In the most recent addition of Emergency Medicine Clinics of North America (yup, you’ll need to register to view), some big wigs in bedside ultrasound (Tirado, Teresa Wu, Resa Lewiss, Vicki Noble, Adam Sivitz) published an article reviewing the ultrasound – guided techniques (with images) of procedures where an ultrasound machine can make all the difference in decreasing complications, increasing patient satisfaction, and decreasing time of procedure. From pericardiocentesis, thoracentesis, abscess drainage to lumbar puncture, arthrocentesis, and foreign body removal, these physicians discuss it all. “Bedside ultrasound is an extremely valuable and rapidly accessible diagnostic and therapeutic modality in potentially life- and limb-threatening situations in the emergency department. In this report, the authors discuss the role of ultrasound in quick assessment of pathologic conditions and its use to aid in diagnostic and therapeutic interventions”

In the same issue, Drs. Tirado, Nagdev and others discuss ultrasound-guided venous central and peripheral venous access and nerve blocks (a topic near and dear to Arun Nagdev’s heart – given how many publications he has done on the topic – a true expert!). “Ultrasound has rapidly become an essential tool in the emergency department, specifically in procedural guidance. Its use has been demonstrated to improve the success rate of procedures, while decreasing complications. In this article, we explore some of these specific procedures involving needle guidance and structure localization with ultrasound.”

And, in the same issue, Drs. Lewis, Crapo, and Williams discuss more procedural guidance using bedside ultrasound for central venous access as well as a review of other procedures, like IO lines an arterial lines. “The venous and/or arterial vasculature may be accessed for fluid resuscitation, testing and monitoring, administration of blood product or medication, or procedural reasons, such as the implantation of cardiac pacemaker wires. Accessing the vascular system is a common and often critically important step in emergency patient care. This article reviews methods for peripheral, central venous, and arterial access and discusses adjunct skills for vascular access such as the use of ultrasound guidance, and other forms of vascular access such as intraosseus and umbilical cannulation, and peripheral venous cut-down. Mastery of these skills is critical for the emergency medicine provider.”

A great review of pericardiocentesis, thoracentesis, paracentesis, vascular access, foreign body localization, abscess drainage, and nerve blocks can be found on Sonoguide as well.

Here are some great videos on how-to perform the varying procedures:

Pericardiocentesis:

Thoracentesis:

Paracentesis:

Abscess drainage:

Central venous access: internal jugular

Central venous access – supraclavicular approach to the subclavian vein:

Ultrasound Podcast on the Subclavian and Supraclavicular venous access in only the way they know how.

Central venous access – axillary vein cannulation

Peripheral venous access:

A great video on US guided Peripheral IV can be found here, by HQMedEd

Lumbar puncture:

Foreign Body removal:

Femoral nerve block:

Axillary Nerve block:

Distal Sciatic nerve block:

Nerve blocks of all kinds can be found here on SonicNerve.

Other procedures:

US guided fracture reduction