I just gave a lecture at the excellent late summer school organised by the sono4you group. The course was in Graz in Austria but I was safely in my office at home unfortunately. The idea was to provide an anatomic refresher for those just starting to learn point of care ultrasound, in this case a group of super enthusiastic med students.

Thanks again for the invite and hopefully the lectures are somewhat informative.

Some of the images used in the talk were found via these great resources:

CoreUltrasound

The POCUS Atlas

Toronto TOE Simulator

I just gave a lecture at the excellent late summer school organised by the sono4you group. The course was in Graz in Austria but I was safely in my office at home unfortunately. The idea was to provide an anatomic refresher for those just starting to learn point of care ultrasound, in this case a group of super enthusiastic med students.

Thanks again for the invite and hopefully the lectures are somewhat informative.

CoreUltrasound

The POCUS Atlas

Toronto TOE Simulator

I just gave a lecture at the excellent late summer school organised by the sono4you group. The course was in Graz in Austria but I was safely in my office at home unfortunately. The idea was to provide an anatomic refresher for those just starting to learn point of care ultrasound, in this case a group of super enthusiastic med students.

Thanks again for the invite and hopefully the lectures are somewhat informative.

CoreUltrasound

The POCUS Atlas

Toronto TOE Simulator

So, yes this is another very much exam focused one. Ankle blocks are certainly handy but I always find that the foreign body is right on the overlapping border of all the territories and you end up having to block everything.

These days it might just be easier to an ultrasound guided sciatic and get everything you need but I digress…

• 5 Min Sono Popliteal
• Radiopaedia
• NYSORA
• Emory Ultrasound

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You can find more things on the FRCEM on this site here.

This one is special and has turned into an AFEM episode

This seems to be a favourite for examiners and not something i use commonly in real life

4 Nerves involved (the biggies in bold)

• auricolotemporal [V3]
• greater auricular [C2,3]
• auricular branch of [X]
• lesser occipital [C2]

Also note the names of the parts of the ear

The block (from the OHEM)

• Greater Auricular
  • 1cm below ear lobe all the way from post border of SCM to angle of mandible
• Lesser occipital
  • infiltrate just behind the ear
• Auriculotemporal
  • just anterior to the EAM and tragus (watching out for the superficial temporal artery

Here’s a video from EMRAP with a further somewhat simplified method

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This is adapted from a take I gave in EuSEM 2016 in Vienna. This is part 3

The most important links you need are:

• Larry Mellick’s YouTube channel. This is incredible stuff and Prof Mellick was happy for me to use his videos
• NYSORA

—

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This is adapted from a take I gave in EuSEM 2016 in Vienna. This is part 3

The most important links you need are:

• Larry Mellick’s YouTube channel. This is incredible stuff and Prof Mellick was happy for me to use his videos
• NYSORA
• Radiopaedia Case

—

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This is adapted from a take I gave in EuSEM 2016 in Vienna.

The most important links you need are:

• Larry Mellick’s YouTube channel. This is incredible stuff and Prof Mellick was happy for me to use his videos
• NYSORA

—

The AFEM podcast will always be free but feel free to donate to help cover hosting and the cost of web hosting and producing new episodes

Donate via PayPal

iTunes | Generic RSS

This is adapted from a take I gave in EuSEM 2016 in Vienna.

The most important links you need are:

• Larry Mellick’s YouTube channel. This is incredible stuff and Prof Mellick was happy for me to use his videos
• NYSORA
• Here’s a link to the slightly geeky article on facial and trigeminal cross overs.

—

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Slides as PDF

This was the final podcast on the hand but we’ll be back again in a month or two with a series on dental problems and max fax bits and bobs. Thanks again for all the paypal donations. It really helps.

—

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Slides

with apologies to xkcd.com

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Slides as PDF

Further Reading:

• Rosens 8th Chapter 50
• Roberts & Hedges 6th Chapter 31
• 5minsono.com on ultrasound guided blocks
  • Ulnar Nerve
  • Median Nerve
• Double-dorsal versus single-volar digital subcutaneous anaesthetic injection for finger injuries in the emergency department: A randomised controlled trial. PMID 26991958
  • RCEM FOAMed discussion on this paper
• Brian Lin demonstrating the transthecal technique

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Slides as pdf

Some papers referenced in the podcast

• Rosens 8th Chapter 50
• Zafonte et al on pulley systems
• Lutsky et al on flexor tendon injury

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The video

Slides as PDF

—

Huge kudos to ALIEM who have some recent great posts on this that were released while i was prepping for the podcast. Thanks again to Michelle Lin for allowing their use.

• The Elson’s test by Michelle Lin (original paper here)

• Extensor Tendon Injuries
• Diagnosing the central slip

—

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Slides as PDF

—

The AFEM podcast will always befree but feel free to donate to help cover hosting and the cost of web hosting and producing new episodes

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Slides PDF

Further Reading

• LacerationRepair.com – great website by Brian Lin with great videos on all lacerations including nail bed injuries
• Nice review on Nail Bed injuries in Journal Hand Surgery: American

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I’m not sure how many podcasts this series will stretch to but let’s get started.

Slides PDF

Further Reading

• Nice EMJ Review on soft tissue injuries

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The single most important resource you need is Ophthobook.com

The single most important resource you need is Ophthobook.com

The single most important resource you need is Ophthobook.com

Every talk from the conference is coming out via the SMACC podcast so make sure you subscribe.

As my talk is so predominantly visual, it really needs the slides for it to make sense so I’ve included the slideset here and put the audio over the slides so you can get the feel of the talk.

For people interested in learning some more detailed neuroanatomy I’d strongly recommend headneckbrainspine.com

They’ve done what I’ve always wanted to do and have created scrolling, labelled radiology images that wonderfully demonstrate the anatomy in 3 dimensions. Really invaluable stuff.

Here’s a list of previous neuro related podcasts I’ve done:

• The C-Spine
• Vertebral Artery
• CSF Circulation
• Spinal Cord Injury
  • Part one
  • Part two
  • Part three
• Venous Sinuses
• Brain Herniation
• Internal Capsule
• Anterior and middle cerebral arteries
• Posterior Cerebral Artery
• Posterior Communicating Artery
• Cavernous Sinus

And if you’re interested in working where I work as an ultrasound or education fellow then get in touch.

I’m currently trying to introduce fascia iliaca blocks as part of routine care for patients in our department so i thought a podcast on some of the anatomy wouldn’t go a miss. If you want some light reading on the literature, then I’ve included a big list below. If you’re more practically orientated then I’d strongly recommend the following:

Ultrasound Podcast: Fem Nv Block

NYSORA: Fascia Iliaca Block.

Slides are on slideshare

References:

1.Godoy Monzón D, Vazquez J, Jauregui JR, Iserson KV. Pain treatment in post-traumatic hip fracture in the elderly: regional block vs. systemic non-steroidal analgesics. Int J Emerg Med. 2010;3(4):321–5.

2.Mouzopoulos G, Vasiliadis G, Lasanianos N, Nikolaras G, Morakis E, Kaminaris M. Fascia iliaca block prophylaxis for hip fracture patients at risk for delirium: a randomized placebo-controlled study. J Orthopaed Traumatol. 2009 Aug 19;10(3):127–33.

3.Høgh A, Dremstrup L, Jensen SS, Lindholt J. Fascia iliaca compartment block performed by junior registrars as a supplement to pre-operative analgesia for patients with hip fracture. Strat Traum Limb Recon. 2008 Sep 2;3(2):65–70.

4.Godoy Monzón D, Iserson KV, Vazquez JA. Single fascia iliaca compartment block for post-hip fracture pain relief. JEM. 2007 Apr;32(3):257–62.

5.NZ Guidelines Group. Acute Management and Immediate Rehabilitation After Hip
Fracture Amongst People Aged 65 Years and Over. 2003;:1–40.

6.National Clinical Guideline Centre. The management of hip fracture in adults. 2011;:1–664.

7.SIGN SIGN. Management of hip fracture in older people. 2009 Jun;:1–56.

8.(null) INHFDSG. Irish Hip Fracture Database Preliminary Report 2013. 2014 Mar 4;:1–50.

9.(null) TCOEM. Clinical Standards for Emergency Departments. 2013;:1–16.

10.Beaudoin FL, Haran JP, Liebmann O. A Comparison of Ultrasound-guided Three-in-one Femoral Nerve Block Versus Parenteral Opioids Alone for Analgesia in Emergency Department Patients With Hip Fractures: A Randomized Controlled Trial. Academic Emergency Medicine. 2013 Jun 12;20(6):584–91.

11.Elkhodair S, Mortazavi J, Chester A, Pereira M. Single fascia iliaca compartment block for pain relief in patients with fractured neck of femur in the emergency department: a pilot study. Eur J Emerg Med. 2011 Dec;18(6):340–3.

12.Williams R, Saha B. Best evidence topic report. Ultrasound placement of needle in three-in-one nerve block. Emergency Medicine Journal. 2006 May;23(5):401–3.

13.Christos SC, Chiampas G, Offman R, Rifenburg R. Ultrasound-guided three-in-one nerve block for femur fractures. West J Emerg Med. 2010 Sep;11(4):310–3.

14.Fletcher AK, Rigby AS, Heyes FLP. Three-in-one femoral nerve block as analgesia for fractured neck of femur in the emergency department: a randomized, controlled trial. Ann Emerg Med. 2003 Feb 1;41(2):227–33.

15.Beaudoin FL, Nagdev A, Merchant RC, Becker BM. Ultrasound-guided femoral nerve blocks in elderly patients with hip fractures. Am J Emerg Med. 2010 Jan;28(1):76–81.

16.Haines L, Dickman E, Ayvazyan S, Pearl M, Wu S, Rosenblum D, et al. Ultrasound-guided fascia iliaca compartment block for hip fractures in the emergency department. JEM. 2012 Oct;43(4):692–7.

17.Rashid A, Beswick E, Galitzine S, Fitton L. Regional analgesia in the emergency department for hip fractures: survey of current UK practice and its impact on services in a teaching hospital. Emergency Medicine Journal. 2013 Jul 22.

18.Abou-Setta AM, Beaupre LA, Rashiq S, Dryden DM, Hamm MP, Sadowski CA, et al. Comparative effectiveness of pain management interventions for hip fracture: a systematic review. Ann Intern Med. 2011 Aug 16;155(4):234–45.

19.Parker MJ, Griffiths R, Appadu BN. Nerve blocks (subcostal, lateral cutaneous, femoral, triple, psoas) for hip fractures. Cochrane Database Syst Rev. Wiley Online Library; 2002;1.

20.Foss NB, Kristensen BB, Bundgaard M, Bak M, Heiring C, Virkelyst C, et al. Fascia iliaca compartment blockade for acute pain control in hip fracture patients: a randomized, placebo-controlled trial. Anesthesiology. 2007 Apr;106(4):773–8.

First part lives here

I don’t expect anyone to pay for this but feel free to donate to help cover hosting and the cost of producing new episodes

[paypal-donation]

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It’s longer than the usual podcasts so I’ve split into two parts.

Feedback, is as always, welcome.

I don’t expect anyone to pay for this but feel free to donate to help cover hosting and the cost of producing new episodes

[paypal-donation]

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It’s the the most exciting conference happening this year. All the your favourited FOAMites in one place giving it dixie on all things EM and Critical Care. There is still time to get booked in for it.

I, alas, will be holding fort on the Emerald Isle supporting the dog, wife and her ever enlarging bump and saving the spondoolies for next years SMACC (that’s happening lads isn’t it?)

They’ve put out the challenge for short, high impact teaching videos for the EM/CC community in the form of PK talks. Below is my offering. It’s a rehash of some old material but hope you like it.

All show notes over at emergencymedicineireland.com

All the show notes over at emergencymedicineireland.com

More on our walk through the shoulder joint

There is more to managing shoulder pain and injuries than just x-ray and ruling out fracture. This short podcast starts with the rotator cuff.

More info here: http://wp.me/p2GZ98-A4

More detail on the wrist and in particular the Terry Thomas sign and carpal instability. As always there’s much more going on in the x-ray than just the bones.

Please check out radiopaedia.org.

And some cases from the podcast.

http://radiopaedia.org/cases/scapholunate-dissociation

http://radiopaedia.org/cases/scapholunate-dissociation-1

http://radiopaedia.org/cases/lunate-dislocation

The big textbook I mentioned is Clinical Sports Medicine, available here. One of the lead authors, Karim Khan is even on Twitter and worth a follow.

More of the Grandma photos here.

Wheeless on Colles and EPL

Hi guys. This is yet another Zebra diagnosis but it’s a great one for illustrating some of the relevant anatomy. Let me know what you think.

Here’s the link to the article mentioned

Rudinsky, Sherri L, and Michael J Matteucci. “Emergency Department Presentation of Superior Mesenteric Artery Syndrome: Two Cases in Marine Corps Recruits..” JEM 42, no. 2 (February 2012): 155–158. PMID 19111427

The case report in the video can be found here

Don’t forget to hit the HD tab if you’re watching it on the website.

Links to RootAtlas.com

And a really neat one:

The nice little picture of the brain in the case presentation can be found here

As mentioned in the video here are some of the cric resources out there on the interweb

UPDATE:

The very smart and astute Chris Nickson points out that central cord syndrome normally presents with motor weakness in the distally (in the hands) rather than proximally in the case in the video.

My bad…

He is of course right and has a nice little mnemonic for remembering it MUD: Motor/Upper/Distal

And remember that the symptoms and signs are relative not absolute:

motor>sensory
upper>lower
distal> proximal

Based on the pure anatomy – with the corticospinal tracts arranged somatotopically with the highest spinal segments most medial – one would expect proximal weakness (C5,6 etc..) more than distal (C7-8, T1 etc…). But since when does the textbook play ball with reality! Maybe it’s just representative of the level of lesion in cervical cord (ie a lower lesion when the upper segments have already exited the cord) but it has me beat. Let me know if you have a better answer

Either way the more important thing is that central cord syndrome more usually presents with distal not proximal upper limb weakness.

Kudos to Chris for spotting it.

As always, feel free to download and reuse or embed or whatever.

Let me know what you think

And if you have a slightly more accurate account of where the LisFranc story is from then I’d love to know

As always this is free to re-use as you see fit, it’s also downloable for free too. If there’s technical things that are bugging let me know and I’ll see if I can fix them.

Andy

Origins, course and things that go wrong with the vertebral artery