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.

Ultrasounds 40

Ultrasounds Emergency Department Wellness EMS 40

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

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. Well, adding extra or bigger drains is all very reasonable and it would seem wise to involve a thoracic surgeon at some point. 11, 1419–1425 (2014). – M.,

Wellness 52

Wellness 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%

Ultrasounds 52

Ultrasounds Radiology Radiology Outcomes 52

Advanced Emergency Nursing from AENJ

JANUARY 26, 2015

All went well. Keep your ultrasound handy. 2014) Emergency Care Institute, New South Wales. 2014) Tiny Tip: PRE -eclampsia. Not in the textbook, but it worked. Usually, in the ED, the simple and great goal is to get the parturient upstairs to OB-GYN, if you have one, as soon as possible. Stafford, I. Leibowitz, A.

OB/GYN 40

OB/GYN Ultrasounds Emergency Department Resuscitation 40

The Skeptics' Guide to EM

SEPTEMBER 14, 2019

He is interested in ultrasound and international emergency medicine. Case: It’s a busy night in the emergency department, your next patient is a well appearing 70-year-old man, presenting after a mechanical fall from standing with loss of consciousness. He is not on anticoagulation and there is no history of seizures.

Head Injuries 52

Head Injuries Emergency Department Seizures EMS 52

Taming the SRU

MAY 22, 2023

Use your exam to guide your initial management as well as your imaging decisions and differential diagnosis. 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. Respect, but do not rely upon, the mechanism.

Fractures 77

Fractures Dislocations Operations Radiology 77

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. You can also see petechiae and hemorrhage, as well as superficial bulla, vesicles, or even echemosis. Well, bacteria, and the most common etiology.

Infectious Diseases 59

Infectious Diseases Sepsis Wellness Pediatrics 59

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. Is there a correlation? percent in the post-pneumococcal-conjugate-vaccine era. Arch Pediatr Adolesc Med.

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. Absent bowel sounds Peritoneal signs (i.e. Am Surg 2010; 76:687-691.

Operations 52

Operations Sepsis Resuscitation Ultrasounds 52

Pediatric Emergency Playbook

FEBRUARY 1, 2017

Symptoms – either typical dysuria, urgency, frequency in a verbal child, or non-descript abdominal pain or vomiting in a well appearing child. In a low risk child, with obviously very vigilant parents, who is well appearing, you may choose not to test now, and ensure close follow up. 2014 Apr;99(4):342-7. No obvious source?

Wellness 52

Wellness Dehydration Ultrasounds Pediatrics 52

Pediatric Emergency Playbook

JUNE 1, 2017

This child is at risk for expected complications, as well as overdiagnosis and iatrogenia. These children depend on their preload to run blood passively into the pulmonary circuit; afterload reduction is also important to compensate for a poor left ejection fraction, as well as to avoid the development of pulmonary hypertension.

Pediatrics 52

Pediatrics EKG/ECG Wellness Seizures 52

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

PulmCCM

SEPTEMBER 13, 2021

While more detailed analyses are available for the keen reader [1-3], this brief approach will consider a simplified model first proposed well over a century ago. Taylor KJW, Burns PN, Wells PNT: Clinical Applications of Doppler Ultrasound. Pulmonary circulation 2014, 4(2):211-219.

Burns 40

Burns Stroke Ultrasounds Wellness 40

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

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. MY Clinical Impression: The ECG in Figure-1 — shows sinus tachycardia — incomplete RBBB — with marked ST depression in multiple leads ( with ST elevation in lead aVR , as well as in leads V1 and aVL ).

EKG/ECG 52

EKG/ECG Shock Sepsis Emergency Department 52

Dr. Smith's ECG Blog

OCTOBER 24, 2018

The patient was given sublingual nitroglycerine and his symptoms greatly improved, and another ECG was recorded: Now there is much less ST Elevation If you had not seen the prior ECG, you might have called this normal variant STE, or early repolarization --there are well-formed J-waves. Suppose you had used the formula? There was good flow.

EKG/ECG 40

EKG/ECG Ultrasounds Wellness 40

EB Medicine

OCTOBER 1, 2018

Jeff : So as well all know Sepsis is bread and butter emergency medicine, but, what is sepsis? In 2014, the Society of Critical Care Medicine and the European Society of Intensive Care Medicine started a task force, and by 2016, updated definitions were out again! Two, your ultrasound is your best tool for assessing volume status.

Sepsis 40

Sepsis Shock Fluid Resuscitation Hospitals 40

Don't Forget the Bubbles

AUGUST 9, 2023

His thyroid ultrasound is normal, and thyroid antibodies are negative. Six months later, his weight and height remain normal, he still does not have a goitre and his thyroid ultrasound is unchanged. She has a normal thyroid ultrasound and negative anti-microsomal and anti-thyroglobulin antibodies. She also has a goitre.

Ultrasounds 98

Ultrasounds Pediatrics Wellness 98

EMDocs

APRIL 22, 2024

Point-of-Care-Ultrasound (POCUS) is a bedside modality that can assist Emergency Physicians (EPs) in differentiating PE from other causes of cardiac arrest. Multiorgan POCUS The diagnostic power of POCUS often resides in combining multiple ultrasound exams. 1-3 As many as 25% of acute PE cases present as sudden cardiac death.

Ultrasounds 93

Ultrasounds Advances Cardiac Life Support (ACLS) EKG/ECG Resuscitation 93

Pediatric Emergency Playbook

AUGUST 1, 2017

J Pediatr Surg 2014; 49:1619. Hypertrophic pyloric stenosis: tips and tricks for ultrasound diagnosis. 2014; 8(5):533-541. J Ultrasound. Single-stage versus multi-stage pull-through for Hirschsprung's disease: practice trends and outcomes in infants. Pyloric Stenosis Aspelund G, Langer JC. Semin Pedaitr Surg. 2008; 15-21.

Pediatrics 52

Pediatrics Ultrasounds Resuscitation Sepsis 52

Don't Forget the Bubbles

JULY 17, 2023

Reviews and opinion articles Point-of-care ultrasound in pediatric nephrology. Prenatal opioid exposure and well-child care in the first 2 years of life: population-based cohort study. 2023 Jun 14;46:8-23 One-year survival and outcomes of infants born at 22 and 23 weeks of gestation in Sweden 2004-2007, 2014-2016 and 2017-2019.

Pediatrics 98

Pediatrics Emergency Department Outcomes Fractures 98

Don't Forget the Bubbles

JULY 5, 2023

SCD, therefore, is not only a mechanical disease but there are also many other cellular and plasma factors as well as endothelial interaction that generate chronic inflammation. Recent studies have shown that low-dose ketamine can reduce pain in acute painful crises of sickle cell patients as well as being an opioid-sparing drug.

Blood Transfusions 126

Blood Transfusions Stroke Dehydration Sepsis 126

Pediatric Emergency Playbook

JANUARY 1, 2017

Tachycardia, tachypnea, and a change in behavior can be indicators not only to the presence of pain, but possibly to its etiology as well. For children greater than one year who are preverbal, a well performing scale is the FLACC score: Face, Legs, Activity, Cry, Consolability ( Table 3 ).

Pediatrics 40

Pediatrics Soft Tissue Injuries Burns Emergency Department 40

Advanced Emergency Nursing from AENJ

FEBRUARY 29, 2016

A natural one, and especially suited for increasing capability without regard to physician residency program output of graduates, and in less-well-served rural areas. Advances in Medical Imaging (CT, MRI, and Ultrasound) facilitating rapid, accurate, diagnosis affording new potential to save additional lives. EDNA->ENA.

Emergency Nursing 40

Emergency Nursing EMS Resuscitation Military 40

EMDocs

JULY 15, 2023

A lower extremity radiograph does not reveal any gas formation and an ultrasound of the lower extremity is negative for DVT or cobblestoning, WBC is within normal limits and there are mild elevations in ESR and CRP. 2014 Jul 15;59(2):e10-52. No fungal infections are identified on the feet. What is the most likely diagnosis?

EMS 76

EMS Infectious Diseases Shock Ultrasounds 76

Pediatric Emergency Playbook

DECEMBER 1, 2016

If the otherwise healthy child one month and older is: Euvolemic Not hypoxic Well appearing He can likely go home. Ultrasound Not ready for prime time. Pros and Cons in Audio; the 2006 AAP Guidelines and the 2014 AAP Guidelines use same data to come to divergent recommendations. 2014 Jan 20;(1):CD009609. Pediatrics.

Pediatrics 40

Pediatrics Emergency Department Hospitals Wellness 40

Dr. Smith's ECG Blog

JANUARY 10, 2020

Here is the parasternal short axis, performed by a real expert in emergency department point of care cardiac ultrasound: There does not appear to be an anterior wall motion abnormality. Beware a negative Bedside ultrasound. I may well have also been convinced this patient had acute myocarditis given the findings we have been told.

EKG/ECG 40

EKG/ECG Ultrasounds Emergency Department Wellness 40

Pediatric Emergency Playbook

MARCH 1, 2016

Adults tolerate hypotension relatively well, and is sufficient until we send them to the OR or interventional radiology suite. In other words, feel free to use ultrasound – especially for things that we in the ED will react to and intervene on – but CT may help to manage the traumatized child non-operatively. 2014 Apr;63(4):460-2.

Resuscitation 40

Resuscitation Pediatrics Hyperthermia / Hypothermia Operations 40

EMDocs

OCTOBER 23, 2023

She had been feeling well until yesterday when she had a follow-up with her surgeon, at which time she reported that they performed an internal exam and inserted a ‘medication disk’ into her vagina. The patient is noted to be mildly tachycardic as well as febrile. March 2014. She is status post (s/p) hysterectomy 2 weeks ago.

OB/GYN 78

OB/GYN Operations EMS Ultrasounds 78

EB Medicine

JULY 8, 2019

Jeff: Well that’s kind worrisome. Jeff: A 2014 study even showed an up to 80% reduction in the likelihood of developing DM2 postoperatively at the 7-year mark. Which again reiterates why this is such an important topic for us as EM clinicians to be well-versed in. While it was < 15% in 1990, by 2016 it reached 40%.

Emergency Department 40

Emergency Department Sepsis Operations Ultrasounds 40

EMDocs

DECEMBER 18, 2023

Furthermore, since the 2021 guidelines, multiple RCTs have shown that utilizing IVC respiratory variation, assessed by bedside ultrasound, as a guide to fluid resuscitation can result in less fluid administered. 1 Similarly, if a patient is at high risk for fungal infection, then empiric antifungals should be administered as well (Table 4).

Sepsis 75

Sepsis Fluid Resuscitation Resuscitation Shock 75

Taming the SRU

AUGUST 30, 2023

As the name would suggest, inflammatory markers are biological markers of, well, inflammation. Instead, they strongly advocated for the use of lung ultrasound to diagnose bacterial CAP [45]. Epub 2014 Dec 3. Epub 2014 Oct 27. Paosong S, Narongroeknawin P, Pakchotanon R, Asavatanabodee P, Chaiamnuay S. Int J Rheum Dis.

Infectious Diseases 88

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 88

Taming the SRU

MAY 5, 2023

2014, Hjortrup, Haase et al. There were similar baseline characteristics and the groups were well-matched. Respiratory failure and more severe acute kidney injury were demonstrated to be more common in patients who received higher volumes of intravenous fluid (Andrews, Muchemwa et al. 2016, Andrews, Semler et al.

Sepsis 52

Sepsis Shock Administration Resuscitation 52

Mind The Bleep

JUNE 17, 2023

Examine for capillary refill, peripheral pulses, are they warm and well perfused? The child will be well in between episodes of pain. Brott NR, 2023) The child will look otherwise well and the abdomen will be soft with only mild tenderness to palpation in the lower abdomen with no guarding. Are there crepitations? Bluman J, G.

Shock 93

Shock Wellness Emergency Department Ultrasounds 93

Mind The Bleep

JUNE 17, 2023

Examine for capillary refill, peripheral pulses, are they warm and well perfused? The child will be well in between episodes of pain. Brott NR, 2023) The child will look otherwise well and the abdomen will be soft with only mild tenderness to palpation in the lower abdomen with no guarding. Are there crepitations? Bluman J, G.

Shock 52

Shock Wellness Emergency Department Ultrasounds 52