Aorta

Ultrasound of the aorta is essential learning for all emergency medicine physicians. Not only does it rapidly and reliably identify AAAs, EM physicians have actually been sued for failure to perform an ultrasound of the aorta in a timely fashion. Please review the below video!

AORTA Minimal Imaging Criteria

When performing ultrasound the Aorta please obtain the following images or clips:

1. Transverse proximal at SMA with measurement

2. Transverse mid with measurement

3. Transverse distal with measurement

4. Transverse iliac bifurcation with measurement

5. Sagittal aorta

Note: The normal diameter of the aorta is < 3cm and < 1.5cm after the bifurcation into the iliacs. You should measure outer wall to outer wall in the anterior-posterior diameter.

Additional Recommended Materials:

• Introduction to Bedside Ultrasound Ch 3

• 5 Min AAA Rapid Review

Bowel Ultrasound: SBO & Appy

Required: Review AEUS SBO and Appendicitis videos (below)

Additional recommended material:

• Sonoguide SBO Chapter

• Sonoguide Appy Chapter

• Introduction to Bedside Ultrasound Volume 2 Chapters 13-14

• 5 Min Core Ultrasound GI Lectures (Appy, SBO, Hernia, Pyloric Stensosis, Diverticulitis)

Cardiac

Required: Review the AEUS Narrated Lecture Series Echo Part I and Part II (below)

Additional Recommended Material:

• 5 Min How to Obtain Cardiac Windows

• 5 Min Basic Cardiac Function

• Introduction to Bedside Ultrasound ch 2

DVT

Required:

• Review AEUS Narrated DVT Lecture

Additional Material:

• Intro to Bedside Ultrasound Vol 2 Ch 12

• Core (5 Min) Ultrasound DVT

• Sonoguide DVT Chapter

E-Fast

Required: Review the SAEM E-FAST Lecture Below

Additional Recommend Material:

• Intro to Bedside Ultrasound ch 1

• ACEP Sonoguide E-FAST Chapter

• 5 Min Sono E-FAST

 HEENT Ultrasound Applications

Dental Abscess - Sonoguide ENT Chapter

Peritonsillar Abscess

Ultrasound Guided Vascular Access

Required: Review both AEUS Lectures Below

Additional Recommended Material

• Introduction to Bedside Ultrasound ch 8

• 5 Min Sono Vascular Access

IVC

Required: Review the below lecture on IVC

Assignments:

• Introduction to Bedside Ultrasound Ch 12

• 5 Min IVC

Lung

Required: Review AEUS Thoracic Ultrasound Lecture (below)

Additional Recommended Material:

• Intro to Bedside Ultrasound Vol 1 Ch 4

• Core (5 Min) Ultrasound Lung Videos

• Sonoguide Lung Chapter

• 5 Min Sono BLUE Protocol

Nerve Blocks

The use of ultrasound guidance for nerve blocks has exploded particularly in Emergency Medicine. The blocks in this module are some of the most high yield blocks from our perspective. Before you jump in to any specific block, you should understand some basics that apply to all blocks including probe selection, contraindications, needle selection, anesthetic choice and possible complications such as LAST. Below are some recommended sources.

Nerve Block Introductions

5 Min Sono Nerve Block Basics

Additional Reading:

• EMRA Nerve Block Chapter (Beginning Section)

• Introduction to Bedside Ultrasound Vol 2 Chapter 5

• Highland Ultrasound - Femoral Block Overview

Lower Extremity Nerve Blocks (Femoral, Posterior Tibial)

Upper Extremities Blocks

Additional Reading:

• A quick 5 Min overview of almost every block can be found at Core Ultrasound Nerve Blocks

Ocular

Required Review: SAEM AEUS Narrated Ocular Lecture (below)

Additional Recommended Material:

• ACEP Sonoguide Ocular ChapterLinks to an external site.

• Ocular Chapter in Introduction to Bedside Ultrasound Volume 2 Chapter 16Links to an external site.

• Core Ultrasound Ocular VideosLinks to an external site.

OB/GYN

Required: Review AEUS Lecture on Transabdominal Pelvic Ultrasound (Below)

Assignments:

• IBU ch 7

• 5 Min OB

• Sonoguide OB Chapter

 USG Diagnostic Procedures

LP, Paracentesis and Thoracentesis:

Arthrocentesis

Required: Review Sonoguide Chapter which covers hip, knee, elbow and ankle

Additional Material: 5 Minute Sono MSK Library

Renal

Required: Review AEUS Renal Lecture

Additional Material:

• Introduction to Bedside Ultrasound Vol 1 Chapter 6

• Core (5 Min) Ultrasound - Hydronephrosis and Bladder Volume Measurement

RUQ

Required: Review AEUS Lecture on Biliary Ultrasound below.

Additional Recommended Material

• IBU2 ch 15

• 5 Min Gallbladder

BILIARY Minimal Imaging Criteria

1. Longitudinal gallbladder to include neck

2. Transverse gallbladder

3. Anterior gallbladder wall measurement (normal is 3mm or less)*

4. Common bile duct (measure inner to inner wall, normal is < 6mm)**

5. Assess for a Sonographic Murphy Sign***

*When measuring GB wall be sure to measure any areas of focal thickening in addition to the anterior wall as cholecystitis is not a symmetric process. 

** The common bile duct may be >6mm in older patients (you can add 1mm for each decade of life). Additionally post cholecystectomy patients will have an enarged gallbladder.

*** A Sonographic Murphy Sign is when you visualize the gallbladder on ultrasound and then direct light pressure directly over the gallbladder. You then move the probe to a location where there is no gallbladder visualized and apply similar pressure. A positive Sonographic Murphy Sign is when the pain is highest directly over the gallbladder. If pain is equal everywhere or less over the gallbladder you should report a negative Sonographic Murphy Sign.

Shock

Required: Watch the Core 5 Min Rush Ultrasound Video and the video below on Pericardiocentesis.

Additional Resources:

• Introduction to Bedside Ultrasound Vol 1 - Ch 5

• Sonoguide RUSH Chapter

Soft Tissue

Soft tissue ultrasound can rapidly aid in diagnosis of celllulitis and abscess as well as help to localize foreign bodies. Additionally, findings of necrotizing soft tissue infection can be identified which can be limb or life saving.

Required Review:

• ACEP Sonoguide Soft Tissue Chapter

• Core (5 Min) Ultrasound Soft Tissue - Cellulitis vs Abscess

Additional recommended material:

• Core (5 Min) Ultrasound for FB Removal, Flexor Tenosynovitis, Necrotizing Soft Tissue Infections

• Introduction to Bedside Ultrasound Volume 2 Chapter 10