The Skeptics' Guide to EM

JULY 30, 2022

Point-of-Care Ultrasound-First for the Evaluation of Small Bowel Obstruction: National Cost Savings, Length of Stay Reduction, and Preventable Radiation Exposure. Point-of-Care Ultrasound-First for the Evaluation of Small Bowel Obstruction: National Cost Savings, Length of Stay Reduction, and Preventable Radiation Exposure.

Ultrasounds 52

Ultrasounds Operations Documentation/Coding Outcomes 52

The Trauma Pro

OCTOBER 25, 2024

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). The primary outcome was the development of VTE during the hospitalization.

Fractures 113

Fractures Head Injuries Operations Ultrasounds 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

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

Don't Forget the Bubbles

JANUARY 17, 2024

After Meshram et al, 2020 When Orbeez are exposed to water, the water molecules diffuse into the polymer network through osmosis. Abdominal ultrasound, used in 34 cases, was able to visualize a rounded intraluminal image corresponding to a bead in 28 patients. There have been reports of the Orbeez Challenge leading to serious outcomes.

Pediatrics 111

Pediatrics Poisoning Ultrasounds Dehydration 111

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? OPTN/SRTR 2020 Annual Data Report: Liver. Vital signs: HR 118, BP 103/68, RR 20, T 99.8. LFTs are in the thousands. Pediatr Radiol.

EMS 89

EMS Ultrasounds Emergency Department Outcomes 89

EMDocs

MAY 15, 2024

Ultrasound Sensitivity 88-100%, specificity 68-94% Positive likelihood ratio of 14.6 (95% While chest radiograph is often the first-line imaging modality, lung ultrasound has higher sensitivity and can detect pulmonary abnormalities earlier; CT imaging should be considered if initial imaging is negative or if concern for PE is present.

Blood Transfusions 97

Blood Transfusions Fluid Resuscitation Dehydration Ultrasounds 97

Emergency Medicine Journal

NOVEMBER 28, 2023

Manipulation performed under ultrasound guidance has the potential to decrease the number of reduction attempts. Methods This multicentre randomised controlled trial was undertaken between December 2018 and July 2020 in the ED of four hospitals in the Netherlands.

Fractures 40

Fractures Ultrasounds Emergency Department Operations 40

EMDocs

MAY 28, 2024

Ultrasound Sensitivity 88-100%, specificity 68-94% LR+ of 14.6 (95% While chest radiograph is often the first-line imaging modality, lung ultrasound has higher sensitivity and can detect pulmonary abnormalities earlier; CT imaging should be considered if initial imaging is negative or if concern for PE is present. Am J Emerg Med.

Blood Transfusions 94

Blood Transfusions Fluid Resuscitation Dehydration Ultrasounds 94

RebelEM

APRIL 29, 2024

The current standard of practice has moved away from landmark-based central line placement given the efficacy and safety of ultrasound-based techniques. This study also showed the median time for IO placement was only 1.2 minutes compared to a mean placement time of 10.7 minutes CVC group. Resuscitation. 2012 PMID: 21893125. 9 Zhang W et al.

Resuscitation 105

Resuscitation Administration Emergency Department Ultrasounds 105

EMDocs

MAY 11, 2024

Semin Ultrasound CT MR. 2013 Apr;34(2):131-41. Salim Rezaie, “Thrombolysis in Acute Ischemic Stroke: Now We Have No Positive RCTs”, REBEL EM blog, July 27, 2020. Endovascular and Clinical Outcomes of Vertebrobasilar Intracranial Atherosclerosis-Related Large Vessel Occlusion. 2020 Feb;19(2):115-122.

Stroke 107

Stroke EMS EKG/ECG Radiology 107

Mount Sinai EM

OCTOBER 11, 2024

There was significant heterogeneity among studies and outcomes were not measured consistently. 2020 performed a systematic review and meta-analysis of medical intervention alone vs surgical drainage. I+D was associated with lower PTA recurrence rate, but associated with more pain. Deemed existing evidence “very low quality”.

Ultrasounds 100

Ultrasounds Wellness Outcomes Hospitals 100

ALiEM

JANUARY 29, 2024

Case Question: What treatments can you perform in the ED for this diagnosis and do they improve outcomes? Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine vol. 39,1 (2020): 197-202. This has the potential to expedite consultations with specialty teams and treatment.

Stroke 64

Stroke Ultrasounds Academics Outcomes 64

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]. Published 2020 Jul 23. Accuracy of Ultrasound in Diagnosis of Pneumothorax: A Comparison between Neonates and Adults-A Systematic Review and Meta-Analysis.

Fractures 96

Fractures COPD Hospitals Emergency Department 96

Dr. Smith's ECG Blog

APRIL 22, 2024

EKG from triage: Here is his previous ECG: Normal ST Elevation Resident's interpretation: Reperfusion pattern/Wellens' with biphasic T waves in V2 and V3, and in comparison to an EKG in 2020 this is new. Bedside ultrasound with no apparent wall motion abnormalities, no pericardial effusion, no right heart strain. 2019;40:283–291.

EKG/ECG 119

EKG/ECG Outcomes Ultrasounds Hospitals 119

ACEP Now

SEPTEMBER 3, 2024

These stakeholders are similarly shielded in court when adverse patient outcomes, such as negligent deaths, occur under their management or when the bought-out companies are challenged for anticompetitive business practices overseen by the PE firm. Her primary interests are in ultrasound, machine learning, and health justice.

Hospitals 113

Hospitals Radiology Radiology Emergency Department 113

ACEP Now

MAY 9, 2024

These questionable practices led to a rash of bad outcomes. 6 Theoretically, ultrasound guidance should decrease this risk, which formed the basis for the 2022 Florida Medical Board regulation. 7 The impact of this latest set of regulations on the complication rate has yet to be reported. References Garcia SE. Butt Lifts Are Booming.

Emergency Department 52

Emergency Department Operations Ultrasounds Shock 52

Taming the SRU

JANUARY 10, 2024

R4 Case Follow-up: SCAD WITH dr. Martella Spontaneous Coronary Artery Dissection (SCAD) is a diagnosis confirmed via imaging: Coronary Angiography, Optical Coherence Tomography, Intravascular Ultrasound Therefore, treatment in the ED is the same as atherosclerotic ACS: ASA, heparin gtt and possible statin.

EKG/ECG 93

EKG/ECG Shock Fractures Dislocations 93

The Skeptics' Guide to EM

JANUARY 25, 2020

Date: January 9th, 2020 Reference: Casey et al. His primary interests are resuscitation, critical care, airway management, and point-of-care ultrasound. His primary interests are resuscitation, critical care, airway management, and point-of-care ultrasound. Date: January 9th, 2020 Reference: Casey et al.

EMS 40

EMS Airway Management Administration Resuscitation 40

Dr. Smith's ECG Blog

MAY 30, 2023

Case continued A bedside ultrasound showed diminished LV EF and of course bradycardia. The primary outcomes were sensitivity/specificity of 1) STD in lead I ≥ 0.5 mm and 2) STE in lead V1 ≥ 0.5 mm, stratified by presence or absence of posterior (inferobasal) MI, as determined by ≥0.5 mm STD in lead V2, for differentiating RVMI from non-RVMI.

Shock 97

Shock EKG/ECG Academics Stroke 97

Dr. Smith's ECG Blog

APRIL 12, 2023

On arrival, lung ultrasound confirmed pulmonary edema (B lines). In comparison to the previous study, 11/11/2020, there has been a significant interval deterioration of left ventricular systolic function (previous EF 80%), and there is a new large apical wall motion abnormality. This is proximal LAD Occlusion until proven otherwise.

EKG/ECG 52

EKG/ECG COPD Ultrasounds Outcomes 52

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

Dr. Smith's ECG Blog

NOVEMBER 12, 2020

A bedside cardiac ultrasound was normal, with no effusion. Clin Chem [Internet] 2020;Available from: [link] Smith mini-review: Troponin in Emergency Department COVID patients Cardiac Troponin (cTn) is a nonspecific marker of myocardial injury. JAMA Cardiol [Internet] 2020;Available from: [link] 4. 3–8 Shi et al.

Shock 52

Shock EKG/ECG Outcomes Hospitals 52

Taming the SRU

SEPTEMBER 8, 2023

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.” 1109, 2020, p. Hepatology, vol. 2, 2013, pp. 612–621, [link] Yeoman, Andrew D., 4, 2014, pp. 8, 2014, pp.

Radiology 59

Radiology Radiology Ultrasounds EMS 59

Taming the SRU

AUGUST 30, 2023

Significantly elevated CRP (>122mg/L) and PCT (>0.5ng/mL) levels are predictors of bad outcomes, and are useful for tracking therapy progress, but are not specific enough to rule-in infectious endocarditis [38-39]. Instead, they strongly advocated for the use of lung ultrasound to diagnose bacterial CAP [45].

Infectious Diseases 89

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

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 110

EKG/ECG Ultrasounds Wellness Stroke 110

Taming the SRU

MAY 5, 2023

The CLASSIC trial is a randomized controlled trial conducted in the ICU setting which compared restrictive versus standard fluid strategies with a primary outcome of death by 90 days in patients with septic shock. Safety outcomes Serious adverse event occurrences were similar in both groups. 2019, Bauer, Gerlach et al. versus 59.2%).

Sepsis 52

Sepsis Shock Administration Resuscitation 52

Dr. Smith's ECG Blog

OCTOBER 2, 2021

After rethinking the case, he remained concerned about ACS and subsequently performed a point-of-care ultrasound in order to evaluate for regional wall motion abnormality. In equivocal cases, point-of-care ultrasound may be the difference between taking the patient to the lab or not. 1] Wereski, R., Chapman, A. Gray, A., &

EKG/ECG 52

EKG/ECG Ultrasounds EMS Documentation/Coding 52

Northwestern EM Blog

FEBRUARY 14, 2022

The primary outcome of the study was the response in MAP three hours after the start of angiotensin II infusion. It showed improvement in blood pressure which is a clinically important parameter but not a patient-oriented outcome. Published online October 21, 2020. 2021;159(2):596-605. doi:10.1016/j.chest.2020.08.2074

Shock 52

Shock Resuscitation Fluid Resuscitation Sepsis 52

Dr. Smith's ECG Blog

FEBRUARY 23, 2023

Here is PM Cardio's Queen of Hearts interpretation (AI ECG interpretation trained by Meyers, Smith, and PM Cardio team using thousands of cases and their outcomes): The output number ranges from 0 to 1, with numbers closer to zero meaning likely NOT OMI, and numbers closer to 1 meaning OMI.

EKG/ECG 52

EKG/ECG Ultrasounds Outcomes Hospitals 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. References: 1.

EKG/ECG 52

EKG/ECG Emergency Department Ultrasounds Hospitals 52

Dr. Smith's ECG Blog

JANUARY 6, 2023

Smith comment: We have shown that use of opiates is associated with worse outcomes in ACS: Bracey, A. Smith comment: Point of Care ultrasound is not adequate to rule out wall motion abnormality; moreover, diffuse subendocardial ischemia often has no wall motion abnormality because the epicardium is still contracting. Abstract 556.

EKG/ECG 52

EKG/ECG Wellness Academics Ultrasounds 52

Dr. Smith's ECG Blog

JANUARY 9, 2023

Smith Major Learning Point: The worst risk factor for a bad outcome in OMI is young age because cardiologists cannot believe that a young person can have an OMI. Beware a negative Bedside ultrasound. He was readmitted a few weeks later for a heart failure exacerbation, diuresed, and discharged again. This gets drilled into them.

EKG/ECG 52

EKG/ECG Wellness Ultrasounds Outcomes 52

Pediatric EM Morsels

SEPTEMBER 20, 2024

HUS findings: Microangiopathic hemolytic anemia , Renal failure , and Thrombocytopenia The most dreaded outcomes of HUS include need for renal replacement therapy both short and long term and unfortunately death. It is critical to detect HUS early in its disease course to ensure the best outcomes. Clin Pediatr (Phila). PMID: 20075028.

Pediatrics 164

Pediatrics Ultrasounds Dehydration Emergency Department 164

ALiEM

OCTOBER 30, 2024

Clinical impact: The patient’s DVT ultrasounds were negative. Emergency department-initiated buprenorphine for opioid dependence with continuation in primary care: outcomes during and after intervention. Microdosing Methods Help, 2020. 2022 May;14(5). PMID 35774687 D’Onofrio G, Chawarski MC, O’Connor PG, et al.

Emergency Department 64

Emergency Department Operations Psychiatric Hospitals 64

Don't Forget the Bubbles

FEBRUARY 7, 2024

This week, NCEPOD (National Confidential Enquiry into Patient Outcomes and Death) produced a much-anticipated report on how we manage acute testicular torsion in young people. What is the role of ultrasound? Whilst we all love to wield the ultrasound probe, its use in diagnosing torsion remains controversial. Sharma, A.P.,

Pediatrics 111

Pediatrics Ultrasounds Operations Hospitals 111

EMDocs

JUNE 21, 2023

Functional outcomes Severe soft tissue injuries and damage to the bony structures => poor functional outcomes. Curr Orthop Pract, 31 (5) (2020 Sept), pp. Can Ultrasound Identify Traumatic Knee Arthrotomy in a Cadaveric Model? 2020 Sep;29(9):1869-1875. Konda SR, et al. J Orthop Trauma. 2013 Sep;27(9):509-14.

Soft Tissue Injuries 88

Soft Tissue Injuries Fractures Dislocations Radiology 88