January 18, 2021

Case: A 51-year-old woman, with no pertinent past medical history, presented to the Emergency Department (ED) complaining of right hand pain after a large fragment from a wooden cooking spoon penetrated her right palm approximately 1 week ago. She reported immediately removing the splinter and starting old, previously prescribed amoxicillin prior to her visit. She was prompted to visit the ED after her pain gradually increased, affecting her ability to flex and extend her right fourth digit.

On physical exam, the patient was afebrile with all other vital signs within normal limits. There was significant tenderness localized to the base of the right fourth digit near the proximal interphalangeal (PIP) joint, associated with edema, ecchymosis, and erythema. While the patients right hand remained neurovascularly intact, significant restrictions in passive motion, including flexion and extension, was noted to the right fourth digit. On visual inspection, no foreign bodies were appreciated.

A radiograph of the right hand was ordered, which was negative for any acute abnormalities, including foreign body. However, due to the patients clinical presentation and the potential radiolucency of the suspected foreign body, a point-of-care ultrasound was performed.

November 19, 2020

Background Information: Central venous catheterization is a common procedure performed in the ICU for the purposes of drug administration and resuscitation. The subclavian vein is the more preferred access site given its fixed puncture location, ease for nursing access and low incidence of infections.1 Landmark guided catheterization has a widely variable success rate and has been shown to increase the risk of complications such as hematoma formation and pneumothoraxes.2,3 The use of real-time ultrasound guidance has thus led to more central lines being placed in the internal jugular and femoral lines, however there is substantial debate regarding its use in subclavian vein catheterization.4,5 The authors of this study sought to compare the efficacy and safety of static ultrasound-guided puncture with traditional anatomic landmark guided subclavian vein puncture.

November 16, 2020

Background Information:

US vs Landmark for Radial Arterial LinesUltrasound guided peripheral and central venous access has become more common while simultaneously decreasing complications and increasing first pass success. Landmark guided palpation has historically been considered the standard of care when placing arterial lines, however the use of ultrasound is challenging that notion as anatomic landmarks are not helpful in 30% of patients.1 Additionally, increasing obesity and hemodynamic instability can make radial arterial line placement even more difficult when using landmark-guided palpation alone. The literature comparing the different methods of arterial line placement is limited to two prospective studies. The first assessed second- and third-year emergency medicine residents while the second study evaluated only four emergency medicine attendings, all with extensive ultrasound training and experience.2,3 The authors of this study sought to compare radial arterial line placement using ultrasound vs landmark guided palpation performed by novice emergency medicine interns with respect to overall success.

October 10, 2020

From Oct 6th – 8th, 2020, Haney Mallemat (@CriticalCareNow) and his team put on an absolutely amazing online critical care conference called ResusX Rewired.  ResusX is a conference designed by resuscitationists to provide clinicians with the most up to date skills and knowledge to help make a difference in your patients' lives.  Haney and his crew made a combination of short-format, high-yield lectures, and completely customizable small group sessions with procedural demos seem easy.  There were so many high-quality speakers and pearls that I learned from this conference that I wanted to archive them here in one post for reference and to share with our readers/followers.

October 1, 2020

Background information: There are two popular blade shapes for video laryngoscopy, a standard-geometry blade comparable to a Macintosh blade and a hyperangulated blade. The standard-geometry blade permits both direct and indirect visualization during intubation, whereas the hyperangulated blade permits only indirect visualization. The hyperangulated blade is used with a rigid stylet, whereas the standard-geometry blade allows the use of a bougie if indicated. Proposed benefits of the hyperangulated blade include decreasing the need for head and neck manipulation. Previous research includes an observational study using emergency department data that compared the two blade shapes found no association between blade geometry and first-attempt success rates (Moiser et al.), but this was a single-center study with only 463 patients. Previous unadjusted data from the registry used in the current study by Driver et al. found that standard-geometry video laryngoscopy had a higher first-attempt success rate than video laryngoscopy using the hyperangulated blade (91 percent versus 80 percent, n=1,644) based on data from 2002 through 2012 (Brown et al.).
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