Ultrasound Gel

Ultrasound in cardiac arrest is a favorite topic of the GEL Team and thus, we are back to crack open a radical new concept in the field. Does the left ventricular function actually matter in patients that are arresting?? Current practice for many is to assess for the binary presence or absence of cardiac activity, but these audacious authors suggest that a higher LV systolic function could be associated with a greater likelihood of return of spontaneous circulation!   https://www.ultrasoundgel.org/119 https://pubmed.ncbi.nlm.nih.gov/34087419/

The FAST exam has been used in trauma for decades - so why is there still confusion on how to use it in pediatrics? Because kids are different than adults! This article takes a look at the associations between intraabdominal injury and the FAST, physical exam, and labs. The authors then combine the FAST with physical exam findings to create the exFAST, the FAST-enhanced physical exam! Our GEL Jr hosts deliver great pearls for the FAST exam and how we should be using it based on the evidence to date. https://www.ultrasoundgel.org/118 https://pubmed.ncbi.nlm.nih.gov/32159909/

Do you use ultrasound for suspected peritonsillar abscess (PTA)? Some of us probably do, some don't - but what does the evidence say?? Does it help the clinician? and (dare we ask) does it help the patient? This paper is potentially the best data we currently have on the topic. Mike and special guest Kim Fender dive straight into the purulence of this fluctuant topic.   https://www.ultrasoundgel.org/117 https://pubmed.ncbi.nlm.nih.gov/32826122/

GEL Jr coming in hot with the latest in neuro-ocular sonography - optic disc elevation! That's right - not optic nerve sheath diameter (ONSD), the actual elevation of the disc as seen on ocular ultrasound. Super cool new idea - lets how how it pans out in this pilot study!   https://www.ultrasoundgel.org/116 https://pubmed.ncbi.nlm.nih.gov/34051397/

Everyone's new favorite doppler marker for pulmonary embolism is back! We discussed the ESN (early systolic notching) when this concept was first introduced as a marker for large PEs, but now we have a prospective study that improves upon some of the limitations of the past article...or does it? https://www.ultrasoundgel.org/115 https://pubmed.ncbi.nlm.nih.gov/33987920/

One of the gang's favorite topics - ultrasound in cardiac arrest! This article delves into the importance of "pre-pause imaging", getting that picture of the heart ready even before the compressions are stopped! This seems like an important part of minimizing pauses in CPR, but how convincing is this data? https://www.ultrasoundgel.org/114 https://pubmed.ncbi.nlm.nih.gov/34223359/

The GEL Jr. team is back with another great use for pediatric POCUS! You might not have known that you can actually use ultrasound to confirm that your endotracheal tube is in the right place! But how good is it?? https://www.ultrasoundgel.org/113 https://pubmed.ncbi.nlm.nih.gov/32168296/

This Special Edition podcast covers not one - but 7 really important POCUS articles! These articles were selected by the Academy of Emergency Ultrasound (an academy of the Society of Academic Emergency Medicine) as the top articles from the past year. Here we briefly discuss the winningest articles from each of the categories! https://www.ultrasoundgel.org/112

We have talked about ocular ultrasound many times before - it certainly can be useful in identifying many acute ophthalmologic pathologies. But what about papilledema? We know that POCUS can be used to measure the optic nerve sheath diameter (ONSD), which dilates with increased intracranial pressure. So theoretically this should work well in patients with suspected increased intracranial pressure, such as those with idiopathic intracranial hypertension. The question now is how well does POCUS fare in finding papilledema compared to the good ol' fashioned physical exam? https://www.ultrasoundgel.org/111 https://pubmed.ncbi.nlm.nih.gov/33532756/

We have been ultrasounding hips for a while now. We know this modality is accurate for finding effusions. This can really help in cases of suspected septic arthritis. Unlike patients with this disease, this study takes multiple steps forward. First it asks the question - "Does point-of-care ultrasound (POCUS) in the emergency department lead to a faster diagnosis?". Then it goes further by trying to determine whether or not POCUS can lead to earlier treatment as well. Fascinating results from a really hip study! https://www.ultrasoundgel.org/110 https://pubmed.ncbi.nlm.nih.gov/33000078/

In this Special Edition podcast, Mike is joined by POCUS leaders and educators Nova Panebianco and Cameron Baston to discuss their recent publication on interdepartmental collaboration with ultrasound. They discuss their process for creating a combined fellowship and share additional pointers in achieving mutually beneficial relationships between departments. https://www.ultrasoundgel.org/109 https://pubmed.ncbi.nlm.nih.gov/30592332/

Acute chest syndrome is such a great application for lung ultrasound, especially in pediatrics where we do everything we can to dodge the harmful affects of ionizing radiation. We have covered this once before on the podcast, but it was ages ago. This is a recent well-done study that takes another look to see how ultrasound compares to the commonly employed chest radiography. Join the GEL Jr team as they discuss how this might play out in practice! https://www.ultrasoundgel.org/108 https://pubmed.ncbi.nlm.nih.gov/32928462/

Transcranial doppler has been a developing interest to point-of-care ultrasound enthusiasts. While it has been a mainstay for certain inpatient indications, only relatively recently have some bold souls proposed application in the acute care setting. These uses include assessing for midline shift, vasospasm, elevated intracranial hemorrhage. This article explores an even more novel idea - using it in the early period after a traumatic brain injury to assess resultant changes in cerebral blood flow. Perhaps this could provide a non-invasive measurement with important prognostic implications. https://www.ultrasoundgel.org/107 https://bit.ly/2O04ycd

This is the first episode of GEL Jr. - our pediatric series! Hosts Delia Gold and Lianne McLean join Mike in discussing an important article on the learning of pediatric POCUS. These authors studied how participants learned image interpretation from an online POCUS educational system. The findings have many important implications for education and competency! https://www.ultrasoundgel.org/106 https://pubmed.ncbi.nlm.nih.gov/32313857/

Look - we're sorry. We know you are sick of COVID-19, but when this came across our desk we knew it was important. So far we know that point-of-care lung ultrasound is accurate for the diagnosis and even that extent of sonographic findings can correlate with the severity of disease. Now we ask - could it provide a superior diagnostic strategy to even our beloved PCR?? https://www.ultrasoundgel.org/105 https://www.annemergmed.com/article/S0196-0644(20)31269-5/fulltext

We are back for Part 2 of this raucous jamboree! Creagh, Mike, and the gang from Denver Health Ultrasound continue sounding the depths of the article on optic nerve sheath diameter in patients with elevated intracranial pressure. There are more lessons learned about general principles in dissecting POCUS articles. This is Part 2 of 2 episodes! https://www.ultrasoundgel.org/104

This episode is a real holiday special! Creagh and Mike collaborate with the Denver Health Ultrasound team to do a live (at the time) journal club on a recent article about optic nerve sheath diameter. We do a deep dive into the intricacies of the article but also develop important general principles for Gathering Evidence from the POCUS Literature. This is Part 1 of 2 episodes! https://www.ultrasoundgel.org/103

I know your first thought - is this for real?! The POCUS enthusiasts have gone off the rails again! Well - that very well may be the case, but hear me out- this is a fascinating idea. This article presents a novel strategy for searching for embolic etiologies in the acute phase of ischemic strokes (which means even climbing into CT with a handheld device!). "Why?" you may rightfully ask. That is a really great question, and I'm glad you asked. I guess you will have to check out this episode to find out! https://www.ultrasoundgel.org/102 https://pubmed.ncbi.nlm.nih.gov/32532655/

Ultrasound of the bowel is a relatively new application for POCUS users. It came into the spotlight proving itself with small bowel obstruction, but now we are slowly peristalsing even further down the colon of indications. You may be surprised to find that you can actually see diverticulitis on ultrasound, but it turns out it's not that hard! The question is - how reliable are the sonographic findings? This study is one of the largest to compare POCUS to CT to investigate this important application. https://www.ultrasoundgel.org/101 https://pubmed.ncbi.nlm.nih.gov/32653332/

Well...we finally made it. This is the 100th episode of the Ultrasound G.E.L. Podcast! The whole team is on this one, and we discuss thoughts sent in by our listeners on the future of point-of-care ultrasound research. Also reflections, plans, and thank yous. https://www.ultrasoundgel.org/100