Taming the SRU

JULY 24, 2023

THE CASE A male in his 60s presented to the emergency department for right upper quadrant abdominal pain. A bedside right upper quadrant ultrasound was performed, and the images are below. Ultrasound is the gold standard for diagnosing cholelithiasis because it is more sensitive for detecting gallstones.

Ultrasounds 78

Ultrasounds Sepsis Radiology Radiology 78

The Skeptics' Guide to EM

JULY 30, 2022

Point-of-Care Ultrasound-First for the Evaluation of Small Bowel Obstruction: National Cost Savings, Length of Stay Reduction, and Preventable Radiation Exposure. AEM July 2022 Guest Skeptic: Dr. Kirsty Challen is a Consultant in Emergency Medicine at Lancashire Teaching Hospitals. specificity with ultrasound [1].

Ultrasounds 52

Ultrasounds Operations Documentation/Coding Outcomes 52

Emergency Medicine Journal

NOVEMBER 28, 2023

Manipulation performed under ultrasound guidance has the potential to decrease the number of reduction attempts. Methods This multicentre randomised controlled trial was undertaken between December 2018 and July 2020 in the ED of four hospitals in the Netherlands.

Fractures 40

Fractures Ultrasounds Emergency Department Operations 40

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

Greater Sydney Area HEMS

FEBRUARY 20, 2024

The evidence for improved safety and quality with the use of ultrasound for CVC implementation is well established [i]. In fact, it’s use is so ubiquitous that the newer generation of emergency physicians are largely inexperienced in the insertion of central lines as a blind technique. One approach to obtaining BCV origin access (fig.1)

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Ultrasounds Shock Research Operations 98

Taming the SRU

JULY 22, 2024

INDICATIONS Arthrocentesis is a common procedure performed in the Emergency Department, in which a needle is inserted into a joint to withdraw fluid from the joint capsule. Studies have shown that effusions of as little as 2 to 4 mL can be identified using ultrasound [6]. ANESTHETIZE THE AREA step 7. Step 1: Prepare STEP 2.

Ultrasounds 96

Ultrasounds Emergency Department EMS 96

RebelEM

JANUARY 25, 2024

Background: Point-of-care ultrasound (PoCUS) is a valuable clinical tool in the assessment of acute dyspnea. In many emergency departments (ED), US machines are readily available and can be used to rapidly assess and monitor patients with acute dyspnea at the bedside. Emerg Med J. 2023;40(10):700-707.

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Ultrasounds Outcomes COPD Hospitals 130

Northwestern EM Blog

SEPTEMBER 16, 2024

For those new to the probe, we recommend first reviewing the basics in the incredible FOAMed Introduction to Bedside Ultrasound Book , 5 Minute Sono , and POCUS Atlas. The one absolute contraindication for ocular ultrasound is any suspicion for globe rupture, as placing any pressure on the globe can worsen extrusion of intraocular contents.

Ultrasounds 52

Ultrasounds Emergency Department Academics EMS 52

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) The results revealed a rate of emergency surgery of 9.8%

Ultrasounds 93

Ultrasounds Emergency Department Pediatrics Radiology 93

Taming the SRU

MAY 13, 2024

Discussion Acute appendicitis is one of the most common causes of acute abdomen that present to the Emergency Department requiring surgical intervention. [1] A clinical suspicion of stump appendicitis may be confirmed with various imaging modalities, abdominal ultrasound or CT imaging being most common. Clin Case Rep.

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Ultrasounds Emergency Department Wellness Operations 97

ALiEM

FEBRUARY 2, 2024

Laboratory Data Ultrasound reveals a 1.7 Because of the concern for malignancy, a biopsy was performed in the emergency department after the ultrasound and CT scan confirmed there was no extension into the thorax. 2018 Sep;40(9):631-641. There is no fluctuance. No other skin lesions are present. Am J Dermatopathol.

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Ultrasounds Academics Emergency Department 67

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. Emergency Department Management: Emergency ophthalmology consultation. Ophthalmology, in Marx J et al (eds): Rosens Emergency Medicine: Concepts and Practice, ed 9.

Stroke 52

Stroke Emergency Department Ultrasounds Outcomes 52

RebelEM

FEBRUARY 12, 2024

There are greater than 2 million annual emergency department visits for suspected renal colic in the US, and Ct scanning is performed for more than 90% of patients who receive a diagnosis of kidney stone. ” The Journal of Urology 199.4S (2018): e683-e684. What Your Gut Says: We need a CT report to diagnose a kidney stone.

Radiology 85

Radiology Radiology Emergency Department Ultrasounds 85

EMDocs

DECEMBER 4, 2023

Johnson, MD ( Community EM, Salina Regional Health Center) // Reviewed by: Joshua Lowe, MD (EM Attending Physician, USAF); Marina Boushra, MD (Cleveland Clinic Foundation, EM-CCM); Brit Long, MD (@long_brit) Case A 40-year-old woman presents to a rural emergency department (ED) with left leg pain and swelling for the past 5 days.

Ultrasounds 71

Ultrasounds Documentation/Coding Wellness EMS 71

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. Acad Emerg Med. US Department of Health and Human Services. Am J Roentgenol.

Pediatrics 52

Pediatrics Ultrasounds Emergency Department Poisoning 52

The Skeptics' Guide to EM

MAY 26, 2018

[display_podcast] Date: May 16th, 2018 Reference: Beltaief K et al. 2018 Guest Skeptic: Dr. Tony Seupaul is the Chairman of the Department of Emergency Medicine, University of Arkansas. display_podcast] Date: May 16th, 2018 Reference: Beltaief K et al. J Pain Res. J Pain Res.

Emergency Department 52

Emergency Department Ultrasounds 52

The Skeptics' Guide to EM

SEPTEMBER 22, 2018

[display_podcast] Date: September 17th, 2018 Reference: Meltzer, A. JAMA Internal Med, 2018. Guest Skeptics: Dr. Tony Seupaul, Professor and Chair, University of Arkansas for Medical Sciences Department of Emergency Medicine. display_podcast] Date: September 17th, 2018 Reference: Meltzer, A.

Ultrasounds 52

Ultrasounds Emergency Department 52

EMDocs

NOVEMBER 18, 2023

A point of care ultrasound of the liver reveals the following: Image 1: Ultrasound of the liver showing abnormal hepatic artery flow and resistance index 1 Question: What is the diagnosis? Emergency department visits and unanticipated readmissions after liver transplantation: A retrospective observational study.

EMS 70

EMS Ultrasounds Emergency Department Outcomes 70

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). It is most helpful to do the ultrasound immediately before needle insertion, as movement of the patient may shift cutaneous landmarks from underlying bony structures. WHY - Why Not? REFERENCES 1.

Infectious Diseases 97

Infectious Diseases Seizures Ultrasounds Sepsis 97

The Skeptics' Guide to EM

JANUARY 14, 2018

[display_podcast] Date: January 9th, 2018 Reference: Soleimanpour H et al. Effectiveness of intravenous lidocaine versus intravenous morphine for patients with renal colic in the emergency department. Dr. Rachel Littlefield is a PGY2 in Emergency Medicine at the University of […] The post SGEM#202: Lidocaine for Renal Colic?

Emergency Department 52

Emergency Department Ultrasounds Hospitals 52

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.

Ultrasounds 52

Ultrasounds Urgent Care Emergency Department Hospitals 52

EB Medicine

NOVEMBER 1, 2018

But this month’s episode is special in its own way - we’ll be tackling Electrical Injuries in the emergency department - from low and high voltage injuries to the more extreme and rare lightning related injuries. In total, they pulled references from 1966 until 2018. Jeff: Let’s move on to evaluation in the emergency department.

Emergency Department 40

Emergency Department Burns EKG/ECG Shock 40

Urgent Care Ultrasounds

JULY 17, 2019

Left PLAPS point Despite the obvious consolidation on ultrasound the CXR is clear. In all three there was clear ultrasound evidence of pneumonia. However I am becoming increasingly convinced that an answer to this question is the use of point of care lung ultrasound (LUS). 2018; 28(1):40. Ultrasound quarterly.

Urgent Care 52

Urgent Care Ultrasounds Wellness Emergency Department 52

Taming the SRU

JANUARY 10, 2024

89% agree that violence in the emergency department has harmed patient care. Additionally, ED boarding is a now a larger factor than in 2018. None of the physicians in the study believe that the rate of violence has decreased at all. It usually takes 4-6 weeks for a coronary artery to heal from dissection.

EKG/ECG 93

EKG/ECG Shock Fractures Emergency Department 93

Taming the SRU

OCTOBER 7, 2024

epidemiology of venous thromboembolism in pregnancy VTE is not only important to understand because it is the number one cause of mortality for pregnant patients, but also because it is common and will show up in your Emergency Department likely frequently throughout your career. If you feel the patient is high-risk (ie.

Ultrasounds 63

Ultrasounds CDC Research Stroke 63

EB Medicine

SEPTEMBER 1, 2018

Jeff: Welcome back to Emplify, the podcast corollary to EB Medicine’s Emergency Medicine Practice. I’m Jeff Nusbaum, and I’m back with my co-host, Nachi Gupta and we’ll be taking you through the September 2018 issue of Emergency Medicine Practice - Emergency Department Management of North American Snake envenomations.

Emergency Department 40

Emergency Department Poisoning Anaphylaxis Allergic Reactions 40

Don't Forget the Bubbles

NOVEMBER 20, 2023

Neck lumps are a common presenting complaint to the paediatric emergency department with many aetiologies, sometimes resulting in a diagnostic conundrum. These may require surgical drainage following confirmation on ultrasound scan. Thorough history taking and detailed examination can aid in diagnosis. Dermatopathology.

Pediatrics 123

Pediatrics Documentation/Coding Emergency Department Hospitals 123

Taming the SRU

OCTOBER 28, 2024

When should I get a consultant involved in the emergency department? Dr Goel is an Adjunct Assistant Professor in Emergency Medicine at the University of Cincinnati and an Assistant Editor of TamingtheSRU. She is a graduate from the UC EM residency, class of 2018. West J Emerg Med. References 1.

COPD 78

COPD Pediatrics Emergency Department Ultrasounds 78

EMDocs

JANUARY 16, 2024

Louis) // Reviewed by: Alex Koyfman, MD (@EMHighAK); Brit Long, MD (@long_brit) Case You are working in the trauma/critical care pod of your emergency department (ED). You receive a page for a cardiac arrest and take report from emergency medical services (EMS). Resuscitation 2018. Am J Emerg Med. N Engl J Med.

Hyperthermia / Hypothermia 85

Hyperthermia / Hypothermia Resuscitation CPR EMS 85

Taming the SRU

MAY 5, 2023

doi:10.1056/NEJMoa2212663 BACKGROUND Sepsis, including severe sepsis and septic shock, is a frequently encountered condition in the emergency department and carries a high mortality rate. 2018, Kuttab, Lykins et al. Sixty centers participated during the years 2018-2022. N Engl J Med. 2023;388(6):499-510. N Engl J Med.

Sepsis 52

Sepsis Shock Administration Resuscitation 52

The Skeptics' Guide to EM

FEBRUARY 2, 2018

[display_podcast] Date: January 31st, 2018 Reference: Frohlich LC, et al. Guest Skeptic: Dr. Melissa Langhan is an Associate Professor of Pediatric Emergency Medicine at Yale University in New Haven, CT. display_podcast] Date: January 31st, 2018 Reference: Frohlich LC, et al. AEM Dec 2017. AEM Dec 2017. Time is testis.

Pediatrics 40

Pediatrics Ultrasounds Emergency Department Research 40

Taming the SRU

AUGUST 30, 2023

While PCT may be more specific for bacterial infections, it is flawed by still being rather non-specific and is not validated as a stand-alone diagnostic criteria for infection in the setting of the emergency department. Instead, they strongly advocated for the use of lung ultrasound to diagnose bacterial CAP [45]. ng/mL, 0.25-0.5

Infectious Diseases 88

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

EB Medicine

AUGUST 6, 2019

But next we should talk about ultrasound. Nachi: Next up is recombinant coagulation factor Xa (brand name Andexxa), which was approved in 2018 for the FXa inhibitors. Jeff: Interestingly, though only a small retrospective study of 156 patients, one study found markedly reduced mortality, 4.9%

Emergency Department 40

Emergency Department Stroke Wellness Outcomes 40

Don't Forget the Bubbles

AUGUST 28, 2023

Ultrasound can be used to identify any large pleural effusions. Five-year-old Ginny presents to the Emergency Department with a syncopal episode. doi:10.1136/archdischild-2018-315269 Hammer MM, Miskin N, Madan R, Hunsaker AR. Although CT is the gold standard imaging modality, the child may be too unstable. RadioGraphics.

Pediatrics 97

Pediatrics Research Emergency Department Ultrasounds 97

Don't Forget the Bubbles

NOVEMBER 1, 2023

This month, Bubble Wrap has teamed up with Sheffield Children’s Hospital Emergency Department to have a look at what’s new in paediatric literature. Lactate as a screening tool for critical illness in a pediatric emergency department. Pediatric Emergency Care. 2023 Oct 1;39(10):735-8. What’s it about?

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Emergency Department Hospitals Resuscitation Administration 140

EMDocs

MAY 11, 2024

Semin Ultrasound CT MR. 2013 Apr;34(2):131-41. Available from: [link] American College of Emergency Physicians Clinical Policies Subcommittee (Writing Committee) on Use of Intravenous tPA for Ischemic Stroke:; Brown MD, Burton JH, Nazarian DJ, Promes SB. Ann Emerg Med. Erratum in: Ann Emerg Med. doi: 10.1053/j.sult.2013.01.004.

Stroke 89

Stroke EMS EKG/ECG Radiology 89

Dr. Smith's ECG Blog

JANUARY 15, 2024

Colin is an emergency medicine resident beginning his critical care fellowship in the summer with a strong interest in the role of ECG in critical care and OMI. A patient in their 40s with type 1 diabetes mellitus and hyperlipidemia presented to the emergency department with 5 days of “flu-like” illness. Edits by Willy Frick.

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EKG/ECG Wellness Point-of-Care Testing Shock 64