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Jerry Chiricolo, MD FACEP
Chief, Division of Clinical Ultrasound, New York Methodist Hospital, USA

A 26-year-old female, with no significant past medical history, presented to the emergency department complaining of severe lower abdominal pain. It began as moderate intensity, right lower quadrant (RLQ) pain and was associated with her menses beginning six days prior; however, it acutely worsened two hours prior to arrival. The pain was now sharp and localized to the RLQ, and radiated to the lower back. On presentation, the patient appeared in moderate distress with normal vital signs. The patient was evaluated by the emergency medicine physician who elicited right adnexal tenderness on physical examination. The clinical concerns included ovarian torsion and an immediate point-of-care ultrasound was performed. 

Christopher C. Raio, MD MBA FACEP
Chairman, Department of Emergency Medicine, Good Samaritan Hospital Medical Center, West Islip, NY, USA Progressive Emergency Physicians

A 55-year-old male with a past medical history significant for gastroesophageal reflux disease and hypertension presented to the emergency department, complaining of severe abdominal pain and distention. The patient stated that the pain began to develop while attending a party the previous evening. The pain was sharp, greater in the upper-abdominal area, and worsened throughout the course of the night. On presentation at the emergency department, the patient was tachycardic, diaphoretic, and appeared to be in moderate distress, exhibiting diffuse abdominal tenderness. The patient was immediately evaluated by the emergency department team, placed on telemetry monitoring, intravenous access was gained and hydration initiated, and appropriate blood specimens were collected. The emergency medicine resident decided to perform a focused abdominal ultrasound to help elucidate the cause of the patient’s undifferentiated acute abdominal pain.

This article, an excerpt from our eBook “Ultrasound-Guided Regional Anesthesia” by Dr. Brandon Winchester, co-founder of blockjocks.com, discusses the approaches and anatomy of an ultrasound-guided axillary block.

Dr. Brian J. Moran is Medical Director at Chicago Prostate Cancer Center in Illinois and an experienced practitioner of prostate brachytherapy, having performed thousands of prostate seed implants. He is a frequent speaker at professional meetings and has authored numerous publications in medical journals and textbooks.

Dr. Hereford discusses how the bk3500 point of care ultrasound system helps him address some of the challenges he faces as an anesthesiologist. You may have found yourself in a situation similar to the one described below.

Professor Hongguang Wang is a hepatobiliary surgeon at the Chinese PLA General Hospital, in Beijing, China, one of the largest hospitals in the country. The facility has five sections in the hepatobiliary surgery department: hepatic surgery, biliary surgery, pancreatic surgery, minimally invasive surgery, and liver transplantation surgery. Dr. Wang is in charge of the minimally invasive surgery section. There, he performs laparoscopic hepatectomies, laparoscopic cholecystectomies, and laparoscopic common bile duct exploration.

Anesthesiologists have only been incorporating ultrasound guidance for regional anesthesia into their practice for about 10 years. Using ultrasound allows clinicians to visualize their needle and target structures with confidence, while also avoiding structures in the needle’s path, potentially decreasing complications.

Pelvic floor disorders lead to hundreds of thousands of surgical interventions on female patients in the USA each year. An estimated 30% of these cases require re-operations.

Dr. Gavin Quigley is a prominent consultant neurosurgeon based at the Royal Victoria Hospital in Belfast, Northern Ireland, where his team provide care for 1.8 million people. Dr. Quigley has previously worked as an advisor for HIQA (Health Information and Quality Assessment) in the Republic of Ireland and for NICE (National Institute for Clinical Excellence) in the UK, and was appointed as a Consultant Neurosurgeon to the National Neurosurgical Unit in Dublin, Ireland in 2006. He returned to Northern Ireland in 2009, taking up his current position at The Royal Victoria Hospital.