Procedures


17 year old male with hand pain after striking a stationary hard surface with a closed fist. What US guided nerve block would facilitate reduction of the patient's fracture? 

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What to Know
  1. List indications, contraindications, and limitations when using ultrasound for procedural guidance.
  2. Describe the transverse, longitudinal and oblique approaches to procedural guidance, as well as their advantages and disadvantages.
  3. Identify the clinically relevant sonographic anatomy and findings for each procedure.
  4. Preform the required protocols for abscess identification and drainage, central and peripheral vascular access, paracentesis, thoracentesis, foreign body detection removal, bladder aspiration, arthrocentesis, pericardiocentesis and pacemaker placement and capture.

What to Read: Introduction to Bedside Ultrasound
Free iBook download Vol 1 and Vol 2
Chapter 9: Central Lines
Chapter 13: Joint Injections
Chapter 23: Peripheral IV Placement
Chapter 24: Procedures

Where to Learn More

Pericardiocentesis 3/19/2013 
Hip US Aspiration and Injection 11/15/2012 
Peritonsillar Abscess Drainage 1/12/2012

ACEP US Section Resources
ACEP Sonoguide Vascular Access Page by Rajesh Geria and Beatrice Hoffman
ACEP Sonoguide Pericardiocentesis Page by Rajesh Geria
ACEP Sonoguide Thoracentesis Page by Rajesh Geria
ACEP Sonoguide Paracenteis Page by Rajesh Geria
ACEP Sonoguide Foreign Body Localization Pate by Rajesh Geria
ACEP Sonoguide Abscess I&D Page by Brian Euerle

 Other Awesomeness
University of Toronto LP Tutorial 
Highland US Nerve Block Site

SAEM Academy of EUS Narrated Lectures
Ultrasound Guided Procedures: Lumbar Puncture, Paracentesis, and Thoracentesis by Negean Vandordaklou
Ultrasound Guided Peripheral IV Lines by Jennifer Martin
Ultrasound Guided Central Venous Access by Arun Nagdev

 Key Articles
  1. Consensus. ACEP Emergency ultrasound guidelines. Ann Emerg Med. 2009;53(4):550–570.
  3. Nomura JT, Leech SJ, Shenbagamurthi S, et al. A randomized controlled trial of ultrasound-assisted lumbar puncture. J Ultrasound Med. 2007;26(10):1341-1348. 
  4. Stone MB, Sutijono D. Intraarticular injection and closed glenohumeral reduction with emergency ultrasound. Acad Emerg Med. 2009;16(12):1384-1385.
  5. Tirado A, Nagdev A, Henningsen C, Breckon P, Chiles K. Ultrasound-guided procedures in the emergency department-needle guidance and localization. Emerg Med Clin North Am. 2013;31(1):87–115..
  6. Tirado A, Wu T, Noble VE, et al. Ultrasound-guided procedures in the emergency department-diagnostic and therapeutic asset. Emerg Med Clin North Am. 2013;31(1):117–49.

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