How To Videos

Performing Common Bile Duct Ultrasound Measurements

Read more about Performing Common Bile Duct Ultrasound Measurements

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Learn how to measure the common bile duct with ultrasound

Publication Date

Tue, 01/26/2016 - 12:00

Media Library Type

How To Videos

Subtitles

- The more advanced area that you may want to look at
is actually measuring the bile duct.
That's a pretty straight forward procedure.
First thing you do is again find that exclamation sign.
And again we see it here with the gallbladder in length
we see the portal vein,
and just above the portal vein lies the bile duct.
So when we carefully scan you can see an area.
Just above the portal vein which is anechoic.
I'm going to freeze this here in a moment.
And you should be able to see a very tiny duct.
If you are squinting at the screen like I am
trying to see where the duct is.
You are dealing with a patient with a normal duct.
Usually if the duct is enlarged it will be quite evident,
and it can be as large as the portal vein itself.
So I'm going to freeze this here.
So on the screen right now I have a reasonably good image
of the portal vein,
and the associated structures around it.
Right above it we see a very tiny anechoic stripe,
that is the bile duct.
In addition, we also note a very small area which is the
hepatic artery which I'll point out in a moment.
So what we are going to do now is go ahead
and do the measurement of the bile duct.
A normal bile duct measurement is about four millimeters
or less or about one millimeter per decade of life.
So I'm going to go ahead and hit caliper.
And I'm going to drag one end of this to the inter aspect
of the bile duct.
Once I have found that I'm going to hit select,
and I'm going to drag this down.
Just adjacent to it and you can see we are getting
a measurement here of .14 centimeters or 1.4 millimeters,
so well within the normal limits.
Okay I'm going to illustrate to you where
the hepatic artery is.
We can see first this is the portal vein right here.
Right above it is that little anechoic stripe,
which is very tiny and difficult to see,
because this bile duct is normal.
This is the common bile duct.
But right adjacent to here is another anechoic structure,
which is an hepatic artery.
If there is ever any confusion of what you're measuring
you can easily turn the color flow on
to differentiate the two.

Brightcove ID

5733871281001

https://youtube.com/watch?v=S72PbzqihrI

Body

Learn how to measure the common bile duct with ultrasound

How to: Greater Occipital Nerve Block

Read more about How to: Greater Occipital Nerve Block

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This video discusses some of the scanning techniques involved when performing the greater occipital nerve block under ultrasound guidance.

Clinical Specialties

Anesthesiology (Regional)

Media Library Type

How To Videos

Media Library Tag

Nerve Block

Occipital Nerve Block

Lesser Occipital Nerve

Cervicogenic Headaches

Corticosteroid

Anesthetic

Technique

Subtitles

- Today, I'm going to demonstrate
a greater occipital nerve block
performed under ultrasound guidance.
The purpose of this block is to help diagnose
and treat headache syndromes
that may be arising from the posterior occiput.
This can occur as a result of trauma or other incident.
The inion is located,
the occipital protuberance.
The measurement is made 3 1/2 centimeters down
and 1 1/2 centimeters over.
This is the approximate location
and the tracking of the greater occipital nerve,
and the artery with it.
Utilized in this particular block will be
the M-Turbo ultrasound system,
utilizing the high frequency HFL 50 linear probe.
The patient is placed in the prone position.
A bolster is placed under the thorax.
The head is slightly flexed.
And then the hair moved out of the way.
The anatomic location to begin
is the inion, or the occipital protuberance.
Three centimeters below this, the skin is marked
and then typically 1 1/2 centimeters lateral to that
is the entry point for the blind technique.
These will serve as our landmarks to place the ultrasound.
Part of the reason to utilize ultrasound in this case,
is to avoid the accidental injection
within the greater occipital artery
as well as hematoma and other complications
that can occur from this block.
To perform the block, the following items are used:
chlorhexidine prep,
and the local anesthetic solution,
typically a buffered lidocaine for the skin,
and then below this, approximately two to three ccs
of 1% lidocaine, and .25% bupivacaine,
and potentially a small amount of steroid, if desired.
The needle size is simply a 1 1/2 inch standard needle,
27 gauge will suffice.
We will also use ultrasound gel
as well as a band-aid if necessary
for the conclusion of the procedure.
To commence, the target site is covered
with this thin layer of ultrasound gel.
And then the probe placed in the transverse application
at the mid-line.
And then the probe is gently rolled out.
In the midpoint of the screen at this point,
when turning on the Color Flow Doppler,
we will be able to identify the greater occipital artery.
So immediately medial to this,
is the location of the greater occipital
and lesser occipital nerve,
prior to their branching.
The injection would occur
above local anesthetic injected for the skin,
followed by the 1 1/2 inch needle
to contact (mumbles),
and avoid entry into the blood vessel.
The needle removed,
and then the probe placed,
the area cleansed,
and a band-aid placed over the incision.
This concludes the successful placement
of a greater occipital block under ultrasound guidance.

Brightcove ID

5508104683001

https://youtube.com/watch?v=94tmDILJVg4

EDU00150 How to Kidney Ultrasound Exam 2

Read more about EDU00150 How to Kidney Ultrasound Exam 2

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EDU00150 How to Kidney Ultrasound Exam 2

Publication Date

Wed, 09/25/2019 - 12:00

Media Library Type

How To Videos

Subtitles

- Another examination you can do in the ED
is the evaluation of kidney for nephrolithiasis.
And this is a relatively easy examination to do.
We're gonna do, again, using the phased array transducer,
your all-purpose ED transducer,
and the first view that we're going to look at
is a sagittal view of the kidney.
So I'm gonna start on the right side,
but I will do both sides to show you how to do
an evaluation on both sides,
and we're gonna go in with the orientation marker
pointing to the patient's head.
So this will be a sagittal view.
And I'm gonna go in fairly laterally.
With this starting point,
I can quickly identify where the kidney is.
In the anterior aspect of the image, you see the liver,
and immediately posterior to that,
you see a crescent shaped organ, which is the kidney.
And so what I want to do is evaluate, in a long view,
sweeping medially and laterally,
looking at the cortex to determine
if there is any echogenic, or bright shadowing stones.
So I can evaluate the superior pole,
sweep from side to side,
come and look at the inferior pole, sweep from side to side,
and look in the mid pelvis area of the kidney
to determine if there's hydronephrosis,
an indirect sign of nephrolithiasis.
Once I've finished the sagittal sweep,
I'm gonna turn the transducer so it's in a transverse view
with the marker to the patient's right.
And using the same window as I did for the sagittal view,
identify the kidney.
It will now appear as a horseshoe shape,
and we can see the renal vein
coming into the pelvis of the kidney.
And I'm gonna sweep superiorly,
until I move past the superior aspect of the upper pole
and then sweep back down inferiorly,
see the mid-level of the kidney, renal vein,
moving down a rib space
and into the inferior pole of the kidney.
And I continue until I do not see
any tissue of the kidney anymore.
An important part of the kidney evaluation
is a bilateral comparison between the right and left kidney
to determine if there's hydronephrosis present
on one side versus the other.
So we'll go ahead and do the left side as well.
So an easy landmark here
is just to identify the costal margin
and then move up one hand's width
and bring your transducer in at the midaxillary line.
This should get us right in the area
of the spleen and the kidney.
You may need to move up a rib space or two
to determine on how high and how small the spleen is,
'cause we're using the spleen as your window
to evaluate the kidney.
So if I move up a little bit,
I can see the superior part of the kidney
on this ultrasound image,
and I'll just sweep from side to side,
again looking at the cortex of the kidney,
looking at the renal pyramids,
and also trying to determine
if there's hydronephrosis present.
And then I'm going to move down one rib space,
evaluate the lower pole of the kidney,
and sweep medial to lateral,
to make sure I've looked at all of the tissue.
'Cause these stones can be quite small,
so you have to do a very thorough evaluation.
Once I've completed this view,
I'm gonna turn the transducer to a transverse view,
so I'm going to turn the transducer counterclockwise,
and the marker again will face the patient's right.
This will give me
that horseshoe-shaped appearance of the kidney,
and if I start it at mid-level,
I will see the renal vein entering the pelvis of the kidney,
and from here, this is my mid-point,
I'm gonna sweep superior.
I might have to go up a rib space to find it,
go all the way through the kidney, superior pole,
and then start to move inferiorly to mid-level,
continue on down, inferior again,
to the lower pole of the kidney, and all the way out.
So that completes the kidney evaluation.

https://www.youtube.com/watch?v=_1MrwBAeIA8

How to: Ultrasound Guided Greater Occipital Nerve Block

Read more about How to: Ultrasound Guided Greater Occipital Nerve Block

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How to: Ultrasound Guided Greater Occipital Nerve Block

Publication Date

Wed, 09/25/2019 - 12:00

Media Library Type

How To Videos

Subtitles

today I'm going to demonstrate a greater
occipital nerve blog performed under
ultra
the purpose of the
is to help diagnose and treat headache
syndromes that may be arising from the
posterior
ossipon this can occur as a result of
trauma or other incident the inion is
located the occipital protuberance the
measurement is made three and a half
centimeters down and 1 and 1/2
centimeters over this is the approximate
location and the tracking of the greater
occipital nerve and the artery with it
utilized in this particular block will
be the m turbo ultrasound system
utilizing the high-frequency HF L 50
linear probe the patient is placed in
the prone position a bolster is placed
under the thorax the head is slightly
flexed and then the hair moved out of
the way the anatomic location to begin
is the inion or the occipital
protuberance 3 centimeters below this
the skin is marked and then typically
one and a half centimeters lateral to
that is the entry point for the blind
technique these will serve as our
landmarks to place the ultrasound part
of the reason to utilize ultrasound in
this case is to avoid accidental
injection within the greater occipital
artery as well as hematoma and other
complications that can occur from this
block to perform the block the following
items are used chlorhexidine prep and
the local anaesthetic solution typically
a buffered lidocaine for the skin and
then below this approximately 2 to 3 ccs
of 1% lidocaine and quarter percent
bupivacaine and potentially a small
amount of steroid if desired the needle
size is simply a one and a half inch
standard needle 27 gauge will suffice we
will also use ultrasound gel as well as
a band-aid if necessary for the
conclusion of the procedure to commence
the target site is covered with a thin
layer of ultrasound gel and then the
probe placed in the transverse
application at the midline
and then the probe is gently rolled out
in the midpoint of the screen at this
point when turning on the color flow
Doppler we will be able to identify the
greater occipital artery so immediately
medial to this is the location of the
greater occipital and lesser occipital
nerve prior to their branching the
injection would occur above local
anesthetic injected for the skin
followed by the one-and-a-half inch
needle to contact us and avoid entry
into the blood vessel
you
the needle removed and then the probe
placed the area cleansed and a band-aid
placed over the incision this concludes
the successful placement of a greater
occipital block under ultrasound
guidance

https://www.youtube.com/watch?v=94tmDILJVg4

3D Video: Paravertebral Block

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3D Video: Paravertebral Block

Publication Date

Thu, 02/21/2019 - 12:00

Media Library Type

How To Videos

Subtitles

- [Instructor] A high frequency linear array transducer
with a nerve exam type is used to perform an ultrasound
guided thoracic nerve block.
The patient may be placed in either a sitting
or prone position depending on the preference
of the anaesthesiologist.
If the patient is placed in the sitting position
their forehead should rest on an adjustable height table
topped with a pillow and their hands should be resting
in their lap.
The neck should be flexed in a neutral position.
If the block is performed in the prone position a pillow
should be placed under their lower chest with their arms
dangling over the edges of the bed.
Once the desired level to be blocked is determined
the transducer is placed in a sagittal plane with the
orientation marker directed to the patient's head
over the spinus process parallel to the spine.
The transducer should be moved laterally until the
transverse processes are seen as round,
hyper acoic structures posteriorly.
The target for needle placement is a triangle shaped area
just deep to the costal transverse ligament
and the other borders of the triangle being the
transverse process and the parietal plura.
The parietal plura is seen as a bright hyper acoic line
anterior to the lung that moves with respirations.
A needle is inserted immediately adjacent to the superior
aspect of the probe and advanced using an in plane technique
in a cephalad to cadad approach.
It is useful to have your assistant hydro dissect as you
advance the needle to assist in visualization
of the needle tip.
Once the needle tip is deep to the costo-transverse ligament
and superficial to the parietal plura local anesthetic
should be injected.
The goal is to observe the parietal plura being displaced
to a deeper position in the ultrasound image
to ensure you are injecting in the paravertebral space.

Brightcove ID

6005325921001

https://youtu.be/Bl21d-BVz8Y

How To Perform An Adductor Canal Block

Read more about How To Perform An Adductor Canal Block

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This 3D animation here demonstrates a saphenous nerve block that can be done with Sonosite II in mid-thigh. The procedure is useful as a supplement to sciatic nerve block for foot and ankle procedures that involve the medial aspect of the malleolus and the foot. The nerve block has also been reported as a supplement to multimodal analgesia protocols in patients having knee arthroplasty. The saphenous nerve illustrated here is a terminal sensory branch of the femoral nerve. It supplies innervation to the medial aspect of the leg down to the ankle and foot. It also sends infrapatellar branches to the knee joint.

Publication Date

Thu, 02/21/2019 - 12:00

Media Library Type

How To Videos

Subtitles

- [Narrator] A high frequency linear array transducer
with a nerve exam type is used to perform
an adductor canal block.
The patient is positioned in a supine position,
with the leg slightly externally rotated.
The transducer is placed in the medial mid-thigh,
in a transverse position, with the orientation marker
directed towards the patient's right side.
At this level, the femur is easily identified
as a bony structure, to which the vastus medialis
muscle is attached.
The femoral nerve, with the femoral artery and vein,
follow a course, along the medial aspect of the thigh,
beneath the sartorius muscle, in the sub-sartorial
or adductor canal.
The sartorius muscle forms the roof of the canal,
and appears as an oval-shaped muscle,
beneath the subcutaneous fat.
The vastus medialis forms the lateral wall.
And the adductor longus forms the medial wall.
The canal contains the terminal branch of the femoral nerve
and the saphenous nerve.
When the nerve is visualized at this location,
it appears as a small, round hyperechoic image
on ultrasound.
If the saphenous nerve cannot be visualized
on the ultrasound image, the target should be lateral
to the femoral artery below the sartorius
and above the vastus medialis muscles.
The needle should be inserted in plane
in a lateral, to medial, direction.
Once the needle tip is visualized next to the nerve,
or, if unable to visualize the nerve lateral
to the artery, local anesthetic is injected.
A hypoechoic pool of local anesthetic,
will be seen spreading above and around the femoral artery.

Brightcove ID

5798182565001

https://www.youtube.com/watch?v=bMrkO60Jb_o

Body

This 3D animation here demonstrates a saphenous nerve block that can be done with Sonosite II in mid-thigh.

The procedure is useful as a supplement to sciatic nerve block for foot and ankle procedures that involve the medial aspect of the malleolus and the foot. The nerve block has also been reported as a supplement to multimodal analgesia protocols in patients having knee arthroplasty.

The saphenous nerve illustrated here is a terminal sensory branch of the femoral nerve. It supplies innervation to the medial aspect of the leg down to the ankle and foot. It also sends infrapatellar branches to the knee joint.

3D Video: Elbow – Olecranon

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3D Video: Elbow – Olecranon

Publication Date

Thu, 02/21/2019 - 12:00

Media Library Type

How To Videos

Subtitles

- [Voiceover] A linear array transducer

with a musculoskeletal exam type is used

to perform and ultrasound 
examination of the olecranon.

The patient is asked to 
flex their elbow 90 degrees

with the hand placed on 
the examination table.

The transducer is placed 
over the posterior elbow

in a longitudinal fashion 
with the orientation marker

directed toward the patient's head.

The distal triceps muscle appears

as a hypoechoic striated structure,

which transitions to the 
fibular triceps tendon.

The olecranon is seen as a bright,

hyperechoic curved structure.

The posterior fat pad 
can be seen as a complex

hyperechoic area overlying the 
posterior olecranon recess.

The transducer is rotated 
90 degrees counterclockwise

with the orientation marker directed

toward the patient's right side.

The triceps tendon appears as 
a hyperechoic oval structure

overlying the hyperechoic 
surface of the olecranon.

Gentle backward and forward 
rocking of the patient's elbow

may be helpful to shift elbow joint fluid

into the olecranon 
recess for visualization.

Brightcove ID

5751314432001

https://youtu.be/nUwRLfhMMZs

3D Video: Elbow – Medial Aspect

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3D Video: Elbow – Medial Aspect

Publication Date

Thu, 02/21/2019 - 12:00

Media Library Type

How To Videos

Subtitles

- [Voiceover] A linear array transducer

with a musculoskeletal exam type

is used to perform an 
ultrasound examination

of the medial elbow.

The patient is placed in a supine position

with the elbow slightly flexed,

and the forearm forcefully 
externally rotated

and resting on the examination table.

The transducer is placed 
over the medial epicondyle

in a longitudinal fashion, 
with the orientation marker

directed towards the patient's head.

The flexor tendon can be seen

as a fibrillar patterned structure.

The medial epicondyle is seen as

a bright, hyperechoic, curved structure

lying below the tendon.

The anterior bundle of the 
medial collateral ligament

can be seen as a thin, hyperechoic band

that runs between the medial 
epicondyle and the ulna.

Dynamic scanning with valgus stress

can be used to evaluate the 
medial collateral ligament

for laxity or injuries.

Brightcove ID

5751301528001

https://youtu.be/q6a4_fI4_4g

3D Video: Elbow – Lateral Aspect

Read more about 3D Video: Elbow – Lateral Aspect

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3D Video: Elbow – Lateral Aspect

Publication Date

Thu, 02/21/2019 - 12:00

Media Library Type

How To Videos

Subtitles

- [Narrator] A linear array transducer
with a musculoskeletal exam type is used to perform
an ultrasound examination of the lateral elbow.
The patient is placed in a sitting position
with the arm flexed 90 degrees
and resting comfortably on the examination table.
The transducer is placed over the proximal forearm
in a longitudinal fashion with the orientation marker
directed toward the patient's head.
The lateral epicondyl and rounded radial head
are seen as bright hyperechoic lines.
The extensor tendon can be see
as a hyperechoic fibular structure
that inserts on the surface of the epicondyl.
Joint diffusions can be seen in this view,
just deep to the extensor tendon.
The transducer should be moved slightly down the arm
to evaluate the tendon for calcifications,
tendinosis, or discontinuities associated with injury.
The transducer is then turned 90 degrees counterclockwise
for a transverse image.
The extensor tendon overlies the hyperechoic radial head.
The articular cartilage can be seen
as a thin hyperechoic line overlying the radius.
The transducer should be moved distally
to evaluate the entire tendon and joint space
for evidence of loose bodies or tears.

Brightcove ID

5751312017001

https://youtu.be/Q478ZBqai1E

3D Video: Elbow Anterior Recess

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3D Video: Elbow Anterior Recess

Publication Date

Thu, 02/21/2019 - 12:00

Media Library Type

How To Videos

Subtitles

- [Voiceover] A linear 
array transducer with

a musculoskeletal exam type,

is used to perform an 
ultrasound examination

of the anterior recess of the elbow.

The patient is placed 
in a supine position,

with the elbow extended 
over the examination table,

a pillow under the elbow, 
and the forearm supinated.

The transducer is placed 
over the distal humerus

in a transverse fashion, 
with the orientation marker

directed toward the patient's right side.

The brachialis tendon is seen as

a hypoechoic fibrillar structure

extending over the bright 
hyperechoic curved surface

of the distal humerus.

The articular cartilage of the humerus

can be seen as a thin hypoechoic line

that extends over the humeral surface.

The corrinoid fossa is seen as

a concavity of the anterior 
surface of the humerus.

The anterior fat pad 
fills the corrinoid fossa

and appears as a hypoechoic structure.

The transducer is rotated 
90 degrees counter-clockwise

with the orientation marker

directed toward a 9 o'clock position.

The brachialis muscle is seen as

a hypoechoic striated structure

encompassing the hyperechoic 
brachialis tendon.

The anterior distal humeral epiphysis

appears as a bright hyperechoic wavy line

with a thin overlying articular cartilage.

The humeral capitellum is seen as

a rounded structure laterally,

and the humeral trochlea appears as

a V-shaped structure medially.

Brightcove ID

5751296793001

https://youtu.be/KBO0Gy9N6rc

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Performing Common Bile Duct Ultrasound Measurements

Performing Common Bile Duct Ultrasound Measurements

How to: Greater Occipital Nerve Block

How to: Greater Occipital Nerve Block

EDU00150 How to Kidney Ultrasound Exam 2

EDU00150 How to Kidney Ultrasound Exam 2

How to: Ultrasound Guided Greater Occipital Nerve Block

How to: Ultrasound Guided Greater Occipital Nerve Block

3D Video: Paravertebral Block

3D Video: Paravertebral Block

How To Perform An Adductor Canal Block

How To Perform An Adductor Canal Block

3D Video: Elbow – Olecranon

3D Video: Elbow – Olecranon

3D Video: Elbow – Medial Aspect

3D Video: Elbow – Medial Aspect

3D Video: Elbow – Lateral Aspect

3D Video: Elbow – Lateral Aspect

3D Video: Elbow Anterior Recess

3D Video: Elbow Anterior Recess

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