65 year old man with acute shortness of breath. Attended rural ED at the middle of night. 2am to be precise.
Bedside echo apical 4 chamber view attached here.
ECG shows old LBBB
X-ray not available at present
Started treatment with sitting up, frusemide, GTN infusion
What else would you do differently to manage him in the ED?
What are the challenges one might face during working in a rural and remote emergency department with limited resources?
Anything we need to be particularly mindful of?
Thank you
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88 yr female. Unwitnessed fall. Painful right hip. Unable to weight bear. CT pan scan performed due bruises over various parts of the body.
Isolated right neck of femur confirmed.
In your experience, which type of ultrasound guided nerve block is most effective in such cases?
- Femoral nerve block
- PENG block
- Fascia Iliaca Block
- Anything else
Adding some dexamethasone prolongs the duration of effects of the regional anaesthesia
When I apply an ultrasound guided regional anaesthesia, it is very satisfying to watch the hydrodissection.
What is your experience with hydrodissection?
Do you have any tips to share?
Ultrasound is useful for the guidance for joint aspirations or arthrocentesis. It's use in the emergency department is well recognised. However, the research evidence for it is limited. This scoping review sums it up
Do you use ultrasound guidance for joint aspirations?
Or do you find landmark technique more useful?
Ultrasound probe cover is commonly used during ultrasound guided nerve block. Personally I use this all the time.
However some clinicians don't
What is the evidence?
Any suggestions?