SonoCase and Procedure: Supraclavicular Subclavian lines from @EMNews #FOAMed

In a recent issue of EM News where Dr. Christine Butts once again offers insightful advice on how bedside ultrasound can assist with patient care, she gets help by one of her residents from Louisiana State University, Dr. Talbot Bowen. They offer their insights into ultrasound guided SUPRAclavicular subclavian lines – yup, that’s right – read below as they say it best:

“Ultrasound guidance in supraclavicular subclavian vein (SCV) catheterization is a relatively new concept. Traditional infraclavicular SCV catheterization is poorly amenable to ultrasound guidance because of the overlying clavicle, which can make visualization and direct guidance difficult. Supraclavicular SCV catheterization for central line placement has several advantages: practicality in cardiopulmonary arrest, decreased incidence of central line infections, lower risk of pneumothorax, and decreased incidence of thrombosis……..Once the subclavian vein is identified, the central venous catheter may be placed by dynamic ultrasound guidance. The introducer needle is advanced with gentle negative pressure from the end of the transducer. (Image 3.) This “in-plane” approach allows the operator to visualize the needle and needle tip at all times while advancing toward the vessel.”

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Read the entire entry to get even more of the goodness they describe, here.

For a post on all ultrasound guided procedures, go here.

SonoCase: Motorcycle victim: needs OR! But wait…

So, this case that I just had the other day is an example of an “oldy but goody” reason why bedside ultrasound rocks, especially in the blunt trauma victim with multiple injuries. 40 year-old motorcycle helmeted driver going moderate speed was T-boned by a car and fell onto his left side. He c/o severe left leg pain and mild left lower back pain, with STABLE (and yes, I mean, stable/normal/not worrisome vitals – HR 72, RR 16, BP 148/90, O2 sat 97%RA) with a clear primary trauma survey, and a secondary that revealed a small abrasion on his cheek, no left sided chest wall tenderness, nontender abdomen, no pelvis instability, an obvious deformed open fracture of his left tibia/fibula, and left lower posterior rib cage tenderness without crepitance or bruising. An E-FAST was done… Continue reading