Prior to leaving for ACEP in Denver, CO there was a gathering (aka “party”) at my home in sunny San Francisco with my friends and colleagues in emergency medicine / emergency ultrasound – from all of the ultrasound programs in the region – it was amazing… and yes, wine was served! … along with pizza (of course!) We discussed 4 articles as listed below and I took down the US pearls noted from the various physicians who attended:
Guest list: Sarah Williams and Zoe Howard from Stanford along with our fellow Viveta Lobo and 2 emergency medicine residents doing our US elective (Patrick Lenehan and James Chung), Arun Nagdev from Highland along with his 2 fellows Dan Mantuani and Andrew Herring, Ken Kelley from UC Davis along with his fellow, Pedro Campus the fellow from UCSF, Brita Zaia from Kaiser San Francisco and our prior US fellow from Stanford, Rusty Oshita from Kaiser South Sacramento and a prior fellow from UC Irvine along with his fellow, Rimon Bengiamin from UCSF/Fresno who is also the course director for Northern CA US course, Manish Asarvala from Kaiser Santa Clara and prior UCSF fellow, and…. Im sure there were more who I forgot to mention but were equally well-dressed that night.
US Pearls from Northern California Ultrasound Journal club:
First Pearl: know and love each other, man this is fun! Warning: all pearls are coming with wine on board!
Article #1: Lung US for Pneumonia dx: ultrasound has a high sensitivity and specificity, more than CXR!! The study had pneumonia confirmed by CT…, limitation of the lung article: no ambulatory patients studied, only those admitted, not blinded or randomized, no outcomes stated; Reality of medicine right now: what we (the ultrasound savvy bunch) do / think is enough for the patient is different than what admitting teams do/need since they don’t do US yet; All agree: we need to use both US and CXR because US diagnoses pneumonia, but not the pattern of the pneumonia…viral and bacterial pneumonia look the same on US ?? Some, yes… Correlate clinically ;)
Article #2: US v landmark for Peritonsillar abscess: less I&D, less complications, less time spent – in practice…From Arun Nagdev at highland: for a study to change our practice, it needs to be more than just a case series. By Sarah Williams at Stanford: it’s tough to study an US v landmark when doctor is an US savvy person after they’ve seen the US image; By Ken Kelley at UCDavis: phlegmon v abscess tough to differentiate, if densities on US are only hypoechoic, not anechoic; By Rusty Oshita at Kaiser South Sac: use suction to depress the tongue, probe with one hand , needle/scalpel with another; By Rimon Bengiamin at UCSF/Fresno: have patient hold probe or suction and you do the rest, they’ll do it right and feel less anxious.
Article #3: Prehospital US in emergencies: PAUSE protocol for Pneumothorax, Pericardial effusion, cardiac standstill: 19/20 EMTs could identify above, what will they do with results in practice? By Sarah Williams at Stanford: biggest help will be to not needle a chest because they see sliding lung when they don’t hear breath sounds; By Rusty Oshita: prehospital US will help greatly in the military, austere environments, disasters, and the future in EMS here…… And also at burning man ;)
Article #4: Techincal errors in Physicians performing FAST: in lecture they get it; in practice: environment not ideal, rushed, don’t do enough in the short time period they get; the FAST is not fast, “how do we drive this home?!” – teach the non-EM doctors that…By Sarah Williams: it’s been studied that for procedural skills it only takes 6 months to lose it… Maintain your skills; ” We need to make others earn the right to drink the US kool aid'”…..As wine glasses raise up across the room…
What a journal club! After that we played with Mindray machines and the GE Vscanner – meaning, we scanned ourselves with one hand, holding the glass of wine with the other – yeah, I know, weird… but oh so fun!