EMDocs

DECEMBER 4, 2023

The facility does not have ultrasound (US) availability at the time of the patient’s presentation, as the sonographer comes to the hospital only 2 days a week. First, examine the patient and risk-stratify them for the diagnosis of DVT before deciding on the clinical utility of an ultrasound. What findings make a DVT more likely?

Ultrasounds 71

Ultrasounds Documentation/Coding Wellness EMS 71

ACEP Now

SEPTEMBER 5, 2024

What Is the Sensitivity of Ultrasound for Detecting Volvulus in Infants When Compared to An Upper GI Study? But what about ultrasound? In cases where the clinical suspicion is lower for a midgut volvulus, but you feel it still needs to be explored, can ultrasound help? Not all studies included all of these ultrasound signs.

Ultrasounds 52

Ultrasounds Wellness Pediatrics Poisoning 52

PulmCCM

APRIL 1, 2024

That could (and should) change if improved functional outcomes, persisting for months after hospital discharge, are ever confirmed in large, well-conducted trials. ” But less than half of the included studies used ultrasound guidance during central line placements.

Ultrasounds 40

Ultrasounds Operations Outcomes Research 40

Urgent Care Ultrasounds

JULY 17, 2019

On examination she appeared well, t = 38.0. She had had a cough for the past month but has been otherwise well. She appeared well. Left PLAPS point Despite the obvious consolidation on ultrasound the CXR is clear. In all three there was clear ultrasound evidence of pneumonia.

Urgent Care 52

Urgent Care Ultrasounds Wellness Emergency Department 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 Emergency Department Radiology 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). 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 95

Infectious Diseases Seizures Ultrasounds Sepsis 95

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. Ital J Pediatr 44 , 25 (2018).

Ultrasounds 98

Ultrasounds Pediatrics Wellness 98

PulmCCM

JUNE 26, 2023

After the 2018 MIND-USA trial found neither haloperidol nor ziprasidone reduced delirium in the ICU, critical care guidelines advised against their wide use. Cervical and pancreatic cancer patients often do as well with less invasive surgery, and some patients with rectal cancer or Hodgkin lymphoma can safely get less radiation.

Outcomes 98

Outcomes Ultrasounds Hospitals Wellness 98

Urgent Care Ultrasounds

APRIL 17, 2019

On examination she appeared well. Suspecting pneumonia, an ultrasound examination began over the site of the crackles at the left posterio-lateral chest. Disposition An initial clinical suspicion of pneumonia was replaced by the ultrasound diagnosis of pleural and pericardial effusions. Polyserositis: a diagnostic challenge.

Ultrasounds 52

Ultrasounds Urgent Care Hospitals Wellness 52

RebelEM

FEBRUARY 12, 2024

Research from our very own SIUH department of radiology recommended that contrast-enhanced CT scans can safely exclude obstructive urolithiasis just as well as noncontrast CTs. ” The Journal of Urology 199.4S (2018): e683-e684. When you are using CT imaging, a CT with IV contrast is preferred.

Radiology 69

Radiology Radiology Emergency Department Ultrasounds 69

Emergency Medicine Ireland

DECEMBER 17, 2020

And this seems to work exceptionally well. I suppose this is somewhat similar to ultrasound for CVCs as plenty of people seem to cope perfectly well without it * no good data to guide a solid recommendation as yet. 2018 Mar;7(2):255-260. Surgical anatomy of the trachea. Ann Cardiothorac Surg. doi: 10.21037/acs.2018.03.01.

Ultrasounds 40

Ultrasounds Documentation/Coding Wellness 40

The Skeptics' Guide to EM

MAY 11, 2019

JAMA Surgery 2018 Guest Skeptic: Dr. Robert Leeper is an assistant professor of surgery at Western University and the London Health Sciences Centre. His practice is in trauma, emergency general surgery, and critical care with an academic interest in ultrasound and medical simulation. Reference: Sceats et al.

Documentation/Coding 52

Documentation/Coding Operations Academics Ultrasounds 52

Dr. Smith's ECG Blog

JANUARY 15, 2024

A bedside ultrasound should be done to assess volume and other etiologies of tachycardia, but if no cause of type 2 MI is found, the cath lab should be activated NOW. While awaiting transfer to the cath lab, STAT echocardiogram was performed and showed LVEF 30-35%, as well as anterior, inferior, and apical hypokinesis, and apical thrombus.

EKG/ECG 67

EKG/ECG Wellness Point-of-Care Testing Shock 67

Don't Forget the Bubbles

DECEMBER 25, 2023

In the BUCKLED trial that looked at whether ultrasound was non-inferior to X-ray in diagnosing forearm fractures, the primary outcome was physical function of the affected arm at four weeks. How well a patient can use their arm matters greatly to the patient! doi:10.1136/bmjebm-2018-110891 Perkins GD, Ji C, Deakin CD, et al.

Research 83

Research Outcomes Fractures Hospitals 83

Don't Forget the Bubbles

AUGUST 28, 2023

Ultrasound can be used to identify any large pleural effusions. Management must be multidisciplinary involving anaesthetics, paediatric retrieval service/paediatric intensive care, ENT and oncology teams (as well as the cardiothoracic surgery team – not always available). The median age at diagnosis was 47 months (range 1-173 months).

Pediatrics 96

Pediatrics Research Emergency Department Wellness 96

Taming the SRU

MAY 5, 2023

2018, Kuttab, Lykins et al. Sixty centers participated during the years 2018-2022. There were similar baseline characteristics and the groups were well-matched. 2019, Evans, Rhodes et al. 2021, Im, Kang et al. vs 33.2%; OR, 0.42; 95% CI 0.32-0.55; 0.55; P < 0.0001) (Malbrain, Marik et al. N Engl J Med. 2023;388(6):499-510.

Sepsis 52

Sepsis Shock Administration Resuscitation 52

The Skeptics' Guide to EM

JULY 31, 2021

Background: The latest ATLS guidelines were published in 2018. Needle thoracostomy is subject to several complications compared to a tube thoracostomy primarily due to the shorter length of the needle as well as the smaller lumen, so site selection has focused on finding a short distance and a site unlikely to kink or get dislodged.

Military 52

Military Ultrasounds EMS Wellness 52

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

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]. Most frequent reasons for emergency department visits, 2018. 12): e0244291.

Fractures 75

Fractures Dislocations Operations Radiology 75

Dr. Smith's ECG Blog

MAY 30, 2023

Case continued A bedside ultrasound showed diminished LV EF and of course bradycardia. The RV is supplied during systole as well as diastole. For review — GO TO: The June 4, 2018 post ( LA-LL reversal ). The July 29, 2018 post ( LA-RA reversal ). The November 4, 2018 post ( Leads V1,V2 misplacement ).

Shock 81

Shock EKG/ECG Academics Stroke 81

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]. How can this situation be rectified or has the use of ultrasound rendered this blind subclavian “trauma line” a thing of the past? One approach to obtaining BCV origin access (fig.1) 2020;35(3):303-321.

Ultrasounds 98

Ultrasounds Shock Research Emergency Department 98

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: Diagnosis of appendicitis, in a pregnant patient, ultrasound vs. mri. Which is reasonable, as that is the crux of our job as emergency physicians. Jeff: Indeed. Sounds familiar.

Ultrasounds 40

Ultrasounds Radiology Radiology Sepsis 40

Dr. Smith's ECG Blog

SEPTEMBER 19, 2023

A b rief chart review revealed his most recent echo in 2018, with LV EF 67%, “very small” inferior wall motion abnormality. Pads were placed with ultrasound guidance, so they were in the correct position. Over past 3 months, he has had similar intermittent episodes of sharp chest pain while running, but none at rest. What to do now?

EKG/ECG 138

EKG/ECG Shock Documentation/Coding Academics 138

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

Can J of Cardiol 2018, 34: 132-145 Here are some other cases: LVH, LBBB, RBBB, and RVH may manifest ST depression without any ischemia! Methods STEMI activations between January 2014 and April 2018 at the University of Arizona Medical Center were identified. A emergent cardiology consult can be helpful for equivocal cases.

EKG/ECG 52

EKG/ECG Shock Sepsis Emergency Department 52

Pediatric EM Morsels

AUGUST 4, 2023

Ganss, 2018) There are additional associations with scoliosis, burn injuries, and spinal cord injuries. (Oka, Oka, 2023) Abdominal ultrasound with doppler can also be used to measure the angle, and with a trained ultra-sonographer was found to be as sensitive as CTA. (Oka, 2023) Female to male predominance with a ratio of 3:2.

Pediatrics 246

Pediatrics Burns Operations Ultrasounds 246

Dr. Smith's ECG Blog

MARCH 15, 2023

But when you see this, you should suspect that the AV node is not well. Her bedside cardiac ultrasound was normal We decided to cardiovert her since the time of onset was very recent. For more on SSS — See My Comment at the bottom of the page in the July 5, 2018 post in Dr. Smith’s ECG Blog.

EKG/ECG 52

EKG/ECG Dehydration Stroke Wellness 52

Dr. Smith's ECG Blog

JUNE 20, 2018

A 40 something woman with a history of hyperlipidemia and additional risk factors including a smoking history presented with substernal chest pain radiating to "both axilla" as well as the upper back. Journal of Electrocardiology 2018. She was reportedly "pacing in her room while holding her chest". 0 0 1 24 140 MMRF 1 1 163 14.0

EKG/ECG 52

EKG/ECG Documentation/Coding Wellness Ultrasounds 52

RebelEM

JANUARY 25, 2024

Background: Point-of-care ultrasound (PoCUS) is a valuable clinical tool in the assessment of acute dyspnea. Impact of serial cardiopulmonary point-of-care ultrasound exams in patients with acute dyspnoea: a randomized, controlled trial. PoCUS evaluations included lung ultrasound (LUS) and focused cardiac ultrasound (FoCUS).

Ultrasounds 122

Ultrasounds Outcomes COPD Hospitals 122

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 52

EKG/ECG Ultrasounds Wellness 52

Sensible Medicine

JUNE 17, 2024

Europeans do PFA ablation in well under an hour. Proponents wrote back in 2018 that longer-term safety studies are needed that specifically assess…”cerebral microemboli assessed by magnetic resonance imaging.” Fortunately, we now know about the complication, and have active avoidance measures.

Shock 126

Shock Stroke Operations Ultrasounds 126

EB Medicine

AUGUST 1, 2018

I’m Jeff Nusbaum, and I’m back with my co-host, Nachi Gupta and we’ll be taking you through the August 2018 issue of Emergency Medicine Practice. 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.

Seizures 40

Seizures Hyperthermia / Hypothermia Administration Dehydration 40

All Ohio EM

JANUARY 14, 2019

Well, several reasons. Remember, ultrasound can help you identify the thyroid and cricoid cartilage, ideally enabling you to better identify the membrane connecting the two. You have identified the cricothyroid membrane and prepped the neck, as well as your equipment. So many questions, so let’s keep this as simple as possible.

Pediatrics 52

Pediatrics EMS Fractures Wellness 52

Dr. Smith's ECG Blog

SEPTEMBER 29, 2018

His ED cardiac ultrasound (which is not at all ideal for detecting wall motion abnormalities, and is also very operator dependent for this finding) was significant for depressed global EF. Overall voltage is decreased as well. The patient's initial troponin I was 2.0 ng/mL (99% reference level = 0.030 ng/mL. THANK YOU Dr. Lee!

EKG/ECG 52

EKG/ECG Wellness Operations Ultrasounds 52

Dr. Smith's ECG Blog

FEBRUARY 6, 2020

ALL TROPS WERE UNDETECTABLE A formal ultrasound was done: Normal estimated left ventricular ejection fraction at rest. N OTE : I am not well versed in the technicalities of such prehospital ECG recordings — so if ANYONE reading this post has expertise and insight on this subject — PLEASE write us a Comment!

EKG/ECG 52

EKG/ECG Wellness Ultrasounds 52

Dr. Smith's ECG Blog

JULY 5, 2024

That would likely slow the ventricular rate as well, but would have a higher likilihood of converting to sinus. A formal ultrasound later showed reasonably good LV function, and so he later received carvedilol and diltiazem, Unfortunately, those led to hypotension at 80/40 with a HR 40. Therefore, digoxin is a good choice.

EKG/ECG 98

EKG/ECG Stroke Administration Wellness 98

EB Medicine

SEPTEMBER 1, 2018

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. Nachi: Recurrent and late onset coagulopathy after FabAV treatment has also been well described.

Emergency Department 40

Emergency Department Poisoning Anaphylaxis Allergic Reactions 40

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. Published February 2018. Is there a correlation? Cooperative study of Sickle cell disease.

Pediatrics 52

Pediatrics Ultrasounds Emergency Department Poisoning 52