11/02/2026
Welcome to another Gel and Tell post!!
What are we seeing?
➡️ Nippling: the optic disc is elevated and bulges forward into the back of the globe. That “nipple” sign is a classic sonographic clue for papilledema.
➡️ Increased optic nerve sheath diameter (ONSD): an ONSD above ~5 mm in adults is concerning for elevated intracranial pressure
When these are put together...you’ve got a fast, non-invasive, bedside tool that can raise concern for elevated ICP before the patient ever leaves the room for imaging!
At RPH EM Residency, this is the kind of learning that happens every single day. As residents get hands-on ultrasound training from day one: dedicated ultrasound rotations with a dedicated ultrasound instructor (!), regular QA sessions, and faculty who love teaching at the bedside. You won’t just learn to scan. You’ll learn to make real-time decisions that change patient care. 💪