2024 Workshop Handout Bundle-W11AS Advanced EMG and US of the Respiratory System Boon and Litchy

W11AS Advanced EMG and US of the Respiratory System Boon and Litchy

Pdf Summary

The document covers the "Advanced EMG and Ultrasound (US) of the Respiratory System" presented by Dr. Andrea Boon and Dr. William Litchy at the 2024 AANEM Annual Meeting. The focus is on the electrodiagnostic evaluation (EDX) for patients experiencing unexplained dyspnea or difficulty weaning from mechanical ventilation.<br /><br />Key components are as follows:<br /><br />1. **Etiologies Causing Respiratory Issues**: Various underlying causes for respiratory problems include lack of central drive, anterior horn cell or nerve root diseases, polyneuropathy, neuromuscular transmission disorders, myopathy, and phrenic neuropathy.<br /><br />2. **Phrenic Nerve Conduction Studies (NCS) and Needle EMG**: These tests are crucial for evaluating pathophysiology, differentiating between disorders, and providing prognostic information. However, competency is required for accurate and safe implementation.<br /><br />3. **Ultrasound Usage**: Ultrasound facilitates diaphragm needle EMG by guiding needle insertion, particularly beneficial in challenging cases (e.g., obesity, anticoagulation). It provides real-time visualization, ensuring safety and enhancing diagnostic accuracy.<br /><br />4. **Diaphragm Anatomy and Function**: The diaphragm, innervated by the phrenic nerve (C3-C5), is the primary inspiratory muscle. It has both muscular and tendinous parts and is prone to injury due to its proximity to vital organs.<br /><br />5. **Phrenic NCS Procedure**: Techniques for electrode placement and nerve stimulation are detailed, emphasizing the importance of precise placement and the role of ultrasound in optimizing the procedure's success.<br /><br />6. **Ultrasound Imaging Techniques**: B mode and M mode ultrasound are used to assess diaphragm structure and function. B mode evaluates diaphragm thickness and motion, while M mode assesses diaphragm excursion. Both have high sensitivity and specificity in diagnosing diaphragmatic dysfunction.<br /><br />7. **Safety and Troubleshooting**: The challenges include difficulty in recording reliable signals in ICU patients or those with anatomical variations. The importance of ultrasound in troubleshooting and guiding EMG is highlighted, along with precautions to avoid complications like pneumothorax.<br /><br />8. **Ultrasound-guided EMG of the Diaphragm**: This technique decreases risk and improves diagnostic accuracy, especially in difficult cases or when the diaphragm is severely atrophic.<br /><br />The document concludes by underlining the importance of ultrasound in modern diagnostic and interventional EMG of the respiratory system, ensuring accurate assessment, enhancing safety, and providing valuable information for patient management.

Keywords

Advanced EMG

Ultrasound Respiratory System

Dr. Andrea Boon

Dr. William Litchy

AANEM Annual Meeting 2024

Electrodiagnostic Evaluation

Phrenic Nerve Conduction Studies

Diaphragm Anatomy

Ultrasound Imaging Techniques

Safety and Troubleshooting