Where Will You Cut the Neck? POCUS Makes Perfect

Where Will You Cut the Neck? POCUS Makes Perfect

Practicing to find the midpoint of the cricothyroid membrane with ultrasound is a much better way to learn than by using only external landmarks and no ultrasound.

POCUS for Kidney Stone - Be Careful

POCUS for Kidney Stone - Be Careful

Point-of-care ultrasound in patients with renal colic had tepid diagnostic accuracy for nephrolithiasis.  If hydronephrosis was present, specificity was 94% and often indicated a stone >5mm.

POCUS for Retinal Detachment - Be Careful

POCUS for Retinal Detachment - Be Careful

In less experienced sonographers, ocular ultrasound for retinal detachment was specific but not sensitive.  It's useful to rule it in, but don't use it as the sole means to rule it out.

More Clarity on IVC POCUS for Fluid Responsiveness

More Clarity on IVC POCUS for Fluid Responsiveness

In intubated patients, respiratory variation of IVC diameter by 16% had fairly high diagnostic accuracy for predicting fluid responsiveness, but only when the tidal volume (TV) was ≥8 mL/kg and positive end-expiratory pressure (PEEP) ≤5 cm H2O.

Does POCUS Degrade CPR Quality?

Does POCUS Degrade CPR Quality?

Point of care ultrasound may be very useful during CPR, but it should not get in the way of chest compressions.  If you're going to use it, get in there quick and get out of the way or choose a view that allows continuous chest compressions (i.e. subxiphoid).

Ultrasound guided IV blows more in CT

Short Attention Span Summary

Do you have the anecdotal sense that ultrasound guided IVs blow more often with IV contrast in CT?  Your hunch is now proven with this study.  Unadjusted RR for contrast extravasation compared with standard IV was 14.


FOAM Report


Abstract

Acad Emerg Med. 2016 May 6. doi: 10.1111/acem.13000. [Epub ahead of print]

Extravasation Risk Using Ultrasound Guided Peripheral Intravenous Catheters for Computed Tomography Contrast Administration.

Rupp JD1, Ferre RM1, Boyd JS1, Dearing E1, McNaughton CD1, Liu D2, Jarrell KL3, McWade CM3, Self WH1.

Author information:

1Department of Emergency Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.

2Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.

3School of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.

 

Abstract

OBJECTIVE:

Ultrasound guided intravenous catheter (USGIV) insertion is increasingly being used for administration of intravenous contrast for computed tomography (CT) scans. The goal of this investigation was to evaluate the risk of contrast extravasation among patients receiving contrast through USGIV catheters.

METHODS:

A retrospective observational study of adult patients who underwent a contrast-enhanced CT scan at a tertiary-care emergency department during a recent 64-month period was conducted. The unadjusted prevalence of contrast extravasation was compared between patients with an USGIV and those with a standard peripheral IV inserted without ultrasound. Then, a two-stage sampling design was used to select a subset of the population for a multivariable logistic regression model evaluating USGIVs as a risk factor for extravasation while adjusting for potential confounders.

RESULTS:

In total, 40,143 patients underwent a contrasted CT scan, including 364 (0.9%) who had contrast administered through an USGIV. Unadjusted prevalence of extravasation was 3.6% for contrast administration through USGIVs and 0.3% for standard IVs (relative risk: 13.9, 95% CI: 7.7 to 24.6). After adjustment for potential confounders, CT contrast administered through USGIVs was associated with extravasation (adjusted odds ratio: 8.6; 95% CI: 4.6, 16.2). No patients required surgical management for contrast extravasation; one patient in the standard IV group was admitted for observation due to extravasation.

CONCLUSIONS:

Patients who received contrast for a CT scan through an USGIV had a higher risk of extravasation than those who received contrast through a standard peripheral IV. Clinicians should consider this extravasation risk when weighing the risks and benefits of a contrast-enhanced CT scan in a patient with USGIV vascular access. This article is protected by copyright. All rights reserved.

This article is protected by copyright. All rights reserved.

PMID: 27151898 [PubMed - as supplied by publisher]

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