Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine
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Randomized Controlled Trial
Ultrasound guidance versus electrical stimulation for infraclavicular brachial plexus perineural catheter insertion.
Electrical stimulation (ES)- and ultrasound-guided placement techniques have been described for infraclavicular brachial plexus perineural catheters but to our knowledge have never been previously compared in a randomized fashion, leaving the optimal method undetermined. We tested the hypothesis that infraclavicular catheters placed via ultrasound guidance alone require less time for placement and produce equivalent results compared with catheters placed solely via ES. ⋯ Placement of infraclavicular perineural catheters takes less time, is more often successful, and results in fewer inadvertent vascular punctures when using ultrasound guidance compared with ES.
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Patients with penetrating trauma or field injuries are commonly encountered by emergency physicians. Clinical examination by inspection or palpation can detect superficial foreign bodies (FBs), and radiographs can detect radiopaque FBs. However, soft tissue FBs can be easily missed. The aim of our series was to evaluate the role of high-resolution sonography in detection of soft tissue FBs. ⋯ High-resolution sonography is a very sensitive tool in diagnosis of soft tissue FBs. It also helps the surgeon with accurate localization, permitting easy removal.
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Case Reports
Clinical utility of low-volume ultrasound-guided interscalene blockade: contraindications reconsidered.
The purpose of this series is to describe cases in which ultrasound guidance was used to allow patients to receive the benefits of regional anesthesia while safely circumventing traditional contraindications to interscalene blockade (ISB). ⋯ Although further studies are warranted, we report on 3 cases in which ultrasound guidance was used to allow patients to receive the benefits of regional anesthesia while safely avoiding standard contraindications to ISB. Ultrasound technology may allow providers to perform low-volume brachial plexus blockade while avoiding issues related to phrenic nerve blockade and systemic local anesthetic toxicity.
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Case Reports
Video analysis of accidental arterial cannulation with dynamic ultrasound guidance for central venous access.
Accidental arterial cannulation during ultrasound-guided central venous cannulation is rarely reported and should be much less likely with dynamic guidance. Although accidental arterial penetration with the needle may occur periodically without notice and with little harm, actual arterial dilation and line placement may result in serious complications. ⋯ The short-axis approach, as seen in this series, can provide a false sense of security to the practitioner and allows for potentially dangerous accidental arterial cannulation. In the setting of critically ill patients, it may be prudent to not only visualize the entire path of the needle with the long-axis approach but also confirm correct cannulation by tracing the guide wire in the long axis before line placement.