PoCUS for Diverticulitis

Dal PoCUS Fellowship – Journal Club – Feb 2021

Dr. Mandy Peach  CCFP-EM

PoCUS Fellow

Dalhousie University Department of Emergency Medicine

 

A Prospective Evaluation of Point-of-Care Ultrasonographic Diagnosis of Diverticulitis in the Emergency Department Allison Cohen, MD*; Timmy Li, PhD; Brendon Stankard, RPA-C; Mathew Nelson

 

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Tube Thoracostomy

Saint John EM Rounds – February 2021

Dr Crispin Russell

Thoracic Surgeon, Dalhousie University, Saint John

 

 


 

Trauma Rounds Summary:  January 19 2021 “Chest Tube Management in Trauma – Insights from a Thoracic Surgeon”

Summary – Dr. Andrew Lohoar

Major take home points:

 

  • Most common complication with insertion is advancing tube too far.

  • Consider placing tube if pneumothorax is > 10%, lower threshold if transporting patient from peripheral hospital.

  • Use 28 French tube for most cases

  • Direction you puncture chest wall is generally direction chest tube will follow

  • Bigger skin incision may make procedure easier

  • “Corkscrewing” or twisting chest tube while placing it, helps ‘feel’ where it is in the chest cavity (avoids advancing too far)

  • Post-chest tube insertion CXR is critical to identify placement issues

  • Use large volume of local anesthetic (20+ cc) – try to infiltrate parietal pleura

  • Consider infiltrating prior to setting up your tray, allowing more time for anesthesia

  • Consider holding Kelly clamp with one hand when puncturing pleural, to protect from pushing tip to far into chest. Spread clamp parallel to ribs

  • 0 Silk is still preferred for securing chest tube

  • Consider tying an ‘air knot’ 1 cm above skin when securing tube, allows easier adjustment later

  • Secure chest tube connections with longitudinal taping – stronger and can see joint

  • U/S can be used to assist with placement

  • Always assess for chest tube functioning post-procedure

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