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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Ultrasound-Guided Lumbar Puncture

December 18, 2015

Lumbar punctures can be one of the most rewarding and frustrating procedures we do.  If your patient has good landmarks it can be fairly simple, but what do you do if the proper landmarks elude you? 

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When is a Lung Point Not a Lung Point?

December 13, 2015

It's liberally quoted that the lung point is 100% specific for a pneumothorax, but I'm not sure thats actually the case. The two studies used to describe the specificity of a lung point were both published by the same ICU sonographer, and there have been a few case studies that report false-positive lung points.  Watch the video to learn more

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December 11, 2015

The ability to detect pneumothorax on ultrasound has been well described, as well as it's superior accuracy when compared to chest x-ray in supine trauma patients.  

Learn the technique with this 5 Minute Sono video
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TAP that - Use ultrasound to block the anterior abdominal wall

December 9, 2015

Adequately anesthetizing the anterior abdominal wall can be a challenge if you don't use ultrasound.  Watch this video and learn how to perform a Transversus Abdominus Plane block and lance that abscess pain free. 

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Need to anesthetize the neck? Block the SCP

December 7, 2015

Patients often arrive to the emergency department with pathology that is localized to the neck.  From abscesses to lacerations and central lines, local infiltration often is inadequate and painful. 

The superficial cervical plexus (SCP) block is a plane block that is relatively easy to perform and causes minimal discomfort to the patient.  Learn it here!
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