2023 Workshop Handout Bundle-Advanced EMG and US of Respiratory System

Advanced EMG and US of Respiratory System

Pdf Summary

The workshop, "Advanced EMG and US of the Respiratory System," at the 2023 AANEM Annual Meeting, led by Dr. Andrea Boon and Dr. William Litchy from Mayo Clinic, addresses the use of electrodiagnostic evaluations (EDX) for respiratory issues like unexplained dyspnea and failure to wean from a ventilator. These problems may stem from various causes, including central drive issues, nerve diseases, polyneuropathy, myasthenia gravis, myopathy, or phrenic neuropathy. <br /><br />Phrenic nerve conduction studies (NCS) and needle electromyography (EMG) are crucial in diagnosing these conditions, but they can be challenging and involve risks like diaphragm EMG. Recently, ultrasound has become integral for examining the diaphragm. It enhances needle EMG by identifying safe needle insertion points and depths and provides real-time guidance in complex cases.<br /><br />Ultrasound aids in visualizing diaphragm movements and diagnosing issues like decreased motion or paralysis. M-mode ultrasound evaluates motion, while B-mode examines atrophy or contractility. The workshop covers phrenic NCS, diaphragm needle EMG, and diagnostic ultrasound techniques.<br /><br />Anatomically, the diaphragm is a dome-shaped muscle primarily responsible for respiration, innervated by the phrenic nerve from C3-C5 roots. Phrenic NCS involves stimulating the nerve and recording diaphragm responses to assess respiratory integrity. Key procedures include placing recording and stimulating electrodes following anatomical landmarks.<br /><br />EMG needle insertion techniques, based on anatomy, avoid nearby vital structures. The diaphragm is accessed perpendicularly to the chest wall, with motor unit potentials indicating diaphragm entry.<br /><br />Safety measures include addressing potential risks, especially for patients on anticoagulation or with challenging anatomy. Ultrasound guidance enhances the safety and accuracy of needle placements, particularly in difficult cases.<br /><br />The workshop illustrated that ultrasound and advanced EMG techniques are invaluable in diagnosing and managing complex respiratory system disorders, providing a comprehensive and safer approach to patient evaluation.

Keywords

Advanced EMG

Ultrasound

nmus

sono

Respiratory System

Phrenic Nerve

Diaphragm

Electrodiagnostic Evaluations

Phrenic Neuropathy

Needle EMG

M-mode Ultrasound

B-mode Ultrasound

ultrasound

nmus

sono

ultrasound