VOTW: Small Bowel Obstruction

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HPI: 60 yo male with PMH of cerebral palsy, hx of SBO s/p resection and PEG tube presented to ED for vomiting. 

POCUS showed:

Note the to and fro peristalsis. Usually bowel is not visualized this well on POCUS due to air artifact. This, in itself, is a sign of surrounding edema and fluid filled structures.

Note that this is small bowel because of the “keyboard” sign representing plicae circulares (vs haustra seen in large bowel)

SBO POCUS findings:

  1. 3 dilated small bowel loops >2.5 cm

  2. To and fro peristalsis

  3. Bowel wall edema >3 mm

  4. Free fluid (previously known as “tanga sign”)


Case conclusion: Patient was admitted to surgical service for management of SBO!


Happy Scanning!

  • The US Team

VOTW: Interscalene Block for Shoulder Dislocation Reduction

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This week’s VOTW is brought to you by the US Team Drs. Jennie Xu and Laura Gonzalez and ED team Drs. Jennifer Wolin and Daniel Evans!

HPI: 45 year old male with no PMH presenting for left shoulder pain after falling off his scooter today. He was found to have an anterior shoulder dislocation and luckily the US team was available for an interscalene nerve block to help with pain control and an easier shoulder reduction!


Supplies you’ll need

Chlorhexidine

US probe cover

Echogenic needle

Sterile flush

10 mL of 1-2% lidocaine with or without epi (short acting anesthetic because it’s just for the shoulder reduction and has the potential to cause diaphragm paralysis- remember C3-5 innervates the diaphragm).

Place your linear probe at the medial/anterior neck at the level of the cricoid cartilage. Visualize the “stoplight” between the anterior and middle scalene muscles. The stoplight represents C5-7 in the brachial plexus.

Advance your echogenic needle through the prevertebral fascia and continue to bath the nerves (C5-7) with lidocaine. Use your saline flush to make sure you are in the right fascial plane prior to injecting your lidocaine.

Case conclusion: The ED team easily and quickly were able to reduce the patient’s shoulder dislocation!


Happy Scanning!

  • The US Team

References

  1. https://highlandultrasound.com/interscalene-block

VOTW: Lost my Appy-tite

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This week's VOTW is brought to you by Drs. Mark Calandra, Evan Mahl, and the Ultrasound Team (Drs. Jessie Chen and Lawrence Haines)!

HPI: 20 yo male with RLQ pain since last night with no associated symptoms.

Appendix POCUS anatomy review

You can usually find the appendix draping over the iliac vessels



Video/Image 1: Non-compressible structure, with “target sign”, >6 mm



Video/Image 2: Dilated, tubular structure with likely appendicolith


POCUS appendicitis criteria:

  1. Noncompressible tubular structure

  2. >6 mm

  3. Other signs: “ring of fire” (w/color flow), edema in the area

Case conclusion: General surgery consulted and patient went to OR for surgery for acute appendicitis!

References:

  1. https://www.thepocusatlas.com/new-blog/appendicitis

  2. https://coreultrasound.com/appendicitis/