Moving your probe while using color flow is rookie move. It creates motion artifact (a screen-wide flash of color), which obscures the flow you are actually trying to observe or the new area you are trying to examine. Remember to hold the probe still and look like a pro the next time you save color flow images.
WTF is scanning efficiency? It’s improving your image acquisition skills, so you get the right images faster. Why does this matter? Let’s be honest. On a busy shift are you likely to use ultrasound if it takes you awhile to get images…?
Now let’s talk about tightening up your right upper quadrant skills. We scan the right upper quadrant a lot in the ED; kidney, FAST, gallbladder, IVC, pleural effusion, etc. Everyone of these scans can be improved by knowing three simple landmarks. The anterior, mid, and posterior axillary lines are your window to scanning efficiently.
In the anterior axillary line is the gallbladder. In the mid axillary line you’ll find the IVC. In the posterior axillary line is the kidney. Because these three structures are stacked anterior to posterior in this order, you can guide your probe movement accordingly. If you’re looking for kidney and see gallbladder, simply sweep or fan posteriorly. If you’re looking for gallbladder and see IVC, just sweep or fan anteriorly. It’s as simple as that. When you’re looking for a structure, your movements should be purposeful and based on relative anatomy. Now that you know the right upper quadrant’s sonographic organization you can make purposeful movements guided by the surrounding anatomy to get images faster.
Happy scanning!
Ultrasound for suspected thoracic dissection is an excellent tool to decrease time to diagnosis and treatment for this high mortality diagnosis. When scanning for suspected thoracic dissection, combine a parasternal long view with an abdominal aorta view for maximum sensitivity. Start with the parasternal view to look for dilation of the aortic root > 4 cm or a visible dissection flap. You should also look for a flap in the descending thoracic aorta (found just deep to the left atrium). A quick peek at the abdominal aorta can also give you valuable information. If there is visible dissection flap in the setting of chest pain, this suggests there’s also a thoracic dissection. If you have a positive scan for dissection that has fluid around the heart, this is extra bad and resources should be mobilized ASAP. Just like any test, you have to know its limitations. With sensitivities ranging from 77-96% it’s not a sufficient rule out test for dissection. Think of ultrasound as a rule in test that will save time to diagnosis and treatment for this life threatening condition, so pick up the probe the next time you think thoracic aortic dissection.
Even time you use too much depth a kitten dies…. or you greatly reduce your image quality and image the bed instead of the patient. Not only does it shrink the size of what you’re looking at, but it also moves your structure of interest out of the focal zone (you know the area of highest image resolution in the mid field of the ultrasound screen). Plus it adds poor quality images to the patient’s chart with your name, so don’t do it and think of the kittens.
Happy scanning everyone!
Know your right from left heart. In a perfect world probe positioning would be right every time and you’d just know the right heart is on screen left. However no one is perfect and it’s important to know your right from left heart to prevent errors like calling right heart strain when there isn’t. Here are some tips to help (even when your image is flipped like this one):
Happy scanning everyone!
Hemodynamically unstable, sick patient have high mortality and morbidity. Their physical exam findings can be misleading and the diagnosis still broad or unclear even after examination. When time counts and your patient is sick, bedside ultrasound can quickly make the diagnosis to help you provide appropriate and definitive care when it matters most. This is the basis for the SonoSave series, which examines ultrasound saves and the critically ill patients alive today because of point of care ultrasound.
Ultrasound is a lifesaver and luckily for a recent patient I mean this literally. Thanks to the early use of ultrasound a life was saved that would have been lost. A critical diagnosis was made within 5 minutes of arrival, preventing investment of precious time in ineffective treatments or delaying definitive care and making me look real slick in the process. The patient was successfully treated and admitted to the ICU. When I walk into work the next day, I find out the patient is not only alive but sitting up in bed talking to the team! With some simple ultrasound views and less than 2 minutes, the direction of our treatment completely changed and a man lived to see his family that I doubt would have otherwise. Two minutes to save a life… that’s some good stuff and even better ultrasound! These are the moments that make medicine worth it.
That Feeling When You Walk Out of Your Shift After A Good Save Continue reading SonoSave – It’s Just Sepsis
Everything in the you need to know about the eFAST in 2 minutes or less…
Heart
Continue reading Life in the eFAST Lane: Sonography for Trauma (Part 3)
The latest SonoMojo ultrasound cheat sheet is here! The Ocular Ultrasound Cheat Sheet is a brief review of ocular ultrasound and it’s applications. This and our other great Cheat Sheets are perfect for a quick review before performing a scan, teaching others, or as an overview of ocular ultrasound before diving into the Ocular Ultrasound Module.
In case you haven’t heard… Ultrasound Cheat Sheets are all the basic info you need to review before performing (or teaching) a specific ultrasound scan. They’re 1-2 pages long and consist of an brief check list of information on the application, image acquisition, and interpretation of a scan.
Be sure check out SonoMojo’s latest addition to the Ultrasound Cheat Sheets Collection, ocular ultrasound!
The Case
There are a few cases I could talk about… Ultrasound guided LPs have turned out to be a surprisingly useful skill. Lucky for you, I’ve restrained myself.
The first time I heard about ultrasound guided LPs was during a spectacular yearlong ultrasound elective in medical school. I was sitting in the doctor’s pod with THE ultrasound attending of ultrasound attendings. He casually asked “Have you ever heard of ultrasound guided LPs?” Never. “Do you want to see one?” Obviously. He explained how ultrasound guided LPs follow the principle of “Measure twice. Cut once.” He spent a minute (and I mean literally just one minute) visualizing the spinal landmarks and marking them on a somewhat altered, seriously chunky patient. He proceeded to get the LP in one stick! I remember thinking he was a wizard in that moment, a wizard who uses ultrasound to elevate patient care to another level; and that I want to be the badass attending that gets LPs on obese, altered patients in one stick. I had to learn this skill… Continue reading Getting to the Point of Ultrasound Assisted Lumbar Punctures