ACEP Resolution 27

Resolution 27    

Reimbursement for Ultrasound Performed by Emergency Physicians (as amended)

RESOLVED, That ACEP develop a statement declaring that insurance companies and other payers reimburse emergency physicians for ultrasound studies and services that they perform and interpret as separate and identifiable procedures while providing patient care services in the Emergency Department; and be it further

RESOLVED, That ACEP support efforts to reduce payment denials for appropriately performed and documented clinical ultrasonography.

2015 Peds Ultrasound CME course

Over forty participants joined Sinai faculty Jim Tsung, Ee Tay, Bret Nelson, Joshua Guttman, Jacob Goertz, Turan Saul, Jenny Sanders, Kimberly Kahne, Michelle Vazquez, Joe Sorravit, and Rupi Mudan. Course Directors Ee Tay and Joshua Guttman organized great didactic content and lost of hands-on training (HOT) with pediatric models.

Participants from many pediatric and acute care specialties attended. They left with greater scanning skills, reduced reliance on CT scans, a multi-tool, and one lucky winner received Kaushal Shah’s new junior medical detective book, My Tummy Hurts

Our next hands-on ultrasound course will be in Ponte Vedra, Florida on June 17 at the Clinical Decision Making conference.

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Brachial veins

When assessing patients with difficult peripheral venous access it is often helpful to look in the medial upper arm. Here, the brachial artery (A) and veins (V) are predictably located between the biceps and brachialis muscles. The median nerve (N) resides there as well.

NAV-labelsHere’s a plate from Grey’s Anatomy for some perspective:


So how can you tell which is which? Apply pressure slowly and watch for movement.

  1. The veins will collapse
  2. The artery will pulsate
  3. The nerve will do nothing

Brachial vv art median nerve

Giving a great talk

Lots of inspiring speakers at today’s academic retreat. I had ten minutes to give my opinion on how to give a great talk, and referred to a few great books to help:

My opinion? Craft a powerful message and find the best tools at your disposal to convey it. Easy!

Improving left upper quadrant view

Many clinicians are challenged when evaluating patients for perisplenic fluid as part of the FAST or RUSH examination. Here are some common problems and how to fix them.

Fix probe location

  • Make sure you are holding the probe in a longitudinal view, probe marker towards the patient’s head. Place the probe just above the costal margin, in the posterior axillary line. The knuckles of your probe hand should be touching the stretcher

Left renal ultrasound probe position

Start too high (too cephalad)

  • Starting with the very posterior probe position described above, slide towards the patient’s head until you clearly see pleura and rib shadows. Once you’ve established clear evidence you are over the thorax, slide the probe toward the patient’s feet along the same posterior axillary line until the pleura ends. Now you have found the diaphragm! Scan just caudal to the end of the pleura and you should see the diaphragm and spleen.
  • Another way to simplify this- If you see pleura, slide towards the feet. If you see bowel gas (or “nothing”), slide towards the head.

Use a slightly oblique approach

When rib shadows obscure the view, use the “sonographic rib spreader” technique.

Rib shadows obscure view of spleen

Rotate the probe slightly towards the patient’s back so the probe is slightly more parallel to the ribs. Do not go fully transverse.
LUQ oblique probe orientation

This exposes more of the probe to the interspace, yielding a larger window through which to view the spleen.
Spleen in the left upper quadrant window

For more tips on viewing the spleen, check out this post.

SonoSweden 2015

Bret Nelson and Felipe Teran took part in an incredible conference just outside of Stockholm, Sweden. Over one hundred participants and twenty faculty attended this sold-out conference at the Hasseludden Yasuragi Japanese spa . Among the luminaries were Matt Dawson and Mike Mallin (from the Ultrasound Podcast), lung ultrasound queen Vicki Noble, Mike Lambert and Joe Wood (directors of the first ultrasound program in the United States), and many, many others.

Videos from the conference are available here. Besides excellent lectures, there were hands-on sessions recorded. An incredible amount of practical information is conveyed during these hands-on sessions, so it is worth checking out some of these videos as well as the lectures. Bret Nelson’s session on aorta scanning is here,

Felipe Teran and Bret Nelson Matt Dawson and Mike Mallin Organizer Christofer Muhr welcomes participants Participant getting a bit of light reading done on the flight to Stockholm