ED Ultrasound: When is it useful?

[Daiphon]

The dean of our school (cardiologist) lectured us during our preclinical years on heart murmurs. "Grade I/VI means I can hear it, you can't."

Edit: apparently autocorrect likes I/V better than I/VI.

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VI = med student
V = intern
IV = resident
III = fellow
II = non-cards attending
I = stethoscopologists only

Semper Brunneis Pallium

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[deleted547339]

My charts read:

No murmur

Faint murmur

Loud murmur

 

[engineeredout]

My charts read:

No murmur

Faint murmur

Loud murmur

Either:

No murmur

Systolic murmur

Diastolic murmur


I will not be able to provide more useful diagnostic information (sorry to the Board writers who expected me to know that the murmur which you can auscultate everywhere but is loudest at the left 11th intercostal space and radiates to the right great toe is a atrial blowing hum ejection anterior tricuspid leaflet excursion murmur)

 

[gman33]

Lots of hate for US here. There's no doubt in the right hands it's extremely useful as a diagnostic tool. Most ER docs overall are pretty ****ty with ultrasound, barring those out in recent years. My main barrier to its use is that it's a pain in the ass - cords, gel, login screens, dead battery, rolling it around, wtf. But I diagnose all kinds of cool **** with it and save a lot of time waiting for formal studies when I have a slam dunk finding. Had a guy yesterday with colicky left flank pain, hematuria, sonod his aorta normal and had left hydro and dcd him home in 5 minutes. Normally takes a long ass time to get a formal or a CT. I would use it more in private practice if the hardware, software, and technology were more practical (hopefully soon).

Hydro and home?

Great so the guy had an obstructing stone.
No idea where and how big.
I'd agree with no hydro and home, but I don't think you did that patient any favors with the us.

 

[Vigileo]

Disclaimer: I'm an IM resident, so my experience is obviously different. But they teach us U/S, and the ED attendings are actively involved in teaching us throughout residency. I'm also applying to PCCM, so I'd like to learn more.

I mostly have used it for procedural guidance: IJs, paras, thoras at bedside on the floor or in the unit. All of our CVCs are placed with U/S. We are also the code leaders for floor/unit codes, so I will sometimes use it/ask someone to do it for cardiac activity. Beyond that, I don't use it much. They teach us bedside basic echo and pulmonary exams, but unless the EF is obviously < 20%, I don't feel comfortable commenting on it and will be talking to cardiology regardless. I don't know how our experience compares to other IM residencies, but for what it's worth, I train at a residency where several of the big name ED guys in FOAM ultrasound work and have had them teaching us.

I did do a retinal ultrasound for the first time in the ED as an off-service and diagnosed a retinal detachment. That was pretty cool though unlikely to be something I do routinely.