Taming the SRU

FEBRUARY 5, 2024

The LP is now a standard procedure and in 2010 well over 135,000 LPs were performed in Emergency Departments throughout the US (3). As may be seen in the table below, there are several themes as well a range of stringency. This resource offers additional information on ultrasound assisted LP’s. WHO - Who Needs an LP in the ED?

Infectious Diseases 97

Infectious Diseases Seizures Ultrasounds Sepsis 97

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

Mount Sinai EM

OCTOBER 11, 2024

2016 performed a Cochrane systematic review and meta-analysis of 11 studies (614 patients) that compared needle aspiration with incision and drainage. Hennepin Ultrasound has a blog post on how to perform this both statically and dynamically–visualizing the needle as it aspirates the PTA. And there you have it!

Ultrasounds 100

Ultrasounds Wellness Outcomes Hospitals 100

RebelEM

APRIL 29, 2024

CVC vs PIV The critically ill patient is often associated with pathology that makes IV access difficult such as shock state, hypovolemia, obesity, IV drug abuse, end-stage renal disease, cardiac arrest, as well as other conditions. 2016 PMID:27075364 13 Astasio-Picado Á et al. minutes compared to a mean placement time of 10.7

Resuscitation 105

Resuscitation Administration Emergency Department Ultrasounds 105

ALiEM

MAY 19, 2023

A heavy alcohol drinker, who is well known to your Emergency Department, presents with altered mental status, except that he looks different this time. Additional trick: If the x-ray is delayed, you can pre-check with ultrasound [7]. PulmCrit Wee: Ultrasound-guided blakemore tube placement. Published May 4, 2016.

Emergency Department 98

Emergency Department Ultrasounds Wellness EMS 98

Don't Forget the Bubbles

JANUARY 17, 2024

Forrester reported data from the Texas Poison Centers surrounding 110 cases of superabsorbent polymer bead ingestions between 2011 and 2016. Abdominal ultrasound, used in 34 cases, was able to visualize a rounded intraluminal image corresponding to a bead in 28 patients. Children will swallow almost anything. J Pediatr Surg Case Rep.

Pediatrics 111

Pediatrics Poisoning Ultrasounds Dehydration 111

Taming the SRU

JUNE 24, 2024

Conduction Abnormalities AV blocks, which can also be seen in patients with MI, may require pacing as well, due to ischemia affecting the electrical pathways of the heart. Bektas, Firat, and Secgin Soyuncu. The efficacy of transcutaneous cardiac pacing in ED.” The American Journal of Emergency Medicine , vol. Circulation , vol.

Advances Cardiac Life Support (ACLS) 90

Advances Cardiac Life Support (ACLS) CPR Burns Resuscitation 90

ACEP Now

FEBRUARY 13, 2024

See below: Fascia iliaca Serratus anterior Erector spinae The risks of opioid medications, especially in the elderly, has been well described. published a study, “Safety and Pain Reduction in Emergency Practitioner Ultrasound-Guided Nerve Blocks: A One-Year Retrospective Study.” 2016 May;31(5):478-85. mean) to 2.8 Goodwin J.

Ultrasounds 52

Ultrasounds Emergency Department Hospitals Wellness 52

Don't Forget the Bubbles

JANUARY 31, 2024

Edelman J, Taylor H, Goss A, et al Point-of-care ultrasound as a diagnostic tool in respiratory assessment in awake paediatric patients: a comparative study Archives of Disease in Childhood Published Online First: 14 December 2023 What’s it about? All of which leads to easier image acquisition. Accredited trainers are currently lacking.

Hospitals 72

Hospitals Ultrasounds Emergency Department Pediatrics 72

RebelEM

AUGUST 31, 2023

CVC placement under ultrasound guidance has decreased overall complication rates and there is increased awareness of transfusion reactions, alloimmunization, acute lung injury, circulatory overload, as well as infection. Despite being common practice, the necessity of routine prophylactic transfusions is now being called into question.

Ultrasounds 58

Ultrasounds Outcomes Wellness Research 58

Dr. Smith's ECG Blog

DECEMBER 19, 2023

Two thirds of MINOCA cases are due to atherosclerotic causes One way to prove the diagnosis in this case would have been with intravascular imaging such as optical coherence tomography (OCT) or intravascular ultrasound (IVUS). The patient did well afterward without any recurrence of symptoms. Fortunately, that is exactly what happened.

EKG/ECG 127

EKG/ECG EMS Wellness Operations 127

Taming the SRU

FEBRUARY 24, 2024

Providers should use ultrasound as early as possible to evaluate for cardiac dysfunction, pulmonary edema, and fluid status. Patients will typically present in acute respiratory distress. They tend to be hypertensive, tachycardic, tachypneic, and hypoxic. Do not always appear volume overloaded on exam.

Leadership 94

Leadership EMS Pediatrics Stroke 94

Pediatric Emergency Playbook

AUGUST 1, 2017

2016; 13:590-600. Eur J Pediatr Surg 2016; 26:192. Hypertrophic pyloric stenosis: tips and tricks for ultrasound diagnosis. Necrotizing Enterocolitis. N Eng J Med. 2011; 364(3):255-264. Niño DF et al. Necrotizing enterocolitis: new insights into pathogenesis and mechanisms. Walsh MC et al. Pediatr Rev. 1988; 9(7):219-226.

Pediatrics 52

Pediatrics Ultrasounds Resuscitation Sepsis 52

Urgent Care Ultrasounds

MAY 15, 2018

The importance of patient positioning, probe position and patience, for the detection of small pneumothoraces Ultrasound to rule out a pneumothorax is easy! Well, maybe. If you are using ultrasound in the primary care setting as a rule out test, you really don’t want to miss any pneumothorax, however small.

Ultrasounds 40

Ultrasounds Academics Fractures Wellness 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. Accessed 2/29/2016.

Emergency Nursing 40

Emergency Nursing EMS Resuscitation Military 40

SheMD

APRIL 24, 2023

There is NO BEST TIME, but this article discusses some of the risks of #physicianinfertility as well as highlighting the utility of egg freezing to preserve fertility for women in medicine (or any career). They will take a detailed history, do a physician exam, and perform a transvaginal ultrasound. Oct 2016; 25 (10): 1059-1065.

Ultrasounds 52

Ultrasounds Outcomes Wellness 52

Taming the SRU

OCTOBER 1, 2023

This topic is additionally complicated by the development of multiple diagnostic tools now available for diagnosis as well as variable sizing algorithms used around the world. Trends in the Incidence and Recurrence of Inpatient-Treated Spontaneous Pneumothorax, 1968-2016. The "lung point": an ultrasound sign specific to pneumothorax.

Fractures 96

Fractures COPD Hospitals Emergency Department 96

The Skeptics' Guide to EM

MAY 11, 2019

His practice is in trauma, emergency general surgery, and critical care with an academic interest in ultrasound and medical simulation. His practice is in trauma, emergency general surgery, and critical care with an academic interest in ultrasound and medical simulation. first appeared on The Skeptics Guide to Emergency Medicine.

Documentation/Coding 40

Documentation/Coding Operations Academics Ultrasounds 40

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. 2016 May 14. 2016 Apr;35(4):363-8. Factors that are predictive of a definite infiltrate are: significant hypoxia ( 39°C). pii: S0022-3476(16)30170-6. Pediatr Infect Dis J.

Pediatrics 40

Pediatrics Emergency Department Hospitals Wellness 40

PEMBlog

SEPTEMBER 24, 2024

Further evaluation with computed tomography (CT) chest was obtained with representative cuts shown and a 3D reconstruction shown as well. With improved access to prenatal care and ultrasounds, CLMs are commonly detected prenatally. doi: 10.1128/microbiolspec.TNMI7-0032-2016. What’s the Diagnosis? Aspirated foreign body B.

Pediatrics 52

Pediatrics Ultrasounds Hospitals Wellness 52

Advanced Medical Reviews

MAY 15, 2018

VR’s possible applications in healthcare, particularly in WC, extend well beyond these improved visuals. Implemented well, VR could reduce expensive trips to clinics and hospitals and also deliver results that help payers understand the utility of specific telehealth and home care treatments in WC. billion market by 2020.

Telemedicine 45

Telemedicine Hospitals Operations Ultrasounds 45

Advanced Emergency Nursing from AENJ

NOVEMBER 24, 2016

While Point of Care Ultrasound has made limited entry in prehospital care, largely with physician-led services and some Advanced Paramedics; it has largely been as a proof of concept rather than everyday care. How useful these would have been to let us know how well the patient was oxygenating and ventilating!

Emergency Nursing 40

Emergency Nursing Seizures CPR Wellness 40

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

EB Medicine

JULY 8, 2019

Jeff: Well that’s kind worrisome. While it was < 15% in 1990, by 2016 it reached 40%. Which again reiterates why this is such an important topic for us as EM clinicians to be well-versed in. Vitamin D, B12, Calcium, foate, iron, and thiamine deficiencies are all well documented complications. million adults!!

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 40

Taming the SRU

MAY 5, 2023

2016, Andrews, Semler et al. There were similar baseline characteristics and the groups were well-matched. Perner (2016). 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. 2014, Hjortrup, Haase et al.

Sepsis 52

Sepsis Shock Administration Resuscitation 52

Dr. Smith's ECG Blog

JUNE 2, 2023

She was awake, alert, well perfused, with normal mental status and overall unremarkable physical exam except for a regular tachycardia, possible rales at both bases, some mild RUQ abdominal tenderness. They are best seen in leads V1,V2 — and a bit less well seen in V3,V4. In contrast — a broader passband ( typically from 0.05

EKG/ECG 96

EKG/ECG Wellness Ultrasounds EMS 96

EB Medicine

JUNE 6, 2019

CT is good but you really should learn ultrasound, and lastly, sick patients need prompt consultation and resuscitation, not rapid trips to radiology. Nachi: For more information on HIV and its management, check out the February 2016 issue of Emergency Medicine Practice , which covered this and more in depth. Jeff: Indeed.

Ultrasounds 40

Ultrasounds Radiology Radiology Sepsis 40

Pediatric Emergency Playbook

DECEMBER 1, 2015

Victims of electrical injuries present either in extremis or as the seeming well patient with insidious, developing disease. Most patients do well, and the burn heals by secondary intention. Ultrasound can be used to troubleshoot when needed. Household or Industrial electricity? The eschar will slough off in 1 to 2 weeks.

Burns 40

Burns Emergency Department EKG/ECG Shock 40

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]. 2016 Dec;115(6):317-21. 2016 Aug 23;134(8):e113. Bray C, Bell LN, Liang H, Haykal R, Kaiksow F, Mazza JJ, Yale SH. PMID: 29094869.

Infectious Diseases 89

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

Dr. Smith's ECG Blog

OCTOBER 24, 2019

Many of these issues were described in a prior post by Dr. Angie Lobo ( @aloboMD ) (For open-access reviews of this literature, see Saw 2016 , Saw 2017 , or Hayes 2018.) Often, intravascular ultrasound or intravascular optical coherence tomography is requeried to make the diagnosis. A study by Hassan et al. Lobo et al.

EKG/ECG 52

EKG/ECG Shock Ultrasounds Wellness 52

Mind The Bleep

FEBRUARY 29, 2024

This may well seem daunting given how unwell and complex the patients might be but a thorough, well-structured A-E will give you most of the information you need to progress that patient’s care. 2016) Oxford Handbook of Anaesthesia. Hb drop, with bloodstaining of the CSF from their EVD and a difficult-to-manage ICP? Allman, K.G.

Documentation/Coding 52

Documentation/Coding Hospitals Wellness Best Practices 52

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

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. Jeff: And the etiology of CHS is not well understood. Similarly, the exact criteria for CHS are poorly defined.

Seizures 40

Seizures Hyperthermia / Hypothermia Administration Dehydration 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 91

Sepsis Fluid Resuscitation Resuscitation Shock 91

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

Dr. Smith's ECG Blog

APRIL 8, 2015

Check : [vitals, SOB, Chest Pain, Ultrasound] If the patient has Abdominal Pain, Chest Pain, Dyspnea or Hypoxemia, Headache, Hypotension , then these should be considered the primary chief complaint (not syncope). Aortic Dissection, Valvular (especially Aortic Stenosis), Tamponade. Vasovagal syncope is generally benign. orthostatic vitals b.

Emergency Department 52

Emergency Department EKG/ECG Outcomes Seizures 52

EMDocs

JANUARY 6, 2024

A bedside cardiac ultrasound is performed which shows biventricular failure with a dilated inferior vena cava. Answer : Cardiac Transplant Complications Epidemiology: There were over 3,000 heart transplants in North America in 2016. What is most likely the cause for his symptoms?

EMS 89

EMS Infectious Diseases Shock Emergency Department 89