Ultrasound GEL

Supraclavicular vs Infraclavicular Subclavian Lines

Ultrasound has been a friend to central venous catheter placement for a long time. It's always there to make sure you are putting that line in the right place without causing problems. While this has been standard for internal jugular lines for years, it is only more recently that this has been proposed for subclavian lines. There is now ample literature supporting this latter practice, although as far as I know, it is not yet widely adopted. This article starts off with the assumption that ultrasound is being used for subclavian lines and now asks the question, which is the safer approach - above or below the clavicle?

https://www.ultrasoundgel.org/122
https://pubmed.ncbi.nlm.nih.gov/34231204/

Dedicated POCUS vs Primary Team

If you have listened to this podcast for any amount of time, you know how POCUS studies usually go. Someone does an ultrasound on something cool and then compares it to another test to see how good it is. Well this study is different. In this case, we are taking a tried and true application of POCUS (undifferentiated dyspnea) and comparing a dedicated ultrasound team's POCUS to the treating emergency team's POCUS. You can imagine the important implications for how we do and define POCUS!!

 

https://www.ultrasoundgel.org/121

https://pubmed.ncbi.nlm.nih.gov/34348868/

Ectopic Pregnancy

Can you believe we have never talked about ectopic pregnancy on this podcast?? Fortunately for you, a new research article allows our faithful hosts to dive into this core application of POCUS. These authors ask the practical question of whether or not a POCUS saves time in patients with ectopic pregnancy requiring an operation. The results may not be too surprising, but there are many twists and turns to this discussion - not unlike the course traversed from the uterus to the adnexa!

https://www.ultrasoundgel.org/120
https://pubmed.ncbi.nlm.nih.gov/34146921/

Quantitative LV Function in PEA

Ultrasound in cardiac arrest is a favorite topic of the GEL Team and thus, we are back to crack open a radical new concept in the field. Does the left ventricular function actually matter in patients that are arresting?? Current practice for many is to assess for the binary presence or absence of cardiac activity, but these audacious authors suggest that a higher LV systolic function could be associated with a greater likelihood of return of spontaneous circulation!

 

https://www.ultrasoundgel.org/119

https://pubmed.ncbi.nlm.nih.gov/34087419/

The exFAST

The FAST exam has been used in trauma for decades - so why is there still confusion on how to use it in pediatrics? Because kids are different than adults! This article takes a look at the associations between intraabdominal injury and the FAST, physical exam, and labs. The authors then combine the FAST with physical exam findings to create the exFAST, the FAST-enhanced physical exam! Our GEL Jr hosts deliver great pearls for the FAST exam and how we should be using it based on the evidence to date.

https://www.ultrasoundgel.org/118
https://pubmed.ncbi.nlm.nih.gov/32159909/

Peritonsillar Abscess

Do you use ultrasound for suspected peritonsillar abscess (PTA)? Some of us probably do, some don't - but what does the evidence say?? Does it help the clinician? and (dare we ask) does it help the patient? This paper is potentially the best data we currently have on the topic. Mike and special guest Kim Fender dive straight into the purulence of this fluctuant topic.

 

https://www.ultrasoundgel.org/117
https://pubmed.ncbi.nlm.nih.gov/32826122/

Optic Disc Elevation

GEL Jr coming in hot with the latest in neuro-ocular sonography - optic disc elevation! That's right - not optic nerve sheath diameter (ONSD), the actual elevation of the disc as seen on ocular ultrasound. Super cool new idea - lets how how it pans out in this pilot study!

 

https://www.ultrasoundgel.org/116
https://pubmed.ncbi.nlm.nih.gov/34051397/

Early Systolic Notching Part 2

Everyone's new favorite doppler marker for pulmonary embolism is back! We discussed the ESN (early systolic notching) when this concept was first introduced as a marker for large PEs, but now we have a prospective study that improves upon some of the limitations of the past article...or does it?

https://www.ultrasoundgel.org/115
https://pubmed.ncbi.nlm.nih.gov/33987920/

Pre-Pause Imaging in Cardiac Arrest

One of the gang's favorite topics - ultrasound in cardiac arrest! This article delves into the importance of "pre-pause imaging", getting that picture of the heart ready even before the compressions are stopped! This seems like an important part of minimizing pauses in CPR, but how convincing is this data?

https://www.ultrasoundgel.org/114
https://pubmed.ncbi.nlm.nih.gov/34223359/

Pediatric Intubation

The GEL Jr. team is back with another great use for pediatric POCUS! You might not have known that you can actually use ultrasound to confirm that your endotracheal tube is in the right place! But how good is it??

https://www.ultrasoundgel.org/113
https://pubmed.ncbi.nlm.nih.gov/32168296/