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PRINCIPLES OF SOUND « VAULT Principles of Sound. Sound is a form of mechanical energy that travels in a longitudinal wave in a series of compressions (high pressure) and rarefactions (low pressure). The transmission of sound requires a medium such as air, liquid, or tissue. Because all mediums have some elastic properties, energy and momentum are transported by means ofABOUT US - VAULT
VAULT- Regional Anesthesia + Vascular Access Training. Christian R. Falyar, DNAP, CRNA is a staff anesthetist at Great River Health Systems, in Burlington, IA. It is a regional medical center serving a community of approximately 100,000 from southeast Iowa, northeast Missouri and western Illinois. He serves as adjunct faculty for theDepartment
TRANSDUCER SELECTION « VAULT Transducer selection is ultimately determined by two factors; frequency and “footprint”. When using ultrasound for regional anesthesia, the goal is to create a high resolution image that creates minimal artifacts. Selection is often determined by the depth of the structures to be imaged. REFLECTION, REFRACTION, SCATTERING AND ATTENUATION « VAULT The culminating effect of tissue on sound as it travels through the body is attenuation . Attenuation is the decreasing intensity of a sound wave as it passes through a medium. It is the result of energy absorption of tissue, as well as reflection and scattering that occurs between the boundaries of tissue with different densities. TRANSDUCERS « VAULT The transducer is the link between the anesthetist and patient. All transducers require several key components to generate an image. Elements located in the transducer use the piezoelectric effect tocreate sound.
TISSUE ECHOGENICITY « VAULT Acoustic impedance of difference mediums. Echogenicity is the amount of reflection caused by varying degrees of acoustic impedance in tissues. Several terms are used to describe tissue echogenicity. Anechoic refers to those tissues that produce no echo. This is commonly seen with Rayleigh scattering (discussed later) that occurswithin blood
ARTIFACTS « VAULT
Artifacts. An artifact is any phenomenon that affects the acquisition or interpretation of an ultrasound image. Artifacts can occur because of properties within the tissue itself, or be created by the anesthetist. The most commonly seen artifacts are air artifact, shadow artifact, reverberation, and acoustic enhancement. LOWER EXTREMITY BLOCKS Lumbar and Lumbosacral Plexi • The lumbar and lumbosacral plexi supply the majority of nerve innervation to the lower extremity • The lumbar plexus, derived form L1-4, and DOPPLER EFFECT « VAULT First described by the Austrian Christian Doppler in the 1842, it explains how the frequency of a wave is perceived to change relative to movement. The central premise of the Doppler Effect is a change in the frequency of a detected wave when the source or detector is moving. A change in pitch of a moving ambulance is a familiar exampleof the
ULTRASOUND-GUIDED REGIONAL ANESTHESIA RICHMOND, VA Ultrasound is now commonplace in anesthesia practice. It is used routinely for regional anesthesia procedures, vascular access, and perioperative patient assessment. This site reviews basic and advanced ultrasound-guided techniques by presenting best practice through evidenced-based research. The information contained on this site isfor any
PRINCIPLES OF SOUND « VAULT Principles of Sound. Sound is a form of mechanical energy that travels in a longitudinal wave in a series of compressions (high pressure) and rarefactions (low pressure). The transmission of sound requires a medium such as air, liquid, or tissue. Because all mediums have some elastic properties, energy and momentum are transported by means ofABOUT US - VAULT
VAULT- Regional Anesthesia + Vascular Access Training. Christian R. Falyar, DNAP, CRNA is a staff anesthetist at Great River Health Systems, in Burlington, IA. It is a regional medical center serving a community of approximately 100,000 from southeast Iowa, northeast Missouri and western Illinois. He serves as adjunct faculty for theDepartment
TRANSDUCER SELECTION « VAULT Transducer selection is ultimately determined by two factors; frequency and “footprint”. When using ultrasound for regional anesthesia, the goal is to create a high resolution image that creates minimal artifacts. Selection is often determined by the depth of the structures to be imaged. REFLECTION, REFRACTION, SCATTERING AND ATTENUATION « VAULT The culminating effect of tissue on sound as it travels through the body is attenuation . Attenuation is the decreasing intensity of a sound wave as it passes through a medium. It is the result of energy absorption of tissue, as well as reflection and scattering that occurs between the boundaries of tissue with different densities. TRANSDUCERS « VAULT The transducer is the link between the anesthetist and patient. All transducers require several key components to generate an image. Elements located in the transducer use the piezoelectric effect tocreate sound.
TISSUE ECHOGENICITY « VAULT Acoustic impedance of difference mediums. Echogenicity is the amount of reflection caused by varying degrees of acoustic impedance in tissues. Several terms are used to describe tissue echogenicity. Anechoic refers to those tissues that produce no echo. This is commonly seen with Rayleigh scattering (discussed later) that occurswithin blood
ARTIFACTS « VAULT
Artifacts. An artifact is any phenomenon that affects the acquisition or interpretation of an ultrasound image. Artifacts can occur because of properties within the tissue itself, or be created by the anesthetist. The most commonly seen artifacts are air artifact, shadow artifact, reverberation, and acoustic enhancement. LOWER EXTREMITY BLOCKS Lumbar and Lumbosacral Plexi • The lumbar and lumbosacral plexi supply the majority of nerve innervation to the lower extremity • The lumbar plexus, derived form L1-4, and DOPPLER EFFECT « VAULT First described by the Austrian Christian Doppler in the 1842, it explains how the frequency of a wave is perceived to change relative to movement. The central premise of the Doppler Effect is a change in the frequency of a detected wave when the source or detector is moving. A change in pitch of a moving ambulance is a familiar exampleof the
SOUND/TISSUE INTERACTION « VAULT Sound/Tissue Interaction. Tissue appearance on ultrasound is determined by their physical properties and its interaction with the sound beam. The varying degrees of brightness (and darkness) seen on the BMode image are the result of reflection, refraction, and scattering. This causes tissues to appear either as anechoic,hypoechoic, or
GLOSSARY « VAULT
Glossary. Absorption – the conversion of sound to heat because of its interaction with tissue. Acoustic enhancement – an increase in reflection amplitude that occurs when a wave strikes a medium that is located behind a tissue of weak acoustic impedance. Acoustic impedance – the resistant properties of a medium to sound transmission.REFRACTION « VAULT
Legal Disclaimer; Provision of education and research information only - always seek professional advice The VAULT website was developed by Christian R. Falyar, CRNA, DNAP, to share information related to ultrasound-guided regional anesthesia with other anesthesia providers. VASCULAR ACCESS « VAULT Vascular Access. With few exceptions, vascular access is required to perform an anesthetic. As the patient population continues to age and the number of comorbidities in these patients increase, obtaining adequate vascular access can be very challenging. When properly used, studies show ultrasound-guided vascular access improves success rates GASTRIC ULTRASOUND UTILITY IN PATIENTS WITH DELAYED Legal Disclaimer; Provision of education and research information only - always seek professional advice The VAULT website was developed by Christian R. Falyar, CRNA, DNAP, to share information related to ultrasound-guided regional anesthesia with other anesthesia providers. SEDONA ULTRASOUND COURSE « VAULT Legal Disclaimer; Provision of education and research information only - always seek professional advice The VAULT website was developed by Christian R. Falyar, CRNA, DNAP, to share information related to ultrasound-guided regional anesthesia with other anesthesia providers. ADDUCTOR CANAL / SAPHENOUS « VAULT Adductor Canal / Saphenous. The saphenous nerve is the terminal branch of the femoral nerve. It courses distally along the superficial femoral artery and vein until approximately the distal third of the thigh. At this point the artery and vein dive deep through the adductor canal. The saphenous continues caudal where it passes throughthe
INTERSCALENE « VAULT The interscalene block is directed at cervical roots 5-7 of the brachial plexus. They are generally found at the level of the cricoid cartilage (C6) in the neck, located beneath the Sternocleidomastoid muscle (SCM) between the anterior scalene (ASM) and middle scalene (MSM) muscles. The US image for this block is best obtained with thepatient
FEMORAL NERVE BLOCK « VAULT The femoral nerve block (FNB) was once the preferred peripheral nerve block for patients undergoing total knee arthroplasty (TKA). However, the FNB results in quadriceps weakness which impairs early ambulation and increases the potential for postoperative falls making other blocks, such as the adductor canal block, more desirable in thispatient population.
ULTRASOUND REIMBURSEMENT INFORMATION Ultrasound reimbursement information Payment for Ultrasound-Guided Regional Anesthesia 2010 This guide focuses on coding, coverage, andpayment for
ULTRASOUND-GUIDED REGIONAL ANESTHESIA RICHMOND, VA Legal Disclaimer; Provision of education and research information only - always seek professional advice The VAULT website was developed by Christian R. Falyar, CRNA, DNAP, to share information related to ultrasound-guided regional anesthesia with other anesthesia providers. PRINCIPLES OF SOUND « VAULT Legal Disclaimer; Provision of education and research information only - always seek professional advice The VAULT website was developed by Christian R. Falyar, CRNA, DNAP, to share information related to ultrasound-guided regional anesthesia with other anesthesia providers. REFLECTION, REFRACTION, SCATTERING AND ATTENUATION « VAULT Reflection can be categorized as either specular or diffuse. Specular reflectors are large, smooth surfaces, such as bone, where the sound wave is reflected back in a singular direction. The greater the acoustic impedance between the two tissue surfaces, the greater the reflection and the brighter the echo will appear on ultrasound. TISSUE ECHOGENICITY « VAULT Echogenicity is the amount of reflection caused by varying degrees of acoustic impedance in tissues. Several terms are used to describe tissue echogenicity. LOWER EXTREMITY BLOCKS Lumbar and Lumbosacral Plexi • The lumbar and lumbosacral plexi supply the majority of nerve innervation to the lower extremity • The lumbar plexus, derived form L1-4, and TRANSDUCER SELECTION « VAULT Transducer selection is ultimately determined by two factors; frequency and “footprint”. When using ultrasound for regional anesthesia, the goal is to create a high resolution image that createsminimal artifacts.
ARTIFACTS « VAULT
References. Gray AT. Atlas of ultrasound-guided regional anesthesia. Philadelphia, PA. Saunders, Elsevier; 2010:8-9. Sites B D, Brull R, Chan V W, et al. Artifacts and pitfall errors associated with ultrasound-guided regional anesthesia. part II: a pictoral approach to understanding and avoidance. VASCULAR ACCESS « VAULT This video is a cross-sectional view of the brachial artery and veins in the antecubital fossa with Doppler applied to the BMode image. While both vessels appear pulsatile with color-flow Doppler, note the difference in pulsatility between the artery (red) and vein (blue). TRANSDUCERS « VAULT The transducer is the link between the anesthetist and patient. All transducers require several key components to generate an image. Elements located in the transducer use the piezoelectric effect tocreate sound.
ADDUCTOR CANAL / SAPHENOUS « VAULT The saphenous nerve is the terminal branch of the femoral nerve. It courses distally along the superficial femoral artery and vein until approximately the distal third of the thigh. ULTRASOUND-GUIDED REGIONAL ANESTHESIA RICHMOND, VA Legal Disclaimer; Provision of education and research information only - always seek professional advice The VAULT website was developed by Christian R. Falyar, CRNA, DNAP, to share information related to ultrasound-guided regional anesthesia with other anesthesia providers. PRINCIPLES OF SOUND « VAULT Legal Disclaimer; Provision of education and research information only - always seek professional advice The VAULT website was developed by Christian R. Falyar, CRNA, DNAP, to share information related to ultrasound-guided regional anesthesia with other anesthesia providers. REFLECTION, REFRACTION, SCATTERING AND ATTENUATION « VAULT Reflection can be categorized as either specular or diffuse. Specular reflectors are large, smooth surfaces, such as bone, where the sound wave is reflected back in a singular direction. The greater the acoustic impedance between the two tissue surfaces, the greater the reflection and the brighter the echo will appear on ultrasound. TISSUE ECHOGENICITY « VAULT Echogenicity is the amount of reflection caused by varying degrees of acoustic impedance in tissues. Several terms are used to describe tissue echogenicity. LOWER EXTREMITY BLOCKS Lumbar and Lumbosacral Plexi • The lumbar and lumbosacral plexi supply the majority of nerve innervation to the lower extremity • The lumbar plexus, derived form L1-4, and TRANSDUCER SELECTION « VAULT Transducer selection is ultimately determined by two factors; frequency and “footprint”. When using ultrasound for regional anesthesia, the goal is to create a high resolution image that createsminimal artifacts.
ARTIFACTS « VAULT
References. Gray AT. Atlas of ultrasound-guided regional anesthesia. Philadelphia, PA. Saunders, Elsevier; 2010:8-9. Sites B D, Brull R, Chan V W, et al. Artifacts and pitfall errors associated with ultrasound-guided regional anesthesia. part II: a pictoral approach to understanding and avoidance. VASCULAR ACCESS « VAULT This video is a cross-sectional view of the brachial artery and veins in the antecubital fossa with Doppler applied to the BMode image. While both vessels appear pulsatile with color-flow Doppler, note the difference in pulsatility between the artery (red) and vein (blue). TRANSDUCERS « VAULT The transducer is the link between the anesthetist and patient. All transducers require several key components to generate an image. Elements located in the transducer use the piezoelectric effect tocreate sound.
ADDUCTOR CANAL / SAPHENOUS « VAULT The saphenous nerve is the terminal branch of the femoral nerve. It courses distally along the superficial femoral artery and vein until approximately the distal third of the thigh. PRINCIPLES OF SOUND « VAULT Legal Disclaimer; Provision of education and research information only - always seek professional advice The VAULT website was developed by Christian R. Falyar, CRNA, DNAP, to share information related to ultrasound-guided regional anesthesia with other anesthesia providers.ABOUT US « VAULT
Legal Disclaimer; Provision of education and research information only - always seek professional advice The VAULT website was developed by Christian R. Falyar, CRNA, DNAP, to share information related to ultrasound-guided regional anesthesia with other anesthesia providers.NEWS | VAULT
Legal Disclaimer; Provision of education and research information only - always seek professional advice The VAULT website was developed by Christian R. Falyar, CRNA, DNAP, to share information related to ultrasound-guided regional anesthesia with other anesthesia providers. FEMORAL NERVE BLOCK « VAULT The femoral nerve block (FNB) was once the preferred peripheral nerve block for patients undergoing total knee arthroplasty (TKA). However, the FNB results in quadriceps weakness which impairs early ambulation and increases the potential for postoperative falls making other blocks, such as the adductor canal block, more desirable in thispatient population.
TRANSDUCER HANDLING « VAULT Legal Disclaimer; Provision of education and research information only - always seek professional advice The VAULT website was developed by Christian R. Falyar, CRNA, DNAP, to share information related to ultrasound-guided regional anesthesia with other anesthesia providers. ULTRASOUND EXAMINATION OF PERIPHERAL NERVES IN THE FOREARM Ultrasound Examination of Peripheral Nerves in the Forearm Colin J. L. McCartney, M.B., Ch.B., F.R.C.A., Daquan Xu, M.D., Corina Constantinescu, M.D., Sherif Abbas, M ADDUCTOR CANAL / SAPHENOUS « VAULT Legal Disclaimer; Provision of education and research information only - always seek professional advice The VAULT website was developed by Christian R. Falyar, CRNA, DNAP, to share information related to ultrasound-guided regional anesthesia with other anesthesia providers. SEDONA ULTRASOUND COURSE « VAULT Legal Disclaimer; Provision of education and research information only - always seek professional advice The VAULT website was developed by Christian R. Falyar, CRNA, DNAP, to share information related to ultrasound-guided regional anesthesia with other anesthesia providers. GASTRIC ULTRASOUND UTILITY IN PATIENTS WITH DELAYED Legal Disclaimer; Provision of education and research information only - always seek professional advice The VAULT website was developed by Christian R. Falyar, CRNA, DNAP, to share information related to ultrasound-guided regional anesthesia with other anesthesia providers. ULTRASOUND REIMBURSEMENT INFORMATION Ultrasound guidance Medicare covers ultrasound guidance when reasonable and necessary for the diagnosis or treatment of a Medicare patient. However, as ULTRASOUND-GUIDED REGIONAL ANESTHESIA RICHMOND, VA Legal Disclaimer; Provision of education and research information only - always seek professional advice The VAULT website was developed by Christian R. Falyar, CRNA, DNAP, to share information related to ultrasound-guided regional anesthesia with other anesthesia providers. PRINCIPLES OF SOUND « VAULT Legal Disclaimer; Provision of education and research information only - always seek professional advice The VAULT website was developed by Christian R. Falyar, CRNA, DNAP, to share information related to ultrasound-guided regional anesthesia with other anesthesia providers. TRANSDUCER SELECTION « VAULT Transducer selection is ultimately determined by two factors; frequency and “footprint”. When using ultrasound for regional anesthesia, the goal is to create a high resolution image that createsminimal artifacts.
ARTIFACTS « VAULT
References. Gray AT. Atlas of ultrasound-guided regional anesthesia. Philadelphia, PA. Saunders, Elsevier; 2010:8-9. Sites B D, Brull R, Chan V W, et al. Artifacts and pitfall errors associated with ultrasound-guided regional anesthesia. part II: a pictoral approach to understanding and avoidance. TRANSDUCERS « VAULT The transducer is the link between the anesthetist and patient. All transducers require several key components to generate an image. Elements located in the transducer use the piezoelectric effect tocreate sound.
TISSUE ECHOGENICITY « VAULT Echogenicity is the amount of reflection caused by varying degrees of acoustic impedance in tissues. Several terms are used to describe tissue echogenicity. REFLECTION, REFRACTION, SCATTERING AND ATTENUATION « VAULT Reflection can be categorized as either specular or diffuse. Specular reflectors are large, smooth surfaces, such as bone, where the sound wave is reflected back in a singular direction. The greater the acoustic impedance between the two tissue surfaces, the greater the reflection and the brighter the echo will appear on ultrasound. DOPPLER EFFECT « VAULT No discussion of sound would be complete without revisiting the Doppler Effect. First described by the Austrian Christian Doppler in the 1842, it explains how the frequency of a wave is perceived to change relative to movement. LOWER EXTREMITY BLOCKS Lumbar and Lumbosacral Plexi • The lumbar and lumbosacral plexi supply the majority of nerve innervation to the lower extremity • The lumbar plexus, derived form L1-4, and ULTRASOUND REIMBURSEMENT INFORMATION Ultrasound reimbursement information Payment for Ultrasound-Guided Regional Anesthesia 2010 This guide focuses on coding, coverage, andpayment for
ULTRASOUND-GUIDED REGIONAL ANESTHESIA RICHMOND, VA Legal Disclaimer; Provision of education and research information only - always seek professional advice The VAULT website was developed by Christian R. Falyar, CRNA, DNAP, to share information related to ultrasound-guided regional anesthesia with other anesthesia providers. PRINCIPLES OF SOUND « VAULT Legal Disclaimer; Provision of education and research information only - always seek professional advice The VAULT website was developed by Christian R. Falyar, CRNA, DNAP, to share information related to ultrasound-guided regional anesthesia with other anesthesia providers. TRANSDUCER SELECTION « VAULT Transducer selection is ultimately determined by two factors; frequency and “footprint”. When using ultrasound for regional anesthesia, the goal is to create a high resolution image that createsminimal artifacts.
ARTIFACTS « VAULT
References. Gray AT. Atlas of ultrasound-guided regional anesthesia. Philadelphia, PA. Saunders, Elsevier; 2010:8-9. Sites B D, Brull R, Chan V W, et al. Artifacts and pitfall errors associated with ultrasound-guided regional anesthesia. part II: a pictoral approach to understanding and avoidance. TRANSDUCERS « VAULT The transducer is the link between the anesthetist and patient. All transducers require several key components to generate an image. Elements located in the transducer use the piezoelectric effect tocreate sound.
TISSUE ECHOGENICITY « VAULT Echogenicity is the amount of reflection caused by varying degrees of acoustic impedance in tissues. Several terms are used to describe tissue echogenicity. REFLECTION, REFRACTION, SCATTERING AND ATTENUATION « VAULT Reflection can be categorized as either specular or diffuse. Specular reflectors are large, smooth surfaces, such as bone, where the sound wave is reflected back in a singular direction. The greater the acoustic impedance between the two tissue surfaces, the greater the reflection and the brighter the echo will appear on ultrasound. DOPPLER EFFECT « VAULT No discussion of sound would be complete without revisiting the Doppler Effect. First described by the Austrian Christian Doppler in the 1842, it explains how the frequency of a wave is perceived to change relative to movement. LOWER EXTREMITY BLOCKS Lumbar and Lumbosacral Plexi • The lumbar and lumbosacral plexi supply the majority of nerve innervation to the lower extremity • The lumbar plexus, derived form L1-4, and ULTRASOUND REIMBURSEMENT INFORMATION Ultrasound reimbursement information Payment for Ultrasound-Guided Regional Anesthesia 2010 This guide focuses on coding, coverage, andpayment for
NEWS | VAULT
Legal Disclaimer; Provision of education and research information only - always seek professional advice The VAULT website was developed by Christian R. Falyar, CRNA, DNAP, to share information related to ultrasound-guided regional anesthesia with other anesthesia providers.ARTIFACTS « VAULT
References. Gray AT. Atlas of ultrasound-guided regional anesthesia. Philadelphia, PA. Saunders, Elsevier; 2010:8-9. Sites B D, Brull R, Chan V W, et al. Artifacts and pitfall errors associated with ultrasound-guided regional anesthesia. part II: a pictoral approach to understanding and avoidance.GLOSSARY « VAULT
Absorption – the conversion of sound to heat because of its interaction with tissue.. Acoustic enhancement – an increase in reflection amplitude that occurs when a wave strikes a medium that is located behind a tissue of weak acoustic impedance.. Acoustic impedance – the resistant properties of a medium to sound transmission.. Amplification – Increasing small echoes into larger VASCULAR ACCESS « VAULT This video is a cross-sectional view of the brachial artery and veins in the antecubital fossa with Doppler applied to the BMode image. While both vessels appear pulsatile with color-flow Doppler, note the difference in pulsatility between the artery (red) and vein (blue). SEDONA ULTRASOUND COURSE « VAULT Legal Disclaimer; Provision of education and research information only - always seek professional advice The VAULT website was developed by Christian R. Falyar, CRNA, DNAP, to share information related to ultrasound-guided regional anesthesia with other anesthesia providers. GASTRIC ULTRASOUND UTILITY IN PATIENTS WITH DELAYED Legal Disclaimer; Provision of education and research information only - always seek professional advice The VAULT website was developed by Christian R. Falyar, CRNA, DNAP, to share information related to ultrasound-guided regional anesthesia with other anesthesia providers. ADDUCTOR CANAL / SAPHENOUS « VAULT The saphenous nerve is the terminal branch of the femoral nerve. It courses distally along the superficial femoral artery and vein until approximately the distal third of the thigh. ULTRASOUND EXAMINATION OF PERIPHERAL NERVES IN THE FOREARM Ultrasound Examination of Peripheral Nerves in the Forearm Colin J. L. McCartney, M.B., Ch.B., F.R.C.A., Daquan Xu, M.D., Corina Constantinescu, M.D., Sherif Abbas, M FEMORAL NERVE BLOCK « VAULT The femoral nerve block (FNB) was once the preferred peripheral nerve block for patients undergoing total knee arthroplasty (TKA). However, the FNB results in quadriceps weakness which impairs early ambulation and increases the potential for postoperative falls making other blocks, such as the adductor canal block, more desirable in thispatient population.
ULTRASOUND REIMBURSEMENT INFORMATION Ultrasound guidance Medicare covers ultrasound guidance when reasonable and necessary for the diagnosis or treatment of a Medicare patient. However, as ULTRASOUND-GUIDED REGIONAL ANESTHESIA RICHMOND, VA Ultrasound is now commonplace in anesthesia practice. It is used routinely for regional anesthesia procedures, vascular access, and perioperative patient assessment. This site reviews basic and advanced ultrasound-guided techniques by presenting best practice through evidenced-based research. The information contained on this site isfor any
PRINCIPLES OF SOUND « VAULT Principles of Sound. Sound is a form of mechanical energy that travels in a longitudinal wave in a series of compressions (high pressure) and rarefactions (low pressure). The transmission of sound requires a medium such as air, liquid, or tissue. Because all mediums have some elastic properties, energy and momentum are transported by means of TRANSDUCER SELECTION « VAULT Transducer selection is ultimately determined by two factors; frequency and “footprint”. When using ultrasound for regional anesthesia, the goal is to create a high resolution image that creates minimal artifacts. Selection is often determined by the depth of the structures to be imaged. REFLECTION, REFRACTION, SCATTERING AND ATTENUATION « VAULT The culminating effect of tissue on sound as it travels through the body is attenuation . Attenuation is the decreasing intensity of a sound wave as it passes through a medium. It is the result of energy absorption of tissue, as well as reflection and scattering that occurs between the boundaries of tissue with different densities. TRANSDUCERS « VAULT The transducer is the link between the anesthetist and patient. All transducers require several key components to generate an image. Elements located in the transducer use the piezoelectric effect tocreate sound.
ARTIFACTS « VAULT
Artifacts. An artifact is any phenomenon that affects the acquisition or interpretation of an ultrasound image. Artifacts can occur because of properties within the tissue itself, or be created by the anesthetist. The most commonly seen artifacts are air artifact, shadow artifact, reverberation, and acoustic enhancement. TISSUE ECHOGENICITY « VAULT Acoustic impedance of difference mediums. Echogenicity is the amount of reflection caused by varying degrees of acoustic impedance in tissues. Several terms are used to describe tissue echogenicity. Anechoic refers to those tissues that produce no echo. This is commonly seen with Rayleigh scattering (discussed later) that occurswithin blood
DOPPLER EFFECT « VAULT First described by the Austrian Christian Doppler in the 1842, it explains how the frequency of a wave is perceived to change relative to movement. The central premise of the Doppler Effect is a change in the frequency of a detected wave when the source or detector is moving. A change in pitch of a moving ambulance is a familiar exampleof the
LOWER EXTREMITY BLOCKS Lumbar and Lumbosacral Plexi • The lumbar and lumbosacral plexi supply the majority of nerve innervation to the lower extremity • The lumbar plexus, derived form L1-4, and ULTRASOUND REIMBURSEMENT INFORMATION Ultrasound reimbursement information Payment for Ultrasound-Guided Regional Anesthesia 2010 This guide focuses on coding, coverage, andpayment for
ULTRASOUND-GUIDED REGIONAL ANESTHESIA RICHMOND, VA Ultrasound is now commonplace in anesthesia practice. It is used routinely for regional anesthesia procedures, vascular access, and perioperative patient assessment. This site reviews basic and advanced ultrasound-guided techniques by presenting best practice through evidenced-based research. The information contained on this site isfor any
PRINCIPLES OF SOUND « VAULT Principles of Sound. Sound is a form of mechanical energy that travels in a longitudinal wave in a series of compressions (high pressure) and rarefactions (low pressure). The transmission of sound requires a medium such as air, liquid, or tissue. Because all mediums have some elastic properties, energy and momentum are transported by means of TRANSDUCER SELECTION « VAULT Transducer selection is ultimately determined by two factors; frequency and “footprint”. When using ultrasound for regional anesthesia, the goal is to create a high resolution image that creates minimal artifacts. Selection is often determined by the depth of the structures to be imaged. REFLECTION, REFRACTION, SCATTERING AND ATTENUATION « VAULT The culminating effect of tissue on sound as it travels through the body is attenuation . Attenuation is the decreasing intensity of a sound wave as it passes through a medium. It is the result of energy absorption of tissue, as well as reflection and scattering that occurs between the boundaries of tissue with different densities. TRANSDUCERS « VAULT The transducer is the link between the anesthetist and patient. All transducers require several key components to generate an image. Elements located in the transducer use the piezoelectric effect tocreate sound.
ARTIFACTS « VAULT
Artifacts. An artifact is any phenomenon that affects the acquisition or interpretation of an ultrasound image. Artifacts can occur because of properties within the tissue itself, or be created by the anesthetist. The most commonly seen artifacts are air artifact, shadow artifact, reverberation, and acoustic enhancement. TISSUE ECHOGENICITY « VAULT Acoustic impedance of difference mediums. Echogenicity is the amount of reflection caused by varying degrees of acoustic impedance in tissues. Several terms are used to describe tissue echogenicity. Anechoic refers to those tissues that produce no echo. This is commonly seen with Rayleigh scattering (discussed later) that occurswithin blood
DOPPLER EFFECT « VAULT First described by the Austrian Christian Doppler in the 1842, it explains how the frequency of a wave is perceived to change relative to movement. The central premise of the Doppler Effect is a change in the frequency of a detected wave when the source or detector is moving. A change in pitch of a moving ambulance is a familiar exampleof the
LOWER EXTREMITY BLOCKS Lumbar and Lumbosacral Plexi • The lumbar and lumbosacral plexi supply the majority of nerve innervation to the lower extremity • The lumbar plexus, derived form L1-4, and ULTRASOUND REIMBURSEMENT INFORMATION Ultrasound reimbursement information Payment for Ultrasound-Guided Regional Anesthesia 2010 This guide focuses on coding, coverage, andpayment for
CONTACT « VAULT
Legal Disclaimer; Provision of education and research information only - always seek professional advice The VAULT website was developed by Christian R. Falyar, CRNA, DNAP, to share information related to ultrasound-guided regional anesthesia with other anesthesia providers.ARTIFACTS « VAULT
Artifacts. An artifact is any phenomenon that affects the acquisition or interpretation of an ultrasound image. Artifacts can occur because of properties within the tissue itself, or be created by the anesthetist. The most commonly seen artifacts are air artifact, shadow artifact, reverberation, and acoustic enhancement.GLOSSARY « VAULT
Glossary. Absorption – the conversion of sound to heat because of its interaction with tissue. Acoustic enhancement – an increase in reflection amplitude that occurs when a wave strikes a medium that is located behind a tissue of weak acoustic impedance. Acoustic impedance – the resistant properties of a medium to sound transmission. VASCULAR ACCESS « VAULT Vascular Access. With few exceptions, vascular access is required to perform an anesthetic. As the patient population continues to age and the number of comorbidities in these patients increase, obtaining adequate vascular access can be very challenging. When properly used, studies show ultrasound-guided vascular access improves success ratesREFRACTION « VAULT
Legal Disclaimer; Provision of education and research information only - always seek professional advice The VAULT website was developed by Christian R. Falyar, CRNA, DNAP, to share information related to ultrasound-guided regional anesthesia with other anesthesia providers. ADDUCTOR CANAL / SAPHENOUS « VAULT Adductor Canal / Saphenous. The saphenous nerve is the terminal branch of the femoral nerve. It courses distally along the superficial femoral artery and vein until approximately the distal third of the thigh. At this point the artery and vein dive deep through the adductor canal. The saphenous continues caudal where it passes throughthe
SEDONA ULTRASOUND COURSE « VAULT Legal Disclaimer; Provision of education and research information only - always seek professional advice The VAULT website was developed by Christian R. Falyar, CRNA, DNAP, to share information related to ultrasound-guided regional anesthesia with other anesthesia providers. GASTRIC ULTRASOUND UTILITY IN PATIENTS WITH DELAYED Legal Disclaimer; Provision of education and research information only - always seek professional advice The VAULT website was developed by Christian R. Falyar, CRNA, DNAP, to share information related to ultrasound-guided regional anesthesia with other anesthesia providers. ULTRASOUND EXAMINATION OF PERIPHERAL NERVES IN THE FOREARM Ultrasound Examination of Peripheral Nerves in the Forearm Colin J. L. McCartney, M.B., Ch.B., F.R.C.A., Daquan Xu, M.D., Corina Constantinescu, M.D., Sherif Abbas, M ULTRASOUND REIMBURSEMENT INFORMATION Ultrasound reimbursement information Payment for Ultrasound-Guided Regional Anesthesia 2010 This guide focuses on coding, coverage, andpayment for
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ULTRASOUND PHYSICS
See how sound is used to create an image that can make your regional anesthesia practice more safe and efficient. Learn More THE RIGHT APPROACH... What are the key elements in performing an efficacious ultrasound-guided regional anesthetic? A review of the basic upper and lower extremity blocks can be found here. Learn MoreUPCOMING EVENTS
Interested in attending a course or lecture. Click the link below to see where we will be during the upcoming year. Learn More SUPPORT SRNA EDUCATION The Christian R. Falyar Endowment for the Advancement of Regional Anesthesia was created to enhance SRNA education and experience in this specialty. Support the future of our profession by clicking on the link below. Learn More*
EXPAND YOUR PRACTICE Ultrasound is now commonplace in anesthesia practice. It is used routinely for regional anesthesia procedures, vascular access, and perioperative patient assessment. This site reviews basic and advanced ultrasound-guided techniques by presenting best practice through evidenced-based research. The information contained on this site is for any practitioner seeking to improve their practice. We hope you find it informative and look forward to hearing your comments andsuggestions.
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LATEST NEWS
Speaking at the 2nd Annual Geisinger CRNA Meeting in Danville, PAMarch…
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Point-of-Care Ultrasound (POCUS) can be a valuable tool during themanagement of…
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I will be speaking at the 2018 Virginia Association of NurseAnesthetists…
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VAULT BLOG
A systematic review and meta-analysis conducted by Abdallah et al.showed that…
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An interesting article in Anaesthesia supporting perioperative use of gastric ultrasound in…Read more…
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PROVISION OF EDUCATION AND RESEARCH INFORMATION ONLY - ALWAYS SEEKPROFESSIONAL ADVICE
The VAULT website was developed by Christian R. Falyar, CRNA, DNAP, to share information related to ultrasound-guided regional anesthesia with other anesthesia providers. It is not intended to be a substitute for accredited regional anesthesia training. Christian R. Falyar CRNA, DNAP does not accept any liability for any injury, loss or damage that results from the use of or reliance on information contained in thiswebsite.
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QUALITY OF INFORMATION - ALWAYS CHECK THE INFORMATION Christian R. Falyar, CRNA, DNAP has made every effort to ensure the quality of the information presented on this website is current and checks it regularly. However, before relying on the material on this website, users should carefully evaluate its accuracy, currency, completeness and relevance to their practice. Christian R. Falyar, CRNA, DNAP, cannot guarantee and assumes no legal liability or responsibility for the accuracy, currency or completeness of theinformation.
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LINKS TO EXTERNAL WEBSITES This website may contain links to other websites which are external to the VAULT website. Christian R. Falyar, CRNA, DNAP takes reasonable care in selecting linking websites. It is the responsibility of the user to make their own decisions about the accuracy, currency, reliability and correctness of information contained in linked external websites. Linkage to external websites should not be taken to be an endorsement or a recommendation of any third party products or services offered by virtue of any information, material or content linked from or to this website. Users of links provided by this website are responsible for being aware of which organization is hosting the website they visit. Views or recommendations provided in linked websites do not necessarily reflect those of Christian R.Falyar, CRNA, DNAP.
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