Tobias Kummer, M.D.

Intravascular catheterization is a common procedure in critically ill patients to enable measurement of hemodynamic variables, delivery of medications and nutritional support. Ultrasound-guided central venous catherization (CVC) placement has been shown to significantly reduce the number of procedural complications in comparison to the traditional landmark technique. The standard ultrasound-scanning includes two different approaches, an out-of-plane and in-plane approach. Using the out-of-plane approach could affect visualization of the needle tip during CVC placement. Complications such as posterior wall puncturing of the target vein or artery and pneumothorax can occur. When using the in-plane approach, the entire needle including the tip may be visualized, but it is technically more difficult to align the ultrasound transducer perfectly with the target vessel as well as the needle during cannulation. A novel 4D needle position technology utilizing magnetic field induction is able to detect the needle position and trajectory in both in- and out-of-plane approaches. This could potentially invaluable, especially for novice proceduralists and lead to improve procedural success and further decrease in complication rates. We hypothesize that 4D needle position ultrasound technology will lead to a significant increase in the first attempt success rate in simulated central venous catheter placement using a low-fidelity simulator . The study will be conducted in the multidisciplinary Simulation-Center, Mayo Clinic, Rochester. We will record participants’ characteristics (including demographics (gender, age), prior experience with CVC placement, prior experience with use of ultrasound, prior experience in video gaming, and assessment of spatial ability using the 24 item - Mental Rotation Test by Peters (MRT) (Peters)). Participants will be given a short tutorial to explain the procedure. CVC placement will use the low-fidelity simulator (Gen II Ultrasound Central Line Training Model, CAE Healthcare). All placements will be video recorded.

This study seeks to define normal values and repeatability of the deltoid muscle in healthy volunteers and to establish scanning parameters and protocols to enable further clinical trials to examine the utility of shear wave elastography of the deltoid in various disease processes, targeted operative planning and predicting of surgical outcomes.

Inclusion Criteria:

• Healthy volunteers over the age of eighteen that have been recently dismissed from the Emergency Department at Mayo Clinic Hospital, Saint Marys Campus.
• We will recruit a convenience sample of 100 patients from the Emergency Department who have completed their Emergency Department evaluation and treatment and are being discharged to home with non-painful conditions.

Exclusion Criteria:

• We will exclude persons under the age of eighteen
• Vulnerable populations (pregnant patients and prisoners)
• Those with an allergy to any of the study agents
• Those with acute pain
• Those using antihypertensive or antiarrhythmic agents
• Those with significant cardiopulmonary comorbidities (namely history of arrhythmia, coronary artery disease, hypertension, and heart failure)
• Those with concomitant use of MAO-Inhibitors
• Those with a diagnosis of angle closure glaucoma or BPH
• Those with a history of cerebrovascular disease
• As well as those with a history of previous nasal surgery or known nasal anatomic abnormalities.

What is the effect of two common tourniquet techniques on the first attempt success rate of peripheral intravenous cannulation?

The purpose of this study is to determine if point-of-care echocardiography is a useful tool for assessing heart rhythm in patients that present with various tachyarrhythmia.

Traumatic and non-traumatic soft tissue hematomas are frequently encountered in the acute care setting. The incidence of these hematomas appears to be on the rise secondary to the increased use of anticoagulants among older patients for a variety of medical conditions. The management of soft tissue hematomas depends on the accurate diagnosis of any ongoing bleeding as well as of identification of the injured vessel type. While the majority of cases can be managed conservatively, expanding hematomas leading to hemodynamic instability or ongoing blood loss might require embolization or surgical intervention. The mainstay diagnostic imaging modality is multidetector computed tomography (MDCT) with intravenous contrast that allows accurate assessment of hematoma size, location as well as evaluation for active extravasation. However, many patients cannot undergo CT imaging due to underlying kidney disease, allergy to contrast, or due to concerns for radiation exposure, especially in young age. Currently there are no alternative tests for these patients with a similarly high diagnostic accuracy available. This study intends to establish an imaging protocol and investigate the utility of contrast-enhanced ultrasound (CEUS) in the diagnostic work-up of soft tissue hematoma as an ionizing radiation-free alternative to computed tomography (CT) that can be used independent from the kidney function of the patient.