Are two planes better than one? Creagh, Mike, and Jailyn investigate a paper on biplane technology for placing central venous catheters. https://www.ultrasoundgel.org/165 https://pubmed.ncbi.nlm.nih.gov/37742018/

In this Bonus Cut author interview, Zack and Mike go off the rails by interviewing the author of a case series describing a fascinating and mysterious procedure - the transgluteal hydrodissection! Guest Gabe Rose gives us the low down of how this nerve block alternative might be the way to go to help a radicu-lous amount of patients. https://www.ultrasoundgel.org/164 https://pubmed.ncbi.nlm.nih.gov/36933988/

The GEL Jr team strikes back with a fascinating topic - using POCUS to guide response in the treatment of Crohn's disease! Join the gang as they peristalse their way through an article describing this inflammatory idea. https://www.ultrasoundgel.org/163  https://pubmed.ncbi.nlm.nih.gov/32453126/

In this Father's Day Special, Mike interviews his old man about the state of point-of-care ultrasound in general surgery. All sorts of learning ensues. https://www.ultrasoundgel.org/162

It's been a while since we talked about Venous Excess Ultrasound, aka VEXUS. There is still a lot of buzz around this concept, but not a lot of honey (honey is evidence in this metaphor). Ross Prager, international friend to POCUS researchers everywhere, joins Mike to discuss what's new and where this is going. https://www.ultrasoundgel.org/161

Part 2 of the discussion with Rachel Liu and Cian McDermott for Yale Emergency Medicine podcast day. Now the banter turns to a favorite topic: POCUS in cardiac arrest - is there a right or wrong way to do it? https://www.ultrasoundgel.org/160 Sponsor: Echonous

Creagh and Mike were invited to speak at the first ever Yale Emergency Medicine Podcast day! They join their old buddies Rachel Liu and Cian McDermott to discuss podcasting and POCUS in cardiac arrest. This is part 1 of 2.  https://www.ultrasoundgel.org/159 Sponsor: Echonous

The GEL trio return to discuss an old idea made new again - the mitral annular plane systolic excursion, aka MAPSE. How good is it compared to other methods for estimating left ventricular function? https://www.ultrasoundgel.org/158 https://pubmed.ncbi.nlm.nih.gov/36933334/

In this Special Edition ep, Mike interviews the multi-talented Adaira Landry and Resa Lewiss. They share some of the wisdom they have gleaned from their experiences as physicians, mentees, mentors, authors, academicians, ultrasound experts, and humans. https://www.ultrasoundgel.org/157 https://www.harpercollins.com/products/microskills-adaira-landryresa-e-lewiss?variant=41082651443234

The GEL Jr. team is back and they have a bone to pick. What's the deal with using ultrasound for forearm fractures in kids? They examine a recent article on this topic from the New England Journal of Medicine. https://www.ultrasoundgel.org/156 https://pubmed.ncbi.nlm.nih.gov/37256975/

In September 2023, the GEL crew traveled to Portland, Maine to do some on-the-street reporting at the annual conference for the Society of Clinical Ultrasound Fellowships (SCUF).  What evolved was a series of incredible mini-interviews focusing on the different paths to ultrasound and the exciting new frontiers of ultrasound technology. This is Part 2 of 2. https://www.ultrasoundgel.org/155https://www.awakeandawarebend.com/a/2147793147/QULTuhF9

In September 2023, the GEL crew traveled to Portland, Maine to do some on-the-street reporting at the annual conference for the Society of Clinical Ultrasound Fellowships (SCUF).  What evolved was a series of incredible mini-interviews focusing on the different paths to ultrasound and the exciting new frontiers of ultrasound technology. This is Part 1 of 2. https://www.ultrasoundgel.org/154 https://www.awakeandawarebend.com/a/2147793147/QULTuhF9

Have you been PENG attention? This block is everywhere! In this episode, we talk about the preliminary data for the PEricapsular Nerve Group (PENG) block used for analgesia of acute hip fractures in the emergency department.

Bonus Cuts back again! Zack and Mike talk with guest Yale Tung-Chen about the POCUS vibe in Spain and his recently reviewed study on using doppler flow as a measure of right ventricular dysfunction in heart failure. https://www.ultrasoundgel.org/152

Mike flies solo and ventures into the wily world of artificial intelligence in clinical ultrasound. How well does the machine measure up to the expert when it comes to hemodynamic measurements with echo? https://www.ultrasoundgel.org/151 https://pubmed.ncbi.nlm.nih.gov/36835888/

To celebrate 150 episodes we are doing a deep dive into one of POCUS's most beloved applications - acute heart failure. We bring in echo expert Sean Hickey to help delve into the ins and outs of the hearts, the lungs, and the IVCs. https://www.ultrasoundgel.org/150

Another author-focused Bonus Cuts episode with Zack and Mike joined by the one and only Rob Farrow! Rob represents the research team behind the recently discussed US-guided trigger point article. Discussion ensues regarding the methodology, procedural pearls, and a strained Bob Dylan reference. https://www.ultrasoundgel.org/149

Another cutting edge topic! These insatiable investigators propose to use doppler waveforms from the common femoral vein as a marker of right heart dysfunction in heart failure patients. Novel? Certainly. Useful? We shall see! https://www.ultrasoundgel.org/148 https://pubmed.ncbi.nlm.nih.gov/37088380/

What if I told you that you could use ultrasound to find traumatic injuries to the vertebral arteries? I am not telling you that...yet. The team has some thoughts on this novel idea. https://www.ultrasoundgel.org/147 https://pubmed.ncbi.nlm.nih.gov/37087444/

The GEL Jr crew sets up shop at the 2023 P2 Convention in Washington, D.C. and interviews the leaders of this organization about its history, purpose, and future. https://www.ultrasoundgel.org/146 https://p2network.com

Hold onto your hats - the latest episode discusses an application for ultrasound that you have probably never even thought about doing! Ultrasound-guided trigger point injections - do they work?!

Virtual reality ultrasound?! It is here, and it might be a valuable educational tool. Special host Shawn Sethi, usual but still somewhat special host Mike, and definitely special guest ultrasound educator Suean Pascoe discuss the available evidence and their own perspectives on this innovative technology. https://www.ultrasoundgel.org/144

Can looking at the diaphragm with ultrasound help us understand a patient's respiratory status? This is one of the first papers to look at this question in an emergency department population. https://www.ultrasoundgel.org/143 https://pubmed.ncbi.nlm.nih.gov/36680779/

This is the second and final part of our episode on diversity, equity, and inclusion within the point-of-care ultrasound community. Guests Almaz Dessie and Javier Rosario lend their insights to the discussion of their articles and practical next steps. https://www.ultrasoundgel.org/142

Special guests Almaz Dessie and Javier Rosario join Mike, Creagh, and Jai to discuss diversity, equity, and inclusion specifically in the point-of-care ultrasound community. This is the first of a two part discussion that covers the recently published articles on this topic and what you can do to help these efforts. https://www.ultrasoundgel.org/141

Delia and Lianne take on the topic of pediatric gastric POCUS. Is it a helpful way to assess the effect of fasting prior to procedural sedation? Is fasting itself a helpful way to empty the stomach?? https://www.ultrasoundgel.org/140 https://pubmed.ncbi.nlm.nih.gov/32769837/

Vicki Noble is a veritable legend of point of care ultrasound. Zach and Mike are lucky enough to sit down with this proverbial fountain of wisdom and scoop some razor insights into the past, present and future of the field. We discuss Vicki's origin story, multi-disciplinary collaboration, hot takes on POCUS research, and the middle-age of POCUS. https://www.ultrasoundgel.org/139

This episode has been a long time coming! We're talking ultrasound-guided subclavian central lines, and a lot of people have opinions. Are they better than landmark? What should we teach learners? The GEL team discusses through the lens of this fascinating RCT. https://www.ultrasoundgel.org/138 https://pubmed.ncbi.nlm.nih.gov/35562246/

Here's a little bit about our podcast. You can find out more at UltrasoundGEL.org.

We can only go so long without talking about cardiac arrest! Here is the latest idea - using sonographic carotid compression to help determine if a pulse is present. Can it save time compared to manual palpation and thus help our patients? https://www.ultrasoundgel.org/137 https://pubmed.ncbi.nlm.nih.gov/35792305/

Another Bonus Cuts author interview - this time with Amy Zhou, Pediatric Emergency Medicine specialist and first author of the recently reviewed article on IVC collapse duration. Zach and Mike ask the hard questions about how this paper came to be and how we should be thinking about the IVC in our pediatric patients. https://www.ultrasoundgel.org/136

Pneumoperitoneum is usually bad news for patients, and it would be great to have a quick way to make this diagnosis. These authors ingeniously used ultrasound contrast software (without any contrast) to boost the accuracy of ultrasound for this pathology! https://www.ultrasoundgel.org/135 https://pubmed.ncbi.nlm.nih.gov/35204492/

New idea alert! Should we be using POCUS to guide nasogastric tube placement? Crazy? Unnecessary, you say? Well listen in to the discussion of this interesting randomized controlled trial designed to answer this burning question. https://www.ultrasoundgel.org/134 https://pubmed.ncbi.nlm.nih.gov/35834792/

In our second in the series of Bonus Cuts, Zach and Mike interview the illustrious Ryan Gibbons for his take on arthrocentesis and a discussion of his research in the field. What an exciting joint venture! https://www.ultrasoundgel.org/133

What do we do with IVC's in kids?! The GEL Jr squad tackles a fascinating article that might have the answer. These authors looked at the Inferior Vena Cava collapse duration in children with dehydration. Will this novel measurement help with figuring out who needs IV fluids? https://www.ultrasoundgel.org/132 https://pubmed.ncbi.nlm.nih.gov/32530838/

Part 2 of this Special Edition episode with Larry Istrail, author of the POCUS Manifesto. More great talk about POCUS, the physical exam, and ultrasound research. https://www.ultrasoundgel.org/131

In this Special Edition episode, Mike and Creagh interview physician, entrepreneur, and author Larry Istrail discussing his recent book The POCUS Manifesto! Awesome discussion of the ups and downs of implementing, teaching, and researching POCUS. Part 1 of 2. https://www.ultrasoundgel.org/130

If you take care of neonates, the last thing you need to worry about is vascular access! In this episode the GEL Jr. team discusses an article on using POCUS to confirm central catheter placement. Can it save these babies a few xrays? https://www.ultrasoundgel.org/129 https://pubmed.ncbi.nlm.nih.gov/35152306/

This clever study questions which cardiac view is best to obtain during a cardiac arrest. By using a simulated arrest scenario on living non-cardiac arrest patients, they compare the subxiphoid window and the parasternal long axis view in terms of speed and image quality. https://www.ultrasoundgel.org/128 https://pubmed.ncbi.nlm.nih.gov/35065867/

Jugular venous distention (JVD) is a classic physical exam finding taught for ages, but assessing it can be a challenge. Can ultrasound do a better job and therefore offer a non-invasive evaluation of the patient’s right heart pressures? This goal has been the pursuit of many ultrasounds before. This time we have a new vessel to assess and a nice reference standard (right heart cath)! https://www.ultrasoundgel.org/127https://pubmed.ncbi.nlm.nih.gov/34958600/

This is a Special Edition podcast which features the winner of a competition at the recent SAEM Sonogames! The challenge was to create the best infographic for a POCUS article of the team's choice. The winning team was from Boston Medical Center. This podcast is a brief discussion of the article and the graphic this talented team created. https://www.ultrasoundgel.org/126 https://pubmed.ncbi.nlm.nih.gov/33795166/

In the first of our new series of author interviews, hosts Zach Risler and Mike Prats interview the illustrious Felipe Teran. They discuss Felipe's take on our coverage of the Quantitative LV Function in PEA article (ep 119) as well as thoughts on ultrasound and cardiac arrest research in general. https://www.ultrasoundgel.org/125

In this episode, Mike and Jacob dive into an important intersection of musculoskeletal and procedural ultrasound - the ultrasound-guided arthrocentesis. People have been doing arthrocentesis without the help of ultrasound for a while, and most would agree it is feasible. BUT what about those smaller joints - like the wrist, elbow, and ankle? Perhaps that is where the greatest benefit would be in making sure your needle gets to the right place. These authors performed a randomized trial of this specific population to investigate this question. https://www.ultrasoundgel.org/124 https://pubmed.ncbi.nlm.nih.gov/34608713/

Intussusception is a big deal and an area where POCUS can potentially make a difference. The literature has been promising, but there hasn't been any definitive studies...until now? The GEL Jr hosts dive into this impressive prospective, multicenter, non-inferiority study and (much like an air enema) they try to get to the bottom of this question to reduce our impacted uncertainty. https://www.ultrasoundgel.org/123 https://pubmed.ncbi.nlm.nih.gov/34226072/

Ultrasound has been a friend to central venous catheter placement for a long time. It's always there to make sure you are putting that line in the right place without causing problems. While this has been standard for internal jugular lines for years, it is only more recently that this has been proposed for subclavian lines. There is now ample literature supporting this latter practice, although as far as I know, it is not yet widely adopted. This article starts off with the assumption that ultrasound is being used for subclavian lines and now asks the question, which is the safer approach - above or below the clavicle? https://www.ultrasoundgel.org/122 https://pubmed.ncbi.nlm.nih.gov/34231204/

If you have listened to this podcast for any amount of time, you know how POCUS studies usually go. Someone does an ultrasound on something cool and then compares it to another test to see how good it is. Well this study is different. In this case, we are taking a tried and true application of POCUS (undifferentiated dyspnea) and comparing a dedicated ultrasound team's POCUS to the treating emergency team's POCUS. You can imagine the important implications for how we do and define POCUS!!   https://www.ultrasoundgel.org/121 https://pubmed.ncbi.nlm.nih.gov/34348868/

Can you believe we have never talked about ectopic pregnancy on this podcast?? Fortunately for you, a new research article allows our faithful hosts to dive into this core application of POCUS. These authors ask the practical question of whether or not a POCUS saves time in patients with ectopic pregnancy requiring an operation. The results may not be too surprising, but there are many twists and turns to this discussion - not unlike the course traversed from the uterus to the adnexa! https://www.ultrasoundgel.org/120 https://pubmed.ncbi.nlm.nih.gov/34146921/

Ultrasound in cardiac arrest is a favorite topic of the GEL Team and thus, we are back to crack open a radical new concept in the field. Does the left ventricular function actually matter in patients that are arresting?? Current practice for many is to assess for the binary presence or absence of cardiac activity, but these audacious authors suggest that a higher LV systolic function could be associated with a greater likelihood of return of spontaneous circulation!   https://www.ultrasoundgel.org/119 https://pubmed.ncbi.nlm.nih.gov/34087419/

The FAST exam has been used in trauma for decades - so why is there still confusion on how to use it in pediatrics? Because kids are different than adults! This article takes a look at the associations between intraabdominal injury and the FAST, physical exam, and labs. The authors then combine the FAST with physical exam findings to create the exFAST, the FAST-enhanced physical exam! Our GEL Jr hosts deliver great pearls for the FAST exam and how we should be using it based on the evidence to date. https://www.ultrasoundgel.org/118 https://pubmed.ncbi.nlm.nih.gov/32159909/

Do you use ultrasound for suspected peritonsillar abscess (PTA)? Some of us probably do, some don't - but what does the evidence say?? Does it help the clinician? and (dare we ask) does it help the patient? This paper is potentially the best data we currently have on the topic. Mike and special guest Kim Fender dive straight into the purulence of this fluctuant topic.   https://www.ultrasoundgel.org/117 https://pubmed.ncbi.nlm.nih.gov/32826122/

GEL Jr coming in hot with the latest in neuro-ocular sonography - optic disc elevation! That's right - not optic nerve sheath diameter (ONSD), the actual elevation of the disc as seen on ocular ultrasound. Super cool new idea - lets how how it pans out in this pilot study!   https://www.ultrasoundgel.org/116 https://pubmed.ncbi.nlm.nih.gov/34051397/

Everyone's new favorite doppler marker for pulmonary embolism is back! We discussed the ESN (early systolic notching) when this concept was first introduced as a marker for large PEs, but now we have a prospective study that improves upon some of the limitations of the past article...or does it? https://www.ultrasoundgel.org/115 https://pubmed.ncbi.nlm.nih.gov/33987920/

One of the gang's favorite topics - ultrasound in cardiac arrest! This article delves into the importance of "pre-pause imaging", getting that picture of the heart ready even before the compressions are stopped! This seems like an important part of minimizing pauses in CPR, but how convincing is this data? https://www.ultrasoundgel.org/114 https://pubmed.ncbi.nlm.nih.gov/34223359/

The GEL Jr. team is back with another great use for pediatric POCUS! You might not have known that you can actually use ultrasound to confirm that your endotracheal tube is in the right place! But how good is it?? https://www.ultrasoundgel.org/113 https://pubmed.ncbi.nlm.nih.gov/32168296/

This Special Edition podcast covers not one - but 7 really important POCUS articles! These articles were selected by the Academy of Emergency Ultrasound (an academy of the Society of Academic Emergency Medicine) as the top articles from the past year. Here we briefly discuss the winningest articles from each of the categories! https://www.ultrasoundgel.org/112

We have talked about ocular ultrasound many times before - it certainly can be useful in identifying many acute ophthalmologic pathologies. But what about papilledema? We know that POCUS can be used to measure the optic nerve sheath diameter (ONSD), which dilates with increased intracranial pressure. So theoretically this should work well in patients with suspected increased intracranial pressure, such as those with idiopathic intracranial hypertension. The question now is how well does POCUS fare in finding papilledema compared to the good ol' fashioned physical exam? https://www.ultrasoundgel.org/111 https://pubmed.ncbi.nlm.nih.gov/33532756/

We have been ultrasounding hips for a while now. We know this modality is accurate for finding effusions. This can really help in cases of suspected septic arthritis. Unlike patients with this disease, this study takes multiple steps forward. First it asks the question - "Does point-of-care ultrasound (POCUS) in the emergency department lead to a faster diagnosis?". Then it goes further by trying to determine whether or not POCUS can lead to earlier treatment as well. Fascinating results from a really hip study! https://www.ultrasoundgel.org/110 https://pubmed.ncbi.nlm.nih.gov/33000078/

In this Special Edition podcast, Mike is joined by POCUS leaders and educators Nova Panebianco and Cameron Baston to discuss their recent publication on interdepartmental collaboration with ultrasound. They discuss their process for creating a combined fellowship and share additional pointers in achieving mutually beneficial relationships between departments. https://www.ultrasoundgel.org/109 https://pubmed.ncbi.nlm.nih.gov/30592332/

Acute chest syndrome is such a great application for lung ultrasound, especially in pediatrics where we do everything we can to dodge the harmful affects of ionizing radiation. We have covered this once before on the podcast, but it was ages ago. This is a recent well-done study that takes another look to see how ultrasound compares to the commonly employed chest radiography. Join the GEL Jr team as they discuss how this might play out in practice! https://www.ultrasoundgel.org/108 https://pubmed.ncbi.nlm.nih.gov/32928462/

Transcranial doppler has been a developing interest to point-of-care ultrasound enthusiasts. While it has been a mainstay for certain inpatient indications, only relatively recently have some bold souls proposed application in the acute care setting. These uses include assessing for midline shift, vasospasm, elevated intracranial hemorrhage. This article explores an even more novel idea - using it in the early period after a traumatic brain injury to assess resultant changes in cerebral blood flow. Perhaps this could provide a non-invasive measurement with important prognostic implications. https://www.ultrasoundgel.org/107 https://bit.ly/2O04ycd

This is the first episode of GEL Jr. - our pediatric series! Hosts Delia Gold and Lianne McLean join Mike in discussing an important article on the learning of pediatric POCUS. These authors studied how participants learned image interpretation from an online POCUS educational system. The findings have many important implications for education and competency! https://www.ultrasoundgel.org/106 https://pubmed.ncbi.nlm.nih.gov/32313857/

Look - we're sorry. We know you are sick of COVID-19, but when this came across our desk we knew it was important. So far we know that point-of-care lung ultrasound is accurate for the diagnosis and even that extent of sonographic findings can correlate with the severity of disease. Now we ask - could it provide a superior diagnostic strategy to even our beloved PCR?? https://www.ultrasoundgel.org/105 https://www.annemergmed.com/article/S0196-0644(20)31269-5/fulltext

We are back for Part 2 of this raucous jamboree! Creagh, Mike, and the gang from Denver Health Ultrasound continue sounding the depths of the article on optic nerve sheath diameter in patients with elevated intracranial pressure. There are more lessons learned about general principles in dissecting POCUS articles. This is Part 2 of 2 episodes! https://www.ultrasoundgel.org/104

This episode is a real holiday special! Creagh and Mike collaborate with the Denver Health Ultrasound team to do a live (at the time) journal club on a recent article about optic nerve sheath diameter. We do a deep dive into the intricacies of the article but also develop important general principles for Gathering Evidence from the POCUS Literature. This is Part 1 of 2 episodes! https://www.ultrasoundgel.org/103

I know your first thought - is this for real?! The POCUS enthusiasts have gone off the rails again! Well - that very well may be the case, but hear me out- this is a fascinating idea. This article presents a novel strategy for searching for embolic etiologies in the acute phase of ischemic strokes (which means even climbing into CT with a handheld device!). "Why?" you may rightfully ask. That is a really great question, and I'm glad you asked. I guess you will have to check out this episode to find out! https://www.ultrasoundgel.org/102 https://pubmed.ncbi.nlm.nih.gov/32532655/

Ultrasound of the bowel is a relatively new application for POCUS users. It came into the spotlight proving itself with small bowel obstruction, but now we are slowly peristalsing even further down the colon of indications. You may be surprised to find that you can actually see diverticulitis on ultrasound, but it turns out it's not that hard! The question is - how reliable are the sonographic findings? This study is one of the largest to compare POCUS to CT to investigate this important application. https://www.ultrasoundgel.org/101 https://pubmed.ncbi.nlm.nih.gov/32653332/

Well...we finally made it. This is the 100th episode of the Ultrasound G.E.L. Podcast! The whole team is on this one, and we discuss thoughts sent in by our listeners on the future of point-of-care ultrasound research. Also reflections, plans, and thank yous. https://www.ultrasoundgel.org/100

You may have heard whispers of a magical new way to determine if your patient has too much fluid on board. The VExuS (Venous Excess UltraSound) grading system has been described as a way to use the IVC in combination with abdominal organ doppler in order to determine the degree of venous congestion. This is the first study that takes a look at the VExUS system to see if it can predict acute kidney injury in post-operative patients. https://www.ultrasoundgel.org/99 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7142196/

We haven't discussed COVID-19 for a long time, despite the explosion of POCUS articles on how ultrasound can be used during this pandemic. Many of the articles have focused on the accuracy of POCUS for making the diagnosis, or comparing the ultrasound findings to those on CT. These are helpful, but now what we really want are studies that help establish that POCUS is helping with delivering patient care - either diagnostically or prognostically. This article seems to take the first step in this direction by examining the prognostic utility of lung ultrasound in this disease. https://www.ultrasoundgel.org/98 https://pubmed.ncbi.nlm.nih.gov/32728966/

We are making some headway in the evidence behind using point-of-care ultrasound in aortic emergencies. This study takes a look at sensitivity and specificity for acute aortic dissection (which has been a few times before) and also compares POCUS to a control group to see if it causes delays or improves times to diagnosis or treatment (has not been done prospectively before). They even look at mortality! https://www.ultrasoundgel.org/97 https://pubmed.ncbi.nlm.nih.gov/31971274/

People have been using POCUS to diagnosis shoulder dislocation for a while now, although it is far from standard of care in most places. We have seen that it is really accurate compared to xray, but this well-done study adds some important information to the existing literature. They measure the glenohumeral distance in an attempt to make a quantifiable cut-off point for dislocation. They also take a look at potential time savings of ultrasound compared to xray! https://www.ultrasoundgel.org/96 https://pubmed.ncbi.nlm.nih.gov/32111508

Deep learning is a branch of artificial intelligence that holds a lot of promise for point-of-care ultrasound, but we don't have much data on how it performs. The fearless investigators in this fascinating study train a deep learning algorithm to recognize sonographic anatomy of the upper extremity and then pit it against expert POCUS users to see who can interpret the images most accurately! https://www.ultrasoundgel.org/95 https://pubmed.ncbi.nlm.nih.gov/32181922/

Placing a tube thoracostomy (aka chest tube) is a very useful procedure but can have complications of injuring the diaphragm or intraabdominal organs. Traditionally, the location for placement is selected using anatomic landmarks to find the correct intercostal space. This study questions the safety of this traditional location by using point-of-care ultrasound to visualize diaphragm movement during respirations. Is this the start of ultrasound-assisted chest tubes? https://www.ultrasoundgel.org/94 https://pubmed.ncbi.nlm.nih.gov/32333800/

We are back with Part 2 of discussing POCUS research with renowned expert and researcher, Michael Gottlieb. More pearls, pitfalls, tips, and tricks to help you step up your POCUS research game. This is the final episode in this two-part special edition, and we wrap it up as always with some take home points! https://www.ultrasoundgel.org/93

We have reviewed a lot of POCUS articles on this podcast, but we don't often talk about the process of performing a research study. On this episode, we bring on world-class POCUS expert and researcher Michael Gottlieb to discuss the ins and outs of performing, publishing, and reviewing ultrasound research studies. This is Part 1 of 2. https://www.ultrasoundgel.org/92

For peritonsillar abscesses, sometimes you need imaging to make the diagnosis clear. Many turn to CT, but ultrasound offers an appealing alternative. A transcervical approach can be used which is likely less uncomfortable than the intra-oral method. This study looks at the implementation of a transcervical ultrasound protocol in a pediatric emergency department to see if it helps this population. https://www.ultrasoundgel.org/91 https://www.ncbi.nlm.nih.gov/pubmed/31713253

The FASH exam is not just a typo when trying to write about the FAST exam. FASH stands for Focused Assessment with Sonography for HIV-associated Tuberculosis (TB). This exam combines various body areas to look for evidence of TB. You can look for extra fluid (pericardial, pleural, ascites), enlarged abdominal lymph nodes, and solid organ lesions (spleen, liver). This has been described for a while, but there have not been many studies on how accurate it might be...until now. https://www.ultrasoundgel.org/90 https://www.ncbi.nlm.nih.gov/pubmed/31904699

It's not what you think - POCUS is not going to be used to diagnose a GI bleed. However, perhaps it can be used to risk stratify this diverse group of patients. These authors had the idea to check IVC, echo, and LVOT VTI to see if it could help predict which patients are going to have adverse events from their bleed. https://www.ultrasoundgel.org/89 https://www.ncbi.nlm.nih.gov/pubmed/31379015

COVID-19 is here, there, and everywhere. Mike Mallin joins in to examine the first published reports on POCUS being used on the front lines. We discuss the sonographic findings and potential uses during this pandemic. https://www.ultrasoundgel.org/88

We know that point of care ultrasound can be used to find evidence of urinary obstruction in patients with renal colic from a kidney stone. However, it is not clear how to put this into practice. Who should get an ultrasound? Who needs further testing after ultrasound? This article poses one protocol to see if it can help save time and money in the emergency department. https://www.ultrasoundgel.org/87 https://pubmed.ncbi.nlm.nih.gov/31661942

A focused cardiac ultrasound is commonly used in the evaluation of patients with possible pulmonary embolism (PE). Based on the literature to date, we know that this can be helpful for ruling in signs of right heart strain. On the other hand, so far, this focused exam has not been that helpful in ruling out PE. These authors try to fix that by optimizing the sensitivity of the exam in a population with abnormal vital signs. https://www.ultrasoundgel.org/86 https://pubmed.ncbi.nlm.nih.gov/31562679

It is an age-old question - short or long axis? Using ultrasound guidance for internal jugular vein cannulation is now fairly standard. There are a lot of opinions regarding if it is best to visualize the target in short axis (cross section) or long axis (parallel to the vein). There are certainly benefits to both. This episode features a prospective randomized trial that attempts to put an end to this debate. https://www.ultrasoundgel.org/85 https://www.ncbi.nlm.nih.gov/pubmed/31230925

Acute aortic syndromes such as aortic dissection, aortic aneurysm, penetrating ulcer are tricky. No one wants to miss these deadly diseases, but we also don't want to test everyone who has the slightest sign of this wily diagnosis. Point of care ultrasound can detect signs of aortic pathologies, but there haven't been any good studies to determine if this is accurate or safe....until now. https://www.ultrasoundgel.org/84 https://www.ncbi.nlm.nih.gov/pubmed/31226214

Back with more blocks in Part 2. Mike and Mike continue to explore, discuss, and laugh about the evidence for ultrasound-guided regional anesthesia for acute pain management. https://www.ultrasoundgel.org/83

Everyone who has ever done one knows that ultrasound guided blocks are great. They seem to help patients, they are fun to do, but are they supported by the evidence? Mike Stone joins in on this two part, special edition dive into the studies out there for performing ultrasound guided regional anesthesia for acute pain. https://www.ultrasoundgel.org/82

Speckle tracking is a relatively new ultrasound technology that lets you graph the movement of tissue over time. We know this can be useful to look at cardiac function, but no one dared to try it out on the lung...until now! The idea here is that by using speckle tracking on the pleural line, there might be a higher accuracy in detecting pneumothorax on ultrasound! It sounds crazy...but maybe it's just crazy enough to work. https://www.ultrasoundgel.org/81 https://www.ncbi.nlm.nih.gov/pubmed/31359081

A focused echo can go a long way in a patient with a suspected pulmonary embolus (PE). It can be especially valuable in those that are so sick and unstable that you need answers right away. In this way, point-of-care echo has been shown to help to diagnose submassive and massive pulmonary emboli by identifying signs of right heart strain. Echo parameters such as right ventricle diameter and right ventricular function (such as in TAPSE) are often part of the evaluation, but these are not as accurate as we would like. These authors propose a new doppler marker of a submassive or massive PE- enter the Early Systolic Notching pattern. https://www.ncbi.nlm.nih.gov/pubmed/31056367

Suspected acute heart failure is a great reason to use point-of-care ultrasound. It can tell you in seconds if this patient is up to their neck in pulmonary edema. Knowing that interstitial edema is more common in dependent areas of the lung, one would think that the lateral areas of the lung fields would be most sensitive for the diagnosis. Likewise, if there is enough pulmonary edema to fill up the anterior lung fields, this theoretically should be pretty specific. But is this actually true?! These authors investigate the issue. https://www.ncbi.nlm.nih.gov/pubmed/30665807

POCUS can be used to visualize small bowel obstruction (SBO) fairly easily. It has proven itself superior to xrays and has some advantages over CT, which for most people is the standard for diagnosis. Although initial work was quite promising, there were no large studies done confirming the accuracy of ultrasound for this purpose. In this podcast we examine the latest study (plus discuss a bonus similar one) that reveals maybe this is not as good as we thought! https://www.ncbi.nlm.nih.gov/pubmed/30762916

There are many ways that TEE can help you in cardiac arrest. One of these is to monitor your chest compressions to make sure they are actually doing what you want. Although this makes sense intuitively and is supported by animal models, there has not been a lot of evidence to date. This article takes a step in that direction by showing some data on outcomes in humans. https://www.ncbi.nlm.nih.gov/pubmed/30825552

We know that the carotid arteries are easily seen on ultrasound, but usually we think of this scan in the context of comprehensive sonography. Certainly, it is not hard to believe that having increased atherosclerotic build up would put someone at increased risk for coronary artery disease, but what can we do with that in the acute setting? These authors had an idea - maybe measuring the Carotid Intima-Media Thickness (CIMT), could be a predictor of the outcomes of a cardiac stress test. Is this brilliance or craziness? Decide for yourself! https://www.ncbi.nlm.nih.gov/pubmed/30612781/

Necrotizing fasciitis (NF) is a real bad deal. We usually rely on clinical exam (which can be misleading) or other imaging studies (which can take forever) to make the diagnosis. POCUS would be an awesome solution in helping to make this time-sensitive determination. We know it can pick up fascial fluid, air, subcutaneous changes...but really how good is it when it comes down to diagnosing this deadly disease? https://www.ncbi.nlm.nih.gov/pubmed/31031033

Theoretically, regional wall motion abnormalities (RWMA) would be really useful in the acute care setting. In the patient with concern for cardiac ischemia, this finding might help push to definitive management. The problem is that this is a nuanced exam - it takes some experience and practice. It hasn't been studied much in the point-of-care world. So can emergency physicians with relatively little training do this accurately? Find out in this next adventure into the world of point-of-care echocardiography! https://www.ncbi.nlm.nih.gov/pubmed/30987914

In part 2 (and the finale) of the series from the IAEM conference, the discussion heats up even more! The same star-studded international band of wisdom and wizardry tackles POCUS in cardiac arrest. They discuss the CASA exam and other pointers for using POCUS in the pulseless patient. A must listen!

In October 2018, an all-star group met during the Irish Association for Emergency Medicine annual conference to talk about point-of-care ultrasound. The result was a convivial discussion of a few key papers and topics, packed with pearls and perspectives. In part 1 of 2, the group talks about the landmark original SHoC-ED trial and performing the erector spinae plane block for rib fractures.

It is great to see more and more research on ultrasound in cardiac arrest. Although many people are already using this, there is still much work to be done to tease out the details of how exactly POCUS should affect our decision making. Here is a nice study that looks to see if ultrasound is associated with increased resuscitation efforts or better survival outcomes. https://www.ncbi.nlm.nih.gov/pubmed/31205842

They say seeing is believing...what about seeing a study about a machine that listens in order to see an organ that itself is used to see? Most scholars agree this too is believing. Of course, we are (in a convoluted way) referring to ocular ultrasound. Historically a great party trick, can this modality accurately diagnose visual problems in the emergency department? It's been done before, but it hasn't been done to this degree. Sit back, relax, and visualize the latest in ocular POCUS research. https://www.ncbi.nlm.nih.gov/pubmed/30977855

The annual conference of the Society of Clinical Ultrasound Fellowships (SCUF) is an incredible opportunity to converse and interact with many leaders in point-of-care ultrasound education and research. We took advantage of having so many brilliant people in one place to ask them all a few question about what they think are the next steps in POCUS research.

Resa and Mike team up to discuss important happening at SCUF 2019 Annual conference. Guest stars Nova Panebianco and Sara Damewood!

We use ultrasound a lot. Sometimes we find things that are not clearly related to the reason the patient came in. The prevalence of these incidental findings relates to the usefulness of the diagnostic test. These authors take the bull by the horns, randomly whole-body-POCUS scanning emergency department patients to see what sort of findings might pop up. But should disease prevalence change our use of the tool? https://www.ncbi.nlm.nih.gov/pubmed/30587153

Fractures of the distal radius are pretty common among people who choose not to break their fall with their face. Sure - it's not hard to see these on xray, but is there a better way? Ultrasound is great for finding fractures, but what about being able to guide the reduction? This has been shown to be useful in a pediatric population, but this study looks at a population of adult patients in the emergency department to see just how accurate ultrasound is for determining if the pieces have been put back together. https://www.ncbi.nlm.nih.gov/pubmed/30191190

TEE has been heralded as the latest and greatest way to monitor a cardiac arrest resuscitation. The advantages include continuous monitoring of cardiac activity, ability to evaluate efficacy of chest compressions, and better evaluation of etiologies of the arrest. Although many places are using it currently, there is not much evidence to support these theoretical benefits. What we do know is that a few studies have shown that transthoracic ultrasound leads to prolonged pauses in cardiac arrest. This study aims to see if TEE is the solution. https://www.ncbi.nlm.nih.gov/pubmed/30773413

Many ultrasound enthusiasts have been using point of care ultrasound to assist in the diagnosis of acute decompensated heart failure, but it has not been widely adopted. It has been shown by many studies that ultrasound can visualize pulmonary edema easily so that treatment can be started quickly. However, some still cling to their chest xrays and their natriuretic peptides, just hoping it won't lead them astray. Well this trial aims to prove the superior accuracy of lung ultrasound combined with clinical assessment over chest xray and pro-BNP (also combined with clinical assessment). Hold onto your hats, because there is a lot we can learn from this well done randomized controlled trial of over 500 patients! https://www.ncbi.nlm.nih.gov/pubmed/30690825

Point of care ultrasound can be used for a great many things, but I don't think many people grab for the probe when a patient comes in with suspected pre-eclampsia. However, we know that pre-eclampsia can lead to pathophysiology that is readily identified on ultrasound - things like interstitial edema, cardiac dysfunction, and increased intracranial pressure. This study takes the first step by examining patients in pre-eclampsia and determining how often you might find something if you go a lookin. https://www.ncbi.nlm.nih.gov/pubmed/30211771

The gallbladder loves to be scanned - a fluid filled sac nestled against a wonderful acoustic window? Are you kidding me? In any case, here is what we know: ultrasound is good for diagnosing cholecystitis, point of care ultrasound in the emergency department is good for diagnosing cholecystitis, BUT many surgeons still prefer a comprehensive RUQ ultrasound prior to cuttin' anyone. This article takes a look to see if these positive findings in the ED lead to people requiring cholecystectomy. Also - does it actually save time? https://www.ncbi.nlm.nih.gov/pubmed/30109274

Chest pain is fun, right? Maybe add in some shortness of breath? It can be hard to sort through the potentially sick from the okay to go home. We know that point of care ultrasound (POCUS) can be helpful in making or excluding many cardiothoracic pathologies, but we don't even know if it really makes a difference! This article takes the first step by asking, "when you use POCUS, does it help lower the diagnostic uncertainty about that patient?" Secondly, it takes on an old rivalry by comparing POCUS to chest xray in these patients. https://www.ncbi.nlm.nih.gov/pubmed/30413369

Fluid responsiveness has been all the rage in emergency and critical care medicine. Trying to determine which patients will benefit from fluids or how much fluids is a daily struggle for providers. However, every new measurement or technique to quantify a patients possible responsiveness to fluids has been riddled with problems. Is carotid flow time, the holy grail that we have been waiting for? This study dives into the use of carotid flow time in an ICU patient population and attempts to answer if flow time can predict fluid responsiveness.

The FAST exam is tried and true for trauma, but in the past it hasn't been super useful for patients with isolated pelvic fractures. This study teases out a very sick subset of this population - patient who have significant hemorrhage associated with their fracture. The question is how well can the FAST identify intraabdominal hemorrhage in these people. The authors' idea is that if the FAST can find intraperitoneal blood, it might help determine who would benefit from REBOA instead of laparotomy.

Speckle tracking? Is that the technology that the government uses to mine data from your phone?! No - totally different! This is an ultrasound technology that recognizes tiny specks in the myocardium, allowing for a measurement of the movement of the heart wall. This has the potential to quantify the contractility of different parts of the heart, and therefore can be used to help diagnose numerous cardiac pathologies. At this time, not many people are using this in the emergency department. This is the first study to take a look to see if this is feasible and if it is accurate in diagnosing patients with acute coronary syndrome.

Ultrasound was made for the diagnosis of small bowel obstruction. It loves when air filled things are turned into fluid filled things - its helps us see it better. When the bowel gets backed up and distends with digested cheeseburgers, ultrasound is there to save the day. As easy as this may seem, it has not been well studied. There are a few small studies that show it can be accurate compared to a CT, but without a large body of evidence - a lot of people are (quite reasonably) unwilling to put their faith in it. Well, we can't say this study is going to turn all that around, but its one more piece of the puzzle of figuring out how we can use POCUS for this diagnosis.

Are you sick of hearing about ultrasound and cardiac arrest? Do you think to yourself - "Why can't everyone just do it my way?." Well - for better or for worse (we think for the better), there are going to be more and more ultrasound and cardiac arrest articles. The reason is that point of care ultrasound can help so much in this situation, yet - it has also been shown to put people at risk for longer times without CPR. So what do we do? This article presents the CASA exam, a cardiac arrest ultrasound protocol, as a way to standardize the exam and (hopefully) minimize pauses in CPR.

The pediatric literature for point of care ultrasound seems to lag behind that of adults. However, it has made some incredible strides to show that this is a tool that is not be neglected in our younger patients. Although point of care ultrasound is used routinely in adults, it may not be as frequently employed in the pediatric emergency department. Clearly, there are differences in cardiac pathology encountered in pediatrics, but the ultrasound can still have great utility. The authors of this paper seek to increase the use of cardiac POCUS by collaborating with cardiologists to create a focused cardiac ultrasound protocol. They collect data to see what happened to POCUS use after they institute this protocol and to see how accurate these scans hold up in kids!

We know that ultrasound can be used to diagnose a superficial cutaneous abscess. That is NOT what this study is about. Forget diagnosing! What about actually helping your patients stay out of the emergency department? These authors performed this study with the hypothesis that using POCUS during the treatment of a superficial abscess might decrease the failure rate of the incision and drainage. That means ultrasound could help prevent patients from requiring additional treatment! They aren't messing around with retrospective chart reviews either - this is a real live randomized controlled trial.

Well the dust has somewhat settled from the initial explosion that this article made when it first hit street corners everywhere. The authors here took on an important question - does point of care ultrasound make a difference in mortality when applied to patients in shock? [SPOILER ALERT] It led to quite a stir when the trial concluded that (I'm paraphrasing here) - "POCUS doesn't help people". Although that conclusion may or may not be the case, this study was a well performed randomized controlled trial. Therefore, you need to know about it and where to go from here.

We know that POCUS can be used in making many diagnoses in the critically ill patient. It also can help guide management. So why not perform it every day on every patient? That is the idea behind this article on POCUS rounds in the ICU. These authors compare patients who received a daily POCUS to those who did not - with real patient-centered outcomes! Is it too good to be true? Is a daily POCUS rounds something you should be doing in your ICU?

The RUSH exam is a family favorite. It's a reliably easy to recall hypotensive protocol that uses ultrasound to help determine the etiology of a patient's shock. Well here's a new idea - trauma patient's can be in shock too, right? So maybe we should perform a full RUSH exam instead of just a measly EFAST? Well...hold your horses there kiddo, there may be more to think about with this one.

The POCUS Atlas is a beautiful resource. You may be familiar with the Image Atlas, a crowd-sourced compendium of sonographic pathology created to help others learn point of care ultrasound. These same talented creators have recently unleashed the Evidence Atlas - another entirely free resource that summarizes much of the best evidence in POCUS. In this special edition interview, we talk with Matthew Riscinti, co-founder of the POCUS Atlas, about how this all came to be. We even do a quick review of one of the Evidence Atlas articles!

This seems like a good idea. Chest pain is common. Ultrasound can see many causes of chest pain. Sooooo lets use ultrasound in patients with chest pain to help with decision making. Well, wipe the smile from your face validity because it is not that simple. This article takes an interesting approach in performing a rather complex "focused" echo in the emergency department and uses it to determine the patient's disposition. The main goal was to see how accurate this method could be. Let's see how this pans out.

Point of care ultrasound for appendicitis has a long and checkered past. It is well-established as first line in the pediatric population, but less accepted in adults. Some studies show that is great, other studies show that it is about as useful as an air conditioner in Antarctica. This article hits on the idea that perhaps we should risk stratify our patients and focus on ruling in the disease in those that are more likely to have it. Sound intriguing? Check it out.

As more and more emergency physicians are using point-of-care ultrasound to assess for hydronephrosis in the setting of renal colic, it becomes important to determine how accurate they are for the diagnosis. This study takes previously recorded clips and compares the EP interpretation to a radiologists interpretation. The idea is to see if EPs can determine the presence or absence of hydro, as well as the grade of it, compared to a radiologist looking at the same images. Both are then compared to CTs done in the same patients for a second standard of comparison. This brings to light interesting findings as well as questions regarding the best standard of comparison in this practice.

Usually in ultrasound we think of the stomach as something that gets in the way or gives us a false positive LUQ view in the FAST. But what if visualizing the stomach could actually be helpful? In some scenarios, such as prior to anesthesia, sedation, or a procedure, it might be nice to know if the patient has a full stomach with the potential to aspirate. These authors test out the accuracy of POCUS for this purpose in healthy volunteers.