Bedside ultrasound survey

[res1cue]

Dude tell us more. What is the link to the product you bought? Does it interface with your mobile phone? Battery life? how good is quality? I want to know more about this.

if I buy this it's a business expense and I get to save like ~30-40%.

Interfaces to IOS or android by wifi similar to a drone (I got my phone to forget the hospital wifi network, so when I boot up the device, it auto connects to the phone)

Here is manufacturer link although I bought from ebay.
Products -Wireless Mini Ultrasounder-Sonostar Technologies Co., Limited

Here is a competiter that I considered as well:
Wuhan QSONO Electronics Co., Ltd.武汉超信电子工程有限公司

It also has wireless charging and also charges by micro USB. It advertises something like several hrs of continuous scanning and after each shift I usually drop from 4 bars of battery to 3.

Quality is decent, not as good as butterfly. I am having a hard time uploading videos, but PM me your email and I will send you some video clips.

No color doppler but it does have M mode and you can measure stuff

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[MechEDoc]

Agree...and often "purulent cellulitis" does better if you give a conduit for the pus to come out. e.g. I&D

There is no abscess below. but I would I&D this. Squeeze pus out and put in some packing, and tell the patient to take it out in a few days:

I usually just put these on antibiotics and discharge. Don't seem to be seeing many bad outcomes. Thoughts? Other people's experiences?

 

[thegenius]

I usually just put these on antibiotics and discharge. Don't seem to be seeing many bad outcomes. Thoughts? Other people's experiences?

Well...I used to put on abx only and I had too high of a return rate a few days later. So now I usually I&D them.

It depends...if it's a tiny area then I'll put on abx only. But if the purulent cellulitis extends several centimeters then I'll usually I&D it.

 

[deleted109597]

Agree...and often "purulent cellulitis" does better if you give a conduit for the pus to come out. e.g. I&D

There is no abscess below. but I would I&D this. Squeeze pus out and put in some packing, and tell the patient to take it out in a few days:

Why pack though?

 

[thegenius]

Why pack though?

Say the leg below is purulent cellulitis, like...you put the ultrasound probe on and it looks like the one of the pictures above. And it extends for most of the lower leg:

I would make a 1-2 cm incision in the middle of the leg, squeeze out some pus, then pack it.

I think packing allows the rest of the pus to come out. You can never get it all out initially. It's tracking all along the inside of the skin.

At the end of the day, this is what I do. I don't know if it's the right thing or not. It is quite possible that packing is an unnecessary step. I dunno

 

[deleted109597]

Not a ton of data to support packing. The few trials out there show no difference in outcomes and increase in pain.
I don't pack.

 

[BoardingDoc]

Not a ton of data to support packing. The few trials out there show no difference in outcomes and increase in pain.
I don't pack.

Agreed. Packing abscesses is another one of those dogmatic things we all "know" but which has little to no evidence to support it.

 

[GonnaBeADoc2222]

Never heard of cutting into "purulent cellulitis." I would characterize that u/s as cobblestoning.

 

[Fox800]

Never heard of cutting into "purulent cellulitis." I would characterize that u/s as cobblestoning.

I believe the term for that is “abscess”.

 

[deleted109597]

I certainly wouldn't document cutting into cellulitis. It's an abscess. Otherwise you're not going to get paid.

 

[Apollyon]

I believe the term for that is “abscess”.

That's what I said above. Pus = abscess, by definition.

 

[xaelia]

I don't routinely pack abscesses. Gross.

Re: the original topic of ultrasound – community hospital, use it once every few shifts. I don't order very many tests in the first place, so it wouldn't obviate much advanced imaging to be doing it myself. I can't remember the last thing I used it for besides just checking a soft-tissue infection for something drainable. I think I've looked at a couple retinas. Use it every once in awhile for landmarks for a -centesis. Wouldn't attempt a central line without one, but I haven't done one of those in awhile. Nursing staff uses U/S for the IVs, so I no longer need to.

 

[thegenius]

Not a ton of data to support packing. The few trials out there show no difference in outcomes and increase in pain.
I don't pack.

The ambivalent studies are for discrete abscesses. I'm packing less of those. I don't know if there are studies about packing drained purulent cellulitis.

Overall I'm packing less and less, but I still pack.

I don't know why.

 

[thegenius]

That's what I said above. Pus = abscess, by definition.

Well not really. The cobblestoning that someone said above, it's pus. Pus doesn't have to be self contained. It can move and swish about in tissue.

Anyway...the only reason why I do cut into some of these (not all!) is I've had a fair number of people fail appropriate empiric antibiotics with purulent cellulitis. The pus never goes away. They come back a week later and everything looks basically the same. So I got the wise idea that maybe it would be nice to get the pus out. Moreover, I can send a culture.

I am aware that it's not standard of care to cut into purulent cellulitis. Even UpToDate says that. I usually give patients the option of abx or abx + I&D, and surprising to me they often do the latter. Cutting into pus-sy skin hurts! Even with local anesthesia.

 

[Apollyon]

No, really. Look it up.

 

[thegenius]

I just did in UpToDate.

Purulent cellulitis (no drainable abscess) — Patients with cellulitis associated with purulent drainage (in the absence of drainable abscess) should be managed with antibiotic therapy (algorithm 2).

 

[Apollyon]

Ipso facto, if there is pus, you can drain it. It might be tedious, and time intensive, but you can. And pus is abscess.

But I won't fight with you. After all, you ARE "the genius". Notwithstanding that I am, I'll give this to you. Happy Hanukkah. Merry Christmas.

 

[thegenius]

Ok I'll get the last word. No hatin. Apparently the UTD authors disagree with your ipso facto statement, prima facie.

Anyway...next topic!

 

[deleted547339]

Hey late to the conversation, but a few weeks ago as a brand new attending, my answer is similar to most of you: couple times a shift at most, mostly soft tissue or fasts, sometimes a quick transabdominal OB for quick dispo. Almost never cardiac, gallbladders, unlike in residency.



Then, I purchased a wireless pocket US probe (not butterfly, which I am still waiting on) and everything changed

I US over half my patients. I am talking to them anyways, and scribe carries gel and towel. Does not slow me down at all, most the time it doesn’t help my clinical decision making, but it does help my ultrasound skills immensely. I am taking a shot at all potential appys, alot of lung and MSK, a few aortas, a lot of weird stuff that I never would ultrasound otherwise.

Patients LOVE it, and it makes my shifts a whole lot more enjoyable and also helps me improve my ultrasound skills

Still havent done a LP since I got it, but cant wait to try sticking it into a sterile glove and using it for guidance and seeing how that works

Does your hospital know you’re doing this? I know some people who wanted to but the hospital quickly put the brakes on it because it wasn’t approved by the facilities people or whom ever upkeep materials. Said it was a liability.

 

[res1cue]

Does your hospital know you’re doing this? I know some people who wanted to but the hospital quickly put the brakes on it because it wasn’t approved by the facilities people or whom ever upkeep materials. Said it was a liability.

ED admin does, dont know about any higher that that, nor do I care

 

[WilcoWorld]

Say the leg below is purulent cellulitis, like...you put the ultrasound probe on and it looks like the one of the pictures above. And it extends for most of the lower leg:

I would make a 1-2 cm incision in the middle of the leg, squeeze out some pus, then pack it.

I think packing allows the rest of the pus to come out. You can never get it all out initially. It's tracking all along the inside of the skin.

At the end of the day, this is what I do. I don't know if it's the right thing or not. It is quite possible that packing is an unnecessary step. I dunno

I probably wouldn't discharge a patient whose leg looked like that & whose US looked like the cobblestoned US you posted earlier*.

HOWEVER, I also don't usually examine patients with my shirt unbuttoned all the way, so I'm clearly an inferior doctor and probably have worse outcomes.

*not saying that you advocating discharging this patient - just clarifying

 

[BoardingDoc]

HOWEVER, I also don't usually examine patients with my shirt unbuttoned all the way, so I'm clearly an inferior doctor and probably have worse outcomes.

Prude

 

[turkeyjerky]

I probably wouldn't discharge a patient whose leg looked like that & whose US looked like the cobblestoned US you posted earlier*.

HOWEVER, I also don't usually examine patients with my shirt unbuttoned all the way, so I'm clearly an inferior doctor and probably have worse outcomes.

*not saying that you advocating discharging this patient - just clarifying

Epic post (seriously I lol'd) but I think that's a tie.

In my experience, purulent cellulitis usually looks rather indurated and acts like an impending abscess. I put them on abx and have them come back in two days. They usually have a nice easly drainnable abscess w/o any surrounding cellulitis and it's one of those perfect I&D's we all dream about vs a frustrating, painful dry incision

 

[BoardingDoc]

Epic post (seriously I lol'd) but I think that's a tie.

In my experience, purulent cellulitis usually looks rather indurated and acts like an impending abscess. I put them on abx and have them come back in two days. They usually have a nice easly drainnable abscess w/o any surrounding cellulitis and it's one of those perfect I&D's we all dream about vs a frustrating, painful dry incision

On further inspection, there does not appear to be any buttons or buttonholes (or a fold in the shirt which could obscure them) visible. I think @turkeyjerky is right, but I'm not happy about it. The picture just became a lot less fun.

 

[deleted109597]

On further inspection, there does not appear to be any buttons or buttonholes (or a fold in the shirt which could obscure them) visible. I think @turkeyjerky is right, but I'm not happy about it. The picture just became a lot less fun.

Of course it's a tie. He doesn't have a reverse farmer's tan.

 

[WilcoWorld]

Stop ruining my fun with facts!

 

[n2b8me]

How much do you use it? every shift
What practice setting are you in? 40k / year community ER triple-->single coverage overnights without US
What do you find ultrasound useful for? gallstones, kidney stones, urinary retention, pedi abd pain, iup, documenting no AAA.
Also paracentesis, pleural effusion, small FF in female pelvic pain, scrotal pain, to end ACLS/CPR, IJs.
What do you find it not so useful for? foreign bodies, vision changes (eyeball scan), peripheral IVs, MSK injuries.
Do you think it increases throughput? yes and no. yes for the important stuff like old abd pain, gallstones and kidney stones. no for other stuff like pedi abd pain... but patients seem to like it. It is definitely like putting on a show for patients. who doesn't want to see their own heart beating?

 

[Jabbed]

Has anyone had experience with the Butterfly? The tech advancement and price point is very intriguing. Still in residency, but physically dragging the ultrasound machine to the bedside and all the room re-positioning involved is by far the biggest barrier to scanning.