Dr. Bryan Matusic Study - Why be satisfied with any failed blocks when you can avoid them altogether?
Why be satisfied with any failed blocks when you can avoid them altogether?
Dr. Bryan Matusic, DO, Director of Anesthesiology for Advanced Surgical Hospital, Washington, PA
Growing Awareness
When Dr. Matusic first started practicing, the block and neurostimulator alone were considered best practice and block success rates of 85% were the accepted norm. "I was using just my own senses and the stimulator," he says. "Even if I had a 10%-15% failure rate, I was still doing better than most." However, when he became a regional anesthesiologist in 2010 and began performing orthopedic nerve…
From Skeptic to Believer
Growing AwarenessWhen Dr. Bryan Matusic first started practicing, the block and neurostimulator alone were considered best practice and block success rates of 85% were the accepted norm. "I was using just my own senses and the stimulator," he says. "Even if I had a 10%-15% failure rate, I was still doing better than most."However, when he became a regional anesthesiologist in 2010 and began performing orthopedic nerve blocks exclusively at the Advanced Surgical Hospital, he recognized that even a 10% failure rate would be unacceptable. "We can't afford as many block failures here because we…
Ultrafest UCI 2014 Highlight Film
Ultrafest Ultrasound Festival hosted at UCI (University of California, Irvine) 2014Ultrafest is a free bedside ultrasound symposium hosted at UC Irvine Under the direction of AIUM member J. Christian Fox, MD, the University of California, Irvine (UCI), hosted Ultrafest, a free bedside ultrasound symposium for medical students throughout California, on Saturday, February 8th at the medical school campus. Ultrafest will provide hands-on workshops in emergency medicine, urology, obstetrics and gynecology, surgery, anesthesia, cardiology, sports medicine, and more. The symposium provides an…
Studies Indicate CT Scan Overuse, Radiation Overexposure
Recently the medical literature has documented the growing use of CT scans. It is certainly no secret that, when circumstances warrant, Sonosite advocates for the consideration of ultrasound first over other imaging modalities. A CT scan is a powerful and valuable test when used appropriately and—as with all medical procedures—when its therapeutic value is carefully weighed against its potential harm. Yet, while acknowledging CT’s value, I can’t ignore mounting evidence indicating CT scans are being ordered more often than are necessary or safe.
According to a June 13, 2012, JAMA report “Use…
Ultrasound Can Diagnose and Prevent Pneumothorax
by Dr. Diku MandaviaIt's ironic that one of the most efficient ways to detect pneumothorax in patients is also one of the most effective ways to prevent two of its more common clinical causes.While scenarios that might trigger the suspicion of pneumothorax are too numerous to list, screening for it has included the standard trinity of chest-imaging procedures: x-rays, tomography, and ultrasound.Ultrasound not only helps to diagnose pneumothorax, but it can play a significant role in helping to prevent it. A leading procedural cause for it in hospital settings is a failed central line…
ASA “Practice Guidelines for Central Venous Access” Published
It may be an exaggeration to suggest that every other month a new guideline or requirement is released by a professional medical body recommending or directing that ultrasound—especially bedside (a.k.a., point-of-care) ultrasound—be incorporated into clinical best practices, but often it feels like it.Case in point: In my last CMO Corner, I commented on the AIUM recognizing the American College of Emergency Physician’s Policy Statement “Emergency Ultrasound Guidelines,” which acknowledged point-of-care ultrasound as part of emergency care’s best practices.Not long ago, new ACGME Program…
A Big Thank-You From Tenwek, Kenya
This story reminds us yet again how lives can be saved when dedicated teamwork combines with progressive medical technology.
An international team of Sonosite employees raced against the clock to deliver a replacement ultrasound machine to Tenwek, Kenya, for a medical emergency at rural Tenwek Hospital, a two-hour drive from Nairobi. A cardiac team had been in place for ultrasound-guided heart-valve surgeries when their machine (made by another company) failed. Another surgeon, who had been using Sonosite machines to screen children in the developing world for rheumatic heart disease,…
AIUM Recognizes ACEP's Emergency Ultrasound Guidelines
While not all portable ultrasound examinations are of an emergency nature, its predominant use originated within the “we-need-it-STAT” category. Hence, the significant role of emergency medicine in contributing to point-of-care ultrasound best practices and insight into the valuable role ultrasonography can play at the bedside.
In mid-November, the contributions of emergency physicians to the proper use of “focused emergency ultrasound examinations” (a.k.a. point-of-care ultrasound) was acknowledged by the American Institute of Ultrasound in Medicine (AIUM). According to their November 17,…
EAU Recommends Ultrasound First for Renal Stone Disease
I’ve seen many patients present to the E.D. in severe pain from kidney stones. Renal colic is a common and recurrent condition; it affects over a million people each year in the U.S. and accounts for approximately 1 percent of admissions.1
Diagnosing kidney stones in patients who present with renal colic is often performed with tomography (CT). In the past, Intravenous Urography (IVU) was used. While CT and IVU are accurate diagnostic tests and define clearly the size, shape, and position of uric acid stones, they also present a number of factors that would discourage use,…
Joint Commission and the Risk of Medical Imaging Radiation
The Joint Commission is sending a powerful notice about the radiation risks of diagnostic imaging. Its August 24, 2011, Sentinel Event Alert clearly states that diagnostic radiation can save lives. That is not in dispute. What is at issue is the amount of radiation patients receive over time and the risk for long-term damage.
Over the last 20 years, Americans’ exposure to ionizing radiation has nearly doubled. As the Joint Commission states, “…any physician can order tests involving exposure to radiation at any frequency, with no knowledge of when the last of when the patient was irradiated…
Dr. Jeff Gonzales' Story
Catching a bus shouldn't be life-threatening. But for one 23-year-old woman, running for the bus could have cost her everything.After rushing to hop on board, she fell unconscious, leaving her arm outstretched beyond the door. Not knowing this, the driver closed the door and drove to the next stop, about two-tenths of a mile away.The passenger was shocked awake by her AICD, which she wore because of a history of hypertrophic obstructive cardiomyopathy. As she regained consciousness, she realized her forearm was still outside of the bus.In the emergency department, the doctors quickly…
Training Standards for Critical Care Ultrasonography
Ultrasound within critical care is growing rapidly and has a large role for multiple diagnostic applications and for guidance of invasive procedures.
A recent international roundtable, composed of 29 experts from five continents, just published recommendations on the need for developing training standards for intensive care medical students. Twelve Critical Care societies from around the world have endorsed the framework. They state, “There was 100% agreement among participants that general critical care ultrasound and ‘basic’ critical care echocardiography should be mandatory in the…
Improving Care while Reducing Costs in Health Care
Would you let your family fly in an airplane at night if the pilot didn’t have radar? I certainly wouldn’t. That pilot would be flying blind. It’s the same for ultrasound. When a physician performs an invasive procure without ultrasound guidance, it’s akin to a flying blind. In one of my recent articles, “Ultrasound Guidance at the Point of Care: This Practice Lets Health Systems and Accountable Care Organizations Improve Patient Safety and Costs,” published in Executive Insight, I argue that health executives should carefully weigh the safety, efficiency, and potential for reducing (or…
Training Standards for Critical Care Ultrasonography
Ultrasound within critical care is growing rapidly and has a large role for multiple diagnostic applications and for guidance of invasive procedures. A recent international roundtable, composed of 29 experts from five continents, just published recommendations on the need for developing training standards for intensive care medical students. Twelve Critical Care societies from around the world have endorsed the framework. They state, “There was 100% agreement among participants that general critical care ultrasound and ‘basic’ critical care echocardiography should be mandatory in the…
Welcome to the CMO Corner
As an emergency physician, I have taken care of thousands of patients who have benefitted from bedside ultrasound and I consider it to be an indispensible tool. Many across the medical profession share the same view. In fact, the value of ultrasound is of such importance that the sheer volume of published information is overwhelming. That’s why we’ve created CMO Corner. It is meant distill relevant information about portable ultrasound so you can access it without spending hours online. CMO Corner will be regularly updated with commentary on peer-reviewed articles, links to relevant abstracts…
Sierra Leone
Scott Farmery, MD Consultant Anaesthetist
at Makeni Hospital, Sierra Leone
Two weeks ago, an email dropped into my hospital inbox in London. It was clearly quite persuasive because, as a direct result, I’m now sitting in a remote hospital in Sierra Leone typing this. Today's star patient is three-year-old Abubakar who had the badly contracted burn scar on his hand released and grafted by Nanak, a plastic surgeon from Birmingham I'd never met before this trip. Abubakar slept comfortably through the whole procedure with some ketamine sedation and an ultrasound-guided arm block.
The email had…