CJEM Articles: Steven J. Socransky

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  • Defining normal jugular venous pressure with ultrasonography
    July 2010 12 4
    Alexandre Anawati, I. Ching Yeung, Marc-Andre Roy, Ray Wiss, Ron Robins, Steven J. Socransky

    Objective: Determination of jugular venous pressure (JVP) by physical examination (E-JVP) is unreliable. Measurement of JVP with ultrasonography (U-JVP) is easy to perform, but the normal range is unknown. The objective of this study was to determine the normal range for U-JVP.

    Methods: We conducted a prospective anatomic study on a con venience sample of emergency department (ED) patients over 35 years of age. We excluded patients who had findings on history or physical examination suggesting an alteration of JVP. With the head of the bed at 45°, we determined the point at which the diameter of the internal jugular vein (IJV) began to decrease on ultrasonography (“the taper”). Research assistants used 2 tech niques to measure U-JVP in all participants: by measuring the vertical height (in centimetres) of the taper above the sternal angle, and adding 5 cm; and by recording the quadrant in the IJV’s path from the clavicle to the angle of the jaw in which the taper was located. To determine interrater reliability, separate examiners measured the U-JVP of 15 participants.

    Results: We successfully determined the U-JVP of all 77 participants (38 male and 39 female). The mean U-JVP was 6.35 (95% confidence interval 6.11–6.59) cm. In 76 participants (98.7%), the taper was located in the first quadrant. Determination of interrater reliability found κ values of 1.00 and 0.87 for techniques 1 and 2, respectively.

    Conclusion: The normal U-JVP is 6.35 cm, a value that is slightly lower than the published normal E-JVP. Interrater reliability for U-JVP is excellent. The top of the IJV column is located less than 25% of the distance from the clavicle to the angle of the jaw in the majority of healthy adults. Our findings suggest that U-JVP provides the potential to reincorporate reliable JVP measurement into clinical assessment in the ED. However, further research in this area is warranted.

  • Intra-articular lidocaine for the reduction of posterior shoulder dislocation
    November 2005 7 6
    Lee V. Toner, Steven J. Socransky

    Anterior shoulder dislocations are the most common major joint dislocation seen in emergency departments. Intra-articular lidocaine is a useful method of analgesia for facilitating the reduction of anterior shoulder dislocations. Posterior shoulder dislocations represent a small minority of shoulder dislocations. We present the case of a posterior shoulder reduction in an elderly female whose reduction was performed following the intra-articular injection of lidocaine. Intra-articular lidocaine represents a useful alternative to facilitate the reduction of shoulder dislocations, particularly in patients at higher risk for complications from sedation.