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

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. The Ultrasound Journal, 11(1). Notable diagnostics CBC : WBC 19.2,

Ultrasounds 98

Ultrasounds Emergency Department Wellness Operations 98

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

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

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).

Ultrasounds 98

Ultrasounds Pediatrics Wellness 98

RebelEM

JUNE 26, 2023

4F-PCC contains factors II, VII, IX, X as well as Proteins S and C. J Trauma Acute Care Surg 2019. 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

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). The patient did well afterward without any recurrence of symptoms. Fortunately, that is exactly what happened.

EKG/ECG 127

EKG/ECG EMS Wellness Operations 127

Taming the SRU

NOVEMBER 3, 2023

Ultrasound‐Guided Serratus Anterior Plane Block (SAPB) Improves Pain Control in Patients With Rib Fractures. Ultrasound Med. The thought with introducing the serratus anterior plane block was that regional anesthesia is well within the purview of EM physicians and can offer a safe alternative to systemic pain medications.

Fractures 98

Fractures Ultrasounds Research Outcomes 98

ALiEM

MAY 19, 2023

A heavy alcohol drinker, who is well known to your Emergency Department, presents with altered mental status, except that he looks different this time. 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.

Emergency Department 98

Emergency Department Ultrasounds Wellness EMS 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

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. 1-3 As many as 25% of acute PE cases present as sudden cardiac death.

Ultrasounds 98

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

Dr. Smith's ECG Blog

JULY 21, 2024

In this study — Procainamide was superior to Amiodarone for terminating monomorphic VT, as well as having fewer adverse effects than Amiodarone ( Ortiz et al — Eur Heart J 1;38 (17): 1329-1335, 2017 ). The decision was made to try Quinidine ( as this case was felt to represent conditions consistent with Quinidine-responsive PMVT ).

EKG/ECG 131

EKG/ECG Shock Hospitals Sepsis 131

EMDocs

OCTOBER 8, 2024

Tachycardia may be present both from many medications or drugs, as well as withdrawal. Let’s use the example of the well appearing patient, without significant comorbidities. Disposition of sinus tachycardia depends on many factors, however the well-appearing asymptomatic patient does not require admission for tachycardia alone.

Shock 105

Shock Emergency Department Pediatrics EKG/ECG 105

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

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

Emergency Medicine Ireland

OCTOBER 14, 2024

Similarly loculations can be very easily seen with ultrasound, better than CT it seems but again don’t necessarily correlate that well with empyema. Well, adding extra or bigger drains is all very reasonable and it would seem wise to involve a thoracic surgeon at some point. 2019, (2019). – Shen, K.

Wellness 52

Wellness Ultrasounds 52

Taming the SRU

OCTOBER 1, 2023

This topic is additionally complicated by the development of multiple diagnostic tools now available for diagnosis as well as variable sizing algorithms used around the world. 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

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? Many patients in the ultrasound groups did get additional imaging, but this was not the majority. How do you proceed? In this study, 40.7%

Ultrasounds 52

Ultrasounds Radiology Radiology Outcomes 52

PulmCCM

JANUARY 8, 2024

But apparently, few centers use them, because … well, no one can give a good reason why. 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. With Doppler ultrasound measures (e.g., What is fluid responsiveness?

Blood Transfusions 96

Blood Transfusions Hospitals Outcomes Operations 96

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

DECEMBER 18, 2023

7) While standard technique for either male or female foley placement is well-known and straightforward, there are several measures that can be taken to ensure the highest likelihood of first-pass success. link] doi: 10.1136/bcr-2019-229855. In most male patients, starting with a 16 to 18-Fr Foley catheter is an ideal choice.(7)

Emergency Nursing 77

Emergency Nursing EMS Emergency Department Ultrasounds 77

Dr. Smith's ECG Blog

NOVEMBER 15, 2023

Over some time and the pain moved into her other arm as well as her jaw. 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.

EKG/ECG 109

EKG/ECG Ultrasounds Wellness Stroke 109

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]. They are used clinically to detect pathological inflammation or measure response to treatment [1-2].

Infectious Diseases 89

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

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 Point-of-Care Testing Wellness Shock 64

Dr. Smith's ECG Blog

OCTOBER 18, 2023

A majority (62.5%) of those presenting with ‘normal’ ECGs had the cath lab activated without any ECG being labeled ‘STEMI’ by automated interpretation – based on signs of Occlusion MI including ECG changes, regional wall motion abnormality on bedside ultrasound, or refractory ischemia. 2019 ; 54 : 79 - 81. Am J Emerg Med.

EKG/ECG 119

EKG/ECG Documentation/Coding Emergency Department Outcomes 119

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. 2019 Nov 1;179(11):1528-1536. Twice-Daily Oral Zinc in the Treatment of Patients With Coronavirus Disease 2019: A Randomized Double-Blind Controlled Trial. Emerg Med J. Epub ahead of print.

Sepsis 52

Sepsis Ultrasounds Hospitals Fractures 52

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. That could (and should) change if improved functional outcomes, persisting for months after hospital discharge, are ever confirmed in large, well-conducted trials.

Ultrasounds 40

Ultrasounds Operations Outcomes Research 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

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. 2019 Apr 1;48(4):e169-e174. What’s the Diagnosis? Aspirated foreign body B. Lymphoma D.

Pediatrics 52

Pediatrics Ultrasounds Hospitals Wellness 52

Dr. Smith's ECG Blog

OCTOBER 24, 2019

Often, intravascular ultrasound or intravascular optical coherence tomography is requeried to make the diagnosis. On the other hand , high-risk lesions appear to do well with aggressive treatment. She did well, and was ultimately discharged from her cardiologist’s care years later! JACC 2019 Sep 10;74(10):1290-1300.

EKG/ECG 52

EKG/ECG Shock Ultrasounds Wellness 52

Dr. Smith's ECG Blog

NOVEMBER 12, 2020

A bedside cardiac ultrasound was normal, with no effusion. He was admitted on oxygen and was doing fairly well with saturations of 100% on 2 L nasal cannula. Higher troponin correlated with more history of heart failure, diabetes, and hypertension, as well as higher D-dimer, and nearly all inflammatory markers.

Shock 52

Shock EKG/ECG Outcomes Hospitals 52

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

Am J Med 2019, 132(5):622-630. Now there is a paper published in 2019 that proves the point beyond doubt, though makes it clear that this pattern is associated with very high mortality. American Journal of Medicine 132(5):622-630; May 2019. A emergent cardiology consult can be helpful for equivocal cases. link] Harhash AA et al.

EKG/ECG 52

EKG/ECG Shock Sepsis Emergency Department 52

Dr. Smith's ECG Blog

NOVEMBER 30, 2022

This case was provided by Spencer Schwartz, an outstanding paramedic at Hennepin EMS who is on Hennepin EMS's specialized "P3" team, a team that receives extra training in advanced procedures such as RSI, thoracostomy, vasopressors, and prehospital ultrasound. Takotsubo is a sudden event, not one with crescendo angina.

EKG/ECG 52

EKG/ECG Emergency Department Ultrasounds Hospitals 52

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. Ballatore et al — Medicina (Kaunas) 55(8): 497, 2019 — and — Page et al — Circulation 107:1141-1145, 2003 ).

EKG/ECG 52

EKG/ECG Dehydration Stroke Shock 52

Dr. Smith's ECG Blog

JUNE 2, 2023

She was awake, alert, well perfused, with normal mental status and overall unremarkable physical exam except for a regular tachycardia, possible rales at both bases, some mild RUQ abdominal tenderness. They are best seen in leads V1,V2 — and a bit less well seen in V3,V4. Here is an explanation of the importance of leads V1 and V2.

EKG/ECG 96

EKG/ECG Wellness Ultrasounds EMS 96

Dr. Smith's ECG Blog

DECEMBER 13, 2019

On exam the patient was well appearing, with normal vitals signs other than BP 155/82, no murmurs or rubs, normal pulses, no reproducible chest pain. Beware a negative Bedside ultrasound. That said — I illustrate HOW this RATIO is arrived at in Figure-2 , which I have adapted from the 3/16/2019 post in Life-In-The-Fast-Lane.

EKG/ECG 52

EKG/ECG Operations Ultrasounds Wellness 52

Dr. Smith's ECG Blog

JANUARY 10, 2020

Here is the parasternal short axis, performed by a real expert in emergency department point of care cardiac ultrasound: There does not appear to be an anterior wall motion abnormality. Beware a negative Bedside ultrasound. 13, 2019 Dr. Smith post. 27, 2019 Dr. Smith post. A bedside echo was done immediately.

EKG/ECG 40

EKG/ECG Ultrasounds Emergency Department Wellness 40