Tuesday, December 21, 2010

Interscalene Block for Deltoid Abscess

Hi everybody...

Another installment in the Emergency Ultrasound Nerve Block Project. And I'm glad to announce we've starting Ultrasound Learning Seminars and are offering nerve block and general ultrasound procedures courses for clinicians who use point-of-care ultrasound. Check us out at ulscourse.com

Sunday, November 21, 2010

Femoral Nerve Block for Large Thigh Laceration

Another installment on regional anesthesia in the Highland ED. Enjoy!

Friday, November 12, 2010

Distal Sciatic (Popliteal) Block for a HUGE Foot Abscess

One of (hopefully) several upcoming posts where Arun Nagdev and I try to share our ultrasound-guided regional anesthesia experience at HGH. Enjoy!!!

Saturday, October 2, 2010

ULS Guided Regional Anesthesia 2010

So here's the audio and presenter's notes from my lecture on ULS guided regional anesthesia this year (split into parts for easier uploading/viewing). Feel free to email me (drmikestone at gmail dot com -- sorry for the spelled out version but trying to limit spam) with questions. And keep checking back on the site as we're launching a new education service for Emergency Physicians and other POC clinicians focusing on ULS guided regional anesthesia -- links will be up in the next 2-3 weeks.



Wednesday, May 26, 2010

Foreign Body Localization

Great case illustrative of the value of point of care ultrasound for suspected foreign body. 11 year old boy who yesterday caught his pant leg in a tree branch while running around the woods in his back yard. Today complains of leg pain and mother notes a small puncture wound to the leg. Brought to the ER "to get some antibiotics". Films did not demonstrate a foreign body (as you would expect given suspicion of wooden foreign body). Video demonstrates wound appearance, radiographs, ultrasound images, and use of ultrasound to localize foreign body with needle, cut down onto foreign body and extract. All that said, check out the size of that thing!!!

Monday, May 17, 2010

Ultrasound Guided Internal Jugular Catheterization, courtesy of Arun Nagdev, MD

Arun says you should use ultrasound to place IJ CVC's. Let him convince you...

Ultrasound to Assess for Pericardial Effusion, courtesy of Arun Nagdev, MD

You think you know everything about pericardial effusions on ultrasound? Arun doesn't think you do...

Ultrasound and Pneumothorax, courtesy of Arun Nagdev, MD

An introduction to the use of ultrasound for the identification of pneumothorax.

Intro to FAST exam, courtesy of Arun Nagdev, MD

A 15 minute or so lecture on the Focused Assessment with Sonography in Trauma.

Abdominal Aortic Aneurysm, courtesy of Arun Nagdev, MD

A 12 minute lecture on the use of bedside point-of-care ultrasound for the detection of AAA.

Tuesday, May 4, 2010

Valvular Pathology : Mitral Stenosis

Was talking to a bunch of residents who were skeptical that they'd be able to pick up on valvular pathology doing a bedside echo. So here's the first of what will be a few posts on valvular heart disease for the EM and Critical Care physician.

Mitral stenosis usually results from rheumatic carditis (though there are, of course, a number of other causes) and most commonly presents decades later with atrial fibrillation (due to LAE), embolic events (due to afib), hoarseness (compression of recurrent laryngeal due to LAE), or hemoptysis (secondary to pulmonary HTN). TEE is more accurate for estimating gradients and judging severity of disease, but TTE is just fine for making the diagnosis at the point of care.

Hallmarks are left atrial enlargement, thickening and restrictive motion of the mitral valve, and atrial thrombus. On a parasternal long or apical 4 chamber view, a characteristic "elbowing" of the anterior mitral valve leaflet (AMVL) is seen as the valve apparatus opens during diastole but the leaflet's tip is tethered at the valve orifice. Clip below is apical oblique with left side of heart on right side of screen (note the elbowing of the AMVL and the biatrial enlargement in this patient with longstanding mitral stenosis):

A parasternal or subcostal short axis view will demonstrate thickening of both anterior and posterior mitral valve leaflets as seen here:

Also M-mode can demonstrate anterior motion of the posterior mitral valve leaflet during diastole as it is tethered to the AMVL.

Grading severity and estimating mitral valve area is best done using Doppler estimation of the pressure gradient between LV and LA, and while not extremely complicated is beyond the focus of this blog and will not be covered here.

Wednesday, March 24, 2010

Blocks Unblinded

A trimmed-down, < 10 minute, youtube-compliant Quicktime version of my lecture on ultrasound guided regional anesthesia.

Head and Neck Ultrasound in the ED

Am posting a Quicktime version of my upcoming lecture at AIUM 2010 in San Diego on Head and Neck sonography in the ED.

Sunday, January 31, 2010

Glenohumeral Injection

This is an awesome instructional video on intra-articular glenohumeral injection for reduction of shoulder dislocations done by Mikaela Chilstrom, MD -- one of the SUNY/County ultrasound fellows. Check it out and stop sedating people in the midst of our propofol shortage! Narration by Brian "The Voice" Baker, MD.


Welcome to the Point of Care Ultrasound blog. My hope is to inspire active learning and discussion in a forum for exchange of ideas on the use of ultrasound by clinicians at the patient's point of care (ER, ICU, OR, wards, clinics, pre-hospital, austere, etc.) My hope is to post something whenever time permits, and to include images, videos, lectures and links to references that can help others learn more about the many advantages of incorporating POC ultrasound into clinical practice.