ACEP Now

MAY 10, 2024

While waiting for laboratory investigations, including troponin and d-dimer, you wonder if a quick point-of-care ultrasound (POCUS) examination looking for three sonographic findings could help determine the likelihood of this being an AoD. They received a four-hour introductory course taught by emergency ultrasound faculty.

Ultrasounds 52

Ultrasounds Outcomes Academics Documentation/Coding 52

RebelEM

JUNE 26, 2023

Interventions such as early application of hemorrhage control, tranexamic acid, reduction of crystalloid fluid administration and balanced ratio blood product transfusion have improved many patients’ outcomes. However, mortality still remains high due to trauma-induced coagulopathy. Severe acute traumatic coagulopathy = PT >1.5

Administration 145

Administration Outcomes Resuscitation Radiology 145

Emergency Medicine Journal

SEPTEMBER 27, 2023

Background Serial point-of-care ultrasound (PoCUS) can potentially improve acute patient care through treatment adjusted to the dynamic ultrasound findings. Methods This was a randomised, controlled, blinded-outcome trial conducted in three EDs in Denmark between 9 October 2019 and 26 May 2021.

Ultrasounds 52

Ultrasounds Outcomes 52

The Trauma Pro

OCTOBER 4, 2024

Clinical outcomes assessed at 60 days included an unplanned return to the emergency department (ED), re-admission, complications, and development of new bleeding confirmed by surgery, ultrasound, or computed tomography (CT) at 60 days post-injury. J Ped Surg 54:335-339, 2019. ” This means they probably did not.

Pediatrics 113

Pediatrics Operations Emergency Department Outcomes 113

Taming the SRU

NOVEMBER 3, 2023

Ultrasound‐Guided Serratus Anterior Plane Block (SAPB) Improves Pain Control in Patients With Rib Fractures. Ultrasound Med. The primary outcome in this study was a change in pain score at rest 60 minutes after block. 41, 2695–2701 (2022).

Fractures 98

Fractures Ultrasounds Research Outcomes 98

RebelEM

FEBRUARY 19, 2024

of cases) Catheter ultrasound confirmation: 49.8% (i.e. Not met in 16.7% of cases) Catheter location: 66.5% (i.e. Not met in 33.5% Not met in 50.2% of cases) Appropriate vasopressor dose: 84.3% (i.e. Not met in 15.7% No Extravasation Event vs Extravasation Event Age: 63 vs 67 years BMI: 28.3 All Catheter Criteria Met: 44.3%

Administration 137

Administration Sepsis EMS Shock 137

EMDocs

AUGUST 8, 2023

Bimodal age of distribution: at birth and 12-18 years 14% of cases occur in adults; older patients have worse outcomes Bell clapper deformity – bilateral in 80% of patients Prior episode of torsion Family history Trauma (can be minor) Clinical Presentation: Sudden/severe testicular pain Often unilateral, may radiate.

Ultrasounds 94

Ultrasounds Documentation/Coding Outcomes Emergency Department 94

The Skeptics' Guide to EM

NOVEMBER 23, 2019

Date: November 21st, 2019 Reference: Daley et al. Increased Sensitivity of Focused Cardiac Ultrasound for Pulmonary Embolism in Emergency Department Patients With Abnormal Vital Signs. AEM November 2019 Guest Skeptic: Dr. Corey Heitz is an emergency physician in Roanoke, Virginia. Reference: Daley et al.

Ultrasounds 52

Ultrasounds Emergency Department Academics Outcomes 52

Emergency Medicine Journal

NOVEMBER 28, 2023

Point-of-care ultrasound has been used to guide ED manipulations but its effect on the quality of fracture reduction or subsequent need for surgical fixation is unknown. This study aims to assess the feasibility of conducting a definitive randomised controlled trial to assess the use of ultrasound to guide these fracture manipulations.

Fractures 40

Fractures Ultrasounds Outcomes Research 40

ACEP Now

JUNE 21, 2023

The lack of differences in the observed outcomes do not suggest one EM training length is superior. The additional year may improve career trajectory or longevity, entrance into fellowship or academic practice, or other longer-term outcomes including successful development of a niche in the specialty. 11 What should we take away?

EMS 114

EMS Academics Telemedicine Operations 114

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? Early hepatic artery thrombosis after liver transplantation: a systematic review of the incidence, outcome and risk factors. Pediatr Radiol.

EMS 95

EMS Ultrasounds Emergency Department Outcomes 95

EMDocs

MAY 11, 2024

Semin Ultrasound CT MR. 2013 Apr;34(2):131-41. Endovascular and Clinical Outcomes of Vertebrobasilar Intracranial Atherosclerosis-Related Large Vessel Occlusion. 2019 Mar 19;10:215. Epub 2019 Dec 9. Reference article, Radiopaedia.org (Accessed on 28 Aug 2023) [link] Ortiz de Mendivil A, Alcalá-Galiano A, et al.

Stroke 110

Stroke EMS EKG/ECG Radiology 110

EMDocs

JANUARY 16, 2024

Patients can have excellent outcomes despite prolonged resuscitation. VF/asystole), a pulse cannot be identified via Doppler ultrasound for a full minute, or if lack of organized cardiac activity is confirmed on bedside echocardiogram. This is a good time to utilize an arterial line or use the ultrasound to find a central pulse.

Hyperthermia / Hypothermia 109

Hyperthermia / Hypothermia Resuscitation CPR EMS 109

Don't Forget the Bubbles

JANUARY 17, 2024

Abdominal ultrasound, used in 34 cases, was able to visualize a rounded intraluminal image corresponding to a bead in 28 patients. Point-of-care ultrasound may show well-demarcated, round, and hypoechoic material in the stomach and first part of the duodenum, though it can underestimate the number of beads present. Darracq, M.A.,

Pediatrics 111

Pediatrics Poisoning Ultrasounds Dehydration 111

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? Do outcomes for patients with suspected nephrolithiasis differ based on the initial imaging? How do you proceed?

Ultrasounds 52

Ultrasounds Radiology Radiology Outcomes 52

PulmCCM

APRIL 24, 2024

Now, a few intensivists are going for the gut, with a new bedside ultrasound-guided Seldinger-style procedure that could displace percutaneous endoscopic gastrostomy tubes (PEGs) placed by gastroenterologists or interventional radiologists. Accessing the esophagus will be new to most intensivists, but certainly not difficult.)

Ultrasounds 52

Ultrasounds Hospitals Operations Outcomes 52

ACEP Now

SEPTEMBER 3, 2024

Hahnemann University Hospital in Philadelphia closed in 2019, a year and a half after it was acquired along with St. Her primary interests are in ultrasound, machine learning, and health justice. Published September 5, 2019. Published July 22, 2019. References Pomorski C. The death of Hahnemann Hospital. The New Yorker.

Hospitals 113

Hospitals Radiology Radiology Emergency Department 113

The Skeptics' Guide to EM

DECEMBER 28, 2019

Date: December 16th, 2019 Reference: Moore et al. Annals of EM, JU, and JACR 2019. He is also the Chief for the Section of Emergency Ultrasound and […] The post SGEM Xtra: Come Together, Right Now – Over Renal Colic first appeared on The Skeptics Guide to Emergency Medicine. Date: December 16th, 2019 Reference: Moore et al.

Radiology 40

Radiology Radiology Ultrasounds Emergency Department 40

The Skeptics' Guide to EM

SEPTEMBER 14, 2019

Date: September 10th, 2019 Reference: Fournier et al. Emergency Medicine Journal 2019. Date: September 10th, 2019 Reference: Fournier et al. Emergency Medicine Journal 2019. He is interested in ultrasound and international emergency medicine.

Head Injuries 52

Head Injuries Emergency Department Seizures EMS 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

The Skeptics' Guide to EM

JANUARY 25, 2020

NEJM February 2019 Guest Skeptic: Andrew Merelman is a critical care paramedic and second year medical student at Rocky Vista University in Colorado. His primary interests are resuscitation, critical care, airway management, and point-of-care ultrasound. Bag-Mask Ventilation during Tracheal Intubation of Critically Ill Adults.

EMS 40

EMS Airway Management Administration Resuscitation 40

PulmCCM

JANUARY 8, 2024

Twenty-five ICUs in Canada were switched to small-volume blood collection tubes at randomly assigned times (a so-called stepped-wedge cluster design) from 2019-2021. Transfusion harms are usually clinically inapparent, showing up in data sets as slightly worsened outcomes among a few more of the transfused, as compared to the not-transfused.

Blood Transfusions 96

Blood Transfusions Hospitals Outcomes Operations 96

Taming the SRU

OCTOBER 1, 2023

As these patients are typically already at a high risk for poor health outcomes, secondary spontaneous PTX is often more serious in presentation and management more complex [11]. Accuracy of Ultrasound in Diagnosis of Pneumothorax: A Comparison between Neonates and Adults-A Systematic Review and Meta-Analysis. Published 2019 Dec 3.

Fractures 96

Fractures COPD Hospitals Emergency Department 96

The Skeptics' Guide to EM

SEPTEMBER 11, 2021

Her point-of-care ultrasound (POCUS) shows appropriate-appearing global ejection fraction and no marked wall motion abnormalities. There is evidence that taking those patients with ROSC and EKG showing STEMI directly for angiography +/- angioplasty is associated with positive patient-oriented outcomes.

EKG/ECG 52

EKG/ECG Academics EMS CPR 52

Dr. Smith's ECG Blog

OCTOBER 18, 2023

1-3] But these studies were very short duration and used cardiology interpretation of ECGs or emergent angiography rather than patient outcomes. Emergent cardiac outcomes in patients with normal electrocardiograms in the emergency department. 2019 ; 54 : 79 - 81. Acad Emerg Med. 2017 ; 24 ( 1 ): 120 - 124 2. Am J Emerg Med.

EKG/ECG 119

EKG/ECG Documentation/Coding Emergency Department Outcomes 119

The Skeptics' Guide to EM

MAY 11, 2019

Date: May 6th, 2019 Reference: Sceats et al. 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.

Documentation/Coding 40

Documentation/Coding Operations Academics Ultrasounds 40

Taming the SRU

MAY 5, 2023

2019, Bauer, Gerlach et al. 2019, Evans, Rhodes et al. The ANDROMEDA-SHOCK trial published in 2019 demonstrated that only one-quarter (25%) of patients were fluid-responsive at baseline, as determined most frequently by velocity time integral or passive leg raise methods (Hernández, Ospina-Tascón et al. 2021, Im, Kang et al.

Sepsis 52

Sepsis Shock Administration Resuscitation 52

Broome Docs

APRIL 6, 2023

Clinical risk factors for testicular torsion and a warning against falsely reassuring ultrasound scans: a 10-year single-centre experience. Renal outcomes following intravenous contrast administration in patients with acute kidney injury: a multi-site retrospective propensity-adjusted analysis. 2019 Nov 1;179(11):1528-1536.

Sepsis 52

Sepsis Ultrasounds Hospitals Fractures 52

ACEP Now

MAY 9, 2024

These questionable practices led to a rash of bad outcomes. Unfortunately, at least 13 deaths were subsequently reported in Miami-Dade County from 2019–2022, the three years immediately following the implementation of the subcutaneous injection regulation. References Garcia SE. Butt Lifts Are Booming. Healing Is No Joke.

Emergency Department 52

Emergency Department Operations Ultrasounds Shock 52

Taming the SRU

AUGUST 30, 2023

The 2019 Journal of Arthroplasty practice guidelines to screen for periprosthetic joint infections recommend using ESR at 30mm/hr and CRP at 10mg/L, citing pooled sensitivities and specificities ranging from 75%-86% and 70-72.3%, respectively, for ESR and 88% and 73-74%, respectively, for CRP [32].

Infectious Diseases 89

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

PulmCCM

APRIL 1, 2024

Both a 2019 meta-analysis and a large 2022 trial by the ANZICS group raised concerns about increased adverse events among patients receiving intensive physical therapy in the ICU. Physical therapy is probably under-provided to critically ill patients, and improving this might improve outcomes for many. Is this safe?

Ultrasounds 40

Ultrasounds Operations Outcomes Research 40

PulmCCM

JULY 10, 2023

At 28 days, there were no observed differences in the primary outcome (an odd composite of mortality and emergence of antibiotic resistance), and no difference in survival at 90 days. Mortality was about 30% in each group, and most patients had hospital-acquired sepsis. A sequel to that trial, BLING III, is underway. access, etc.,

Stroke 52

Stroke Sepsis Infectious Diseases Outcomes 52

ACEP Now

NOVEMBER 16, 2023

The lack of differences in the observed outcomes do not suggest one EM training length is superior. The additional year may improve career trajectory or longevity, entrance into fellowship or academic practice, or other longer-term outcomes, including successful development of a niche in the specialty. Published 2019.

Academics 52

Academics EMS Telemedicine Research 52

Taming the SRU

SEPTEMBER 8, 2023

2019 Jan 5;1(1):CD011451. Prognosis of acute severe autoimmune hepatitis (as-AIH): The role of corticosteroids in modifying outcome.” Diagnostic accuracy of Doppler ultrasound, CT and MRI in Budd Chiari Syndrome: Systematic Review and meta-analysis.” PMID: 34006606; PMCID: PMC8137169. Cochrane Database Syst Rev. Hepatology, vol.

Radiology 59

Radiology Radiology Ultrasounds EMS 59

Dr. Smith's ECG Blog

NOVEMBER 15, 2023

The problem is difficult to study because angiographic visualization of arteries is not perfect, and not all angiograms employ intravascular ultrasound (IVUS) to assess for unseen plaque or for plaque whose rupture and ulceration cannot be seen on angiogram. Thus, intracoronary imaging modalities are crucial in this setting. References: 1.

EKG/ECG 109

EKG/ECG Ultrasounds Wellness Stroke 109

Downeast Emergency Medicine

APRIL 26, 2021

4] We also know that severe TBI is commonly associated with the development of intracranial hemorrhage where the presence and volume of blood are associated with increased mortality and poor outcomes.[5] Lancet 2019; Vol 394, Iss 10210, P 1713-1723[ Full Text ]. There were no differences found in the secondary outcomes.

Head Injuries 52

Head Injuries Administration Outcomes Seizures 52

Dr. Smith's ECG Blog

NOVEMBER 12, 2020

A bedside cardiac ultrasound was normal, with no effusion. However, in multiple studies, even in the absence of AMI, both acute and chronic myocardial injury (as diagnosed by any elevated cTn) are powerful markers of adverse outcomes in both the short and long term. He had the following EKG recorded: Low voltage, suggests effusion.

Shock 52

Shock EKG/ECG Outcomes Hospitals 52