Abdominal ultrasonography.

This article focuses on ultrasonographic examinations of the abdomen and important intra-abdominal pathology. The liver and biliary tree are discussed first, followed by the use of ultrasonography in diagnosing appendicitis, ascites, and bowel obstruction. Pyloric stenosis and intussusception, important pediatric intra-abdominal problems, are also discussed.

Real-time ultrasound-guided femoral vein catheterization during cardiopulmonary resuscitation.

STUDY OBJECTIVE: To compare the use of real-time-ultrasound guidance with the standard landmark-oriented approach for obtaining femoral vein catheterization in patients requiring intravenous access during CPR. METHODS: Prospective, randomized, paired subject-controlled clinical trial in the setting of an urban teaching county hospital emergency department. The study comprised a convenience sample of 20 patients presenting with apnea and pulselessness in the ED. Each patient received bilateral femoral lines, one by ultrasound guidance and one by the landmark approach (control). Randomization determined which technique and which side would be attempted first. The following parameters were recorded: time to initial flash of blood, time to completion of catheterization, number of needle passes, and rate of arterial catheterization. CPR and Advanced Cardiac Life Support protocols were continued during both procedures. RESULTS: Real-time ultrasound-guided catheterization had a higher success rate (90% versus 65%, P = .058), a lower number of needle passes (2.3 +/- 3 versus 5.0 +/- 5, P = .0057), and a lower rate of arterial catheterization (0% versus 20%, P = .025) than the standard landmark-oriented approach. Ultrasound was also slightly faster in time to blood flash and in time to catheterization. An incidental finding of interest was that real-time ultrasound demonstrated the presence of femoral vein pulsations during CPR. CONCLUSION: Real-time ultrasound-guided femoral vein catheterization was faster and produced a lower rate of inadvertent arterial catheterization and a higher rate of success during CPR than the standard landmark-oriented approach. Also, ultrasound demonstrated that palpable femoral pulsation during CPR is venous rather than arterial.

Real-time ultrasound guided internal jugular vein catheterization in the emergency department.

Establishing central intravenous access in the emergency department (ED) is often both crucial and difficult. In patients with nonexistant or ambiguous external anatomic landmarks, a real-time ultrasound guided approach to internal jugular vein cannulation is useful. In addition, the use of ultrasound guidance in internal jugular vein cannulation is supported by reports that have documented reductions in number of cannulation attempts, time required to establish central access, and rate of complications. The use of ultrasound for establishing central venous access has never been described in an ED setting. Two such cases in which ultrasound was extremely helpful for establishing central access in an ED are reported, the techniques employed for real-time ultrasound guidance of internal jugular vein catheterization are described, and the literature that supports the use of this technique is reviewed.