Ultrasound GEL

SHoC-ED & the Erector Spinae Block

In October 2018, an all-star group met during the Irish Association for Emergency Medicine annual conference to talk about point-of-care ultrasound. The result was a convivial discussion of a few key papers and topics, packed with pearls and perspectives. In part 1 of 2, the group talks about the landmark original SHoC-ED trial and performing the erector spinae plane block for rib fractures.

The Impact of POCUS on Resus Effort & Outcomes in Arrest

It is great to see more and more research on ultrasound in cardiac arrest. Although many people are already using this, there is still much work to be done to tease out the details of how exactly POCUS should affect our decision making. Here is a nice study that looks to see if ultrasound is associated with increased resuscitation efforts or better survival outcomes. https://www.ncbi.nlm.nih.gov/pubmed/31205842

Ocular POCUS of Retinal Detachment, Vitreous Hemorrhage, and Vitreous Detachment

They say seeing is believing...what about seeing a study about a machine that listens in order to see an organ that itself is used to see? Most scholars agree this too is believing. Of course, we are (in a convoluted way) referring to ocular ultrasound. Historically a great party trick, can this modality accurately diagnose visual problems in the emergency department? It's been done before, but it hasn't been done to this degree. Sit back, relax, and visualize the latest in ocular POCUS research. https://www.ncbi.nlm.nih.gov/pubmed/30977855

The Future of POCUS Research

The annual conference of the Society of Clinical Ultrasound Fellowships (SCUF) is an incredible opportunity to converse and interact with many leaders in point-of-care ultrasound education and research. We took advantage of having so many brilliant people in one place to ask them all a few question about what they think are the next steps in POCUS research.

FemInEM and Ultrasound GEL Co-Podcast

Resa and Mike team up to discuss important happening at SCUF 2019 Annual conference. Guest stars Nova Panebianco and Sara Damewood!

Unselected Patients

We use ultrasound a lot. Sometimes we find things that are not clearly related to the reason the patient came in. The prevalence of these incidental findings relates to the usefulness of the diagnostic test. These authors take the bull by the horns, randomly whole-body-POCUS scanning emergency department patients to see what sort of findings might pop up. But should disease prevalence change our use of the tool? https://www.ncbi.nlm.nih.gov/pubmed/30587153

POCUS in the Reduction of Distal Radius Fractures

Fractures of the distal radius are pretty common among people who choose not to break their fall with their face. Sure - it's not hard to see these on xray, but is there a better way? Ultrasound is great for finding fractures, but what about being able to guide the reduction? This has been shown to be useful in a pediatric population, but this study looks at a population of adult patients in the emergency department to see just how accurate ultrasound is for determining if the pieces have been put back together. https://www.ncbi.nlm.nih.gov/pubmed/30191190

TEE to Shorten Compression Pauses in Cardiac Arrest

TEE has been heralded as the latest and greatest way to monitor a cardiac arrest resuscitation. The advantages include continuous monitoring of cardiac activity, ability to evaluate efficacy of chest compressions, and better evaluation of etiologies of the arrest. Although many places are using it currently, there is not much evidence to support these theoretical benefits. What we do know is that a few studies have shown that transthoracic ultrasound leads to prolonged pauses in cardiac arrest. This study aims to see if TEE is the solution. https://www.ncbi.nlm.nih.gov/pubmed/30773413

Integrated Lung Ultrasound for Acute Decompensated Heart Failure

Many ultrasound enthusiasts have been using point of care ultrasound to assist in the diagnosis of acute decompensated heart failure, but it has not been widely adopted. It has been shown by many studies that ultrasound can visualize pulmonary edema easily so that treatment can be started quickly. However, some still cling to their chest xrays and their natriuretic peptides, just hoping it won't lead them astray. Well this trial aims to prove the superior accuracy of lung ultrasound combined with clinical assessment over chest xray and pro-BNP (also combined with clinical assessment). Hold onto your hats, because there is a lot we can learn from this well done randomized controlled trial of over 500 patients! https://www.ncbi.nlm.nih.gov/pubmed/30690825

POCUS in Preeclampsia

Point of care ultrasound can be used for a great many things, but I don't think many people grab for the probe when a patient comes in with suspected pre-eclampsia. However, we know that pre-eclampsia can lead to pathophysiology that is readily identified on ultrasound - things like interstitial edema, cardiac dysfunction, and increased intracranial pressure. This study takes the first step by examining patients in pre-eclampsia and determining how often you might find something if you go a lookin. https://www.ncbi.nlm.nih.gov/pubmed/30211771