Duplicated Superficial Femoral Vein

We will always keep learning…

In the book and at the EDE 2 course, we mention the importance of keeping an eye out for the duplicate popliteal vein. It is important to scan both for DVT. At a recent course, something less common was found: a duplicate superficial femoral vein. To boot, there was a DVT in one of them! Kudos to Mike Wolf and Dan Joo and the rest of the team for picking up on this! Quite a number of previously undiagnosed abnormalities have been found at EDE 1/2/3 courses over the years. But this is the first DVT. Interestingly, this model had no symptoms. This is common in the setting of a duplicate vein, since drainage of the extremity can still occur. See below for an image of a duplicate popliteal vein from the book. We do not have any images of a duplicate femoral vein yet :(, so I will instead direct you to this google search: duplicated superficial femoral vein.

POCUS for Pneumonia? EDE 3 Journal Club Meta-analysis presented by TJ

There is more and more research looking at the utility of POCUS for diagnosing pneumonia, both in adults and pediatrics. At the EDE 3 journal club, Dr Tom Jelic presented a meta-analysis on the topic published by Alzahrani et al in CUJO, Critical Ultrasound Journal. The title is “Systematic review and meta-analysis for the use of ultrasound versus radiology in diagnosing of pneumonia“.

Here’s Tom:

Seven Days of EDE

Thanks to the dedication of multiple instructors across the country, we are now able to hold more EDE 2 Courses than ever before. For the next seven weekdays, we are holding EDE 2 events from BC to Québec.

Tomorrow and Wednesday we are holding EDE 2 in Kamloops, BC. EDE 2 team members are Andrew Skinner from St Paul’s, Ben Ho (Master Knobologist!) from Nanaimo, Maja Stachura from VGH/Lions Gate/Squamish, and Matt Petrie from Kelowna.

On Thursday and Friday, EDE 2 is back at CHUL in Quebec City with veteran instructors Marc Charles Parent, Daniel Bernier, and Pierre Collin, along with Mireille Paradis making the trek from Sherbrooke.

Next Monday and Tuesday, EDE 2 is back once again at the EM Update conference in Toronto with a massive team including Jordan Chenkin (Sunnybrook), Tina Bhandari (Sunnybrook), Joel Turner (McGill-JGH), Paul Hannam (Toronto East ED Chief and Loco extra-ordinaire!), Claire Heslop (UHN), Mike Romano (Sunnybrook), Andy Primeau (NOSM-Sudbury), Patrick Wong (Toronto East-Michael Garron), Puneet Kapur (U of T ED Ultrasound Fellow), and Craig Brick (U of T ED Ultrasound Fellow).

Rounding out the events next Wednesday, May 3 at EM Update, Greg Hall and I, Andrea Unger (Brantford), Deborah Leung (Sunnybrook), and Roberta Hood (Markham) will be holding a workshop covering EDE 2 and 3 topics.

And who can forget the course coordinators! Sarah Van Horn from Vancouver, Karine Poirier from Québec, and Andrea & Michelle Ennis from Toronto are truly the quarterbacks of the course. They hold everything together and make sure the course runs smoothly and that all the participants get as much as possible out of the course.

Lastly, a shout out to Chris Prelypchan in Kamloops! Like so many local organizers, he has worked tirelessly to recruit models, get the rooms ready, organize the catering, and on and on. It is thanks to Chris and all of the other local organizers across the country that the course can happen at all!

EDE 2 is truly a team effort! All of the folks mentioned above are key to the education of emergency physicians from across the country who will be learning new techniques in bedside ultrasound to improve the care that they provide. I just wanted to say thanks ?

Steve

CVLs: When gas is useful in #POCUS

Here are 2 studies that Tom Jelic presented at the latest EDE 3 journal club looking at the use of a saline flush to confirm central line placement. In the presentation, Tom shows a video of a subxiphoid view showing what is seen within 2 seconds of the flush being injected. The 2 studies were led by Weekes from Charlotte and Duran-Gohring from Jacksonville.

This is a point that came up in the discussion. If a subclavian line inadvertently gets fed up the internal jugular, you might still get a flush in the right side of the heart. But there will be a few second delay in that flush appearing. Also, if you are uncertain, you can use EDE to look for the catheter in the IJ. Pretty easy stuff!

EDE 3 Journal Club: Is the Tube In? Can #POCUS tell you?

That was a deceiving title. You were all thinking endotracheal tube, weren’t you? Or maybe chest tube? Actually, I am referring to the nasogastric tube. I know what you’re thinking. “Why would we need ultrasound to see if the nasogastric tube is in the stomach? It’s pretty easy to tell clinically with a stethoscope.” You would be correct… usually. And that applies to so many other clinical situations. Usually, we would have gotten the diagnosis right without ultrasound. Usually, we would’ve gone down the right treatment path without ultrasound. And usually, we would have done a procedure without any complications. But as physicians, we really don’t like “usually” in any of these settings. POCUS gets us further away from “usually”, and much closer to “always”.

Dr Tom Jelic presented an article at the recent EDE 3 Journal Club on the topic of using POCUS to confirm nasogastric tube placement. It was a study conducted by Dr Marianna Zatelli, an intensivist from Bolzano, Italy. Here is the pub med link. Take it away, Tom!

This is a relatively simple scan. Give it a try and let us know how it goes. It might make life easier in those equivocal cases.