Pediatric EM Morsels

JUNE 16, 2023

Shen 2013, Nickerson 2014, Scolaro 2016 ] Singh et al proposed an algorithm to guide treatment. Shen 2013, Nickerson 2014, Scolaro 2016 ] Singh et al proposed an algorithm to guide treatment. Shen 2013, Nickerson 2014, Scolaro 2016 ] Singh et al proposed an algorithm to guide treatment.

Soft Tissue Injuries 152

Soft Tissue Injuries Dehydration Fractures Operations 152

Taming the SRU

APRIL 14, 2024

2) Management: Confirmed by CT Surgical consult Utility of Ultrasound Ultrasound can be helpful in identifying hernias and in assisting in reduction. 8) “Ultrasound may decrease the emergency surgery rate of incarcerated inguinal hernia” by Chen et al. (1) If the ultrasound-guided attempt failed, emergency surgery was scheduled.

Ultrasounds 93

Ultrasounds Emergency Department Pediatrics Radiology 93

Dr. Smith's ECG Blog

SEPTEMBER 23, 2024

Answer : Bedside ultrasound! Smith : RV infarct may also have this appearance on ultrasound. So hypoxia without B lines on lung ultrasound strongly weights toward PE. What do you do clinically when the ECG looks like this? How do you emergently triage the patient to cath lab or possibly IR suite for thrombectomy?

EKG/ECG 131

EKG/ECG Ultrasounds Shock EMS 131

Dr. Smith's ECG Blog

DECEMBER 16, 2024

And almost all of them could be detected by bedside ultrasound. Conclusion: you may take a few moments to look for dissection with your bedside ultrasound, but when it is a clear STEMI, do NOT waste time with a CT scan. It is not a waste of time to use bedside ultrasound to look for dissection 3. Ultrasound Med.

Ultrasounds 106

Ultrasounds EKG/ECG Operations Emergency Department 106

RebelEM

DECEMBER 10, 2023

Background: The use of ultrasound is well established for trauma patients in the emergency department, with almost every patient receiving a FAST (Focused Assessment with Sonography in Trauma) examination as part of the “ABC’s” of trauma. Not so FAST- Chest ultrasound underdiagnoses traumatic pneumothorax. PMID: 34932040.

Ultrasounds 40

Ultrasounds Emergency Department Wellness EMS 40

Taming the SRU

MAY 27, 2024

Ultrasound in recent years has become a very helpful tool in diagnosing smaller effusions, and is noted to be almost 100% sensitive for effusions > 100 mL (2). While historically reported rates were ~20%, more recent literature with ultrasound guidance suggests much lower rates of ~3% (3, 4).

Emergency Department 86

Emergency Department Ultrasounds Radiology Radiology 86

EMDocs

APRIL 2, 2024

Check the pulse RSI= Resuscitation Sequence Intubation Hypoxia, Hypotension, and Acidosis are the reason patients code during/post intubation These patients are super high risk for all 4 Optimize first pass success – Induction agent + paralytic Unconscious patients will still have muscle tone Induction Ketamine or Etomidate at half doses (i.e.,

Documentation/Coding 105

Documentation/Coding CPR EKG/ECG Sepsis 105

ALiEM

AUGUST 30, 2024

NG/DL) Ultrasound of the neck revealed an enlarged thyroid gland with lobular contours and diffuse hypoechoic echogenicity, without noticeable nodules, fluid collection, or lymphadenopathy. An ultrasound and thyroid antibodies may also be helpful to confirm diagnosis. 2014 Dec;24(12):1670-751. No distention or tenderness.

Pediatrics 64

Pediatrics Ultrasounds Academics Emergency Department 64

Don't Forget the Bubbles

NOVEMBER 20, 2023

These may require surgical drainage following confirmation on ultrasound scan. December 2014 Soldes O, Yunger J, Hirschl R. Difficulty swallowing, stridor or altered voice should prompt urgent ENT assessment. Simple lymphadenitis can progress into fluctuant masses, suggesting abscess formation. Cervical Lymphadenopathy.

Pediatrics 124

Pediatrics Documentation/Coding Emergency Department Ultrasounds 124

Pediatric Emergency Playbook

JANUARY 1, 2022

Ultrasound shows a pylorus of greater than 3 mm wide and 14 mm long. 2014 Jun;49(6):995-9. 2014 Mar;63(3):289,308. Memory aid: 3.14 In pyloric stenosis, π-lorus > 3 x 14 Treatment Various options, may be deferred depending on age, availability, severity of illness, including: Pyloromyotomy — definitive. J Pediatr Surg.

Dehydration 52

Dehydration Pediatrics Ultrasounds 52

RebelEM

JANUARY 29, 2024

Randomized, Controlled Trial of Ultrasound-Assisted Catheter-Directed Thrombolysis for Acute Intermediate-Risk Pulmonary Embolism. A prospective, Single-Arm Multicenter Trial of Ultrasound-Facilitated, Catheter-Directed, Low-Dose Fibrinolysis for Acute Massive and Submassive Pulmonary Embolism: The SEATTLE II Study. CHEST 2010.

Stroke 130

Stroke Outcomes Hospitals Administration 130

EM Curious

JULY 24, 2015

One of our beloved colleagues from the community has recently declared to us his love of ultrasound guided nerve blocks--a skill that is established in the anesthesia world but is quickly gaining traction in our realm. Saunders 2014, Chapter 31 Beaudoin, F. Ultrasound-Guided Three-In-One Nerve Block for Femur Fractures.

Fractures 52

Fractures Ultrasounds Emergency Department Dislocations 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

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

EM Curious

APRIL 29, 2015

You can view the TTE recordings for each of the 20 standard views used in a full cardiology exam and see the corresponding 3D model of the probe, ultrasound plane, heart and rib cage for that view. Listen to a great review of the top 10 trauma papers in 2014-2015 @ St. Emlyns Blog.

Head Injuries 52

Head Injuries EMS Pediatrics CPR 52

The Skeptics' Guide to EM

DECEMBER 28, 2019

He is also the Chief for the Section of Emergency Ultrasound and […] The post SGEM Xtra: Come Together, Right Now – Over Renal Colic first appeared on The Skeptics Guide to Emergency Medicine. He is also the Chief for the Section of Emergency Ultrasound and Director of the Emergency Ultrasound Fellowship. NEJM 2014 ).

Radiology 40

Radiology Radiology Ultrasounds Emergency Department 40

Advanced Emergency Nursing from AENJ

JANUARY 26, 2015

Keep your ultrasound handy. 2014) Emergency Care Institute, New South Wales. 2014) Tiny Tip: PRE -eclampsia. 2014) Medscape.com Sullivan, MG (2007) Time Is Critical for Success in Perimortem C-Section ACEP News. Here, then, are some links for Third Trimester Emergencies. Stafford, I. Leibowitz, A. B., & Beilin, Y.

OB/GYN 40

OB/GYN Ultrasounds Emergency Department Resuscitation 40

The Skeptics' Guide to EM

JANUARY 14, 2018

One issue that has been to use CT or ultrasound for the diagnosis. The typical acute presentation is sudden onset of pain radiating from the flank to lower abdomen accompanied by microscopic hematuria, nausea, and vomiting [2]. The issue of renal colic a number of times on the SGEM. A study from Bindman et al. A study from Bindman et al.

Emergency Department 52

Emergency Department Ultrasounds Hospitals 52

Emergency Medicine Ireland

OCTOBER 14, 2024

Similarly loculations can be very easily seen with ultrasound, better than CT it seems but again don’t necessarily correlate that well with empyema. This has been moderately well studied with MIST-2 2011 and the Picollo trial (2014) being commonly quoted trials suggesting benefit. 11, 1419–1425 (2014). – M.,

Wellness 52

Wellness Ultrasounds 52

Rural Doctors Net

JANUARY 21, 2014

So here’s today’s case, one which I’m also working though with the PRCC students attached to Kangaroo Island in 2014 in sim and theory. There is also an old SonoSite Titan ultrasound unit with linear and curvilinear transducers. Then listen to RAGE podcast #2 THE SCENARIO The setting, as always, is a small rural ED in Australia.

EKG/ECG 52

EKG/ECG Ultrasounds 52

Urgent Care Ultrasounds

JANUARY 17, 2019

link] Also note thoracic aorta posterior to hernia #POCUS #FOAMed pic.twitter.com/v0B2zAWXxm — VCU Ultrasound (@ultrasound_vcu) December 29, 2018 An elderly woman with chest discomfort #ACCFIT @JGrapsa @VLSorrellImages pic.twitter.com/LobfRATs01 — Edgar Argulian (@argulian) October 31, 2018 References 1. 2014; 27(5):540-6. pubmed ] 2.

Urgent Care 40

Urgent Care Ultrasounds Radiology Radiology 40

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. Case: A 71-year-old man is brought to your emergency department (ED) by emergency medical serviced (EMS) having fallen two steps at home.

Blood Transfusions 52

Blood Transfusions Fractures EMS Emergency Department 52

The Skeptics' Guide to EM

SEPTEMBER 14, 2019

He is interested in ultrasound and international emergency medicine. million emergency department visits in the US in 2014 [1], with the most significant proportion of visits occurring in the elderly ≥75 (1,682/100,000) [1]. She is interested in social determinants of health in the emergency department and health policy.

Head Injuries 52

Head Injuries Emergency Department Seizures EMS 52

ACEP Now

SEPTEMBER 13, 2023

But what if we could measure a patient’s spleen via ultrasound in the emergency department (ED) to guide specific patient care? Practitioners have looked at splenic size on ultrasound and its association with splenic dysfunction. A later prospective study included 694 children with sickle cell disease at 19 U.S. Is there a correlation?

Pediatrics 40

Pediatrics Ultrasounds Emergency Department Poisoning 40

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 Emery Med J 2014; 31(3): 248-9. 3.6 – 55.6) (-) LR: 0.13 (0.08 – 0.20) ED US (+) LR: 9.5 (2.1

Operations 52

Operations Sepsis Resuscitation Ultrasounds 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]. 2014 May;4(3):432-5. Some fractures are often difficult to see on XRs, so consider CT if your index of suspicion is high. MRI can be used in place of CT. Ann Med Health Sci Res.

Fractures 77

Fractures Dislocations Operations Radiology 77

Dr. Smith's ECG Blog

OCTOBER 17, 2024

I would do bedside ultrasound to look at the RV, look for B lines as a cause of hypoxia (which would support OMI, and argue against PE), and if any doubt persists, a rapid CT pulmonary angiogram. Figure-2: From Grauer K: ECG Pocket Brain-2014 ePub — regarding "My Take" on defining the ST segment baseline.

EKG/ECG 76

EKG/ECG EMS Shock Ultrasounds 76

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

Smith comment: This patient did not have a bedside ultrasound. Had one been done, it would have shown a feature that is apparent on this ultrasound (however, this patient's LV function would not be as good as in this clip): This is recorded with the LV on the right. In fact, bedside ultrasound might even find severe aortic stenosis.

EKG/ECG 40

EKG/ECG Shock Fluid Resuscitation Documentation/Coding 40

EMDocs

FEBRUARY 12, 2025

Imaging: In severe cases, imaging with ultrasound, CT or MRI may be useful in assessing the extent of tissue injury and in further evaluating other etiologies including infection and worsening malignancy. Published 2014 Jan 31. Physical Examination: Inspect for erythema, blistering, and ulceration. BMC Cancer. 2014;14:53.

Best Practices 53

Best Practices Documentation/Coding Radiology Radiology 53

PEMBlog

JANUARY 17, 2024

Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis 2014; 59:e10. If you think that there’s an abscess, you can diagnose it clinically by a localized area of induration or fluctuance or use an ultrasound.

Infectious Diseases 59

Infectious Diseases Sepsis Wellness Pediatrics 59

Pediatric Emergency Playbook

FEBRUARY 1, 2017

Renal and bladder ultrasound (RBUS) after the first UTI is recommended (although incompletely followed in practice). 2014 Apr;99(4):342-7. Urachal remnant – a leftover from fetal development, and an abnormal connection between the bladder and the umbilicus. Imaging of choice as an outpatient? Arch Dis Child. Dayan PS et al.

Wellness 52

Wellness Dehydration Ultrasounds Pediatrics 52

Northwestern EM Blog

FEBRUARY 14, 2022

In a patient already on vaso that has stopped responding to escalating doses of norepinephrine, I reach for my ultrasound probe and reassure myself that there isn’t significant sepsis-related myocardial dysfunction because those patients may benefit from a trial of an inotrope like epinephrine. Crit Care 2014; 18(5): 534.

Shock 52

Shock Resuscitation Fluid Resuscitation Sepsis 52

ALiEM

MARCH 7, 2024

Given her pain with a history of intermittent hematuria and dysuria, you perform a renal and bladder point of care ultrasound (POCUS) examination. Pre-warmed ultrasound gel is helpful when available. Then test your skills on the ALiEMU course page to receive your PEM POCUS badge worth 2 hours of ALiEMU course credit.

Ultrasounds 70

Ultrasounds Pediatrics Radiology Radiology 70

PulmCCM

SEPTEMBER 13, 2021

Taylor KJW, Burns PN, Wells PNT: Clinical Applications of Doppler Ultrasound. Pulmonary circulation 2014, 4(2):211-219. Investigative Ophthalmology & Visual Science 1965, 4(6):973-987. Tedford RJ: Determinants of right ventricular afterload (2013 Grover Conference series).

Burns 40

Burns Stroke Ultrasounds Wellness 40

Pediatric Emergency Playbook

JUNE 1, 2017

2014; 14(1): 23-227. 2014; 5(4)L631-634. Cardiovasculr Ultrasound. 2014; 12:15. Congenit Heart Dis. 2007; 2:2-11. Aliku TO et al. A case of anomalous origin of the left coronary artery presenting with acute myocardial infarction and cardiovascular collapse. African Health Sci. Andrews RE et al. 2004; 90:e17. Circulation.

Pediatrics 52

Pediatrics EKG/ECG Wellness Seizures 52

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

Methods STEMI activations between January 2014 and April 2018 at the University of Arizona Medical Center were identified. Widespread ST-depression with reciprocal aVR ST-elevation can be cause by: Heart rate related: tachyarrhythmia (e.g., A emergent cardiology consult can be helpful for equivocal cases.

EKG/ECG 52

EKG/ECG Shock Sepsis Emergency Department 52

Dr. Smith's ECG Blog

OCTOBER 24, 2018

This was diagnosed by IVUS (intravascular ultrasound) as a ruptured plaque. Values: STE60V3 = 2.0, QRS V2 = 10, RAV4 = 15.5, QTc = 377 by computer 4-variable formula value = 16.2, which is very low and suggests early repol The patient was taken to the cath lab and a Type III (wraparound) LAD with a proximal hazy area was seen. Thelin et al.

EKG/ECG 40

EKG/ECG Ultrasounds Wellness 40