Cook County EM Blog

APRIL 11, 2023

So, you reach for your ultrasound… Why It Matters : Shoulder dislocations are a common presentation to the emergency department and account for approximately 200,000 visits annually [1]. In a multicenter, prospective, cohort study, ultrasound was found to have 100% sensitivity and 100% specificity in diagnosing shoulder dislocations.

Dislocations 52

Dislocations Ultrasounds Emergency Department Radiology 52

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

PulmCCM

SEPTEMBER 4, 2024

Kenny MD [ @heart_lung ] Since its first description [1], the Venous Excess Ultrasound Score [VExUS] has received much research attention. Subsequently in the late 1970s, Sivaciyan and Ranganathan [9] confirmed these findings with Doppler ultrasound of the IJV. The ultrasound journal 12: 1-12 2. Jon-Emile S. Echocardiography 7.

Ultrasounds 84

Ultrasounds Operations Research Outcomes 84

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. 2020 Feb;75:55-62. 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! doi: 10.1016/j.seizure.2019.12.016.

Psychiatric 271

Psychiatric Seizures Outcomes Pediatrics 271

CasesBlog

JULY 8, 2020

From CNN : "Handheld devices also cost much less than traditional ultrasound machines. The ones sold by Butterfly, GE and Philips range in price from around $2,000 to $5,000, whereas traditional devices can cost tens or even hundreds of thousands of dollars. The Butterfly iQ is currently equipped for 19 different types of scans and tests.

Ultrasounds 52

Ultrasounds 52

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

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.

Ultrasounds 96

Ultrasounds Emergency Department EMS 96

EMDocs

DECEMBER 1, 2024

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. Flea-Borne Typhus: Epidemiology Summary 2013-2019. Accessed August 19, 2024. doi: 10.1016/j.emc.2009.09.010.

EMS 101

EMS Infectious Diseases Shock Airway Management 101

PulmCCM

NOVEMBER 17, 2023

’ This could be done with the Venous Excess Ultrasound Score [VExUS] [5, 6]. Beaubien-Souligny W, Rola P, Haycock K, Bouchard J, Lamarche Y, Spiegel R et al : Quantifying systemic congestion with Point-Of-Care ultrasound: development of the venous excess ultrasound grading system. The ultrasound journal 2020, 12(1):1-12.

Operations 132

Operations Ultrasounds Resuscitation Blood Transfusions 132

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. Published 2020 Feb 11. N Engl J Med.

Ultrasounds 90

Ultrasounds Documentation/Coding Wellness EMS 90

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). DVT was detected using duplex ultrasound, and PE was detected by CT angiography.

Fractures 113

Fractures Head Injuries Operations Ultrasounds 113

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. PMID: 34932040.

Ultrasounds 40

Ultrasounds Emergency Department Wellness EMS 40

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

Emergency Medicine Journal

MAY 23, 2023

Background Point-of-care (POC) lung ultrasound (LUS) is widely used in the emergency setting and there is an established evidence base across a range of respiratory diseases, including previous viral epidemics. Results Twenty studies were included, published between October 2020 and April 2021, providing data from a total of 4314 patients.

Ultrasounds 52

Ultrasounds Operations Research Hospitals 52

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. A case of ingested water beads diagnosed with point-of-care ultrasound.

Pediatrics 111

Pediatrics Poisoning Ultrasounds Dehydration 111

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

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

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

FEBRUARY 12, 2025

She had previously undergone carbon ion radiotherapy, receiving a cumulative dose of 75 GyE in 20 fractions over two courses from December 2020 to January 2021. IntechOpen; 2020. Radiat Res 1 September 2020; 194 (3): 310313. Physical Examination: Inspect for erythema, blistering, and ulceration. In: Radiation Therapy.

Best Practices 54

Best Practices Documentation/Coding Radiology Radiology 54

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

JournalFeed

SEPTEMBER 26, 2020

21-25, 2020. We cover vitamin D + calcium for BPPV, EMS lights and sirens, optimal defibrillation dose for children, NPO time vs ultrasound gastric content in children, and use of focused cardiac ultrasound. It’s the JournalFeed Podcast for the week of Sept.

Ultrasounds 52

Ultrasounds EMS 52

EB Medicine

OCTOBER 8, 2020

EMplify October 2020 Management of Deep Vein Thrombosis in the Emergency Department Authors: Shane R. EMplify October 2020 Management of Deep Vein Thrombosis in the Emergency Department Authors: Shane R. Write us at emplify@ebmedicine.net.

Emergency Department 52

Emergency Department Ultrasounds 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). SD 3.28) and 6.5,

Fractures 98

Fractures Ultrasounds Research Outcomes 98

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. 2020;4(2):327-355.

Blood Transfusions 94

Blood Transfusions Fluid Resuscitation Dehydration Ultrasounds 94

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

Mount Sinai EM

OCTOBER 11, 2024

2020 performed a systematic review and meta-analysis of medical intervention alone vs surgical drainage. Hennepin Ultrasound has a blog post on how to perform this both statically and dynamically–visualizing the needle as it aspirates the PTA. There were only a few adverse events/complications total–all were I+D.

Ultrasounds 100

Ultrasounds Wellness Outcomes Hospitals 100

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.

Ultrasounds 97

Ultrasounds Advances Cardiac Life Support (ACLS) EKG/ECG Shock 97

JournalFeed

OCTOBER 10, 2020

It’s the JournalFeed Podcast for the week of Oct 5-9, 2020. We cover simple ways to improve ETT first pass success, the ACTS RCT, a meta-analysis of steroids for COVID-19, an echo technique to help risk stratify intermediate risk PE, and ultrasound to improve arterial line success.

Ultrasounds 52

Ultrasounds 52

JournalFeed

DECEMBER 19, 2020

It’s the JournalFeed Podcast for the week of Dec 14-18, 2020. We cover antibiotics for nasal packing, the myth of “Type L” COVID-19 ARDS phenotype, long vs ultralong ultrasound-guided IVs, the rise of ESBL UTIs in the ED, and the HaVOC RCT on haloperidol vs ondansetron for cannabis hyperemesis.

Ultrasounds 52

Ultrasounds 52

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

PulmCCM

NOVEMBER 11, 2023

Diagnosis because P ra is non-invasively transduced with ultrasound, for instance via the size and collapsibility of the inferior vena cava [1] and/or the Venous Excess Ultrasound Score [VExUS] [2-4]. The ultrasound journal 2020, 12(1):1-12. Can these data deduce CO? Clin Chest Med 1983, 4(2):111-126.

Ultrasounds 87

Ultrasounds Operations Shock 87

RebelEM

DECEMBER 18, 2023

Barium contrast X-ray CT scan Magnetic resonance imaging Ultrasound FOR THE RIGHT ANSWER CLICK ON THE ROSH REVIEW LOGO BELOW References Burkart JM, Bleyer A. McGraw Hill; 2020:(Ch) 90. Which of the following imaging modalities is indicated at this time? link] Calvert JH, Cline DM. End-stage renal disease. link] Szeto CC, Li PKT.

EMS 58

EMS Ultrasounds 58

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. 2020 Feb;19(2):115-122. Reference article, Radiopaedia.org (Accessed on 28 Aug 2023) [link] Ortiz de Mendivil A, Alcalá-Galiano A, et al. 2013.01.004.

Stroke 107

Stroke EMS EKG/ECG Radiology 107

Dr. Smith's ECG Blog

JULY 5, 2024

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. Several hours later, this was the effect: NT pro-BNP elevated to 7000 Furosemide was also given. I'd add the following thoughts to Dr. Smith's discussion.

EKG/ECG 114

EKG/ECG Stroke Administration Ultrasounds 114

ALiEM

MAY 19, 2023

Additional trick: If the x-ray is delayed, you can pre-check with ultrasound [7]. PulmCrit Wee: Ultrasound-guided blakemore tube placement. Published June 1, 2020. Then fill the gastric balloon with 50 cc of air. Verify the placement of the gastric balloon with a chest x-ray. EM:RAP HD Videos. Accessed December 17, 2021.

Emergency Department 98

Emergency Department Ultrasounds Wellness EMS 98

ALiEM

JANUARY 29, 2024

Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine vol. 39,1 (2020): 197-202. “Using the Retrobulbar Spot Sign to Assist in Diagnosis and Management of Central Retinal Artery Occlusions.” doi:10.1002/jum.15073

Stroke 64

Stroke Ultrasounds Academics Outcomes 64

Don't Forget the Bubbles

NOVEMBER 8, 2023

Ultrasound has been associated with lower rates of negative appendicectomy. In a meta-analysis of 26 paediatric studies, the pooled sensitivity and specificity of ultrasound for diagnosing appendicitis in children were 88% and 94%, respectively [10]. 2020 Apr;4(4):271-280. European Journal of Pediatrics, 1996. 155 (7): p.

Emergency Department 105

Emergency Department Ultrasounds Pediatrics Best Practices 105