Ultrasound

I'm fortunate in my residency program to have a handful of attendings that are extremely proficient in using the ultraound for various procedures in the ED. The ultrasound has recently gained a lot of popularity in the department for its practicality. Most seasoned physicians have at least taken a CME course or two to learn how to do a pretty accurate F.A.S.T. exam in trauma bays, but now there are entire fellowship programs devoted to its use.

We had this huge woman present today in DKA. She had ketones in her blood and urine and her blood glucose was around 800. Initially, none of the nurses were able to get a line on her so I strolled in the room with the ultrasound machine. I took one look and popped in an IV. The peripheral line was a temporizing measure as I got everything I would need for a central line. Using the ultrasound I took one look at her neck, found her IJ, and with one stick, got the line. If you look at the new data floating around that shows the decrease in complication rates with ultrasounds guided central lines, some would say it is malpractice to attempt CVLs without it.

The lesson of the day: the ultrasound machine is your friend. It takes practice, especially in using it for peripheral IVs, but it is absolutely worth it. I've used the machine for the following: scanning for aneurysms, gall stones, comparing kidneys for hydronephrosis, looking for pericardial effusions, and evaluating for ectopic pregnancy.

It is a great tool for the ED doc to have in his arsenal.

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