title: Water bath evaluation technique for emergency ultrasound of painful superficial structures.
abstract: Researchers have described the use of bedside emergency ultrasound as an effective way to evaluate for and accurately drain potential abscesses. Similarly, descriptions exist of long bone fracture evaluation in the wrist and hands. Tendon injury can also be detected with ultrasound and exploration can be obviated or at least focused. Sonographic examination of painful extremity pathology such as abscesses or lacerations involving the hand or foot can be challenging. Patients may be uncooperative if they experience significant pain when the transducer is placed on the area of interest. While ample amounts of ultrasound gel can decrease the need for firm transducer contact with the skin it is still difficult to obtain a good evaluation without causing any discomfort. The solution may lie in an old technique that has been recently brought back to life for use in hand evaluation in which the patient's extremity is placed in a water bath. The water bath replaces the need for ultrasound gel or contact between the ultrasound transducer and the patient's skin, thus eliminating discomfort. We describe 7 cases in which, despite aggressive attempts at pain control, adequate evaluation of extremity pathology was not possible without the use of the water bath technique. Patients reported no discomfort and superior quality images were obtained due to the water bath properties. Emergency sonologists should keep this technique in mind when contact between skin and the ultrasound transducer is likely to cause a patient significant discomfort.
authors.affiliation: Department of Emergency Medicine, Medical College of Georgia, 1120 15th Street, Atlanta, GA 30912-4007, USA. blaivas@pyro.net
authors.forename: Michael
authors.initials: M
authors.lastname: Blaivas
authors.forename: Matthew
authors.initials: M
authors.lastname: Lyon
authors.forename: Larry
authors.initials: L
authors.lastname: Brannam
authors.forename: Sandeep
authors.initials: S
authors.lastname: Duggal
authors.forename: Paul
authors.initials: P
authors.lastname: Sierzenski
mesh_terms: D000038:Abscess / Q000000981:diagnostic imaging*; D000293:Adolescent; D000328:Adult; D002648:Child; D048909:Diabetes Complications / Q000000981:diagnostic imaging; D004638:Emergency Treatment; D005260:Female; D005384:Finger Joint / Q000000981:diagnostic imaging; D005534:Foot Diseases / Q000000981:diagnostic imaging*; D005547:Foreign Bodies / Q000000981:diagnostic imaging; D006225:Hand / Q000000981:diagnostic imaging*; D006230:Hand Injuries / Q000000981:diagnostic imaging; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D022125:Lacerations / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000000981:diagnostic imaging; D010304:Paronychia / Q000000981:diagnostic imaging; D013708:Tendon Injuries / Q000000981:diagnostic imaging; D013710:Tendons / Q000000981:diagnostic imaging; D014159:Transducers; D014463:Ultrasonography; D014867:Water
chemical_list: D014867:Water