No Xray, No Problem: the evidence

So in case you missed #SMACC in Chicago – I was lucky enough to be able to talk about one of my greatest passions – bedside Ultrasound.

The talk was a bit of the evangelical side – the goal being to try and make the audience think about how we image patients. I wanted to show how I use US to be faster, better, more effective and safer in delivering care.  I deliberately tried to avoid a long-winded evidence  discussion.  After all – it is SMACC, entertainment is important too!

You can pop over to the Intensive Care Network or to the SMACC website to check out the audio and slides from the talk.

So here is the evidence – the references for my talk.  You could also go back and look at this post “Bedside US Evidence Echoes” and the fascinating discussion of ultrasound evidence in the comments thread.

Lets start with the trauma case:

• Detecting a blowout fracture with intraorbital air as per Dr Blaivas in AJEM , Oct 2004
• The “guitar pick sign” of a retro-orbital haematoma described in CJEM, May 2011
• For a serious review of the use of Optic Nerve Sheath Diameter for rasied ICP – go back to my podcast with Dr Hartnett HERE
• Assessment of extraocular movements was described by Harries et al in AJEM, Oct 2010
• US vs. CXR for rib fractures in trauma – review in the EMJ 2014… US wins!
• US vs CXR for sternal fractures: FOAMCast covered this in 2015

Colle’s fracture diagnosis and reduction:

• Check out the Ultrasound Podcast episode with M&M and Dr Mark Goodman here.
• Case series from Chen ( Paed Emerg Care, Aug 2007  ) looking at diagnosis and reduction of distal radial fractures in kids
• Another one from Journ of EM, Chinnock et al May 2011
• Axillary nerve block.. how to do it – just ask my block hero Mike Stone:

How to find the axillary brachial plexus from Mike Stone on Vimeo.

Paediatric PUO ie. “Pyrexia that’s Ultrasonographically Obvious”

• I dissected the state of the evidence for Paeds pneumonia US last year here
• Metanalysis by Perada et al in  Pediatrics, March 2015
• Awesome videos here from Kasia Hampton @Sonokids 
  • Stay tuned for more on this in 2016
• Cellulitis vs. Abscess: Ben Smith covered this on UOTW for references
• Paeds hip effusion – its easy and theres and old BestBet that covers it HERE

Sepsis Resuscitation

• Arterial line insertion: old Broome Docs post HERE
• CVC insertion scans – insertion, pneumothorax rule out and flush to confirm venous placement – Great Emcrit post here on how to do it.
• The original FLUSH trial in Annals of EM, Horowitz, Bailitz etc, June 2014
• IVC fluid responsiveness remains a bit of a controversial area – though I am a fan of looking at IVCs and deciding if they are “appropriate for the clinical scenario”. Check out Dr Justin Bowra’s demolition and Dr Weingart’s defense of the humble IVC HERE at EMCrit
• Airway US – classic paper from Michael Blaivas & James W. Tsung here on confirming intubation and endobronchial tubes.
• Detecting oesophageal intubation – nice video here by Dr Joe Minardi

Bowel Obstruction

• Diagnosing bowel obstruction – from the lads on Ultrasound Podcast – look no further
• Umbilical hernia case from Dr Ben Smith on #UOTW

Neonatal Lung Ultrasound

• Lung US to predict the need for neonatal intubation by Raimondi et al Arch Dis Child, 2014
• Great review article from the Italian group here on all things US in Neonates

OK

Happy scanning

& remember ultrasound gel is the lubricant to smooth the patient’s journey through the ED!

Casey