A cautionary tale for budding bedside sonographers… #FOAMed, #FOAMcc

First of all, congratulations to all who are picking up a probe and working to add it to their diagnostic and therapeutic armamentarium. It will serve you – but more importantly, your patients – for the rest of your career.

I would like to caution you, however, in remembering that this, unlike knowledge, is a skill.  More than half the challenge is in image acquisition, and this requires practice. Practice, practice, practice. You can’t just reach for the probe in that one patient during your shift in whom you really want to have an idea of his or her cardiac function or volume status, then try to remember how to do it.  That’s a road to early discouragement and worse, never developing the skill or the necessary confidence.

Especially early on, scan everyone you can, including yourself.  You make a very patient patient.

If you’re not a fortunate medical student whose school is one of the pioneering ones with an undergraduate programme, take every course you can.  Make friends with ultrasound tech and spend some lunch hours watching some of their exams.  Pin (4 point restraints preferably) a colleague to a gurney when a machine is available.

Once you can reliably acquire images, start making clinical calls on the extremes: the tiny or the huge IVC, the hyperdynamic and the minimally moving ventricle, etc… and as your skills and experience grow, work your way towards the middle.

The last thing we need, as a bedside sonographer community, is to have the current trainees, which really represent the first generation (as most of the educators out there today are largely self-taught, or at least devised their own unique programs), misuse this amazing tool. We are under scrutiny, as it is a novel application (of an old technology), and cannot afford mistakes, lest roadblocks re-appear.

So practice, practice, practice, and if you’re not sure, get another opinion or another diagnostic modality!

happy scanning!



Bedside Ultrasound Picture Quiz 5 – #FOAMed, #FOAMcc

A 55 year old man admitted to the ICU for sepsis, recovering multi-organ failure with persistent culture-negative fever.

Longitudinal view of the left internal jugular vein.

What do you see?


scroll below for an answer!

















Thrombosed internal jugular catheter. This patient was anticoagulated. The fever disappeared within a few days and the thombosis decreased significantly.  It is difficult to be certain whether the fever was a cause but examining central lines is part of our fever workup.

The Ideal Resuscitation Fluid – an N=1 Podcast #FOAMed, #FOAMcc

So here is the first in a series of mini-talks geared towards having us think about fluid resuscitation, which, for those in acute care of almost any type (ER, wards, ICU, anasthesia, surgery, etc…) is part of our daily routine. And that’s exactly what it shouldn’t be, routine. It should be carefully thought out and adapted to each individual clinical situation we’re facing.

So I’ve decided to approach this from a completely different angle, not looking at what we do, what’s available, and see what has been stacked up against what, etc, etc… Instead, I’ve decided to start the discussion from a completely theoretical standpoint and talking about something that doesn’t exist:  The Ideal Resuscitation Fluid.

Please, let me know your thoughts!



(sorry the last 40 seconds were cut – now the “full” 5 minutes are up!  apologies, I am techno-challenged!)