Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine
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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.
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Elastography is a new adjunct to real-time ultrasound imaging that overlays traditional B-mode imaging with a color graphic representation of tissue elasticity. Soft tissue infections are common presenting conditions in the emergency department, and elastography has the potential to help in diagnosis and treatment of evolving soft tissue infections as they progress from induration to fluctuant abscesses, but to our knowledge, no studies of elastography in superficial soft tissue have been published. We hypothesized that elastography would provide increased information regarding skin abscesses. ⋯ Elastography identified the tissue induration and some abscess cavities not seen on B-mode imaging. It offers a way to characterize abscesses that may be useful clinically, but more research is needed.
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The purpose of this study was to investigate the current practice of emergency physician-performed bedside ultrasound examinations in California and to assess differences between academic and community practice. ⋯ Most California EDs do not use bedside ultrasound. Although most EDs using ultrasound report that they follow ACEP emergency ultrasound guidelines, most do not have a QA program as recommended by these guidelines. Compared with community EDs, academic EDs are more likely to use bedside ultrasound, have physicians credentialed in ultrasound use, and have QA programs.