Ultrasound GEL

Difficult Airway Prediction

Mon, 16 Mar 2026 04:03:16 -0400

One relatively new POCUS topic that is gaining a lot of traction is using ultrasound to assess a patient's potential for being a difficult intubation. There are so many measurements being thrown around - is there one best way?? Mike and Creagh gently lift the vallecula of this topic hoping to reveal the shiny cords of truth.

https://www.ultrasoundgel.org/180
https://pubmed.ncbi.nlm.nih.gov/40880958/

Peds Fascia Iliaca Block

Thu, 05 Feb 2026 04:03:31 -0500

The GEL Jr team reunites to discuss the hippest way to provide analgesia for femoral fractures in pediatrics, the fascia iliaca compartment block. Does it work as well in kids as it does for adults?

https://pubmed.ncbi.nlm.nih.gov/40524602/
https://www.ultrasoundgel.org/179

Lightning Talks

Mon, 22 Dec 2025 10:22:08 -0500

The GEL Team has done it again - infiltrating the illustrious Society of Clinical Ultrasound Fellowships annual conference and bringing you the insider's scoop on the latest concepts in POCUS. Special hosts Shawn Sethi, Alyssa Nguyen-Phuc and Roger Vazquez Gomez are on the scene interviewing this year's presenters of the ever-illuminating SCUF Lightning Talks.

https://www.ultrasoundgel.org/178

GEL World Israel

Mon, 17 Nov 2025 04:03:19 -0500

The GEL World Series continues in Israel with a conversation with Eyal Gohar and Leo Fuchs, who teach at the IsraPOCUS Academy.

https://www.ultrasoundgel.org/177

Waves

Mon, 13 Oct 2025 04:03:14 -0400

This is a special episode about riding the ups and downs of a life in medicine. Special guests Adaira Landry and Jeremy Boyd join Mike to discuss the rippling impact of a difficult ultrasound case.

https://www.ultrasoundgel.org/176

Stellate Ganglion Block

Mon, 22 Sep 2025 04:03:29 -0400

Do you like doing challenging procedures that in rare instances can be life-saving? Then this podcast discussing the latest evidence for the stellate ganglion block in ventricular storm is for you! Astral puns abound as Creagh and Mike rocket into this stellar article.

https://www.ultrasoundgel.org/175
https://pubmed.ncbi.nlm.nih.gov/38289867/

Potpourri

Tue, 02 Sep 2025 04:03:06 -0400

After a summer semi-hiatus, we are busting at the seams with things to talk about. Mike gives brief "state-of-GEL" address and then blazes through a baker's dozen of articles.

https://www.ultrasoundgel.org/174

GEL World Italy

Mon, 11 Aug 2025 04:03:24 -0400

On this episode of GEL World we visit Italy as Mike chats with Cristiano Di Gioia about his experiences with ultrasound as an emergency physician.

Pediatric Cardiac Arrest

Thu, 05 Jun 2025 04:03:37 -0400

The GEL Jr. squad returns to discuss a very important topic - ultrasound in pediatric cardiac arrest. Using a recent article as a diving board, they cannonball into the pool of evidence.

https://www.ultrasoundgel.org/172
https://pubmed.ncbi.nlm.nih.gov/39043130/

GEL World Ireland

Mon, 21 Apr 2025 04:04:06 -0400

New series alert! GEL World is about bringing together the global ultrasound community. In this first episode, we travel to Ireland with ultrasound champion Dr. Cian McDermott.

https://www.ultrasoundgel.org/171

GEL Live! Podcast Palooza

Mon, 31 Mar 2025 04:04:20 -0400

Delia and Creagh travel to Houston, Texas to regale audience members of the American College of Osteopathic Emergency Physicians (ACOEP) Scientific Assembly with their tales of ultrasound literature misadventures.

https://www.ultrasoundgel.org/170

BlockHeads

Tue, 25 Feb 2025 04:04:25 -0500

Mike chats with two special guests representing the BlockHeads - a collaborative group dedicated to furthering the use of ultrasound-guided nerve blocks in the emergent setting. Find out what they have been up to and how you can join in!

https://www.ultrasoundgel.org/169

Bronchiolitis

Mon, 10 Feb 2025 04:04:08 -0500

The GEL Jr crew back with a topical episode on bronchiolitis. When you scan the lungs of these kids what do you see, and more importantly.... what does it mean??

https://www.ultrasoundgel.org/168
https://pubmed.ncbi.nlm.nih.gov/37897916/

Bubble Time

Mon, 09 Dec 2024 03:05:04 -0500

It's bubble time! This fascinating paper investigates counting the number of seconds that bubbles can be seen in right side of the heart after a flush as a means to diagnose right heart failure.

https://www.ultrasoundgel.org/167
https://pubmed.ncbi.nlm.nih.gov/38597847/

Lightning Talks

Fri, 15 Nov 2024 04:05:14 -0500

GEL x SCUF back again! This year at the annual meeting of the Society of Clinical Ultrasound Fellowships, the GEL team interviews several up-and-coming leaders in POCUS about a variety of fascinating topics.

https://www.ultrasoundgel.org/166

Biplane Needle Guidance

Tue, 01 Oct 2024 10:22:23 -0400

Are two planes better than one? Creagh, Mike, and Jailyn investigate a paper on biplane technology for placing central venous catheters.

https://www.ultrasoundgel.org/165
https://pubmed.ncbi.nlm.nih.gov/37742018/

Transgluteal Hydrodissection

Mon, 19 Aug 2024 04:05:22 -0400

In this Bonus Cut author interview, Zack and Mike go off the rails by interviewing the author of a case series describing a fascinating and mysterious procedure - the transgluteal hydrodissection! Guest Gabe Rose gives us the low down of how this nerve block alternative might be the way to go to help a radicu-lous amount of patients.

https://www.ultrasoundgel.org/164
https://pubmed.ncbi.nlm.nih.gov/36933988/

Pediatric Crohn’s Disease

Mon, 15 Jul 2024 04:00:42 -0400

The GEL Jr team strikes back with a fascinating topic - using POCUS to guide response in the treatment of Crohn's disease! Join the gang as they peristalse their way through an article describing this inflammatory idea.

https://www.ultrasoundgel.org/163
https://pubmed.ncbi.nlm.nih.gov/32453126/

General Surgery POCUS

Sun, 16 Jun 2024 04:05:04 -0400

In this Father's Day Special, Mike interviews his old man about the state of point-of-care ultrasound in general surgery. All sorts of learning ensues.

https://www.ultrasoundgel.org/162

VEXUS Updates

Mon, 27 May 2024 04:05:05 -0400

It's been a while since we talked about Venous Excess Ultrasound, aka VEXUS. There is still a lot of buzz around this concept, but not a lot of honey (honey is evidence in this metaphor). Ross Prager, international friend to POCUS researchers everywhere, joins Mike to discuss what's new and where this is going.

https://www.ultrasoundgel.org/161

Yale EM Podcast Day Part 2

Mon, 13 May 2024 04:05:04 -0400

Part 2 of the discussion with Rachel Liu and Cian McDermott for Yale Emergency Medicine podcast day. Now the banter turns to a favorite topic: POCUS in cardiac arrest - is there a right or wrong way to do it?

https://www.ultrasoundgel.org/160
Sponsor: Echonous

Yale EM Podcast Day Part 1

Tue, 07 May 2024 09:33:31 -0400

Creagh and Mike were invited to speak at the first ever Yale Emergency Medicine Podcast day! They join their old buddies Rachel Liu and Cian McDermott to discuss podcasting and POCUS in cardiac arrest. This is part 1 of 2.

https://www.ultrasoundgel.org/159
Sponsor: Echonous

MAPSE

Mon, 15 Apr 2024 04:05:06 -0400

The GEL trio return to discuss an old idea made new again - the mitral annular plane systolic excursion, aka MAPSE. How good is it compared to other methods for estimating left ventricular function?

https://www.ultrasoundgel.org/158
https://pubmed.ncbi.nlm.nih.gov/36933334/
Sponsor: Echonous

MicroSkills

Mon, 25 Mar 2024 04:04:05 -0400

In this Special Edition ep, Mike interviews the multi-talented Adaira Landry and Resa Lewiss. They share some of the wisdom they have gleaned from their experiences as physicians, mentees, mentors, authors, academicians, ultrasound experts, and humans.

https://www.ultrasoundgel.org/157
https://www.harpercollins.com/products/microskills-adaira-landryresa-e-lewiss?variant=41082651443234

Distal Forearm Fractures

Mon, 26 Feb 2024 07:38:07 -0500

The GEL Jr. team is back and they have a bone to pick. What's the deal with using ultrasound for forearm fractures in kids? They examine a recent article on this topic from the New England Journal of Medicine.

https://www.ultrasoundgel.org/156
https://pubmed.ncbi.nlm.nih.gov/37256975/

People, Progress, POCUS (Part 2)

Mon, 12 Feb 2024 04:05:07 -0500

In September 2023, the GEL crew traveled to Portland, Maine to do some on-the-street reporting at the annual conference for the Society of Clinical Ultrasound Fellowships (SCUF). What evolved was a series of incredible mini-interviews focusing on the different paths to ultrasound and the exciting new frontiers of ultrasound technology. This is Part 2 of 2.
https://www.ultrasoundgel.org/155https://www.awakeandawarebend.com/a/2147793147/QULTuhF9

People, Progress, POCUS (Part 1)

Mon, 29 Jan 2024 10:25:14 -0500

In September 2023, the GEL crew traveled to Portland, Maine to do some on-the-street reporting at the annual conference for the Society of Clinical Ultrasound Fellowships (SCUF). What evolved was a series of incredible mini-interviews focusing on the different paths to ultrasound and the exciting new frontiers of ultrasound technology. This is Part 1 of 2.

https://www.ultrasoundgel.org/154
https://www.awakeandawarebend.com/a/2147793147/QULTuhF9

PENG Block

Mon, 18 Dec 2023 04:05:04 -0500

Have you been PENG attention? This block is everywhere! In this episode, we talk about the preliminary data for the PEricapsular Nerve Group (PENG) block used for analgesia of acute hip fractures in the emergency department.

https://www.ultrasoundgel.org/153
https://pubmed.ncbi.nlm.nih.gov/35652877/

Femoral Doppler in Heart Failure

Mon, 20 Nov 2023 04:04:02 -0500

Bonus Cuts back again! Zack and Mike talk with guest Yale Tung-Chen about the POCUS vibe in Spain and his recently reviewed study on using doppler flow as a measure of right ventricular dysfunction in heart failure.

https://www.ultrasoundgel.org/152

Artificial Intelligence for Echo

Mon, 23 Oct 2023 06:52:28 -0400

Mike flies solo and ventures into the wily world of artificial intelligence in clinical ultrasound. How well does the machine measure up to the expert when it comes to hemodynamic measurements with echo?

https://www.ultrasoundgel.org/151
https://pubmed.ncbi.nlm.nih.gov/36835888/

Heart Failure Extravaganza!

Mon, 25 Sep 2023 04:05:02 -0400

To celebrate 150 episodes we are doing a deep dive into one of POCUS's most beloved applications - acute heart failure. We bring in echo expert Sean Hickey to help delve into the ins and outs of the hearts, the lungs, and the IVCs.

https://www.ultrasoundgel.org/150

Trigger Point Injections

Mon, 28 Aug 2023 04:05:08 -0400

Another author-focused Bonus Cuts episode with Zack and Mike joined by the one and only Rob Farrow! Rob represents the research team behind the recently discussed US-guided trigger point article. Discussion ensues regarding the methodology, procedural pearls, and a strained Bob Dylan reference.

https://www.ultrasoundgel.org/149

Femoral Vein Doppler

Mon, 31 Jul 2023 09:18:46 -0400

Another cutting edge topic! These insatiable investigators propose to use doppler waveforms from the common femoral vein as a marker of right heart dysfunction in heart failure patients. Novel? Certainly. Useful? We shall see!

https://www.ultrasoundgel.org/148
https://pubmed.ncbi.nlm.nih.gov/37088380/

Vertebral Artery Injury

Mon, 03 Jul 2023 04:05:03 -0400

What if I told you that you could use ultrasound to find traumatic injuries to the vertebral arteries? I am not telling you that...yet. The team has some thoughts on this novel idea.

https://www.ultrasoundgel.org/147
https://pubmed.ncbi.nlm.nih.gov/37087444/

The P2 Network

Mon, 22 May 2023 04:05:07 -0400

The GEL Jr crew sets up shop at the 2023 P2 Convention in Washington, D.C. and interviews the leaders of this organization about its history, purpose, and future.

https://www.ultrasoundgel.org/146
https://p2network.com

US-Guided Trigger Point Injections

Mon, 24 Apr 2023 11:01:52 -0400

Hold onto your hats - the latest episode discusses an application for ultrasound that you have probably never even thought about doing! Ultrasound-guided trigger point injections - do they work?!

https://www.ultrasoundgel.org/145
https://pubmed.ncbi.nlm.nih.gov/36214230/

Virtual Reality

Mon, 27 Mar 2023 04:05:09 -0400

Virtual reality ultrasound?! It is here, and it might be a valuable educational tool. Special host Shawn Sethi, usual but still somewhat special host Mike, and definitely special guest ultrasound educator Suean Pascoe discuss the available evidence and their own perspectives on this innovative technology.

https://www.ultrasoundgel.org/144

Diaphragmatic Dysfunction

Mon, 13 Mar 2023 04:05:06 -0400

Can looking at the diaphragm with ultrasound help us understand a patient's respiratory status? This is one of the first papers to look at this question in an emergency department population.

https://www.ultrasoundgel.org/143
https://pubmed.ncbi.nlm.nih.gov/36680779/

Inclusion in POCUS Part 2

Mon, 27 Feb 2023 04:05:05 -0500

This is the second and final part of our episode on diversity, equity, and inclusion within the point-of-care ultrasound community. Guests Almaz Dessie and Javier Rosario lend their insights to the discussion of their articles and practical next steps.

https://www.ultrasoundgel.org/142

Inclusion in POCUS Part 1

Mon, 13 Feb 2023 04:05:02 -0500

Special guests Almaz Dessie and Javier Rosario join Mike, Creagh, and Jai to discuss diversity, equity, and inclusion specifically in the point-of-care ultrasound community. This is the first of a two part discussion that covers the recently published articles on this topic and what you can do to help these efforts.

https://www.ultrasoundgel.org/141

Gastric POCUS & Sedation

Mon, 30 Jan 2023 04:05:07 -0500

Delia and Lianne take on the topic of pediatric gastric POCUS. Is it a helpful way to assess the effect of fasting prior to procedural sedation? Is fasting itself a helpful way to empty the stomach??

https://www.ultrasoundgel.org/140
https://pubmed.ncbi.nlm.nih.gov/32769837/

The State of POCUS

Mon, 16 Jan 2023 04:05:03 -0500

Vicki Noble is a veritable legend of point of care ultrasound. Zach and Mike are lucky enough to sit down with this proverbial fountain of wisdom and scoop some razor insights into the past, present and future of the field. We discuss Vicki's origin story, multi-disciplinary collaboration, hot takes on POCUS research, and the middle-age of POCUS.

https://www.ultrasoundgel.org/139

Ultrasound vs Landmark Subclavians

Mon, 19 Dec 2022 04:05:02 -0500

This episode has been a long time coming! We're talking ultrasound-guided subclavian central lines, and a lot of people have opinions. Are they better than landmark? What should we teach learners? The GEL team discusses through the lens of this fascinating RCT.

https://www.ultrasoundgel.org/138
https://pubmed.ncbi.nlm.nih.gov/35562246/

Trailer

Thu, 15 Dec 2022 15:05:03 -0500

Here's a little bit about our podcast. You can find out more at UltrasoundGEL.org.

Carotid Compression in CPR

Mon, 05 Dec 2022 04:05:05 -0500

We can only go so long without talking about cardiac arrest! Here is the latest idea - using sonographic carotid compression to help determine if a pulse is present. Can it save time compared to manual palpation and thus help our patients?

https://www.ultrasoundgel.org/137
https://pubmed.ncbi.nlm.nih.gov/35792305/

Pediatric IVC Collapse

Mon, 07 Nov 2022 04:05:04 -0500

Another Bonus Cuts author interview - this time with Amy Zhou, Pediatric Emergency Medicine specialist and first author of the recently reviewed article on IVC collapse duration. Zach and Mike ask the hard questions about how this paper came to be and how we should be thinking about the IVC in our pediatric patients.

https://www.ultrasoundgel.org/136

Pneumoperitoneum

Mon, 24 Oct 2022 04:04:03 -0400

Pneumoperitoneum is usually bad news for patients, and it would be great to have a quick way to make this diagnosis. These authors ingeniously used ultrasound contrast software (without any contrast) to boost the accuracy of ultrasound for this pathology!

https://www.ultrasoundgel.org/135
https://pubmed.ncbi.nlm.nih.gov/35204492/

Nasogastric Tube Placement

Wed, 28 Sep 2022 06:13:21 -0400

New idea alert! Should we be using POCUS to guide nasogastric tube placement? Crazy? Unnecessary, you say? Well listen in to the discussion of this interesting randomized controlled trial designed to answer this burning question.

https://www.ultrasoundgel.org/134
https://pubmed.ncbi.nlm.nih.gov/35834792/

Ultrasound-Guided Arthrocentesis

Mon, 12 Sep 2022 07:41:41 -0400

In our second in the series of Bonus Cuts, Zach and Mike interview the illustrious Ryan Gibbons for his take on arthrocentesis and a discussion of his research in the field. What an exciting joint venture!
https://www.ultrasoundgel.org/133

Duration of IVC Collapse

Mon, 29 Aug 2022 06:34:35 -0400

What do we do with IVC's in kids?! The GEL Jr squad tackles a fascinating article that might have the answer. These authors looked at the Inferior Vena Cava collapse duration in children with dehydration. Will this novel measurement help with figuring out who needs IV fluids?

https://www.ultrasoundgel.org/132
https://pubmed.ncbi.nlm.nih.gov/32530838/

The POCUS Manifesto Part 2

Mon, 01 Aug 2022 08:14:10 -0400

Part 2 of this Special Edition episode with Larry Istrail, author of the POCUS Manifesto. More great talk about POCUS, the physical exam, and ultrasound research.

https://www.ultrasoundgel.org/131

The POCUS Manifesto Part 1

Mon, 18 Jul 2022 08:20:17 -0400

In this Special Edition episode, Mike and Creagh interview physician, entrepreneur, and author Larry Istrail discussing his recent book The POCUS Manifesto! Awesome discussion of the ups and downs of implementing, teaching, and researching POCUS. Part 1 of 2.

https://www.ultrasoundgel.org/130

Neonatal Central Line Positioning

Mon, 04 Jul 2022 04:05:06 -0400

If you take care of neonates, the last thing you need to worry about is vascular access! In this episode the GEL Jr. team discusses an article on using POCUS to confirm central catheter placement. Can it save these babies a few xrays?

https://www.ultrasoundgel.org/129
https://pubmed.ncbi.nlm.nih.gov/35152306/

Brief Echo in Cardiac Arrest

Mon, 20 Jun 2022 08:30:59 -0400

This clever study questions which cardiac view is best to obtain during a cardiac arrest. By using a simulated arrest scenario on living non-cardiac arrest patients, they compare the subxiphoid window and the parasternal long axis view in terms of speed and image quality.

https://www.ultrasoundgel.org/128
https://pubmed.ncbi.nlm.nih.gov/35065867/

Jugular Venous Pressure

Mon, 06 Jun 2022 04:02:31 -0400

Jugular venous distention (JVD) is a classic physical exam finding taught for ages, but assessing it can be a challenge. Can ultrasound do a better job and therefore offer a non-invasive evaluation of the patient’s right heart pressures? This goal has been the pursuit of many ultrasounds before. This time we have a new vessel to assess and a nice reference standard (right heart cath)!
https://www.ultrasoundgel.org/127 https://pubmed.ncbi.nlm.nih.gov/34958600/

Winner of Sonogames Round Zero

Mon, 23 May 2022 13:36:34 -0400

This is a Special Edition podcast which features the winner of a competition at the recent SAEM Sonogames! The challenge was to create the best infographic for a POCUS article of the team's choice. The winning team was from Boston Medical Center. This podcast is a brief discussion of the article and the graphic this talented team created.

https://www.ultrasoundgel.org/126
https://pubmed.ncbi.nlm.nih.gov/33795166/

Felipe Teran

Mon, 09 May 2022 04:00:00 -0400

In the first of our new series of author interviews, hosts Zach Risler and Mike Prats interview the illustrious Felipe Teran. They discuss Felipe's take on our coverage of the Quantitative LV Function in PEA article (ep 119) as well as thoughts on ultrasound and cardiac arrest research in general.

https://www.ultrasoundgel.org/125

US-Guided Arthrocentesis

Fri, 22 Apr 2022 08:54:58 -0400

In this episode, Mike and Jacob dive into an important intersection of musculoskeletal and procedural ultrasound - the ultrasound-guided arthrocentesis. People have been doing arthrocentesis without the help of ultrasound for a while, and most would agree it is feasible. BUT what about those smaller joints - like the wrist, elbow, and ankle? Perhaps that is where the greatest benefit would be in making sure your needle gets to the right place. These authors performed a randomized trial of this specific population to investigate this question.

https://www.ultrasoundgel.org/124
https://pubmed.ncbi.nlm.nih.gov/34608713/

Intussusception

Thu, 07 Apr 2022 19:22:54 -0400

Intussusception is a big deal and an area where POCUS can potentially make a difference. The literature has been promising, but there hasn't been any definitive studies...until now? The GEL Jr hosts dive into this impressive prospective, multicenter, non-inferiority study and (much like an air enema) they try to get to the bottom of this question to reduce our impacted uncertainty.

https://www.ultrasoundgel.org/123
https://pubmed.ncbi.nlm.nih.gov/34226072/

Supraclavicular vs Infraclavicular Subclavian Lines

Mon, 14 Mar 2022 04:00:00 -0400

Ultrasound has been a friend to central venous catheter placement for a long time. It's always there to make sure you are putting that line in the right place without causing problems. While this has been standard for internal jugular lines for years, it is only more recently that this has been proposed for subclavian lines. There is now ample literature supporting this latter practice, although as far as I know, it is not yet widely adopted. This article starts off with the assumption that ultrasound is being used for subclavian lines and now asks the question, which is the safer approach - above or below the clavicle?

https://www.ultrasoundgel.org/122
https://pubmed.ncbi.nlm.nih.gov/34231204/

Dedicated POCUS vs Primary Team

Mon, 28 Feb 2022 04:00:00 -0500

If you have listened to this podcast for any amount of time, you know how POCUS studies usually go. Someone does an ultrasound on something cool and then compares it to another test to see how good it is. Well this study is different. In this case, we are taking a tried and true application of POCUS (undifferentiated dyspnea) and comparing a dedicated ultrasound team's POCUS to the treating emergency team's POCUS. You can imagine the important implications for how we do and define POCUS!!

https://www.ultrasoundgel.org/121

https://pubmed.ncbi.nlm.nih.gov/34348868/

Ectopic Pregnancy

Mon, 14 Feb 2022 04:00:00 -0500

Can you believe we have never talked about ectopic pregnancy on this podcast?? Fortunately for you, a new research article allows our faithful hosts to dive into this core application of POCUS. These authors ask the practical question of whether or not a POCUS saves time in patients with ectopic pregnancy requiring an operation. The results may not be too surprising, but there are many twists and turns to this discussion - not unlike the course traversed from the uterus to the adnexa!

https://www.ultrasoundgel.org/120
https://pubmed.ncbi.nlm.nih.gov/34146921/

Quantitative LV Function in PEA

Mon, 20 Dec 2021 04:00:00 -0500

Ultrasound in cardiac arrest is a favorite topic of the GEL Team and thus, we are back to crack open a radical new concept in the field. Does the left ventricular function actually matter in patients that are arresting?? Current practice for many is to assess for the binary presence or absence of cardiac activity, but these audacious authors suggest that a higher LV systolic function could be associated with a greater likelihood of return of spontaneous circulation!

https://www.ultrasoundgel.org/119

https://pubmed.ncbi.nlm.nih.gov/34087419/

The exFAST

Mon, 22 Nov 2021 04:00:00 -0500

The FAST exam has been used in trauma for decades - so why is there still confusion on how to use it in pediatrics? Because kids are different than adults! This article takes a look at the associations between intraabdominal injury and the FAST, physical exam, and labs. The authors then combine the FAST with physical exam findings to create the exFAST, the FAST-enhanced physical exam! Our GEL Jr hosts deliver great pearls for the FAST exam and how we should be using it based on the evidence to date.

https://www.ultrasoundgel.org/118
https://pubmed.ncbi.nlm.nih.gov/32159909/

Peritonsillar Abscess

Mon, 25 Oct 2021 04:00:00 -0400

Do you use ultrasound for suspected peritonsillar abscess (PTA)? Some of us probably do, some don't - but what does the evidence say?? Does it help the clinician? and (dare we ask) does it help the patient? This paper is potentially the best data we currently have on the topic. Mike and special guest Kim Fender dive straight into the purulence of this fluctuant topic. https://www.ultrasoundgel.org/117
https://pubmed.ncbi.nlm.nih.gov/32826122/

Optic Disc Elevation

Mon, 27 Sep 2021 04:00:00 -0400

GEL Jr coming in hot with the latest in neuro-ocular sonography - optic disc elevation! That's right - not optic nerve sheath diameter (ONSD), the actual elevation of the disc as seen on ocular ultrasound. Super cool new idea - lets how how it pans out in this pilot study! https://www.ultrasoundgel.org/116
https://pubmed.ncbi.nlm.nih.gov/34051397/

Early Systolic Notching Part 2

Mon, 30 Aug 2021 04:00:00 -0400

Everyone's new favorite doppler marker for pulmonary embolism is back! We discussed the ESN (early systolic notching) when this concept was first introduced as a marker for large PEs, but now we have a prospective study that improves upon some of the limitations of the past article...or does it?

https://www.ultrasoundgel.org/115
https://pubmed.ncbi.nlm.nih.gov/33987920/

Pre-Pause Imaging in Cardiac Arrest

Mon, 02 Aug 2021 04:00:00 -0400

One of the gang's favorite topics - ultrasound in cardiac arrest! This article delves into the importance of "pre-pause imaging", getting that picture of the heart ready even before the compressions are stopped! This seems like an important part of minimizing pauses in CPR, but how convincing is this data?

https://www.ultrasoundgel.org/114
https://pubmed.ncbi.nlm.nih.gov/34223359/

Pediatric Intubation

Mon, 19 Jul 2021 04:00:00 -0400

The GEL Jr. team is back with another great use for pediatric POCUS! You might not have known that you can actually use ultrasound to confirm that your endotracheal tube is in the right place! But how good is it??

https://www.ultrasoundgel.org/113
https://pubmed.ncbi.nlm.nih.gov/32168296/

The SAEMMIES 2021

Mon, 21 Jun 2021 04:00:00 -0400

This Special Edition podcast covers not one - but 7 really important POCUS articles! These articles were selected by the Academy of Emergency Ultrasound (an academy of the Society of Academic Emergency Medicine) as the top articles from the past year. Here we briefly discuss the winningest articles from each of the categories!

https://www.ultrasoundgel.org/112

Papilledema

Mon, 10 May 2021 04:00:00 -0400

We have talked about ocular ultrasound many times before - it certainly can be useful in identifying many acute ophthalmologic pathologies. But what about papilledema? We know that POCUS can be used to measure the optic nerve sheath diameter (ONSD), which dilates with increased intracranial pressure. So theoretically this should work well in patients with suspected increased intracranial pressure, such as those with idiopathic intracranial hypertension. The question now is how well does POCUS fare in finding papilledema compared to the good ol' fashioned physical exam? https://www.ultrasoundgel.org/111 https://pubmed.ncbi.nlm.nih.gov/33532756/

Septic Arthritis of the Hip

Mon, 26 Apr 2021 04:00:00 -0400

We have been ultrasounding hips for a while now. We know this modality is accurate for finding effusions. This can really help in cases of suspected septic arthritis. Unlike patients with this disease, this study takes multiple steps forward. First it asks the question - "Does point-of-care ultrasound (POCUS) in the emergency department lead to a faster diagnosis?". Then it goes further by trying to determine whether or not POCUS can lead to earlier treatment as well. Fascinating results from a really hip study! https://www.ultrasoundgel.org/110 https://pubmed.ncbi.nlm.nih.gov/33000078/

Innovation Through Collaboration

Mon, 29 Mar 2021 04:00:00 -0400

In this Special Edition podcast, Mike is joined by POCUS leaders and educators Nova Panebianco and Cameron Baston to discuss their recent publication on interdepartmental collaboration with ultrasound. They discuss their process for creating a combined fellowship and share additional pointers in achieving mutually beneficial relationships between departments. https://www.ultrasoundgel.org/109 https://pubmed.ncbi.nlm.nih.gov/30592332/

Lung Ultrasound for Acute Chest Syndrome

Mon, 15 Mar 2021 04:00:00 -0400

Acute chest syndrome is such a great application for lung ultrasound, especially in pediatrics where we do everything we can to dodge the harmful affects of ionizing radiation. We have covered this once before on the podcast, but it was ages ago. This is a recent well-done study that takes another look to see how ultrasound compares to the commonly employed chest radiography. Join the GEL Jr team as they discuss how this might play out in practice! https://www.ultrasoundgel.org/108 https://pubmed.ncbi.nlm.nih.gov/32928462/

Transcranial Doppler in Traumatic Brain Injury

Mon, 01 Mar 2021 04:00:00 -0500

Transcranial doppler has been a developing interest to point-of-care ultrasound enthusiasts. While it has been a mainstay for certain inpatient indications, only relatively recently have some bold souls proposed application in the acute care setting. These uses include assessing for midline shift, vasospasm, elevated intracranial hemorrhage. This article explores an even more novel idea - using it in the early period after a traumatic brain injury to assess resultant changes in cerebral blood flow. Perhaps this could provide a non-invasive measurement with important prognostic implications. https://www.ultrasoundgel.org/107 https://bit.ly/2O04ycd

Pediatric POCUS Interpretation

Mon, 15 Feb 2021 04:00:00 -0500

This is the first episode of GEL Jr. - our pediatric series! Hosts Delia Gold and Lianne McLean join Mike in discussing an important article on the learning of pediatric POCUS. These authors studied how participants learned image interpretation from an online POCUS educational system. The findings have many important implications for education and competency! https://www.ultrasoundgel.org/106 https://pubmed.ncbi.nlm.nih.gov/32313857/

Integrated Lung Ultrasound for the Diagnosis of COVID-19

Mon, 01 Feb 2021 04:00:00 -0500

Look - we're sorry. We know you are sick of COVID-19, but when this came across our desk we knew it was important. So far we know that point-of-care lung ultrasound is accurate for the diagnosis and even that extent of sonographic findings can correlate with the severity of disease. Now we ask - could it provide a superior diagnostic strategy to even our beloved PCR?? https://www.ultrasoundgel.org/105 https://www.annemergmed.com/article/S0196-0644(20)31269-5/fulltext

GEL Live! Optic Nerve Sheath Diameter & How to G.E.L.

Mon, 21 Dec 2020 04:00:00 -0500

We are back for Part 2 of this raucous jamboree! Creagh, Mike, and the gang from Denver Health Ultrasound continue sounding the depths of the article on optic nerve sheath diameter in patients with elevated intracranial pressure. There are more lessons learned about general principles in dissecting POCUS articles. This is Part 2 of 2 episodes! https://www.ultrasoundgel.org/104

GEL Live! Optic Nerve Sheath Diameter & How to G.E.L.

Mon, 14 Dec 2020 04:00:00 -0500

This episode is a real holiday special! Creagh and Mike collaborate with the Denver Health Ultrasound team to do a live (at the time) journal club on a recent article about optic nerve sheath diameter. We do a deep dive into the intricacies of the article but also develop important general principles for Gathering Evidence from the POCUS Literature. This is Part 1 of 2 episodes! https://www.ultrasoundgel.org/103

Ischemic Stroke

Mon, 23 Nov 2020 04:00:00 -0500

I know your first thought - is this for real?! The POCUS enthusiasts have gone off the rails again! Well - that very well may be the case, but hear me out- this is a fascinating idea. This article presents a novel strategy for searching for embolic etiologies in the acute phase of ischemic strokes (which means even climbing into CT with a handheld device!). "Why?" you may rightfully ask. That is a really great question, and I'm glad you asked. I guess you will have to check out this episode to find out! https://www.ultrasoundgel.org/102 https://pubmed.ncbi.nlm.nih.gov/32532655/

Diverticulitis

Mon, 09 Nov 2020 04:00:00 -0500

Ultrasound of the bowel is a relatively new application for POCUS users. It came into the spotlight proving itself with small bowel obstruction, but now we are slowly peristalsing even further down the colon of indications. You may be surprised to find that you can actually see diverticulitis on ultrasound, but it turns out it's not that hard! The question is - how reliable are the sonographic findings? This study is one of the largest to compare POCUS to CT to investigate this important application. https://www.ultrasoundgel.org/101 https://pubmed.ncbi.nlm.nih.gov/32653332/

G.E.L. 100

Mon, 12 Oct 2020 04:00:00 -0400

Well...we finally made it. This is the 100th episode of the Ultrasound G.E.L. Podcast! The whole team is on this one, and we discuss thoughts sent in by our listeners on the future of point-of-care ultrasound research. Also reflections, plans, and thank yous. https://www.ultrasoundgel.org/100

VExUS

Mon, 28 Sep 2020 04:00:00 -0400

You may have heard whispers of a magical new way to determine if your patient has too much fluid on board. The VExuS (Venous Excess UltraSound) grading system has been described as a way to use the IVC in combination with abdominal organ doppler in order to determine the degree of venous congestion. This is the first study that takes a look at the VExUS system to see if it can predict acute kidney injury in post-operative patients. https://www.ultrasoundgel.org/99 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7142196/

COVID-19 Severity

Mon, 14 Sep 2020 04:00:00 -0400

We haven't discussed COVID-19 for a long time, despite the explosion of POCUS articles on how ultrasound can be used during this pandemic. Many of the articles have focused on the accuracy of POCUS for making the diagnosis, or comparing the ultrasound findings to those on CT. These are helpful, but now what we really want are studies that help establish that POCUS is helping with delivering patient care - either diagnostically or prognostically. This article seems to take the first step in this direction by examining the prognostic utility of lung ultrasound in this disease. https://www.ultrasoundgel.org/98 https://pubmed.ncbi.nlm.nih.gov/32728966/

Return of the Aortic Dissection

Mon, 31 Aug 2020 05:00:00 -0400

We are making some headway in the evidence behind using point-of-care ultrasound in aortic emergencies. This study takes a look at sensitivity and specificity for acute aortic dissection (which has been a few times before) and also compares POCUS to a control group to see if it causes delays or improves times to diagnosis or treatment (has not been done prospectively before). They even look at mortality! https://www.ultrasoundgel.org/97 https://pubmed.ncbi.nlm.nih.gov/31971274/

Shoulder Dislocation Revisited

Mon, 03 Aug 2020 05:00:00 -0400

People have been using POCUS to diagnosis shoulder dislocation for a while now, although it is far from standard of care in most places. We have seen that it is really accurate compared to xray, but this well-done study adds some important information to the existing literature. They measure the glenohumeral distance in an attempt to make a quantifiable cut-off point for dislocation. They also take a look at potential time savings of ultrasound compared to xray! https://www.ultrasoundgel.org/96 https://pubmed.ncbi.nlm.nih.gov/32111508

Deep Learning for Peripheral IV Anatomy

Mon, 06 Jul 2020 05:00:00 -0400

Deep learning is a branch of artificial intelligence that holds a lot of promise for point-of-care ultrasound, but we don't have much data on how it performs. The fearless investigators in this fascinating study train a deep learning algorithm to recognize sonographic anatomy of the upper extremity and then pit it against expert POCUS users to see who can interpret the images most accurately! https://www.ultrasoundgel.org/95 https://pubmed.ncbi.nlm.nih.gov/32181922/

Chest Tube Location

Mon, 22 Jun 2020 05:00:00 -0400

Placing a tube thoracostomy (aka chest tube) is a very useful procedure but can have complications of injuring the diaphragm or intraabdominal organs. Traditionally, the location for placement is selected using anatomic landmarks to find the correct intercostal space. This study questions the safety of this traditional location by using point-of-care ultrasound to visualize diaphragm movement during respirations. Is this the start of ultrasound-assisted chest tubes? https://www.ultrasoundgel.org/94 https://pubmed.ncbi.nlm.nih.gov/32333800/

How to Do POCUS Research - Part 2

Mon, 08 Jun 2020 05:00:00 -0400

We are back with Part 2 of discussing POCUS research with renowned expert and researcher, Michael Gottlieb. More pearls, pitfalls, tips, and tricks to help you step up your POCUS research game. This is the final episode in this two-part special edition, and we wrap it up as always with some take home points! https://www.ultrasoundgel.org/93

How to Do POCUS Research - Part 1

Mon, 25 May 2020 05:00:00 -0400

We have reviewed a lot of POCUS articles on this podcast, but we don't often talk about the process of performing a research study. On this episode, we bring on world-class POCUS expert and researcher Michael Gottlieb to discuss the ins and outs of performing, publishing, and reviewing ultrasound research studies. This is Part 1 of 2. https://www.ultrasoundgel.org/92

Pediatric Peritonsillar Abscess

Mon, 11 May 2020 05:00:00 -0400

For peritonsillar abscesses, sometimes you need imaging to make the diagnosis clear. Many turn to CT, but ultrasound offers an appealing alternative. A transcervical approach can be used which is likely less uncomfortable than the intra-oral method. This study looks at the implementation of a transcervical ultrasound protocol in a pediatric emergency department to see if it helps this population. https://www.ultrasoundgel.org/91 https://www.ncbi.nlm.nih.gov/pubmed/31713253

The FASH Exam

Mon, 27 Apr 2020 05:00:00 -0400

The FASH exam is not just a typo when trying to write about the FAST exam. FASH stands for Focused Assessment with Sonography for HIV-associated Tuberculosis (TB). This exam combines various body areas to look for evidence of TB. You can look for extra fluid (pericardial, pleural, ascites), enlarged abdominal lymph nodes, and solid organ lesions (spleen, liver). This has been described for a while, but there have not been many studies on how accurate it might be...until now. https://www.ultrasoundgel.org/90 https://www.ncbi.nlm.nih.gov/pubmed/31904699

GI Bleed Risk

Mon, 30 Mar 2020 05:00:00 -0400

It's not what you think - POCUS is not going to be used to diagnose a GI bleed. However, perhaps it can be used to risk stratify this diverse group of patients. These authors had the idea to check IVC, echo, and LVOT VTI to see if it could help predict which patients are going to have adverse events from their bleed. https://www.ultrasoundgel.org/89 https://www.ncbi.nlm.nih.gov/pubmed/31379015

POCUS in COVID-19

Tue, 17 Mar 2020 05:00:00 -0400

COVID-19 is here, there, and everywhere. Mike Mallin joins in to examine the first published reports on POCUS being used on the front lines. We discuss the sonographic findings and potential uses during this pandemic. https://www.ultrasoundgel.org/88

A POCUS Protocol for Renal Colic

Mon, 02 Mar 2020 05:00:00 -0500

We know that point of care ultrasound can be used to find evidence of urinary obstruction in patients with renal colic from a kidney stone. However, it is not clear how to put this into practice. Who should get an ultrasound? Who needs further testing after ultrasound? This article poses one protocol to see if it can help save time and money in the emergency department. https://www.ultrasoundgel.org/87 https://pubmed.ncbi.nlm.nih.gov/31661942

Focused Echo for Pulmonary Embolism in Patients with Abnormal Vital Signs

Mon, 17 Feb 2020 05:00:00 -0500

A focused cardiac ultrasound is commonly used in the evaluation of patients with possible pulmonary embolism (PE). Based on the literature to date, we know that this can be helpful for ruling in signs of right heart strain. On the other hand, so far, this focused exam has not been that helpful in ruling out PE. These authors try to fix that by optimizing the sensitivity of the exam in a population with abnormal vital signs. https://www.ultrasoundgel.org/86 https://pubmed.ncbi.nlm.nih.gov/31562679

Short versus Long for IJ Cannulation

Mon, 03 Feb 2020 05:00:00 -0500

It is an age-old question - short or long axis? Using ultrasound guidance for internal jugular vein cannulation is now fairly standard. There are a lot of opinions regarding if it is best to visualize the target in short axis (cross section) or long axis (parallel to the vein). There are certainly benefits to both. This episode features a prospective randomized trial that attempts to put an end to this debate. https://www.ultrasoundgel.org/85 https://www.ncbi.nlm.nih.gov/pubmed/31230925

Focused Cardiac Ultrasound for Acute Aortic Syndromes

Mon, 20 Jan 2020 06:00:00 -0500

Acute aortic syndromes such as aortic dissection, aortic aneurysm, penetrating ulcer are tricky. No one wants to miss these deadly diseases, but we also don't want to test everyone who has the slightest sign of this wily diagnosis. Point of care ultrasound can detect signs of aortic pathologies, but there haven't been any good studies to determine if this is accurate or safe....until now. https://www.ultrasoundgel.org/84 https://www.ncbi.nlm.nih.gov/pubmed/31226214

US-Guided Regional Anesthesia for Acute Pain: The Evidence

Mon, 23 Dec 2019 05:00:00 -0500

Back with more blocks in Part 2. Mike and Mike continue to explore, discuss, and laugh about the evidence for ultrasound-guided regional anesthesia for acute pain management. https://www.ultrasoundgel.org/83

US-Guided Regional Anesthesia for Acute Pain: The Evidence

Mon, 09 Dec 2019 06:00:00 -0500

Everyone who has ever done one knows that ultrasound guided blocks are great. They seem to help patients, they are fun to do, but are they supported by the evidence? Mike Stone joins in on this two part, special edition dive into the studies out there for performing ultrasound guided regional anesthesia for acute pain. https://www.ultrasoundgel.org/82