Dr. Smith's ECG Blog

JANUARY 2, 2025

Bedside cardiac ultrasound showed moderately decreased LV function. Applying my method to the March 19, 2019 case that I show in Figure-1 the rhythm in this Figure-1 ECG is regular, with an R-R interval just under 4 large boxes. She was intubated. CT of the chest showed no pulmonary embolism but bibasilar infiltrates.

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EKG/ECG Sepsis Wellness Documentation/Coding 116

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).

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Ultrasounds Outcomes COPD Hospitals 129

EMDocs

DECEMBER 1, 2024

Flea-Borne Typhus: Epidemiology Summary 2013-2019. The RUSH exam: Rapid Ultrasound in SHock in the evaluation of the critically lll. Rosh Review Website Link References: Texas Department of State Health Services. Flea-Borne Typhus. Accessed August 19, 2024. California Department of Public Health. Accessed August 19, 2024. 2009.09.010.

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PHEM Cast

JULY 27, 2021

Some useful videos: Hopefully you found the podcast interesting, but since this is quite a visual topic we have put together some videos to demonstrate some of the pathologies discussed and what they look like on ultrasound: How does ultrasound work? Want to know how to use ultrasound? Intensive Care Med 2010; 36: 1475-83.

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Ultrasounds Fractures Resuscitation EMS 52

RebelEM

FEBRUARY 24, 2025

Regarding caval indexes, the advent of artificial intelligence and advanced learning has become integrated into many ultrasound machines. Ultrasound Med Biol. Jan 2019; PMID: 30138573. As with most things in medicine, it is important to understand the pitfalls. Most measurements are somewhere around the hepatic confluence.

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Ultrasounds Shock Fluid Resuscitation Resuscitation 74

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 Radiology Radiology 70

Pediatric EM Morsels

JULY 26, 2024

These females should have imaging with either MRI or CT as well as abdominal or transvaginal ultrasound to assess for ovarian teratoma. Epub 2019 Dec 19. Prevalence decreases with decreasing age. Risk of teratoma is higher in African American and Asian women. Moral of the Morsel It’s NOT always psych! 2020 Feb;75:55-62.

Psychiatric 271

Psychiatric Seizures Outcomes Pediatrics 271

Emergency Medicine Journal

JULY 22, 2024

Background and objectives The ability to rule appendicitis in or out using ultrasound is limited by studies where the appendix is not visualised. For those patients who had formal ultrasound, direct and indirect findings of ultrasound were abstracted from the ultrasound report. 95% CI 1.7 95% CI 3.8 95% CI 1.4

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Ultrasounds Radiology Radiology Emergency Department 52

Taming the SRU

JULY 22, 2024

perform arthrocentesis ULTRASOUND-GUIDED PROCEDURE Ultrasound-guided (USG) arthrocentesis may be helpful in instances where there is no obvious effusion that can easily be palpated on physical exam. Studies have shown that effusions of as little as 2 to 4 mL can be identified using ultrasound [6]. ANESTHETIZE THE AREA step 7.

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Cook County EM Blog

MARCH 28, 2023

The Case: The patient is a 61-year-old male with non-insulin dependent diabetes, hypertension, coronary artery disease status post CABG in 2019 who presented with blurry vision of the left eye after being hit on the face with a blunt object by his roommate approximately ten days prior to presentation. Intraocular pressures were unremarkable.

Dislocations 52

Dislocations Ultrasounds Fractures Radiology 52

Downeast Emergency Medicine

FEBRUARY 14, 2023

Credits: Andrew fried, md A point-of-care lung ultrasound is performed, with the following findings on the left lung fields. Point of Care Ultrasound of the Left Lung Fields. Point of Care Ultrasound of the Left Lung Fields. One study from 2012 found lung ultrasound to be 93% sensitive for pneumonia [4]. Emerg Med J.

Ultrasounds 52

Ultrasounds Emergency Department Pediatrics 52

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

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.

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Ultrasounds Outcomes 52

Ultrasound Gel

MAY 13, 2019

Resa and Mike team up to discuss important happening at SCUF 2019 Annual conference. Resa and Mike team up to discuss important happening at SCUF 2019 Annual conference. Guest stars Nova Panebianco and Sara Damewood! Guest stars Nova Panebianco and Sara Damewood!

Ultrasounds 52

Ultrasounds 52

Taming the SRU

MAY 13, 2024

A clinical suspicion of stump appendicitis may be confirmed with various imaging modalities, abdominal ultrasound or CT imaging being most common. For ultrasound, it is recommended to scan the most tender area using a linear probe. Point-of-care ultrasound diagnosis of Stump appendicitis in the emergency department. Nelson, B.

Ultrasounds 98

Ultrasounds Emergency Department Wellness Operations 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%

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Administration Sepsis EMS Shock 137

Taming the SRU

JANUARY 1, 2024

Ultrasound Guided Peripheral IV (USGIV) Access anatomy of arm veins when considering USGIV. unported license [link] Ultrasound allows us to visualize deeper, typically larger veins in the forearm and upper arm. Place ultrasound machine on the opposite side of the bed to minimize neck strain. Check for flash in the IV chamber.

Emergency Department 92

Emergency Department Ultrasounds Administration Burns 92

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

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? Published 2019 Dec 27. doi:10.1155/2019/9108903 18) Fang A, Ashwani K. Ultrasound Clinics. LFTs are in the thousands.

EMS 95

EMS Ultrasounds Emergency Department Outcomes 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. Endocrine 65, 608–615 (2019).

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Ultrasounds Pediatrics Wellness 98

The Skeptics' Guide to EM

NOVEMBER 9, 2019

Date: November 2nd, 2019 Reference: Lee and Yun. Date: November 2nd, 2019 Reference: Lee and Yun. Chip is the CEO of an ultrasound education company called Practical POCUS which is based in the United States but is expanding into an international market. He also hosts a great #FOAMed blog and podcast called TOTAL EM.

Ultrasounds 52

Ultrasounds Fractures Pediatrics Radiology 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

EMDocs

AUGUST 8, 2023

Keys: Order the ultrasound in a patient with testicular pain, especially with any TWIST score >0. Minimal if any harm to patients by obtaining ultrasound. Even with a normal ultrasound, if the history/exam are concerning – call urology. Repeat ultrasound after manual detorsion to look for normal blood flow.

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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

Taming the SRU

NOVEMBER 3, 2023

Ultrasound‐Guided Serratus Anterior Plane Block (SAPB) Improves Pain Control in Patients With Rib Fractures. Ultrasound Med. Results 24 patients were eligible during the study period from January 2019 to June 2020 and 20 patients age 33-95 were ultimately enrolled by the 6 operators. 41, 2695–2701 (2022).

Fractures 98

Fractures Ultrasounds Research Outcomes 98

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

The Skeptics' Guide to EM

MARCH 15, 2019

Date: March 12th, 2019 Reference: Gottlieb, Holladay and Peksa. Date: March 12th, 2019 Reference: Gottlieb, Holladay and Peksa. You have a colleague in the room who is proficient at ultrasound and asks if there is a role for bedside ultrasound in this situation. Ann Emerg Med 2018. Ann Emerg Med 2018.

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Ultrasounds Fractures EMS Hospitals 52

EMDocs

APRIL 22, 2024

Point-of-Care-Ultrasound (POCUS) is a bedside modality that can assist Emergency Physicians (EPs) in differentiating PE from other causes of cardiac arrest. Multiorgan POCUS The diagnostic power of POCUS often resides in combining multiple ultrasound exams. Introduction to Bedside Ultrasound, iBook Ch 2, Basic Cardiac, Pg 27.

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Ultrasounds Advances Cardiac Life Support (ACLS) EKG/ECG Resuscitation 98

EMDocs

APRIL 10, 2024

3] If performing a nerve block with ultrasound guidance, always know where the tip of your needle is. [5] McGraw Hill Companies, Inc; 2019. doi:10.1136/bcr-2019-233119 Neal JM, Barrington MJ, Fettiplace MR, et al. Epidemiology Most common cause: inadvertent intravascular injection. per 10,000 cases of peripheral nerve blocks. [3]

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Advances Cardiac Life Support (ACLS) Seizures EMS Poisoning 111

The Skeptics' Guide to EM

FEBRUARY 16, 2019

Date: February 15th, 2019 Reference: Gottileb, Holladay and Peksa. Point-of-Care Ocular Ultrasound for the Diagnosis of Retinal Detachment: A Systematic Review and Meta-Analysis. AEM January 2019. Louis and the Emergency Medicine Point of Care Ultrasound Section Chief. AEM January 2019.

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Ultrasounds Operations Emergency Department 52

EMDocs

MAY 11, 2024

Semin Ultrasound CT MR. 2013 Apr;34(2):131-41. 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. Brainstem stroke: anatomy, clinical and radiological findings. doi: 10.1053/j.sult.2013.01.004. 2013.01.004. PMID: 23522778.]

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Stroke EMS EKG/ECG Radiology 110

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). Figure-4: I've labeled the first 2 ECGs shown in the November 14, 2019 post ( See text ).

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EKG/ECG EMS Wellness Operations 127

ACEP Now

JUNE 21, 2023

ultrasound and resuscitation procedures) may become a new standard for programs and require a longer training period. Association of American Medical Colleges; 2019:1-12. The 2019 model of the clinical practice of emergency medicine. 15 Some of these training opportunities previously considered unique (i.e., Accessed 2022-03-26.

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EMS Academics Telemedicine Operations 114

ALiEM

MAY 19, 2023

Additional trick: If the x-ray is delayed, you can pre-check with ultrasound [7]. Published January 30, 2019. PulmCrit Wee: Ultrasound-guided blakemore tube placement. Then fill the gastric balloon with 50 cc of air. Verify the placement of the gastric balloon with a chest x-ray. 1950 May;131(5):781-9. Powell M, Journey JD.

Emergency Department 98

Emergency Department Ultrasounds Wellness EMS 98

RebelEM

JUNE 26, 2023

J Trauma Acute Care Surg 2019. Severe acute traumatic coagulopathy = PT >1.5 to 3.33; P = 0.72 NOT STATISTICALLY SIGNIFICANT Also no difference in individual components given Thromboembolic Events: 4F-PCC: 35% Placebo: 24% Absolute Diff: 11%; 95% CI 1 to 21% Relative Risk 1.48; 95% CI 1.04 to 2.10; P = 0.03

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Administration Outcomes Resuscitation Radiology 145

Dr. Smith's ECG Blog

JULY 21, 2024

Another approach is sympathetic chain (stellate ganglion) blockade if you have the skills to do it: it requires some expertise and ultrasound guidance. The decision was made to try Quinidine ( as this case was felt to represent conditions consistent with Quinidine-responsive PMVT ). Administration of Procainamide is 10-17 mg/kg at 20 mg/min.

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EKG/ECG Shock Hospitals Sepsis 131

ALiEM

AUGUST 26, 2024

A vitreous hemorrhage OD was also identified on bedside ultrasound. On slit lamp examination, the patient had a clear cornea, an appropriately deep anterior chamber with no hyphema or hypopyon, and 1+ mixed cells. The lens was clear, with no movement or vibration (phacodonesis) noted. Chapter 2: Ophthalmic Conditions. Agarwal, D.,

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Emergency Department Academics Ultrasounds 70