation

June 12, 2016

Greetings from Ireland! I just got into the airport in Dublin and am waiting for @ultrasoundjelly to land so we can go to our hotel for SMACCdub (The most amazing worldwide conference I've ever been to).  In the meantime, check out this podcast. 

Using ultrasound to confirm endotracheal tube (ETT) placement is generally met with a healthy dose of skepticism.  There's no denying that waveform capnography is the gold standard, but even the gold standard has its limitations.  Capnography requires pulmonary blood flow, may not work as well with exogenous epi, and needs a few bags of ventilation to pick anything up.  US doesn't need any of these things. This weeks video is just a bit longer than the normal 5 minutes, but its totally worth it. 
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The Ultrasound-Guided Parecentesis

May 24, 2016

Sticking a needles into a patients abdomen based solely on physical exam is rarely, if ever, a good idea in the hemodynamically stable patient.  Learn how to use ultrasound to guide your paracentesis in this video:

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Getting Adequate Cardiac Windows

May 17, 2016

So you've heard about how awesome bedside echo is and how it can be used to quickly and accurately diagnose life threatening pathology, but you're not sure how to actually get those views.  Check out this video for some tips on how to optimize your echo views and save a life. 

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Optic Nerve Sheath Diameter

March 25, 2016

The optic nerve sheath diameter is a measurement that can help you rule in or rule out elevated intracranial pressure in your patient.  Learn how with this video:

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Measuring Pleural Effusions

March 5, 2016
I've had a few people ask me about actually quantifying pleural effusions.  Typically, I just eyeball the pleural effusions and categorize them as "causing problems" or "not causing problems", but if you need to find out exactly how much of that thoracic fluid is extrapulmonary, try the Balik or Remerand methods.  Not sure what those words even mean? Watch the podcast to find out. 
Oh, and if you don't know how to look for pleural effusions, let alone measure them, try this first
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Supraclavicular Nerve Block

February 16, 2016

Continuing on my latest nerve block binge, I'll be talking about the amazing supraclavicular brachial plexus nerve block.  This block, if performed correctly, gives anesthesia to the arm from the level of the lower part of the deltoid to the fingertips.  Think about using this block for complex lacerations, fractures, abscesses, or any other painful condition.  

As with any block, there are always bad things that can happen.  Don't lose sight of that needle tip, don't inject into a blood vessel, and don't cause LAST (local systemic anesthetic toxicity). 
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The Median Nerve Blcok

February 8, 2016

I'm passionate about pain control, and also passionate about how dangerous narcotics are.  I've been doing more and more of these nerve blocks and have found that the amount of narcotics I need to give for nerve-block amenable injuries/diseases dramatically decrease when I inject some lidocaine around that nerve.  Learn how to do a median nerve block with this video:

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The Sonographic Air Bronchogram

January 20, 2016

Air bronchograms are something that many of us, even if we don't know ultrasound, have heard before. They refer to a consolidated lung that surrounds small airways.  This finding can easily be seen on ultrasound and is highly specific for pneumonia.  Learn the difference between a dynamic air bronchogram and a static air bronchogram with this video: 

Need some further reading? Look no further:
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Block the sole with a posterior tibial nerve block

January 14, 2016

Have you ever had a patient with the foreign body or a laceration on the sole of the foot? Remember trying to numb it up?  It's awful and painful for the patient, and never seems to work all that well.  Enter the posterior tibial nerve block.  Learn it with this Podcast.

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Vascular Access Phantom DIY

December 23, 2015

I initially posted this video on my website (link) back in April, but since then I've gotten some feedback and messed around with it a bit, and wanted to post an update.  Enjoy!

Vascular access is such an important component of the treatment of ED patients.  Our nurses, paramedics and techs do an amazing job placing IV’s, but sometimes there’s that “difficult stick”.  I’ve found ultrasound to be immensely beneficial in situations in which vascular access is unable to be obtained by standard methods.  I’ve used it on numerous occasions when placing central lines, and over the past few years, I’ve found myself placing more and more US-guided peripheral IV’s.

One of the physicians at my shop (Jacob Hennings) went to the ACEP teaching fellowship a few weeks back and emailed me about this product called “Clear Ballistics.”  He stated that one of the other people there had been using it to make a DIY ultrasound-guided vascular access simulator.  As soon as I heard about this, I ordered a block of this ballistics gel, and started experimenting.  Here’s how I made it:

Items you’ll need to get started:
1. Ballistics gel
2. Small bread loaf pan
3. Drill bits
4. Countersink bit
5. Latex tubing
6. 2 flask funnels
7. Dowels
8. Drill
9. Safety goggles
10. Crock Pot
11. Knife
12. Syringe

Watch the podcast for full instructions, and let me know what you think!

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