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/

VOTW: "Eye-Yahh!"

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This week’s VOTW is thanks to Drs. Jennie Xu and Leily Naraghi!

HPI: 56 yo male with PMH of HTN presenting for sudden near complete vision loss in his right eye since 1pm yesterday.

Review of POCUS eye anatomy



Image/Video 1: Retinal detachment - you can differentiate this from vitreous hemorrhage because retinal detachments are typically thicker and are tethered to the optic nerve posteriorly.

Image/Video 2: “Washing machine sign” is concerning for vitreous hemorrhage

There are ways to figure out if a retinal detachment is “mac-on” or “mac-off”. The macula is temporal to the optic nerve in each eye. “Mac-on” retinal detachments are true ophthalmological emergencies and need to go to the OR emergently to have the retinal reattached and save their vision. It's hard to be sure though so if you see a retinal detachment, consult ophthalmology.

Conclusion: Patient was transferred to SUNY Downstate for ophthalmological repair of partial retinal detachment.