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%

Ultrasounds 52

Ultrasounds Radiology Radiology Outcomes 52

RebelEM

NOVEMBER 30, 2022

History, physical examination and ultrasound are all flawed in making the diagnosis. History, physical examination and ultrasound are all flawed in making the diagnosis. 2014, (Ch) 99: p 1326-1356. The gold standard is surgical exploration. Physical exam, history and imaging all have significant limitations. 10, (-) LR = 0.13

Ultrasounds 52

Ultrasounds Pediatrics Operations EMS 52

Taming the SRU

MAY 22, 2023

Point-of-care ultrasound (POCUS) can evaluate for Achilles tendon rupture with a high sensitivity (96-100%) and specificity (83-100%) [8,9]. weight-bearing status, operative vs. non-operative) If necessary/helpful to ensure adequate follow-up At time of discharge: Counsel on expected course of injury, supportive care (e.g.,

Fractures 76

Fractures Dislocations Operations Radiology 76

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 Late findings Fever Abdominal distension (+) LR: 5.64 – 16.8 (-) LR: 0.34 – 0.43

Operations 52

Operations Sepsis Resuscitation Ultrasounds 52

PHEM Cast

DECEMBER 1, 2017

Journal of Special Operations Medicine : a Peer Reviewed Journal for SOF Medical Professionals , 13 (4), 53–58. Ultrasound determination of chest wall thickness: implications for needle thoracostomy. Ultrasound in Emergency Medicine. [link] Harcke, H. L., & Mazuchowski, E. Branco, B. Eckstein, M., Martin, M. link] MD, B.

Academics 52

Academics Radiology Radiology Resuscitation 52

Advanced Emergency Nursing from AENJ

FEBRUARY 29, 2016

Farrington] Rebuilding of outdated hospitals put emergency rooms on ground level with nearby X-ray service, and, ideally, sometimes closer to the Blood Bank and the Operating Rooms. Advances in Medical Imaging (CT, MRI, and Ultrasound) facilitating rapid, accurate, diagnosis affording new potential to save additional lives.

Emergency Nursing 40

Emergency Nursing EMS Resuscitation Military 40

Pediatric Emergency Playbook

MARCH 1, 2016

Often children even with high-grade splenic and liver lacerations can be managed non-operatively. Unfortunately, a negative FAST cannot help with detecting or grading the laceration for non-operative management. CT Abdomen and Pelvis, IV contrast: helpful in grading splenic and liver lacerations with goal to manage non-operatively.

Resuscitation 40

Resuscitation Pediatrics Hyperthermia / Hypothermia Operations 40

Mind The Bleep

DECEMBER 6, 2024

Initial Management (whilst Urology team are on their way) Bloods FBC, U/Es, CRP, Coagulation screen, Blood glucose levels, Blood cultures IV Antibiotics as per Trust guidelines (may be under section for Necrotising fasciitis) Urethral catheter- this will help with monitoring urine output and help identify the urethra during the operation.

Documentation/Coding 52

Documentation/Coding Operations Ultrasounds Hospitals 52

EB Medicine

JULY 8, 2019

Jeff: A 2014 study even showed an up to 80% reduction in the likelihood of developing DM2 postoperatively at the 7-year mark. overall, these surgeries are relatively safe with one 2014 review publishing a 10-17% overall complication rate and a perioperative 30 day mortality of less than 1%. Nachi: So we have a lot to cover!

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 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%. Epub 2014 Dec 3. Epub 2014 Oct 27. Int J Rheum Dis. 2015 Mar;18(3):352-9.

Infectious Diseases 87

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

Pediatric Emergency Playbook

JANUARY 1, 2017

Neonatal observational scales have been validated in the intensive care and post-operative settings; ED-specific quantitative scales are lacking. CRIES ( Table 1 ) was validated for post-operative patients; to adapt its use for the ED, the most conservative approach is to substitute “preoperative baseline” with normal range for age.

Pediatrics 40

Pediatrics Soft Tissue Injuries Burns Emergency Department 40

Don't Forget the Bubbles

JULY 5, 2023

Afro-Caribbean patients should be screened for sickle cell before anaesthesia for possible pre-operative transfusion. The high blood flow velocities through these stenotic segments can be detected using transcranial doppler ultrasound (TCD). 2014; 349–356. What could be the differential diagnosis? Macharia AW et al.

Blood Transfusions 126

Blood Transfusions Stroke Dehydration Sepsis 126

Pediatric Emergency Playbook

JUNE 1, 2017

Fontan Operation and the Single Ventricle. 2014; 14(1): 23-227. 2014; 5(4)L631-634. Cardiovasculr Ultrasound. 2014; 12:15. Summary Acute MI is a challenging presentation in children: Easily missed: uncommon and atypical Varied etiology Respect vague symptoms with a non-reassuring H&P Try to detect it: CATH IT!

Pediatrics 52

Pediatrics EKG/ECG Wellness Seizures 52

Don't Forget the Bubbles

NOVEMBER 1, 2023

Reviewed by: Leanne Lindenstruth, ENP Article 4: Can we treat appendicitis non-operatively? Non-operative treatment of acute appendicitis in children: clinical efficacy of amoxicillin-clavulanic acid in a retrospective single-centre study. Picard C, Abbo O, Munzer C, et al. BMJ Paediatrics Open 2023; 7: e001855.

Emergency Department 140

Emergency Department Hospitals Resuscitation Administration 140

EMDocs

OCTOBER 23, 2023

Operative complications requiring surgical intervention or hospitalization occur in about 3-6% of all hysterectomies (5). difficile infection, and post-operative hemorrhage. Abscess and Infected Hematoma : This condition is typically delayed, occurring most commonly 10-14 days post-operatively.

OB/GYN 67

OB/GYN Operations EMS Ultrasounds 67

Don't Forget the Bubbles

SEPTEMBER 23, 2024

suprapubic catheters, gastrostomy tubes, haemodialysis or peritoneal dialysis lines – may have been left in situ in the initial post-operative period), and central vascular catheters. Look for scars indicating previous central lines, peritoneal dialysis catheters or operations. If in doubt, ask. CAKUT, catheterization requirement).

Pediatrics 52

Pediatrics Fractures Dehydration Sepsis 52

EMDocs

DECEMBER 18, 2023

When analyzing the receiver operating characteristic (ROC) curve of the pooled data, optimal diagnostic accuracy of MDW for sepsis prediction was seen (pooled sensitivity of 0.838 and specificity of 0.704 for Sepsis-3 criteria). Incidence and trends of sepsis in US hospitals using clinical vs claims data, 2009–2014. West J Emerg Med.

Sepsis 65

Sepsis Fluid Resuscitation Resuscitation Shock 65

EMDocs

NOVEMBER 13, 2023

26 With regards to penetrating neck injuries, particularly those in which the platysma is violated, CTA of the neck has allowed a shift away from mandatory operative exploration of Zone 2 neck wounds (those in the mid-neck). Semin Ultrasound CT MR 2017, 38 (4), 345-356. J Neurosurg 2014, 121 (1), 24-31. DOI: 10.1161/strokeaha.118.023173

Stroke 87

Stroke Radiology Radiology Emergency Department 87

EMDocs

NOVEMBER 4, 2024

Evaluation by ultrasound of traumatic rib fractures missed by radiography. doi:10.1136/heartjnl-2014-306362 LeWinter MM. Pharmacologic therapy should only be utilized for chronic low back pain for patients who have not responded adequately to the aforementioned options. Journal of Osteopathic Medicine. 2020;120(10):696-697.

Emergency Department 99

Emergency Department Fractures Burns EMS 99

SheMD

APRIL 23, 2023

While most of the attributed blame for these findings has focused on older age and demanding working conditions of pregnant surgeons [or one might extrapolate this to physicians in general]; the authors note that “there are reproductive hazards present in the operating room that might also be contributing.” Aghajanova et al. Pham et al.

Ultrasounds 52

Ultrasounds Wellness Operations 52