In addition to the bladder aspiration, mentioned above, there are several other procedural applications for ultrasound in the ED. While plain-film radiography or fluoroscopy is very accurate at identifying radiopaque foreign bodies, other objects, such as wood, can be very difficult to identify in a wound. Ultrasound is capable of identifying wooden objects as small as 2.5 by 1.0 mm in soft tissue and is also capable of identifying metal, plastic, glass, and vegetable matter. 14 With high-frequency probes (Z.5 to 10 MHz), foreign bodies appear echogenic, often with acoustic shadowing.15 With a small wound that is not amenable to exploration, it is acceptable to image directly over the potential entry site with the transducer and gel.
Sonography may also be used to assist in the percutaneous placement of central venous catheters.16 Studies have found that the use of ultrasound to guide this procedure results in a decreased failure rate and lowers the overall incidence of complications. 1Z Here, a Z.5- to 10-MHz probe identifies the location of the vein to be cannulated (e.g., internal jugular vein), and then the percutaneous puncture can be performed with accurate knowledge of the location of the vein. The vein is seen to compress considerably before puncture occurs.
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