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Lung point = exact location where visceral pleura of collapsed lung reattaches to stationary parietal pleura adhered to chest wall. Sono: where lung sliding and absent lung sliding meet. Anterior chest wall = small PTX Lateral = substantial PTX Posterior = complete collapse

Identify SBO at bedside (curvilinear probe): - 3+ fluid-filled loops of bowel w/ >2.5 cm diameter - "To-and-Fro" movement of bowel content/ decreased/ absent peristalsis - Thickened bowel wall > 3mm - Free fluid between loops of bowel (higher grade obstruction, poorer prognosis)

Replacing a G-tube is quick if not out too long and no trauma. Yet, confirmation by gastrograffin x-ray takes forever. Consider POCUS to confirm placement: - Place probe adjacent to tube, see catheter and balloon - Instill 50+ cc of saline, watch stomach expand with bubbles

@rutgerspocus EM residents teaching our amazing paramedics the basics of ultrasound (and a bit more)!

A right heart thrombus is thin, mobile, and worm-like. It floats to-and-fro within the right-sided chambers. A vegetation attaches to the valve, usually the proximal side. Its movement is usually chaotic and independent from that of the valve (though not in this case).

Free fluid is gravitationally dependent. Therefore, placing the patient in Trendelenburg (i.e. head declined below feet) when performing the FAST exam will increase sensitivity for detecting free fluid in Morrison's pouch.

With a shallow object of interest (e.g. ?foreign body in finger or toe), use an ultrasound water bath to: 1) avoid distorting the object via direct pressure from the probe. 2) bring the object within the focal zone in center of the screen where imaging resolution is best.

Evaluating for nephrolithiasis using POCUS usually entails assessing for the secondary finding of hydronephrosis. Try also looking for the primary finding (i.e. the stone itself) in the ureterovesicular junction, which is the most common site of obstruction.

DO-IT-YOURSELF PHANTOM MODELS for ultrasound guided IV placement: go to tinyurl.com/USPHANTOM for a step-by-step guide created by our resident Peter Alsharif

Dynamic air bronchograms (hyperechoic lines, moving within consolidated lung throughout resp cycle) are an ultrasonographic sign of pneumonia • Artifact due to air in bronchioles surrounded by consolidated lung • Up to 94% specificity in differentiating pneumonia vs atelectasis

ET tube confirmation by POCUS: - Bullet sign: reverberation artifact in trachea, single air-mucosal interface = tracheal intubation - Double tract sign: two air mucosal interfaces with posterior shadowing = esophageal intubation

Rutgers EM attendance at the 11th Annual Tri-State Regional Emergency Ultrasound Conference Lenox Hill Hospital

POCUS guidance in thoracentesis helps decrease the risk of complications like pneumothorax, intra-abd or vasc injury: Identify biggest pocket superior to most cephalad position of expirational diaphragm and determine depth to reach pleural fluid and max permissible depth.

POCUS to identify risks for pregnant patients: Myometrial mantle < 5 mm raises concern for interstitial pregnancy

Differentiating Lymph Nodes and Abscesses by POCUS: - Abscess: typically anechoic or mixed echogenicity, irregular contours and the appropriately named “squish sign” - Lymph node: well-circumscribed, typically a hyperechoic hilum is protruding into the hypoechoic core (see image)

Hot tips for Ocular POCUS by Ali Cooper - Use cold gel, it has more structural integrity to minimize applied pressure - Brace scanning hand on patient's forehead to minimize pressure to globe - “Ocular” setting is lower energy, minimizes potential damage to corneal epithelium

A POCUS Echo Pearl by Rutgers alum Robert James Adrian The descending aorta can guide effusion identification. Pericardial effusions are anterior to the descending aorta, while left pleural effusions are posterior to it in the parasternal long axis view.

Gallbladder hydrops: size of GB  > 4 cm (transverse) x > 9 cm (longitudinal) • Most commonly caused by impacted gallstones (at neck) • Prolonged blockage of cystic duct leads to increased intraluminal pressure, inflammation > High suspicion of cholecystitis (surgery consult)

Thank you to Dr Roger Luo for an excellent teaching session on ultrasound guided knee and shoulder injections. Directly from the PM&R pro! @rutgers.njms.em @rutgers_newark

The right ventricle (RV) contracts mostly (70%) in the longitudinal direction. Using tissue Doppler (i.e. hitting the TDI and then PWD buttons), S' represents the velocity of the lateral tricuspid annulus during systole. S’ < 9.5 cm/s suggests RV systolic dysfunction.