Posts in Procedures
Brown Sound: Ultrasound Guided Lumbar Puncture
Brown Sound: Ultrasound Guided Lumbar Puncture

We use ultrasound for a multitude of procedures in the emergency department, including central and peripheral venous access, abscess drainage, and joint aspiration. Less common, but just as useful, is the use of ultrasound to help identify landmarks when performing a lumbar puncture (LP). While the traditional method of LP is based on palpating anatomical landmarks, this is becoming increasingly difficult as the patient population becomes more obese. It may also be difficult in patients who have abnormal spinal anatomy or in those who have had previous spinal surgery. When palpating anatomy is difficult, ultrasound can be a useful tool to help identify appropriate landmarks and increase your LP success rate…

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Procedures, UltrasoundStephanie Hessultrasound, lumbar, puncture, procedureComment
US Guided IV Access: Tips for Success
US Guided IV Access: Tips for Success

A 48 year-old female with idiopathic intracranial hypertension (IIH), with recent shunt removal, presented with increasing right eye vision loss over the last week, headache, and left-sided weakness. Her outpatient neuro-ophthalmologist referred her to the emergency department from clinic for a question of intracranial abscess, optic neuritis, or worsening IIH. She needed an MRI as soon as possible to rule-out these dangerous pathologies. A quick chart review showed that she has needed multiple central lines placed in the past, due to difficult IV access. The nurse was unable to place a peripheral IV…

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Ultrasound, ProceduresMichael TcheyanUltrasound, IV, intravenousComment
Whit-ticisms: Osteophony, or How to Hear Broken Bones

There may be a time when you don’t *gasp* have an x-ray machine. Osteophony is a 19th century technique by which practitioners would use the acoustic properties of intact versus disrupted bone to determine if there was a fracture or dislocation. Extra points if you can get orthopedics to come see the patient based solely on osteophony!

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Orthopedics, Procedures, Whit-ticismsWhit Fisherosteophony, orthopedics, fracture, dislocationComment