PENG block (NYSORA)

PENG block: pericaspular nerve group block >> anterior approach of interventional analgesia for painful hip (femoral neck fracture or total hip replacement surgery)

PENG block is motor sparing.

Target: the articular branches of the femoral, accessory obturator, and obturator nerves

NYSORA’s three-step ultrasound imaging strategy:

  1. Identify the femoral artery and NERVE at the femoral crease.
  2. Slide the Transducer Proximally to identify the pubic ramus and anterior inferior iliac spine.
  3. Tilt the Transducer Caudally to optimize the image of the psoas tendon, minimizing the risk of nerve injury and incorrect needle insertion.

雙和急診超音波教學-UE joint effusion-Shoulder & Elbow


Shoulder

Biceps long head tendon & Anisotropy
>> for joint effusion & Rotator Cuff examination

Anterior approach for shoulder joint
>> for dislocation & reduction

Posterior approach for shoulder joint
>> for effusion & dislocation/ reduction

Posterior approach for shoulder joint (arrow point to posterior labrum)
>> for joint effusion & dislocation/ reduction

Elbow

Clamshell as elbow joint landmark

Anterior approach for elbow joint – from humeral shaft to clamshell
>> for joint effusion

Anterior approach for elbow joint – from humeral shaft , radial/coronoid fossa, to clamshell
>> for joint effusion

Elbow effusion (minimal joint effusion within radial fossa & coronoid fossa)

Radial fossa to radial head
>> for joint effusion & radial head fracture

Coronoid fossa with minimal joint effusion

Olecranon fossa – from humeral shaft to olecranon fossa
>> for joint effusion

Olecranon fossa – longitudinal scan
>> for joint effusion

Olecranon fossa – dynamic examination
>> Elbow flexion to expose olecranon fossa


Intussusception

看到張主任EMNote分享的Intussusception教學影片,
正好前幾天的教學也有分享一個近期個案,所以就把影像拿來分享。

我心中Pediatric POCUS最重要的臨床應用,
就是學會掃描和辨識Intussusception (腸套疊),
最常見的是ileocolic type,最容易在右上腹觀察到,
因此優先掃描的位置是右上腹,肝臟交界的下方,
建議的掃描會是先以腹部探頭為主,
有需要時再切換到線形探頭看細節。
將探頭橫向放在右上腹肋緣下方,進行Sweep & tilt,
視套疊的程度和所在可以看到
Target sign (套疊處的短軸呈像)或pseudokidney sign (套疊處的長軸呈像)。

五歲男童,近2-3天來不定時會有短暫的腹痛,
今天有嘔吐一次,沒有腹瀉,腹部理學檢查沒有明顯壓痛或反彈痛。
影片中可見Intussuception所形成的Target sign和下方的右腎。

小兒患者身型較小,可以用線形探頭來看細節,
如影片一開始可見許多淋巴結,
然後terminal ileum套入colon中, 形成Target sign。

Color Doppler可以幫助我們看到跟隨一起套進去的mesentry,
和腫大充血的結腸。

後續的處理就是會診小兒腸胃科醫師或是放射科醫師來進行灌腸復位,
如果無法順利復位成功,要儘早照會小兒外科醫師進行手術復位。

要及早診斷最重要的是有想到這個疾病,
當患者有間歇性或週期性的行為: 如哭閙、腹痛、嘔吐等,要更高度懷疑。

雙和急診超音波教學-Airway & Neck

Trachea

Right tonsil

Left tonsil

Epiglottis (start from hyoid bone & scan caudally)

Hypoid bone & Epiglottis (longitudinal scan)

From cricoid cartilage (inverted U shape) – CTM to thyroid cartilage (inverted V shape)

Cricoid cartilage (inverted U shape)

Tracheal cartilage to cricoid cartilage to CTM

Trachea to cervical esophagus

Tracheal cartilage > Cricoid cartilage > CTM > Thyroid cartilage (longitudinal scan)

CTM: cricothyroid membrane (longitudinal scan)

Trachea > tracheal cartilage & thyroid gland with isthmus

Thyroid gland: from right lobe > isthmus > left lobe & cervical esophagus

Thyroid gland (right lobe) with Color Doppler

Parotid gland (between mandible bone & mastoid)

Submandibular gland : start from mandible bone then tilt

Submandibular gland : lymph nodes & vessel

Submandibular gland : lymph nodes & vessel (CD)

Sternocleidomastoid muscle