Ultrasound GEL

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...

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...

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 http...

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...

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.ultras...

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...

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 fin...

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

You may have heard whispers of a magical new way to determine if your patient has too much fluid on board. The VExuS (Venous Excess UltraSound) grading system has been described as a way to use the IVC in combination with abdominal organ doppler in order to determine the degree of venous congestion. This is the first study that takes a look at the VExUS system to see if it can predict acute kidney...

We haven't discussed COVID-19 for a long time, despite the explosion of POCUS articles on how ultrasound can be used during this pandemic. Many of the articles have focused on the accuracy of POCUS for making the diagnosis, or comparing the ultrasound findings to those on CT. These are helpful, but now what we really want are studies that help establish that POCUS is helping with delivering patien...

We are making some headway in the evidence behind using point-of-care ultrasound in aortic emergencies. This study takes a look at sensitivity and specificity for acute aortic dissection (which has been a few times before) and also compares POCUS to a control group to see if it causes delays or improves times to diagnosis or treatment (has not been done prospectively before). They even look at mor...

People have been using POCUS to diagnosis shoulder dislocation for a while now, although it is far from standard of care in most places. We have seen that it is really accurate compared to xray, but this well-done study adds some important information to the existing literature. They measure the glenohumeral distance in an attempt to make a quantifiable cut-off point for dislocation. They also tak...

Deep learning is a branch of artificial intelligence that holds a lot of promise for point-of-care ultrasound, but we don't have much data on how it performs. The fearless investigators in this fascinating study train a deep learning algorithm to recognize sonographic anatomy of the upper extremity and then pit it against expert POCUS users to see who can interpret the images most accurately! http...

Placing a tube thoracostomy (aka chest tube) is a very useful procedure but can have complications of injuring the diaphragm or intraabdominal organs. Traditionally, the location for placement is selected using anatomic landmarks to find the correct intercostal space. This study questions the safety of this traditional location by using point-of-care ultrasound to visualize diaphragm movement duri...

We are back with Part 2 of discussing POCUS research with renowned expert and researcher, Michael Gottlieb. More pearls, pitfalls, tips, and tricks to help you step up your POCUS research game. This is the final episode in this two-part special edition, and we wrap it up as always with some take home points! https://www.ultrasoundgel.org/93

We have reviewed a lot of POCUS articles on this podcast, but we don't often talk about the process of performing a research study. On this episode, we bring on world-class POCUS expert and researcher Michael Gottlieb to discuss the ins and outs of performing, publishing, and reviewing ultrasound research studies. This is Part 1 of 2. https://www.ultrasoundgel.org/92

For peritonsillar abscesses, sometimes you need imaging to make the diagnosis clear. Many turn to CT, but ultrasound offers an appealing alternative. A transcervical approach can be used which is likely less uncomfortable than the intra-oral method. This study looks at the implementation of a transcervical ultrasound protocol in a pediatric emergency department to see if it helps this population....

The FASH exam is not just a typo when trying to write about the FAST exam. FASH stands for Focused Assessment with Sonography for HIV-associated Tuberculosis (TB). This exam combines various body areas to look for evidence of TB. You can look for extra fluid (pericardial, pleural, ascites), enlarged abdominal lymph nodes, and solid organ lesions (spleen, liver). This has been described for a while...

It's not what you think - POCUS is not going to be used to diagnose a GI bleed. However, perhaps it can be used to risk stratify this diverse group of patients. These authors had the idea to check IVC, echo, and LVOT VTI to see if it could help predict which patients are going to have adverse events from their bleed. https://www.ultrasoundgel.org/89 https://www.ncbi.nlm.nih.gov/pubmed/31379015

COVID-19 is here, there, and everywhere. Mike Mallin joins in to examine the first published reports on POCUS being used on the front lines. We discuss the sonographic findings and potential uses during this pandemic. https://www.ultrasoundgel.org/88

We know that point of care ultrasound can be used to find evidence of urinary obstruction in patients with renal colic from a kidney stone. However, it is not clear how to put this into practice. Who should get an ultrasound? Who needs further testing after ultrasound? This article poses one protocol to see if it can help save time and money in the emergency department. https://www.ultrasoundgel.o...

A focused cardiac ultrasound is commonly used in the evaluation of patients with possible pulmonary embolism (PE). Based on the literature to date, we know that this can be helpful for ruling in signs of right heart strain. On the other hand, so far, this focused exam has not been that helpful in ruling out PE. These authors try to fix that by optimizing the sensitivity of the exam in a population...

It is an age-old question - short or long axis? Using ultrasound guidance for internal jugular vein cannulation is now fairly standard. There are a lot of opinions regarding if it is best to visualize the target in short axis (cross section) or long axis (parallel to the vein). There are certainly benefits to both. This episode features a prospective randomized trial that attempts to put an end to...

Acute aortic syndromes such as aortic dissection, aortic aneurysm, penetrating ulcer are tricky. No one wants to miss these deadly diseases, but we also don't want to test everyone who has the slightest sign of this wily diagnosis. Point of care ultrasound can detect signs of aortic pathologies, but there haven't been any good studies to determine if this is accurate or safe....until now. https://...