Ultrasound Gel

People have been using POCUS to diagnosis shoulder dislocation for a while now, although it is far from standard of care in most places. We have seen that it is really accurate compared to xray, but this well-done study adds some important information to the existing literature. They measure the glenohumeral distance in an attempt to make a quantifiable cut-off point for dislocation. They also take a look at potential time savings of ultrasound compared to xray! https://www.ultrasoundgel.org/96 https://pubmed.ncbi.nlm.nih.gov/32111508

Deep learning is a branch of artificial intelligence that holds a lot of promise for point-of-care ultrasound, but we don't have much data on how it performs. The fearless investigators in this fascinating study train a deep learning algorithm to recognize sonographic anatomy of the upper extremity and then pit it against expert POCUS users to see who can interpret the images most accurately! https://www.ultrasoundgel.org/95 https://pubmed.ncbi.nlm.nih.gov/32181922/

Placing a tube thoracostomy (aka chest tube) is a very useful procedure but can have complications of injuring the diaphragm or intraabdominal organs. Traditionally, the location for placement is selected using anatomic landmarks to find the correct intercostal space. This study questions the safety of this traditional location by using point-of-care ultrasound to visualize diaphragm movement during respirations. Is this the start of ultrasound-assisted chest tubes? https://www.ultrasoundgel.org/94 https://pubmed.ncbi.nlm.nih.gov/32333800/

We are back with Part 2 of discussing POCUS research with renowned expert and researcher, Michael Gottlieb. More pearls, pitfalls, tips, and tricks to help you step up your POCUS research game. This is the final episode in this two-part special edition, and we wrap it up as always with some take home points! https://www.ultrasoundgel.org/93

We have reviewed a lot of POCUS articles on this podcast, but we don't often talk about the process of performing a research study. On this episode, we bring on world-class POCUS expert and researcher Michael Gottlieb to discuss the ins and outs of performing, publishing, and reviewing ultrasound research studies. This is Part 1 of 2. https://www.ultrasoundgel.org/92

For peritonsillar abscesses, sometimes you need imaging to make the diagnosis clear. Many turn to CT, but ultrasound offers an appealing alternative. A transcervical approach can be used which is likely less uncomfortable than the intra-oral method. This study looks at the implementation of a transcervical ultrasound protocol in a pediatric emergency department to see if it helps this population. https://www.ultrasoundgel.org/91 https://www.ncbi.nlm.nih.gov/pubmed/31713253

The FASH exam is not just a typo when trying to write about the FAST exam. FASH stands for Focused Assessment with Sonography for HIV-associated Tuberculosis (TB). This exam combines various body areas to look for evidence of TB. You can look for extra fluid (pericardial, pleural, ascites), enlarged abdominal lymph nodes, and solid organ lesions (spleen, liver). This has been described for a while, but there have not been many studies on how accurate it might be...until now. https://www.ultrasoundgel.org/90 https://www.ncbi.nlm.nih.gov/pubmed/31904699

It's not what you think - POCUS is not going to be used to diagnose a GI bleed. However, perhaps it can be used to risk stratify this diverse group of patients. These authors had the idea to check IVC, echo, and LVOT VTI to see if it could help predict which patients are going to have adverse events from their bleed. https://www.ultrasoundgel.org/89 https://www.ncbi.nlm.nih.gov/pubmed/31379015

COVID-19 is here, there, and everywhere. Mike Mallin joins in to examine the first published reports on POCUS being used on the front lines. We discuss the sonographic findings and potential uses during this pandemic. https://www.ultrasoundgel.org/88

We know that point of care ultrasound can be used to find evidence of urinary obstruction in patients with renal colic from a kidney stone. However, it is not clear how to put this into practice. Who should get an ultrasound? Who needs further testing after ultrasound? This article poses one protocol to see if it can help save time and money in the emergency department. https://www.ultrasoundgel.org/87 https://pubmed.ncbi.nlm.nih.gov/31661942

A focused cardiac ultrasound is commonly used in the evaluation of patients with possible pulmonary embolism (PE). Based on the literature to date, we know that this can be helpful for ruling in signs of right heart strain. On the other hand, so far, this focused exam has not been that helpful in ruling out PE. These authors try to fix that by optimizing the sensitivity of the exam in a population with abnormal vital signs. https://www.ultrasoundgel.org/86 https://pubmed.ncbi.nlm.nih.gov/31562679

It is an age-old question - short or long axis? Using ultrasound guidance for internal jugular vein cannulation is now fairly standard. There are a lot of opinions regarding if it is best to visualize the target in short axis (cross section) or long axis (parallel to the vein). There are certainly benefits to both. This episode features a prospective randomized trial that attempts to put an end to this debate. https://www.ultrasoundgel.org/85 https://www.ncbi.nlm.nih.gov/pubmed/31230925

Acute aortic syndromes such as aortic dissection, aortic aneurysm, penetrating ulcer are tricky. No one wants to miss these deadly diseases, but we also don't want to test everyone who has the slightest sign of this wily diagnosis. Point of care ultrasound can detect signs of aortic pathologies, but there haven't been any good studies to determine if this is accurate or safe....until now. https://www.ultrasoundgel.org/84 https://www.ncbi.nlm.nih.gov/pubmed/31226214

Back with more blocks in Part 2. Mike and Mike continue to explore, discuss, and laugh about the evidence for ultrasound-guided regional anesthesia for acute pain management. https://www.ultrasoundgel.org/83

Everyone who has ever done one knows that ultrasound guided blocks are great. They seem to help patients, they are fun to do, but are they supported by the evidence? Mike Stone joins in on this two part, special edition dive into the studies out there for performing ultrasound guided regional anesthesia for acute pain. https://www.ultrasoundgel.org/82

Speckle tracking is a relatively new ultrasound technology that lets you graph the movement of tissue over time. We know this can be useful to look at cardiac function, but no one dared to try it out on the lung...until now! The idea here is that by using speckle tracking on the pleural line, there might be a higher accuracy in detecting pneumothorax on ultrasound! It sounds crazy...but maybe it's just crazy enough to work. https://www.ultrasoundgel.org/81 https://www.ncbi.nlm.nih.gov/pubmed/31359081

A focused echo can go a long way in a patient with a suspected pulmonary embolus (PE). It can be especially valuable in those that are so sick and unstable that you need answers right away. In this way, point-of-care echo has been shown to help to diagnose submassive and massive pulmonary emboli by identifying signs of right heart strain. Echo parameters such as right ventricle diameter and right ventricular function (such as in TAPSE) are often part of the evaluation, but these are not as accurate as we would like. These authors propose a new doppler marker of a submassive or massive PE- enter the Early Systolic Notching pattern. https://www.ncbi.nlm.nih.gov/pubmed/31056367

Suspected acute heart failure is a great reason to use point-of-care ultrasound. It can tell you in seconds if this patient is up to their neck in pulmonary edema. Knowing that interstitial edema is more common in dependent areas of the lung, one would think that the lateral areas of the lung fields would be most sensitive for the diagnosis. Likewise, if there is enough pulmonary edema to fill up the anterior lung fields, this theoretically should be pretty specific. But is this actually true?! These authors investigate the issue. https://www.ncbi.nlm.nih.gov/pubmed/30665807

POCUS can be used to visualize small bowel obstruction (SBO) fairly easily. It has proven itself superior to xrays and has some advantages over CT, which for most people is the standard for diagnosis. Although initial work was quite promising, there were no large studies done confirming the accuracy of ultrasound for this purpose. In this podcast we examine the latest study (plus discuss a bonus similar one) that reveals maybe this is not as good as we thought! https://www.ncbi.nlm.nih.gov/pubmed/30762916

There are many ways that TEE can help you in cardiac arrest. One of these is to monitor your chest compressions to make sure they are actually doing what you want. Although this makes sense intuitively and is supported by animal models, there has not been a lot of evidence to date. This article takes a step in that direction by showing some data on outcomes in humans. https://www.ncbi.nlm.nih.gov/pubmed/30825552