Downeast Emergency Medicine

FEBRUARY 14, 2023

Credits: Andrew fried, md A point-of-care lung ultrasound is performed, with the following findings on the left lung fields. Point of Care Ultrasound of the Left Lung Fields. Point of Care Ultrasound of the Left Lung Fields. One study from 2012 found lung ultrasound to be 93% sensitive for pneumonia [4].

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Ultrasounds Emergency Department Pediatrics 52

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 101

Operations Ultrasounds Fractures Outcomes 101

Don't Forget the Bubbles

JANUARY 17, 2024

Abdominal ultrasound, used in 34 cases, was able to visualize a rounded intraluminal image corresponding to a bead in 28 patients. Point-of-care ultrasound may show well-demarcated, round, and hypoechoic material in the stomach and first part of the duodenum, though it can underestimate the number of beads present. 2012 Jan;3(1):6.

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Pediatrics Poisoning Ultrasounds Dehydration 111

ALiEM

JANUARY 29, 2024

2012 Dec;33(7):E263-E267. Epub 2012 Sep 21. Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine vol. The retrobulbar “spot sign” as a discriminator between vasculitic and thrombo-embolic affections of the retinal blood supply. Ultraschall Med.

Stroke 64

Stroke Ultrasounds Academics Outcomes 64

RebelEM

APRIL 29, 2024

The current standard of practice has moved away from landmark-based central line placement given the efficacy and safety of ultrasound-based techniques. 2012 PMID: 21893125. This study also showed the median time for IO placement was only 1.2 minutes compared to a mean placement time of 10.7 minutes CVC group. Resuscitation.

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Resuscitation Administration Emergency Department Ultrasounds 105

RebelEM

NOVEMBER 30, 2022

History, physical examination and ultrasound are all flawed in making the diagnosis. Take Home Points Consider the diagnosis of testicular torsion in all patients with acute testicular pain Testicular torsion is a surgical emergency that requires immediate urologic consultation to increase the rate of tissue salvage. OR = 58.8 (Ben-Israel

Ultrasounds 52

Ultrasounds Pediatrics Operations EMS 52

Pediatric Emergency Playbook

AUGUST 1, 2017

2012; 43(1):49-51. BMJ 2012; 345:e5521. Hypertrophic pyloric stenosis: tips and tricks for ultrasound diagnosis. 2012; 3:247-250. 2012; 92:527-39. Intestinal Malrotation – Not Just the Pediatric Surgeon’s Problem. J Am Coll Surg. 2004; 199(4):628-635. Lee HC et al. J Emerg Med. Martin V, Shaw-Smith C.

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Pediatrics Ultrasounds Resuscitation Sepsis 52

PEMBlog

OCTOBER 16, 2023

She also had a pelvic ultrasound with relevant image seen here: Based on those findings, she then got a CT with relevant images seen here: A. OHVIRA Syndrome The patient’s ultrasound revealed an obstructed hemivagina. 2012 Jan;5(1):67-70. Her workup included normal abdominal x-rays, CBC, CMP, and UA. Ovarian cyst B.

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Ultrasounds Emergency Department Pediatrics 69

Urgent Care Ultrasounds

OCTOBER 24, 2018

An Anomalous Incidental – and ode to #POCUS #FOAMed Point of Care Ultrasound is based on the ability to answer binary, yes / no questions. Unfortunately ultrasound is not binary, but rather multiple shades of grey. Building a memory bank of normal and abnormal ultrasound findings is vital to help make sense of the unexpected.

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Ultrasounds Urgent Care Emergency Department Hospitals 52

PHEM Cast

APRIL 16, 2018

Ultrasound during TCA: Cureton et al. The heart of the matter: utility of ultrasound of cardiac activity during traumatic arrest. 2012; 73: 102-10. Critical Care; 2012. The outcomes from different resuscitative interventions in a haemorrhagic shock model in porcine model: From: Watts et al. Critical Care; 2011.

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Resuscitation Shock Ultrasounds CPR 52

ALiEM

MAY 19, 2023

Additional trick: If the x-ray is delayed, you can pre-check with ultrasound [7]. 2012 Feb;33(1):46-54. PulmCrit Wee: Ultrasound-guided blakemore tube placement. Then fill the gastric balloon with 50 cc of air. Verify the placement of the gastric balloon with a chest x-ray. García-Pagán JC, Reverter E, Abraldes JG, Bosch J.

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Emergency Department Ultrasounds Wellness EMS 98

ACEP Now

FEBRUARY 13, 2024

published a study, “Safety and Pain Reduction in Emergency Practitioner Ultrasound-Guided Nerve Blocks: A One-Year Retrospective Study.” 1 The authors describe a retrospective study of 420 patients who received ultrasound guided nerve blocks. Case Resolution This study reaffirms the safety and efficacy of ultrasound nerve blocks.

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Ultrasounds Emergency Department Hospitals Wellness 52

EMDocs

JULY 13, 2024

2012 May;27(5):1368-74. Epub 2012 Mar 14. Favorable infertility outcomes following anti-tubercular treatment prescribed on the sole basis of a positive polymerase chain reaction test for endometrial tuberculosis. Hum Reprod. doi: 10.1093/humrep/des076. PMID: 22419745. Morens, David. 2024, [link] Accessed 7 February 2024.

OB/GYN 89

OB/GYN EMS Sepsis Fluid Resuscitation 89

Don't Forget the Bubbles

NOVEMBER 8, 2023

Ultrasound has been associated with lower rates of negative appendicectomy. In a meta-analysis of 26 paediatric studies, the pooled sensitivity and specificity of ultrasound for diagnosing appendicitis in children were 88% and 94%, respectively [10]. Pediatrics, 2012. Hospital Admitted Patient Care Activity. Bachur, R.G.,

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Emergency Department Ultrasounds Pediatrics Best Practices 105

The Skeptics' Guide to EM

JANUARY 14, 2018

Urology 2012 Guest Skeptics: Dr. Tony Seupaul is the Chairman of the Department of Emergency Medicine at the University of Arkansas. Urology 2012 Guest Skeptics: Dr. Tony Seupaul is the Chairman of the Department of Emergency Medicine at the University of Arkansas. One issue that has been to use CT or ultrasound for the diagnosis.

Emergency Department 52

Emergency Department Ultrasounds Hospitals 52

PulmCCM

JUNE 26, 2023

An expert panel broadened the definition of acute respiratory distress syndrome (ARDS). They announced this at the American Thoracic Society meeting in May 2023. The prior requirement for mechanical ventilation excluded patients on high-flow oxygen, whose use has expanded dramatically.

Outcomes 98

Outcomes Ultrasounds Hospitals Wellness 98

ALiEM

SEPTEMBER 13, 2024

Tonometry and ocular ultrasound (US) are generally not recommended as you could squeeze more liquid out of the eye or increase the intraocular pressure even more, pushing the iris further out. 2012 Feb;26(2):212-7. An emergent ophthalmology consult is needed to plan for operative repair. American Academy of Ophthalmology. Eye (Lond).

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Emergency Department Academics Fractures Hospitals 64

PHEM Cast

DECEMBER 1, 2017

Ultrasound determination of chest wall thickness: implications for needle thoracostomy. Ultrasound in Emergency Medicine. Optimal positioning for emergent needle thoracostomy: a cadaver-based study. The Journal of Trauma , 71 (5), 1099–103– discussion 1103. link] Inaba, K., McClure, K., Branco, B. Eckstein, M., Shatz, D., Shulman, H.,

Academics 52

Academics Radiology Radiology Resuscitation 52

ALiEM

MARCH 1, 2024

2] Consider bedside ultrasound to rule out posterior pathology (retinal detachment, vitreous hemorrhage, etc.). link] Published November 19, 2012. These additional findings may warrant urgent surgical repair or close monitoring of IOP. [2] In: Knoop KJ, Stack LB, Storrow AB, Thurman R. The Atlas of Emergency Medicine, 5e.

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Dislocations Academics Ultrasounds Hospitals 60

EM Curious

JULY 29, 2015

NO RESPECT FOR THE RIGHT VENTRICLE [PODCAST]: The boys from Ultrasound Podcast sit down with critical care guru, Dr. Haney Mallemat, to discuss the assessment of the right ventricle with ultrasound. Part 1 is here , look out for Part 2 in the coming weeks. Download the screencast here.

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Sepsis EMS Emergency Department Ultrasounds 52

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? Many patients in the ultrasound groups did get additional imaging, but this was not the majority. How do you proceed? In this study, 40.7%

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Ultrasounds Radiology Radiology Outcomes 52

ACEP Now

OCTOBER 30, 2023

28, 2012, the Emirates Society of Emergency Medicine (ESEM) was established by a group of emergency physicians who recognized the necessity for a unified body dedicated to the advancement of emergency medicine practice and research. The UAE government’s support took the country to another level and on Aug.

Leadership 52

Leadership Emergency Department Ultrasounds CPR 52

Taming the SRU

OCTOBER 7, 2024

history of VTE, increased calf circumference, pain and swelling), then the next step is to attain a compressible ultrasound of the affected leg. However, if clinical suspicion is high enough, doppler ultrasound, MR venography, or serial compressive ultrasound imaging can all be considered. Epub 2012 Oct 12. Haematologica.

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Ultrasounds CDC Research Stroke 64

RebelEM

MARCH 8, 2023

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. 790-819 Core Ultrasound: Vitreous vs Retinal Detachmen t Post Created By: Anand Swaminathan MD, MPH Post Peer Reviewed By: Salim R. >10 floaters, (+) LR 8.1-36

Stroke 52

Stroke Emergency Department Ultrasounds Outcomes 52

EMDocs

MAY 11, 2024

Semin Ultrasound CT MR. 2013 Apr;34(2):131-41. 2012) 43:2904–9. Reference article, Radiopaedia.org (Accessed on 28 Aug 2023) [link] Ortiz de Mendivil A, Alcalá-Galiano A, et al. Brainstem stroke: anatomy, clinical and radiological findings. doi: 10.1053/j.sult.2013.01.004. 2013.01.004. PMID: 23522778.] Gowda SN, Munakomi S, De Jesus O.

Stroke 110

Stroke EMS EKG/ECG Radiology 110

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 ).

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Blood Transfusions Fractures EMS Emergency Department 52

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: 23758299 Maung AA et al. PMID: 23114494 Paradis M.

Operations 52

Operations Sepsis Resuscitation Ultrasounds 52

Pediatric Emergency Playbook

OCTOBER 1, 2017

Ultrasound-guided refilling of an intrathecal baclofen pump—a case report. Ghosh D, Mainali G, Khera J, Luciano M. Complications of Intrathecal Baclofen Pumps in Children: Experience from a Tertiary Care Center. Pediatr Neurosurg. 2013; 49:138–144. Yang TF, Wang JC, Chiu JW et al. Childs Nerv Syst. 2013; 29:347–349. J Amer Coll Cardiol.

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Pediatrics Seizures Stroke Ultrasounds 52

Dr. Smith's ECG Blog

JUNE 2, 2023

My bedside ultrasound was of insufficient quality, but showed somewhat reduced overall EF, distended IVC without respiratory variation, no pericardial effusion, and diffuse bilateral B lines. == What do you think of her ECG? J Electrocardiol, 42 (2009), pp.

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EKG/ECG Wellness Ultrasounds EMS 96

Pediatric Emergency Playbook

JUNE 1, 2017

The Systemic Lupus International Collaborating Clinics (SLICC) revised the criteria in 2012. 2012; AID 471759. Cardiovasculr Ultrasound. 2012; 7:19796. Blog Post] July 22, 2012. 2012; 59(13):1123-1133. The patient should have ≥4/17 clinical and/or immunologic criteria. 2015; 19(2):e107-e109. Murgan SJ et al.

Pediatrics 52

Pediatrics EKG/ECG Wellness Seizures 52

Advanced Emergency Nursing from AENJ

FEBRUARY 29, 2016

Advances in Medical Imaging (CT, MRI, and Ultrasound) facilitating rapid, accurate, diagnosis affording new potential to save additional lives. EM makes a strong push into bedside use of ultrasound sonography. Emergency Ultrasound is one of the greatest advances in emergency care. EDNA->ENA. Development of EM Residencies.

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Emergency Nursing EMS Resuscitation Military 40

Taming the SRU

FEBRUARY 19, 2024

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%. Higher doses of vasopressors subsequently leads to even less correlation between central and peripheral measurements (11).

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Shock Resuscitation Ultrasounds Research 59

Pediatric Emergency Playbook

SEPTEMBER 1, 2015

The downside is that it can last 30 minutes or more, but it may be a good choice for an abdominal ultrasound or CT head in unruly toddlers. 2012 Jul-Aug;8(4):237-41. Dex is safe, if titrated, and does not depress airway reflexes or respiration. mcg/kg IN, and can add another 1 mcg/kg if needed. Before You Go: The “Semmelweiss reflex”.

Administration 40

Administration Seizures Emergency Department Ultrasounds 40

Taming the SRU

AUGUST 30, 2023

Notably, lung ultrasound for the diagnosis of bacterial CAP demonstrated exceptional stand-alone diagnostic accuracy in 33 studies including 4,901 adults and children in the emergency department, with a pooled sensitivity of 92% and specificity of 90%. Raised inflammatory markers BMJ 2012; 344 :e454 doi:10.1136/bmj.e454 Gabay C, Kushner I.

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Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 89

Pediatric Emergency Playbook

DECEMBER 1, 2016

Ultrasound Not ready for prime time. 2012 Mar;129(3):e605-10. 2012 Sep;28(9):895-7. Epub 2012 Dec 21. The How Below is a list of modalities, treatments, and the evidence and/or recommendations for or against: Chest Radiograph Usually not necessary, unless the diagnosis is uncertain , or if the child is critically ill.

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Pediatrics Emergency Department Hospitals Wellness 40

Downeast Emergency Medicine

APRIL 26, 2021

9] The BRAIN-PROJECT was a multicenter observational study of the prehospital treatment of patients with severe TBI (based on trauma mechanism or clinical findings and a prehospital GCS <9) who were treated by one of the four Dutch physician-staffed Helicopter Emergency Medical Services from 2012-2017. Arch Surg 2012; 147:113-119.[

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Head Injuries Administration Outcomes Seizures 52

Pediatric Emergency Playbook

JUNE 1, 2016

Cardiogenic Shock: Act Use point-of-care cardiac ultrasound : Good Squeeze? It’s seen easily enough on point of care ultrasound. Tamponade: if any sign of shock, pericardiocentesis, preferentially ultrasound-guided. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012.

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Shock Sepsis Pediatrics Ultrasounds 40