Ultrasound GEL

Carotid Flow Time for Fluid Responsiveness

Fluid responsiveness has been all the rage in emergency and critical care medicine. Trying to determine which patients will benefit from fluids or how much fluids is a daily struggle for providers. However, every new measurement or technique to quantify a patients possible responsiveness to fluids has been riddled with problems. Is carotid flow time, the holy grail that we have been waiting for? This study dives into the use of carotid flow time in an ICU patient population and attempts to answer if flow time can predict fluid responsiveness.

FAST for Hemorrhage from Pelvic Fracture

The FAST exam is tried and true for trauma, but in the past it hasn't been super useful for patients with isolated pelvic fractures. This study teases out a very sick subset of this population - patient who have significant hemorrhage associated with their fracture. The question is how well can the FAST identify intraabdominal hemorrhage in these people. The authors' idea is that if the FAST can find intraperitoneal blood, it might help determine who would benefit from REBOA instead of laparotomy.

Speckle Tracking for Acute Coronary Syndrome

Speckle tracking? Is that the technology that the government uses to mine data from your phone?! No - totally different! This is an ultrasound technology that recognizes tiny specks in the myocardium, allowing for a measurement of the movement of the heart wall. This has the potential to quantify the contractility of different parts of the heart, and therefore can be used to help diagnose numerous cardiac pathologies. At this time, not many people are using this in the emergency department. This is the first study to take a look to see if this is feasible and if it is accurate in diagnosing patients with acute coronary syndrome.

Small Bowel Obstruction

Ultrasound was made for the diagnosis of small bowel obstruction. It loves when air filled things are turned into fluid filled things - its helps us see it better. When the bowel gets backed up and distends with digested cheeseburgers, ultrasound is there to save the day. As easy as this may seem, it has not been well studied. There are a few small studies that show it can be accurate compared to a CT, but without a large body of evidence - a lot of people are (quite reasonably) unwilling to put their faith in it. Well, we can't say this study is going to turn all that around, but its one more piece of the puzzle of figuring out how we can use POCUS for this diagnosis.

Cardiac Arrest Protocol for Shorter Pauses in CPR

Are you sick of hearing about ultrasound and cardiac arrest? Do you think to yourself - "Why can't everyone just do it my way?." Well - for better or for worse (we think for the better), there are going to be more and more ultrasound and cardiac arrest articles. The reason is that point of care ultrasound can help so much in this situation, yet - it has also been shown to put people at risk for longer times without CPR. So what do we do? This article presents the CASA exam, a cardiac arrest ultrasound protocol, as a way to standardize the exam and (hopefully) minimize pauses in CPR.

A Pediatric Cardiac POCUS Protocol

The pediatric literature for point of care ultrasound seems to lag behind that of adults. However, it has made some incredible strides to show that this is a tool that is not be neglected in our younger patients. Although point of care ultrasound is used routinely in adults, it may not be as frequently employed in the pediatric emergency department. Clearly, there are differences in cardiac pathology encountered in pediatrics, but the ultrasound can still have great utility. The authors of this paper seek to increase the use of cardiac POCUS by collaborating with cardiologists to create a focused cardiac ultrasound protocol. They collect data to see what happened to POCUS use after they institute this protocol and to see how accurate these scans hold up in kids!

The Effect of POCUS on Abscess Treatment Failure

We know that ultrasound can be used to diagnose a superficial cutaneous abscess. That is NOT what this study is about. Forget diagnosing! What about actually helping your patients stay out of the emergency department? These authors performed this study with the hypothesis that using POCUS during the treatment of a superficial abscess might decrease the failure rate of the incision and drainage. That means ultrasound could help prevent patients from requiring additional treatment! They aren't messing around with retrospective chart reviews either - this is a real live randomized controlled trial.

POCUS in Hypotension

Well the dust has somewhat settled from the initial explosion that this article made when it first hit street corners everywhere. The authors here took on an important question - does point of care ultrasound make a difference in mortality when applied to patients in shock? [SPOILER ALERT] It led to quite a stir when the trial concluded that (I'm paraphrasing here) - "POCUS doesn't help people". Although that conclusion may or may not be the case, this study was a well performed randomized controlled trial. Therefore, you need to know about it and where to go from here.

POCUS Rounds in the ICU

We know that POCUS can be used in making many diagnoses in the critically ill patient. It also can help guide management. So why not perform it every day on every patient? That is the idea behind this article on POCUS rounds in the ICU. These authors compare patients who received a daily POCUS to those who did not - with real patient-centered outcomes! Is it too good to be true? Is a daily POCUS rounds something you should be doing in your ICU?

The RUSH Exam in Polytrauma

The RUSH exam is a family favorite. It's a reliably easy to recall hypotensive protocol that uses ultrasound to help determine the etiology of a patient's shock. Well here's a new idea - trauma patient's can be in shock too, right? So maybe we should perform a full RUSH exam instead of just a measly EFAST? Well...hold your horses there kiddo, there may be more to think about with this one.