Sunday, September 29, 2013

Sliding Lung Sign Better Than a Chest X-Ray!

I have preached it !  Now it is in Cement and Granite!  The sliding Lung Sign is now Standard of Care!  Forget the rattled x-ray tech being called to the ED or ICU for a STAT portable chest X-Ray.  Let's use the ultrasound machine to look at the lungs.  The image to the left is the sea-shore sign.  When you do not see undulations in the bottom portion of the image, there is a problem.  This is an M-Mode image.  I will post the article.


Ultrasonography is being increasingly utilized in acute care settings with expanding applications. Pneumothorax evaluation by ultrasonography is a fast, safe, easy and inexpensive alternative to chest radiographs. In this review, we provide a comprehensive analysis of the current literature comparing ultrasonography and chest radiography for the diagnosis of pneumothorax.

Many Thanks Sonoworld and the Writer

Saturday, September 21, 2013

A Note About Being Green

Many of us fish about the interwebs and encounter strange things.  The following is funny from a sonographers point of view because it is obvious what the disease is doing to the patient.  The reporter has no clue, (most reporters have no clue) which makes me laugh. The reason the patient is sick is because the worms blocked his biliary system, which the journalist refers to briefly. We are taught about these diseases here in the USA.  Enjoy!

Chinese man turns green after eating river snails

He Yong, 24, had abdominal pains for two months before his skin and the whites of his eyes turned green from a parasitic infection. 'I looked like the Incredible Hulk,' he said.

Read more:

Thanks NYdaily

Saturday, September 14, 2013

Ultrasound Gel And Surgical Procedures

Many studies have been conducted about the safety of ultrasound gels in the operating room environment.  It is well known that the probe and gel must be sterile to perform invasive procedures.  Without naming any manufacturer, I will stress that all ultrasound procedures that involve breaking the skin, or other invasive means should be sure that the probe and the gel is sterile.  Many gel manufacturers provide sterile gel in packets that are marked.  I urge all clinicians to use these packets and observe sterile techniques.  Here is the link:  Thanks TJW


Ultrasound gels may contain propylene glycol and glycerol, which are neurotoxic in high concentrations. If the needle passes through gel during regional anesthesia, gel may be injected near the nerve. It is unknown if this practice poses a risk for neurotoxicity. Using an animal model, we assessed the histological changes of perineural propylene glycol on nerves. We then assessed three commonly used sterile gels for evidence of neurotoxicity.

Thanks Sonoworld

Sunday, September 8, 2013

Underwater Echocardiogram Reveals Risks To Older Divers

OUCH!  An article I will link reveals that scuba diving may be hazardous to divers older than forty years!  I have been a diver since the age of 16, and this is NOT good news.  Both my wife and I are certified divers.  I have logged hundreds of dives, and only had one emergency, which I dealt with as you can see.  To become a certified diver, one must undergo rigorous classroom, and practical experience.  I am fortunate enough to have been trained by a late student of Jacques Cousteau in the early 1970's.  The traditional and flawed bi-tubed regulator was replaced with a single hose regulator around then.  I was trained how to calculate diving times by depth charts, thus to avoid many horrible medical conditions caused by early de-pressurization.  The curriculum includes many issues as relates to health and safety.  All programs are centered around safety including the buddy system, emergency procedures and basic first aid.  I saw first hand 8 years ago what happens to a diver when they do not follow the rules of decompression.  My wife and I were on a cruise to the caribbean, and we took a sport dive near Roatan.   We dove in calm seas, and 45 minutes later rose to find the seas were troubled by ten foot swells, and dark clouds with windy conditions.  Tropical Storm!  We quickly got on the dive boat with horrible thoughts about getting shipwrecked.  Nobody said anything about a possible tropical storm.  We chugged back to Roatan fighting waves the size of  humpback whales, and made it to the cove in time to see another dive boat dock.  As we were carrying our gear towards Antony's Key Resort  We spied a gurney with a diver on it being pulled towards the recompression facility.  We watched in horror as the diver was convulsing on the gurney, and all that diving training came back into my mind.  Diving is serious stuff.  My wife is a nurse, and she had a fit as this guy was pulled into the medical facility.  Did he survive?  We have no idea.  The most probable explanation was the dude surfaced too rapidly because of the weather. This was certainly a dramatic part of our vacation.

So what about my emergency?  I bet you are waiting to hear my story.  Simply put, I started after a manta ray (docile and looking like a Klingon Warship) wanting to ride it.  I have ridden a manta ray once when I was younger.  The are plankton feeders, so no teeth to worry about.  I descended too rapidly and became hyper-ventilated.  The dive master realised my issue and assisted me in a controlled ascent.  It was an emergency.  I got on the boat and breathed through a paper bag for a few moments and got back in the water knowing that if I did not attack my fear, I would never dive again.  That happened 30 years ago.  Good training is key.  I recommend sport diving (Not cave diving, which I have done) to all who are trained rigorously.  Here is the link to the article I mentioned at the top.  Thanks for your time.  TJW

Scuba diving is growing in popularity among older Americans and heart attacks and unknown heart rhythms are the most common cause of diving-related deaths after age 40, according to the Divers Alert Network, a nonprofit research group.
The study, conducted in Italy, involved 18 scuba divers, including 16 men and two women. The participants were about 42 years old and each had made at least 100 dives. None smoked or had hypertension, heart or lung disease.

Thanks WSJ

Monday, September 2, 2013

I Will Now Publish A Wonderful Reply To My Post About OB-GYN Ultrasound

A great sonographer from Israel posted a reply to my BLOG post about OB-GYN male sonographers.  I will post his reply without his name as I have not received permission to use his name. 

I will comment below.

Hi Tom. I fully appreciate your commentary on doing ObGyn sonography as a male. I am horrified by your boyfriend encounter and would certainly have wanted to notify the police. I would have been challenged by the dilemmas of having to reveal a patient's name and would have consulted with medical professionals and administration to determine the correct  of action here. But this was a dangerous person.

That being said, I have always been aware of the fact that I am a male who walks into a room with a woman, asks her to take off clothes and lie down and then turns off the lights. Even in echocardiography, this is a situation that can be severely misread by anyone. Part of my solution for most of my career was to always dress in a business shirt and tie and wear a white lab coat. This was to transmit a sense of professionalism and formality, and to say that I take my profession very seriously. If I were to dress like that here in Israel, I would be more formally dressed than top administrators of the medical center, much more so than any physician and I would look weird and out of place. So I simply dress more formally than anyone in my department (button down shirt and a short white jacket) and leave it to my obviously more senior age to give me that air.

All that being said, my corollary to what you have said is my first job in Echo, which was at Maimonides Medical Center in Boro Park in Brooklyn, New York. This area has a large ultra-Orthodox Jewish community. As an example of their conservationism, during an Orthodox Jewish wedding nobody touches someone of the opposite sex. Dancing is done as men with the men and women with the women. If I recall correctly, the groom and bride may dance by holding opposite corners of a cloth. So when I told my boss (and he was Orthodox although not Ultra) about six months after he hired me that I was surprised to get the job, he was startled and said that he hadn't really thought about it as he was a man and we were practicing medicine.

And now I work in a lab in Haifa, Israel, where we have a certain number of patients who are Orthodox Jews and a significant number who are Orthodox Muslims. Of course, we treat all equally and if a specific request is made for a male or female technologist we try to honor it. But a large number of times, whomever is assigned to take the patient does so without any preference and generally there is no objection.

All this being said, I did do ObGyn as a student back in the late '70s. At that point it was so new and there were no endo-vaginal exams so it was much simpler than it probably is today. One shocker was that at one of my clinical sites where the sonographer was an attractive young woman, I entered on one of my first days to where she had begun an exam to find her with a patient who was stark naked on the bed. Apparently, as we were using straight, very runny mineral oil as our contact material, she felt that she did not want to get oil on the woman's clothes. It was a maturing experience for me to try not to react in anything but the most professional way, but I think I succeeded.

Anyway, enough of my ramble. Back to the unpacking I should be doing as we have just moved into our new apartment, purchased and fully renovated.

Best wishes to you,

Thanks, I will publish your letter with no name out of respect.  TJW

Update  My friend has allowed me to use his name as the author of this letter.  He is Gershom Lichtenberg of Haifa, Israel.  He is a great contributor to the  

Give him a round of applause