Ultrasound GEL

Guest Michael Gottlieb, a world-class POCUS expert and researcher, discusses the process of ultrasound research study, emphasizing the importance of evidence-based practices, conducting comprehensive literature reviews, efficient study running, and navigating the path of research and publication in the field of POCUS.

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

Debate between short and long axis for ultrasound-guided internal jugular vein cannulation. Prospective trial aims to settle the issue. Two-person technique for stability. Study compares outcomes and complications. Practical considerations for each approach discussed. Potential benefits of long axis approach.

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