The Trauma Pro

OCTOBER 25, 2024

Authors from several well-known trauma centers collaborated to re-analyze data from the CLOTT study. Here are the factoids: The original data were derived from a 17-center study conducted from 2018-2020; this study only included 1,387 patients who had pelvic fractures (as well as other injuries).

Fractures 147

Fractures Head Injuries Operations Ultrasounds 147

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 Operations 98

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

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 130

Ultrasounds Outcomes COPD Hospitals 130

Mount Sinai EM

OCTOBER 11, 2024

2018 , compared a random sampling of patients from 12 Southern California Kaiser centers which adopted a PTA algorithm of medical management and ENT follow up the next day, with subsequent I+D if needed vs patients from seven centers in the same system that opted for initial surgical drainage. in the medical cohort and 6.2%

Ultrasounds 100

Ultrasounds Wellness Outcomes Hospitals 100

Taming the SRU

MAY 13, 2024

The patient is a well-appearing male who is awake, alert, and oriented. There is also a well-appearing, healed surgical scar. There is also a well-appearing, healed surgical scar. The skin is warm and well perfused with brisk capillary refill. World J Emerg Surg 13, 22 (2018). Notable diagnostics CBC : WBC 19.2,

Ultrasounds 97

Ultrasounds Emergency Department Wellness Operations 97

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

Taming the SRU

APRIL 14, 2024

You may place cold packs or ice packs to the hernia site to help reduce inflammation and swelling, as well as to assist in local analgesia. Symptoms include persistent tenderness in the area, as well as symptoms of obstruction including nausea, vomiting, and pain, despite reduction. (2) 1) In a study performed by Chen et al.

Ultrasounds 92

Ultrasounds Emergency Department Pediatrics Radiology 92

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 70

Ultrasounds Documentation/Coding Wellness EMS 70

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 125

Shock Stroke Operations Ultrasounds 125

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

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 96

Infectious Diseases Seizures Ultrasounds Sepsis 96

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

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

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. 2018 Jul;48(3):247-250. Epub 2018 Apr 6. What’s the Diagnosis? Lymphoma D.

Pediatrics 52

Pediatrics Ultrasounds 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 85

Radiology Radiology Emergency Department Ultrasounds 85

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

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

Pediatric Education

NOVEMBER 10, 2024

Per the parents through an interpreter the baby was doing well. Consequently in addition to the routine testing that occurs with this type of delivery, it was decided to also include TORCH titers, an eye examination and head ultrasound for a potential congenital infection especially toxoplasmosis; all of which were normal.

Infectious Diseases 40

Infectious Diseases Pediatrics Seizures Resuscitation 40

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

RebelEM

JUNE 26, 2023

4F-PCC contains factors II, VII, IX, X as well as Proteins S and C. J Trauma Acute Care Surg 2018. Some clinicians have advocated for early administration of 4-factor prothrombin complex concentrate (4F-PCC) based on limited observational data. High-quality studies are needed to determine the utility of this intervention.

Administration 145

Administration Outcomes Resuscitation Radiology 145

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

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 96

EKG/ECG Stroke Administration Wellness 96

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 64

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

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 97

Pediatrics Research Emergency Department Ultrasounds 97

Taming the SRU

OCTOBER 28, 2024

If their injury was from trauma, it would not be unreasonable to initiate trauma consult within the emergency visit, but also if the injury is isolated and the patient is well appearing, they could also follow up closely with the trauma clinic. She is a graduate from the UC EM residency, class of 2018. References 1. West J Emerg Med.

COPD 78

COPD Pediatrics Emergency Department Ultrasounds 78

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

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

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

Don't Forget the Bubbles

OCTOBER 14, 2024

The government recognizes they cannot return to their country of origin owing to a well-founded fear of being persecuted for the reasons provided for in the United Nations Refugee Convention or European Convention on Human Rights (such as persecution due to race, sexuality, political opinions, or religion).

Documentation/Coding 59

Documentation/Coding Hospitals Wellness Operations 59

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

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 76

Fractures Dislocations Operations Radiology 76

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]. 2018 Aug 1;10(8):a028456. Epub 2018 Oct 19. PCT thresholds for guiding antibiotic therapy have been established to be < 0.1

Infectious Diseases 87

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 87

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 82

Shock EKG/ECG Academics Stroke 82

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 136

EKG/ECG Shock Documentation/Coding Academics 136