In the emergency room, shortness of breath and cough are common complaints, and chest x-rays are frequently ordered to evaluate for pneumonia.  However, what is the sensitivity and specificity of chest x-ray for pneumonia?  Is it a "rule out" test?  Is there a role for point of care ultrasound (hint...yes!)? 

We're back with some more exciting and beautiful echocardiogram images this month! This case and images are courtesy of Dr. Sarah Bunting, a rising ultrasound star within our program. Here she has obtained some uncommon images of an unfortunately more and more prevalent disease process. So grab your warm holiday drink of choice and enjoy our ultrasound of the month.

This is the inagural installment of our monthly series recognizing some great point of care ultrasound images performed in our department. This case will highlight some beautiful echocardiogram images obtained by the one and only Dr. Nicholas Fling, one of our chief resident physicians. Echo is a basic ultrasound skill that all EM docs need to have, and making sure your probe marker is set up appropriately on the screen is a great first step. The apical four-chamber view of Dr. Fling's would make anyone double check that!

In this Vodcast episode. Dr. Andrew Fried, ultrasound Jedi, give us a masterclass on placing ultrasound guided IVs.

We are extremely fortunate to have one of our fearless ultrasound leaders, Dr. Andrew Fried, lead us into the world of resuscitative transesophageal echocardiography at Maine Medical Center. In our recent grand rounds, he presented the latest cutting edge literature behind this technology and why its the right thing to do for our patients.

COVID19 has presented many difficult challenges in its diagnosis and managment. This is no truer than bedside lung evaluation. Personal protective equipment can be prohibitive of adequate lung ausculation and the use of a stethoscope is discouraged by some as it is considered a high risk fomite. Fortunately, point of care ultrasound (POCUS) continues to be an important tool in the emergency provider’s toolbox for decision support and risk stratification. It is quick to perform, easy to interpret, and may be done quickly at the bedside. To help us quickly understand the technique, findings and evidence behind lung POCUS for the COVID19 (+) or suspected patient, ultrasound fellow Dr. Christopher Allison has crafted us a high yield infographic.

Musculoskeletal ultrasound can be a powerful tool for the emergency provider. It can help diagnose acute and chronic painful conditions, evaluate dynamic movement, and assist in bedside procedures like a hematoma block. It is cost effective, accessible, lacks radiation, and can visualize fine details of local anatomy that xrays cannot (i.e. ligaments, bursa, tendons, muscles and nerves). This year’s ultrasound workshop at our Winter Symposium included various uses of musculoskeletal ultrasound (shoulder evaluation, evaluation of a suspected joint effusion, hematoma blocks/reductions, and tendon injuries). In this week’s post we bring you Dr. Nick Ashenburg’s presentation on the use of ultrasound for the evaluation of joint effusions.

Musculoskeletal ultrasound can be a powerful tool for the emergency provider. It can help diagnose acute and chronic painful conditions, evaluate dynamic movement, and assist in bedside procedures like a hematoma block. It is cost effective, accessible, lacks radiation, and can visualize fine details of local anatomy that xrays cannot (i.e. ligaments, bursa, tendons, muscles and nerves). This year’s ultrasound workshop at our Winter Symposium included various uses of musculoskeletal ultrasound (shoulder evaluation, evaluation of a suspected joint effusion, hematoma blocks/reductions, and tendon injuries). In this week’s post we bring you Dr. Gabriela Lopes presentation on the use of ultrasound for shoulder dislocation.

Musculoskeletal ultrasound can be a powerful tool for the emergency provider. It can help diagnose acute and chronic painful conditions, evaluate dynamic movement, and assist in bedside procedures like a hematoma block. It is cost effective, accessible, lacks radiation, and can visualize fine details of local anatomy that xrays cannot (i.e. ligaments, bursa, tendons, muscles and nerves). This year’s ultrasound workshop at our Winter Symposium included various uses of musculoskeletal ultrasound (shoulder evaluation, evaluation of a suspected joint effusion, hematoma blocks/reductions, and tendon injuries). We are excited to roll out this content to you in the coming weeks, starting with Dr. Fried’s presentation on the use of ultrasound for tendon injury.

Here’s comes another heaping helping of ultrasound highlights from our winter symposium’s echo extravaganza! In this serving, Dr. Mindy Lipsitz, MD shares some pearls about the suprasternal notch view to assess for trauma, coarctation, aortic root regurgitation, and aortic aneurysm.

Here’s comes another heaping helping of ultrasound highlights from our winter symposium’s echo extravaganza! In this serving, Dr. Heidi Kimberly teaches us how to identify and characterize the 5 E’s of echocardiography: effusion, ejection fraction, equality of the right and left ventricle, exit (aortic root) and entrance (IVC).

The apical four chamber view is a key window in obtaining the bedside echo as it helps assess both the size and function of the atria, and ventricles. Window shopping for this view can be tricky, however, as there are specific requirements for probe orientation. In this blog post and video, Dr. Christina Wilson helps us understand the subtleties of this window and how to troubleshoot for the perfect four chamber view.

We apologize that it has been so long since our last blog post . . . we were busy preparing for our annual Winter Symposium. What a fantastic year it was! It included an amazing point of care echocardiography extravaganza by the course’s ultrasound faculty. We covered core content, the 5 E’s of echocardiography, mastering the suprasternal notch, unlocking the apical four chamber view and tricuspid annular plane systolic excursion … phew! We are excited to roll out this content to you over the coming weeks, starting with Dr. Kring’s core content on point of care echocardiography.

The EFAST exam is an integral component of an emergency provider’s trauma evaluation. In the right hands, it has a specificity > 90% for intra-abdominal free fluid. There are some pitfalls, however, that can trick the provider into thinking a false positive represents free fluid. In this post, Dr. Gill and Dr. Kring help us improve our EFAST interpretation and recognize these “fake-outs.”

Hypotensive patients requiring volume resuscitation are a regular occurrence for emergency physicians. Clinicians are often faced with determining whether patients will respond favorably to IV fluids both before and during vasopressor administration. The ability for point of care ultrasound (including assessment for B lines and IVC collapsibility) to predict volume status and fluid responsiveness has mixed evidence. Here we explore the velocity time integral (VTI), a measurement that can be coupled with a passive leg raise to more accurately assess for true fluid responsiveness.

Coding patients in the community setting is difficult given constraints of man power, specialists, equipment, and other resources. Knowing how to code a patient well in the community is a skill all EM practitioners should master. In this post we review the priorities and pitfalls of coding in the community, with our guest Salim Rezaie.

Dr. Rachel Rempell is a pediatric emergency medicine physician in Boston, Massachusetts and is affiliated with Boston Children's Hospital. She is board certified in pediatrics, pediatric emergency medicine and completed an ultrasound fellowship with a focus on pediatrics.  We were fortunate to have her as a guest speaker for our grand rounds where she gave us a tour of the current landscape of pediatric point of care ultrasound in emergency medicine. 

An old mentor of mine liked to say "sometimes lungs are better seen than heard."  While he was referring then to good old fashioned chest xray, current literature clearly supports the use of bedside ultrasound as a valuable tool in evaulating the dyspneic patient.  In this lecture, Dr. Jacob Avila discusses the use of the bedside ultrasound in detecting pneumonia, pulmonary embolism, congestive heart failure, and pneumothorax. 

Still using propofol and brutacaine for shoulder dislocations?  There is a better way.  Bedside ultrasound for shoulder dislocations has been shown to reduce narcotic use, number of sedations, length of stay, cost, and radiation. Let's review the technique for shoulder ultrasonography and intra-articular injection of the glenohumeral joint.