Using Ultrasound for Paracentesis

​Paracentesis can be a quick and simple procedure with the right equipment and a well-rehearsed approach. It's important to practice this skill in the procedure lab and to familiarize yourself with the kit in your department a few times a year. This month, we focus on paracentesis set-up and basics, and next month we will review the nuts and bolts of completing the procedure.Important equipment for paracentesis: Five or six collection bottles, antiseptic prep, and a paracentesis kit. Consider longer needles for abdominal walls thicker than 2.5 cm.Grab the ultrasound and a pen. Position your patient at a 45-degree angle, and begin scanning the abdomen. Find a colleague to help with this procedure because patients may become uncomfortable lying at that angle. You will also need help swapping out collection tubes and repositioning the patient. Rotate the patient slightly toward his side, and choose a left lateral approach for needle insertion. The procedure itself should be relatively painless once the anesthetic is administered.Using the curved linear probe, drop your hand almost flush with the stretcher and scan for fluid.Watch our video showing the basics of imaging and landmarks.Ultrasound can help lower the rate of complications, avoid solid organ or intestine puncture, and help identify which patients are best suited for paracentesis. You can use medial or lateral approaches to identify pockets of fluid in the safe zone, avoiding the epigastric vessels and bladder, to de...
Source: The Procedural Pause - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

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Publication date: Available online 7 April 2020Source: Artificial Intelligence in MedicineAuthor(s): Siva Teja Kakileti, Himanshu J. Madhu, Geetha Manjunath, Leonard Wee, Andre Dekker, Sudhakar Sampangi
Source: Artificial Intelligence in Medicine - Category: Bioinformatics Source Type: research
Conclusion: The most important finding of one-month ticagrelor consumption were dyspnea, bleeding, and hypersensitivity reaction. No case of bradycardia and stent thrombosis was detected. In our study , iranian population has more susceptibility to dyspnea than PLATO result. The rate of drug discontinuation in this series of cases was 6.4 %. PMID: 32259131 [PubMed - as supplied by publisher]
Source: Accident and Emergency Nursing - Category: Emergency Medicine Authors: Tags: Arch Acad Emerg Med Source Type: research
In this report, we presented a case of POT due to knife injury in which the knife blade was removed and bleeding was controlled, the patient's general condition after surgery was good, but the vision of the right eye was lost. PMID: 32259125 [PubMed - as supplied by publisher]
Source: Accident and Emergency Nursing - Category: Emergency Medicine Authors: Tags: Arch Acad Emerg Med Source Type: research
Conclusion: The knowledge, attitude, and practice of EMS staff regarding bleeding control were moderate, positive and appropriate, and incomplete, respectively. Since bleeding is a life threatening status and EMS staff skills are critical in this issue, it seems that we need to provide continuous education in this regard. PMID: 32259111 [PubMed - as supplied by publisher]
Source: Accident and Emergency Nursing - Category: Emergency Medicine Authors: Tags: Arch Acad Emerg Med Source Type: research
Conclusion: Risk factors, aetiology, and precipitating factors of HF in de novo and ADCHF differ. De novo HF also had lower 1-year mortality and 3-month mortality compared to ADCHF. PMID: 32252602 [PubMed - as supplied by publisher]
Source: Acta Cardiologica - Category: Cardiology Tags: Acta Cardiol Source Type: research
Authors: Joseph MS, Palardy M, Bhave NM Abstract End-stage kidney disease (ESKD) and heart failure (HF) often coexist and must be managed simultaneously. Multidisciplinary collaboration between nephrology and cardiology is critical when treating patients with such complicated physiology. There is no "one-size-fits-all" approach to the evaluation of patients with new left ventricular systolic dysfunction, and diagnostic testing should be adapted to an individual's risk factors. Guideline-directed medical therapy (GDMT) for systolic heart failure should be employed in these patients. While limited randomize...
Source: Reviews in Cardiovascular Medicine - Category: Cardiology Tags: Rev Cardiovasc Med Source Type: research
Authors: Kazory A, Costanzo MR Abstract Low serum sodium concentration has long been recognized as an established marker of short- and long-term morbidity and mortality in patients with heart failure (HF), and is commonly included in various risk prediction models. Mechanisms leading to hyponatremia (e.g. maladaptive neurohormonal activation) could also lead to concurrent decline in serum chloride levels. Besides, chloride has distinct biological roles (e.g. modulation of renal tubular sodium transporters) that are relevant to the pathophysiology and therapy of HF, making it a potent cardiorenal connector. Several ...
Source: Reviews in Cardiovascular Medicine - Category: Cardiology Tags: Rev Cardiovasc Med Source Type: research
In this study, we analyzed the National Readmissions' Database (NRD) to identify infective endocarditis cases and the causative organisms, clinical determinants, length of stay, in-hospital mortality, and 30-day hospital readmission rates. The study cohort was derived from Healthcare Cost and Utilization Project's National Readmission Database between 2010-15. We queried the National Readmissions' Database using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnostic code for infective endocarditis (421.0) and identified a total of 187,438 index admissions. SAS 9.4 (SAS Ins...
Source: Reviews in Cardiovascular Medicine - Category: Cardiology Tags: Rev Cardiovasc Med Source Type: research
Authors: Chen X, Jin C, Xie L, Xiang M Abstract Patients with heart failure (HF) are prone to combine with renal insufficiency. Recently, LCZ696 has been used in the treatment of HF, but whether LCZ696 is better than angiotensin converting enzyme inhibitors/angiotensin receptor antagonists (ACEI/ARB) in renal protection for HF patients has not been investigated. Therefore, we conducted a meta-analysis focusing on LCZ696 and its role in preservation of renal function in HF patients. Embase, PubMed, the Cochrane Library and ClinicalTrials.gov databases were electronically searched for available randomized controlled ...
Source: Reviews in Cardiovascular Medicine - Category: Cardiology Tags: Rev Cardiovasc Med Source Type: research
Authors: Chen E, Cai W, Hu D, Chen L Abstract Remote ischemic conditioning is usually associated with cardioprotective intervention against ischemia-reperfusion. However, the effect of remote ischemic preconditioning (RIC-pre) completed before myocardial reperfusion with intermittent limb ischemia-reperfusion in patients with STEMI undergoing primary percutaneous coronary intervention (PPCI) is unclear. PubMed, EMBASE, and the Cochrane Library were fully searched from the beginning of each database up to September 2019 to find seven RCTs, a total of 2796 patients with STEMI undergoing PPCI with RIC-pre and 2818 pat...
Source: Reviews in Cardiovascular Medicine - Category: Cardiology Tags: Rev Cardiovasc Med Source Type: research
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