Northwestern EM Blog

MAY 16, 2022

What is your initial imaging test of choice, ultrasound (US) or non-contrast CT, and why? Would you be confident in a point-of-care-ultrasound evaluation or a formal ultrasound? Do outcomes for patients with suspected nephrolithiasis differ based on the initial imaging? How do you proceed?

Ultrasounds 52

Ultrasounds Radiology Radiology Outcomes 52

EMDocs

DECEMBER 1, 2024

The disease is generally mild, but in untreated cases, it can lead to more severe outcomes, especially in patients with underlying conditions such as glucose-6-phosphate dehydrogenase deficiency. Even though the disease often resolves spontaneously, prompt antibiotic therapy is essential for optimal outcomes. 2012 Jun 30;43(2):175-80.

EMS 82

EMS Infectious Diseases Shock Airway Management 82

RebelEM

MARCH 8, 2023

Rapid diagnosis and emergency referral improves outcomes of ophthalmologic interventions. Signs Shafer’s sign (tobacco dust) May see a Weiss ring when the posterior vitreous (PV) detaches from the optic disc margin Visualization with ultrasound. Rapid diagnosis and emergency referral improves outcomes of ophthalmologic interventions.

Stroke 52

Stroke Emergency Department Ultrasounds Outcomes 52

EMDocs

JULY 13, 2024

Favorable infertility outcomes following anti-tubercular treatment prescribed on the sole basis of a positive polymerase chain reaction test for endometrial tuberculosis. 2012 May;27(5):1368-74. Epub 2012 Mar 14. Incidence, treatment and outcome of peripartum sepsis. PMID: 10439801. Jindal UN, Verma S, Bala Y. Hum Reprod.

OB/GYN 64

OB/GYN EMS Sepsis Fluid Resuscitation 64

The Skeptics' Guide to EM

DECEMBER 17, 2022

After a bedside ultrasound shows fluid in the right hemithorax, you insert an intercostal drain which immediately fills with one litre of blood. Background: Major trauma in older patients is increasing in frequency (1), with the median age of major trauma patients in the UK from 2012-2017 being 63.6 years ( 2 ).

Blood Transfusions 52

Blood Transfusions Fractures EMS Emergency Department 52

Pediatric Emergency Playbook

OCTOBER 1, 2017

Ultrasound-guided refilling of an intrathecal baclofen pump—a case report. Outcomes of Children Bridged to Heart Transplantation With Ventricular Assist Devices: A Multi-Institutional Study. Ghosh D, Mainali G, Khera J, Luciano M. Complications of Intrathecal Baclofen Pumps in Children: Experience from a Tertiary Care Center.

Pediatrics 52

Pediatrics Seizures Stroke Ultrasounds 52

EMDocs

MAY 11, 2024

Semin Ultrasound CT MR. 2013 Apr;34(2):131-41. Endovascular and Clinical Outcomes of Vertebrobasilar Intracranial Atherosclerosis-Related Large Vessel Occlusion. 2012) 43:2904–9. Reference article, Radiopaedia.org (Accessed on 28 Aug 2023) [link] Ortiz de Mendivil A, Alcalá-Galiano A, et al. doi: 10.1053/j.sult.2013.01.004.

Stroke 89

Stroke EMS EKG/ECG Radiology 89

RebelEM

JANUARY 25, 2023

2.3 – 5.4) (-) LR: 0.18 (0.09 – 0.35) Ultrasound Findings Dilated loops of bowel (diameter > 2.5 2.3 – 5.4) (-) LR: 0.18 (0.09 – 0.35) Ultrasound Findings Dilated loops of bowel (diameter > 2.5 J Trauma Acute Care Surg 2012; 73(5): S362-9. PMID: 23114494 Paradis M. Emery Med J 2014; 31(3): 248-9.

Operations 52

Operations Sepsis Resuscitation Ultrasounds 52

EMDocs

SEPTEMBER 9, 2023

Answer : Extensor tendon laceration Epidemiology: Hand extensor injuries make up >25% of orthopedic soft tissue injuries 2, 3 Common in young men in manual labor Dominant hand more likely to be injured 4 2012 study on 86 patients reported 83% men with a mean age of 34.2 Plast Reconstr Surg. 2013;132(4):560e-566e. doi:10.1097/PRS.0b013e3182a0148c

EMS 78

EMS Fractures Soft Tissue Injuries Ultrasounds 78

Downeast Emergency Medicine

APRIL 26, 2021

4] We also know that severe TBI is commonly associated with the development of intracranial hemorrhage where the presence and volume of blood are associated with increased mortality and poor outcomes.[5] Association between prehospital tranexamic acid administration and outcomes of severe traumatic brain injury. JAMA Neurol.

Head Injuries 52

Head Injuries Administration Outcomes Seizures 52

Taming the SRU

MAY 22, 2023

Certain injuries carry risks of further injury, injury-related complications, and poor outcomes which are exacerbated if they are inappropriately managed in the ED. Point-of-care ultrasound (POCUS) can evaluate for Achilles tendon rupture with a high sensitivity (96-100%) and specificity (83-100%) [8,9]. 2012 Nov; 470(11):3270-3274.

Fractures 76

Fractures Dislocations Operations Radiology 76

Taming the SRU

FEBRUARY 19, 2024

This has been the central question of many research projects with variable outcomes. Failure rates An ambispective, observational cohort study from 2012 - 2016 found that femoral arterial lines fail significantly less often than radial arterial lines with an absolute risk reduction of line failure of 20%. But are they good enough?

Shock 59

Shock Resuscitation Ultrasounds Research 59

Taming the SRU

AUGUST 30, 2023

Significantly elevated CRP (>122mg/L) and PCT (>0.5ng/mL) levels are predictors of bad outcomes, and are useful for tracking therapy progress, but are not specific enough to rule-in infectious endocarditis [38-39]. Instead, they strongly advocated for the use of lung ultrasound to diagnose bacterial CAP [45]. Oncotarget.

Infectious Diseases 87

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 87

EB Medicine

MARCH 1, 2019

Nachi: And if the prehospital team is lucky enough, or maybe unlucky enough, i don’t know, to have a credentialed provider who can perform ultrasound for those suspected of having a blunt cardiac injury, the general prehospital data on ultrasound is sparse. Early defibrillation is linked to better outcomes. of those patients.

Emergency Department 40

Emergency Department EKG/ECG Operations Fractures 40

RebelEM

JANUARY 24, 2024

You will notice the squeeze will cause no motion if there is a full rupture/tear, and diminished motion if there is a partial tear Performance Characteristics ( Garras 2012 ) Sensitivity Specificity (+) LR (-) LR 96-100% 93-100% 13.7 Partial rupture of the proximal Achilles tendon: a differential diagnostic problem in ultrasound imaging.

Operations 92

Operations Ultrasounds Fractures Outcomes 92

EMDocs

JANUARY 20, 2024

Bedside ultrasound shows hypokinesis of the basal portion of the left ventricle with an apparent sigmoid-shaped septum and a dilated inferior vena cava. Ultrasound findings can show bulging of the interventricular septum into the LVOT , which can be interpreted as a sigmoid-shaped septum on bedside evaluation. The oral mucosa is moist.

EMS 74

EMS Fluid Resuscitation Shock EKG/ECG 74

EMDocs

OCTOBER 23, 2023

Diagnosis can be confirmed with ultrasound (for deep vein thrombosis) or CT angiography (CTA) chest (for pulmonary embolism) and patients treated with anticoagulants. Morbidity outcomes of 78,577 hysterectomies for benign reasons over 23 years. 2012 APR; 52(2): 121-7. 2020 Sep;127(10):1269-1279. BJOG 2008; 115:1473.

OB/GYN 67

OB/GYN Operations EMS Ultrasounds 67

EB Medicine

JANUARY 2, 2019

With opportunities to improve outcomes for both the fetus and the mother, I’m confident that this episode will be worth your time. Nachi: For patient who have a threatened miscarriage in the first trimester, there is a 2-fold increased risk of subsequent maternal and fetal adverse outcomes. Generally 1500 is used as the cutoff.

Ultrasounds 40

Ultrasounds Radiology Radiology Infectious Diseases 40

EB Medicine

FEBRUARY 1, 2019

Nachi: Unfortunately, the 2008 ACEP guideline and 2012 AHA guidelines still recommend a lumbar puncture in those being worked up for SAH. Anyway, the last test to discuss is our good friend the ultrasound, specifically the ocular ultrasound. Nimodipine should be administered to those with aneurysmal SAH to improve outcomes.

Emergency Department 40

Emergency Department Stroke Outcomes Ultrasounds 40

EB Medicine

AUGUST 1, 2018

It was peer-reviewed by Joseph Habboushe, assistant professor at NYU and Nadia Maria Shaukat, director of the emergency and critical care ultrasound at Coney Island Hospital in Brooklyn, New York. As a second line treatment, consider haloperidol and topical capsaicin applied to the chest, abdomen, or back.

Seizures 40

Seizures Hyperthermia / Hypothermia Administration Dehydration 40

EMDocs

NOVEMBER 13, 2023

2 Outcomes of patients presenting with ischemic stroke who received MRI as initial imaging modality have demonstrated similar outcomes to those with initial CTA, with Kim et al. demonstrating that functional outcome at 3 months did not differ between the CTA and MRI groups (38.5% vs. 38.1%) with a good functional outcome.

Stroke 87

Stroke Radiology Radiology Emergency Department 87