Welcome to The Pearl Log — where post-shift wisdom surfaces, one shiny clinical take at a time. Some pearls are fresh, some are rough, all are found under pressure.
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Subclavian CVCs
Subclavian access offers durability and lower infection risk but demands respect for nearby pleura and artery. Ultrasound guidance reduces complications, with infraclavicular and supraclavicular approaches offering different ergonomic and anatomic advantages. Landmark technique remains a valid option when speed, experience, or resource constraints matter.
Ultrasound for Pneumoperitoneum and C-Collar Clearance
First, pneumoperitoneum on ultrasound—look for the “enhanced peritoneal stripe” and those peritoneal A-lines in the least dependent area (epigastrium or over the liver). A linear probe can help spot the air. Second, C-spine clearance after a negative high-quality CT—Trauma EAST says yes, even in obtunded patients. CT alone has an almost 100% negative predictive value, and prolonged collars can do more harm than good.
Potpourri: Euglycemic DKA, Slit Lamp, Abd Pain in Pregnancy
A few quick takeaways from shift. Euglycemic DKA is real—new ADA criteria now allow for normoglycemia if ketones and acidosis are present. Think alcohol, SGLT2s, or pregnancy. Brush up on some slit lamp basics. And for early pregnancy with pain or bleeding, grab the probe first. If you find an IUP, congrats, then your basically done.