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Not a Stab in the Dark - Mastering the Ultrasound Guided Peripheral IV

Downeast Emergency Medicine

Key concepts for Ultrasound Guided IV placement LENGTH Always use long IV (1.88 Use a tourniquet when you LOOK for the vein as well as when you place the IV otherwise the pressure from the probe will compress the veins and you won’t find anything. 2012 Sep;30(7):1134-40 References Fields JM et al. 2012 Sep;30(7):1134-40.

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SAEM Clinical Images Series: What’s Coming Out of Your Eye?

ALiEM

On arrival to our emergency department, the patient expressed continued eye pain with bloody discharge as well as blurry vision from his right eye. Tonometry and ocular ultrasound (US) are generally not recommended as you could squeeze more liquid out of the eye or increase the intraocular pressure even more, pushing the iris further out.

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Subclinical hypothyroidism

Don't Forget the Bubbles

His thyroid ultrasound is normal, and thyroid antibodies are negative. Six months later, his weight and height remain normal, he still does not have a goitre and his thyroid ultrasound is unchanged. She has a normal thyroid ultrasound and negative anti-microsomal and anti-thyroglobulin antibodies. She also has a goitre.

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How to Manage Elderly Patient Pain without Opioids

ACEP Now

See below: Fascia iliaca Serratus anterior Erector spinae The risks of opioid medications, especially in the elderly, has been well described. published a study, “Safety and Pain Reduction in Emergency Practitioner Ultrasound-Guided Nerve Blocks: A One-Year Retrospective Study.” The pain scores decreased from 7.4 mean) to 2.8

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Don’t Forget the Orbeez!

Don't Forget the Bubbles

Abdominal ultrasound, used in 34 cases, was able to visualize a rounded intraluminal image corresponding to a bead in 28 patients. Point-of-care ultrasound may show well-demarcated, round, and hypoechoic material in the stomach and first part of the duodenum, though it can underestimate the number of beads present. Krisch et al.

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Don’t Forget About the IO in the Critically Ill Patient

RebelEM

CVC vs PIV The critically ill patient is often associated with pathology that makes IV access difficult such as shock state, hypovolemia, obesity, IV drug abuse, end-stage renal disease, cardiac arrest, as well as other conditions. 2012 PMID: 21893125. This study also showed the median time for IO placement was only 1.2 Resuscitation.

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Trick of Trade: Inflating the Esophageal Balloon of a Blakemore/Minnesota Tube without a Manometer 

ALiEM

A heavy alcohol drinker, who is well known to your Emergency Department, presents with altered mental status, except that he looks different this time. Additional trick: If the x-ray is delayed, you can pre-check with ultrasound [7]. 2012 Feb;33(1):46-54. PulmCrit Wee: Ultrasound-guided blakemore tube placement.