This is a fun 10 minutes video explaining the RUSH (Rapid Ultrasound in SHock) exam. I prefer to call it the HIMAP exam because the exam is hoping to make the MAP (mean arterial pressure) HIgher. The video has examples of pathology as well.
Posterior Tibial Nerve Block
This is another simple and safe block that is PERFECT for anesthesia of the bottom of the foot (think lacerations and foreign bodies). The nerve is easy to see and right next to the posterior tibial artery which is a great landmark. This is a great block for those without a lot of comfort/experience with blocks. Here is a nice 5 minute video from 5minsono.
Superficial Cervical Plexus Block
This is a simple and safe block (don’t need large volume, not particularly close to any important anatomy) that can give you anesthesia of the anterior/lateral neck and ear. Consider it for ear lacerations, central line placement and clavicle fracture. It’s effectiveness can be variable but it is always worth a try. Here is a nice 5 minute video from 5minsono.
Fascia Iliaca Block
While this can anesthetize a large portion of the leg, I recommend focusing on the one high-yield application that has a number of studies to support it – Hip Fracture. You can decrease systemic opioid use and decrease the side-effects that come with it – constipation, delirium etc. Here is a nice 5 minute video from 5minsono.
Does the patient have a DVT?
I use bedside ultrasound to look for DVT’s usually in sick patients (read: hypotensive, trying to die). Given easy access to radiology ultrasound, I usually order radiology comprehensive ultrasounds on most of the usual leg swelling patients that I see in the ED. 5minsono video here.
Does this patient have an abdominal aortic aneurysm (AAA)?
Determining the existence of a AAA in a patient can be life-saving. It is not a particularly difficult exam to perform. Be sure to push down hard and be patient. Having the patient’s knees bent and arms resting at the side helps relax the belly and makes the exam easier. 5minsono video here.
Does this patient have a pericardial effusion?
After determining LV function, the next question to ask with bedside cardiac ultrasound is: Does the patient have a pericardial effusion? 5minsono video here. Remember to keep this in clinical context. A small effusion is unlikely to hemodynamically important but certainly could help point towards a diagnosis of pericarditis in the appropriate patient.
How is the cardiac function in this patient?
Bedside ultrasound assessment is aimed at two simple questions. The first and most obvious is this – What is the LV function? 5minsono video here. The main goal should be categorizing the function (qualitatively) into one of five groups: hyperdynamic, normal, moderately depressed, severely depressed, dead. The other question is: Does the patient have a pericardial effusion? 5minsono video here.
How to perform cardiac ultrasound.
Cardiac ultrasound is one of the more complicated aspects of bedside ultrasound in that hearts are often in different orientations in different patients. 10 minute video on performing cardiac ultrasound here.
Does this patient have pulmonary edema?
I will trust ultrasound any day over my stethoscope for finding pulmonary edema on lung exam. This is one of the easiest lung exams on ultrasound. Like all ultrasound findings, be sure to take b-lines in context with other clinical information. 5minsono video here.
Bread & Butter Bedside Ultrasound 