ACEP News - June 2008 - (Page 9)

JUNE 2008 • ACEP NEWS IMAGING TRICKS OF THE TRADE 9 Finding the Foreign Body: Utility of Ultrasonography B Y M E L I S S A M I L A N , M . D. , A N D M I C H E L L E L I N , M . D. lthough still underutilized, ultrasound in the emergency department is gaining popularity in screening for retained foreign bodies. When assessing an open wound, maintain a high index of suspicion for an occult retained foreign body. Foreign body retention can often lead to infection, abscess formation, allergic reaction, chronic pain, disability, and litigation against the initial treating physician. Retention of a foreign body may still be suspected after thorough exploration if, for instance, the wound extends below the subcutaneous fat, or the mechanism is compatible with a foreign body (e.g., broken glass). The use of diagnostic adjuncts is then recommended. Plain radiographs should be the first-line imaging modality in such cases, because they can detect 80%-90% of foreign bodies. Ultrasonography is an important modality to consider, especially if there is concern for retention of a radiolucent object. Most metallic objects are radio-opaque, but fish bones, as well as plastic and wood- A en foreign bodies (i.e., cactus thorns and splinters) are radiolucent and are usually undetected on plain films. In using ultrasonography to seek a retained object, use a high-frequency (7.5 MHz or higher) linear transducer. A high-frequency probe increases image resolution (at the expense of reduced penetration to deeper tissue). When searching for an object, maintain a methodical, steady approach to avoid inadvertently overlooking an area. Often, the best Soft-tissue ultrasound imaging reveals a views are obtained by positioning retained plastic object (hyperechoic). the probe parallel or perpendicular to the foreign body (see photos). ternative is a 50- to 250-cc IV fluid bag or Trick of the trade: A common prob- a water-filled glove as padding between lem that arises when imaging very su- the patient and the transducer probe. ■ perficial structures, especially of the hands and feet, is that the foreign body may ac- DR. MILAN is a recent graduate of tually be too close to the probe. The for- Georgetown University School of Medicine. eign body is outside the focal zone, and DR. LIN practices emergency medicine at within the near-field “dead space.” San Francisco General Hospital (SFGH) A commercial sonolucent stand-off pad and is the associate residency director of can be used to increase the distance from the UCSF-SFGH emergency medicine the transducer probe to the foreign body residency program. Contact Dr. Lin at by about 2 cm. If a stand-off pad is un- mlin@sfghed.ucsf.edu for comments or available, a slightly more cumbersome al- suggestions for other “tricks of the trade.” Metallic foreign body produces a reverberation artifact with ultrasound. Abnormal longitudinal ultrasound shows a splinter at the distal interphalangeal joint. Introducing PageSync™: USA Mobility’s Instant Weight-Loss Plan The urgency of paging with the power of your BlackBerry device or SMS phone » » Pop-up window and alert tone distinguishes critical pages from other messages One device for paging, voice and e-mail USA Mobility customers retain their existing pager numbers Keep your BlackBerry number private User-defined alerts give paging messages a unique tone Pop-up window forces acknowledgement of new messages Easily reply to messages from your BlackBerry smartphone Special offer for ACEP Members: 50% off PageSync Access License Call (888) 878-5014 » » WWW.USAMOBILITY.COM/PAGESYNC COURTESY DR. MARTINE SARGENT IMAGES COURTESY DR. TERESA WU http://WWW.USAMOBILITY.COM/PAGESYNC http://WWW.USAMOBILITY.COM/PAGESYNC

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ACEP News - June 2008 Contents News - Time to Move Tricks of the Trade - Revealing Tips Focus On - Dengue Fever Practice Trends - EMTALA Results

ACEP News - June 2008

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