Ultrasound GEL

A Few Abstracts from WCUME 2017

Members of the GEL team recently traveled to beautiful Montreal, Canada for the World Congress on Ultrasound in Medical Education 2017. Amidst the great speakers, great friends, and wonderful education - we picked out a few interesting research abstracts that we thought would be interesting to discuss.

Variability in Interpretation of Cardiac Standstill

Ultrasound is used in cardiac arrest frequently. We know that it can provide some prognostic information regarding a patient's chance of survival. But before we go calling everybody dead based on our ultrasounds, we should make sure everyone agrees what constitutes "no cardiac activity". This articles takes a look to see the level of agreement among a group of physicians classifying point of care cardiac ultrasound clips as cardiac standstill or not.

Ultrasound in Skin and Soft Tissue Infection

Have you ever stabbed into an abscess only to have nothing come out? Have you missed an abscess because you thought it was just cellulitis? In theory, ultrasound should be able to help us here by finding that magical pocket beneath the skin that is just asking to be drained. Does the literature support this? Is ultrasound superior to the exam alone? This metaanalysis takes a look at the studies that have been done to find out.

Lung and Cardiac Ultrasound Protocol for Acute Heart Failure

Ultrasound can be helpful for diagnosing acute heart failure - mainly by looking for signs of pulmonary edema and poor systolic heart function. Previous results have shown that ultrasound is accurate for the diagnosis, but maybe you're worried that it takes too long. This article tries to test a simple and fast ultrasound protocol that can maintain accuracy in making the diagnosis.

TAPSE to Diagnose Pulmonary Embolism

Alright, we all know that TAPSE (tricuspid annular plane systolic excursion) is a fun word to say, but the question is whether or not it can be used in the emergency department to help diagnose someone with a pulmonary embolism. The TAPSE is a marker of right heart strain, and we know that PEs can cause right heart strain - so...it seems like a reasonable idea, right? Well this article takes a look to see if this is something that can be done in the ED and whether or not it is accurate for the diagnosis.

Ultrasound Associated with Delays in Chest Compressions

Ultrasound is commonly used in the resuscitations of patients in cardiac arrest. It can help to determine cardiac activity and etiologies of the arrest. Usually the ultrasound evaluation is performed during a pulse check. We know that we need to minimize pulse checks to maintain good perfusion - so is it possible that ultrasound causes further delays between chest compressions? This article says yes.

Inferior Vena Cava Collapsibility for Fluid Responsiveness

Ultrasound of the IVC is the people's volume responsiveness test. The idea is that you can non-invasively tell if a patient will benefit from getting more IV fluids. Everybody wants this to work so we can have a simple test to help us in critical situations. It is more reliable in mechanically ventilated patients with a fixed tidal volume but how about the non-intubated patient? Can we trust it?

FAST exam in Stable Pediatrics

The FAST exam is one of the founding fathers of point of care ultrasound. As ultrasound creeps into the pediatric world, it is being used in trauma patients to assess for intraabdominal injury. This article looks at what happens when you apply the FAST exam to a stable pediatric patient with blunt torso trauma. Spoiler Alert! - nothing happens. We discuss what this study shows us, how FAST can be used in pediatrics, and further directions of this modality.

Ultrasound Guided Nerve Block for Shoulder Dislocations

You are treating someone with a shoulder dislocation. You have a few options that can be used to help put it back where it belongs: A) Procedural sedation - the old standby. B) Intraarticular injection - some people love it, some hate it C) Relaxational maneuvers - sometimes feasible, and, last but not least D) Regional anesthesia - the new kid on the (nerve) block. This study compares procedural sedation to regional anesthesia with an ultrasound guided interscalene nerve block for the outcomes of pain and length of stay (and a few other things too).

Ultrasound for Abdominal Stab Wounds

The idea here is that some people that suffer the misfortune and inconvenience of being stabbed in the abdomen will require a surgical laparotomy. On the other hand, some will not. We don't want to miss the ones that do, but we don't want the latter to get unnecessary operations. If the wound does not penetrate so deep as to violate the peritoneum then there is low risk of intraabdominal organ injury. Instead of probing and exploring the wound which can be painful, perhaps ultrasound can offer a less invasive way of determining whether or not the peritoneum was violated.