Don't Forget the Bubbles

JANUARY 1, 2024

Data collected from 2002 to 2021 revealed a 72% decline in IPD incidence among children (<18 years), with continued reductions after the transition from PCV7 to PCV13. During the COVID-19 pandemic (2020-2021), the incidence of IPD reached its lowest level in 20 years. Outcomes From a Randomized Clinical Trial. Eur J Pediatr.

Pediatrics 98

Pediatrics Ultrasounds Blood Transfusions Sepsis 98

PulmCCM

APRIL 1, 2024

Physical therapy is probably under-provided to critically ill patients, and improving this might improve outcomes for many. 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

RebelEM

FEBRUARY 12, 2024

Chang 2021 ) This systematic review was used as the basis for a 9 member panel to develop consensus guidelines on CT imaging for patients with suspected renal colic in 29 scenarios. 2021 Sep;47:70-73. Epub 2021 Mar 22. CT in Detecting Urinary Tract Calculi: Influence on Patient Imaging and Clinical Outcomes Radiology.

Radiology 69

Radiology Radiology Emergency Department Ultrasounds 69

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 84

Hyperthermia / Hypothermia Resuscitation CPR EMS 84

Core Ultrasound

MARCH 25, 2024

Old IVC Vid (2021) TEE VTI Here are Dr. Spiegel’s Notes: 1. The IVC is unable to reliably tell you anything about fluid responsiveness but fluid responsiveness is a flawed outcome and we have to start taking a more holistic view on the administration of fluid. It is our job as clinicians to interpret what that means.

Administration 98

Administration Sepsis Ultrasounds Outcomes 98

ACEP Now

MAY 9, 2024

The procedure has soared in popularity as beauty standards have shifted and cosmetic surgery has become increasingly transparent on social media platforms, with reported cases in the United States increasing from 614 in 2002 to 61,387 by 2021, a nearly 10,000 percent increase. These questionable practices led to a rash of bad outcomes.

Emergency Department 52

Emergency Department Operations Ultrasounds Hospitals 52

Don't Forget the Bubbles

JANUARY 17, 2024

2021 A plain abdominal X-ray shows multiple dilated loops of bo wel. Abdominal ultrasound, used in 34 cases, was able to visualize a rounded intraluminal image corresponding to a bead in 28 patients. 2021 These beads, once hydrated inside the body, reached considerable sizes. His abdominal X-ray looked a lot like this.

Pediatrics 111

Pediatrics Poisoning Ultrasounds Dehydration 111

Broome Docs

JANUARY 30, 2023

Covered or uncovered: A randomized control trial of Tegaderm versus no Tegaderm for ocular ultrasound. 2021 Aug;78(2):253-266. Epub 2021 Apr 29. Association of Chest Pain Protocol-Discordant Discharge With Outcomes Among Emergency Department Patients With Modest Elevations of High-Sensitivity Troponin. Am J Emerg Med.

Emergency Department 52

Emergency Department Outcomes Ultrasounds Pediatrics 52

ACEP Now

JUNE 21, 2023

2,3 In the 2021-2022 academic year, categorical (non-combined) EM residency lengths included 221 (80 percent) PGY 1-3 and 55 (20 percent) PGY 1-4 programs. The lack of differences in the observed outcomes do not suggest one EM training length is superior. 1 Curricula with non-EM internships (i.e., 11 What should we take away?

EMS 114

EMS Academics Telemedicine Research 114

Taming the SRU

SEPTEMBER 8, 2023

Epub 2021 Jul 14. Epub 2021 Jan 4. 2021 May;8(1):e000648. doi: 10.1136/bmjgast-2021-000648. 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.”

Radiology 59

Radiology Radiology Ultrasounds EMS 59

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. 2021 PMID: 34273470 12 Petitpas F et al. 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 102

Resuscitation Administration Emergency Department Hospitals 102

The Skeptics' Guide to EM

SEPTEMBER 11, 2021

Date: September 8th, 2021 Reference: Desch et al. Date: September 8th, 2021 Reference: Desch et al. Her point-of-care ultrasound (POCUS) shows appropriate-appearing global ejection fraction and no marked wall motion abnormalities. The TOMAHAWK Investigators. first appeared on The Skeptics Guide to Emergency Medicine.

EKG/ECG 52

EKG/ECG Academics EMS CPR 52

Taming the SRU

MAY 5, 2023

2021, Jarczak, Kluge et al. 2021, Im, Kang et al. 2021), although this is based on low-quality evidence rather than high-quality randomized trials and has remained a controversial aspect of treatment of patients with sepsis given the potential harms of large-volume fluid administration. N Engl J Med. 2023;388(6):499-510.

Sepsis 52

Sepsis Shock Administration Resuscitation 52

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? McGraw Hill; 2021. Sonographic diagnosis and outcome of hepatic artery thrombosis after orthotopic liver transplantation in adults.

EMS 69

EMS Ultrasounds Emergency Department Outcomes 69

Dr. Smith's ECG Blog

APRIL 2, 2024

Bedside ED ultrasound showed exceedingly poor global LV function, and no B lines. Angiogram in 2021 was normal. The patient awoke and had a good outcome! He was defibrillated, but they also noticed that he was being internally defibrillated and then found that he had an implantable ICD. Here is the initial ED ECG.

EKG/ECG 131

EKG/ECG Shock CPR Stroke 131

ACEP Now

NOVEMBER 16, 2023

2,3 In the 2021-2022 academic year, categorical (non-combined) EM residency lengths included 221 (80 percent) PGY 1-3 and 55 (20 percent) PGY 1-4 programs. The lack of differences in the observed outcomes do not suggest one EM training length is superior. Residency length has varied since the inception of the specialty of EM.

Academics 52

Academics EMS Research Telemedicine 52

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. 2021 Sep 10;12:727962. 2021 May 14;12:661955. Reference article, Radiopaedia.org (Accessed on 28 Aug 2023) [link] Ortiz de Mendivil A, Alcalá-Galiano A, et al.

Stroke 89

Stroke EMS EKG/ECG Radiology 89

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

FEBRUARY 19, 2024

This has been the central question of many research projects with variable outcomes. 12) Axillary While axillary arterial line placement has been uncommon, in the age of facile ultrasound operators it may become a more advantageous and accessible site particularly in patients with high BMIs. But are they good enough? Broadstock, A.

Shock 59

Shock Resuscitation Ultrasounds Research 59

EMDocs

JULY 17, 2023

3 Point of care ultrasound (POCUS) can be highly sensitive for free fluid and pneumoperitoneum when used by a trained physician in the appropriate patient population. Acute mechanical bowel obstruction: clinical presentation, etiology, management and outcome. Published 2021 Apr 22. World J Gastroenterol. 2007 Jan 21;13(3):432-7.

Operations 77

Operations EMS Fluid Resuscitation Resuscitation 77

EMDocs

SEPTEMBER 9, 2023

McGraw Hill; 2021. The value of ultrasound for detecting hand fractures: A meta-analysis. Results of primary extensor tendon repair in relation to the zone of injury and pre-operative outcome estimation. Tendon Lacerations. In: Knoop KJ, Stack LB, Storrow AB, Thurman R. The Atlas of Emergency Medicine, 5e. 2013;29(2):261-268.

EMS 78

EMS Fractures Soft Tissue Injuries Ultrasounds 78

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. 2021 ; 46 : 23 - 26 4. Am J Emerg Med. 2022 ; 51 : 384 - 387 3. Am J Emerg Med.

EKG/ECG 121

EKG/ECG Documentation/Coding Emergency Department Outcomes 121

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 2021 Jun 24.

Fractures 94

Fractures COPD Hospitals Emergency Department 94

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 103

EKG/ECG Ultrasounds Wellness Stroke 103

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] Association between prehospital tranexamic acid administration and outcomes of severe traumatic brain injury. 2021 Jan 1;32(1):37-43.

Head Injuries 52

Head Injuries Administration Outcomes Seizures 52

Don't Forget the Bubbles

MAY 28, 2024

Were there any abnormalities on ultrasounds? Advances in understanding the pathophysiology and treatment have improved outcomes, yet PPHN is still associated with significant morbidity and mortality. So here, we must think about the risk factors for PPHN. Does the baby look septic? Are they covered in meconium? How do you manage PPHN?

Sepsis 52

Sepsis Ultrasounds Pediatrics Research 52

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).

Ultrasounds 122

Ultrasounds Outcomes COPD Hospitals 122

Taming the SRU

MAY 22, 2023

Certain injuries carry risks of further injury, injury-related complications, and poor outcomes which are exacerbated if they are inappropriately managed in the ED. Point-of-care ultrasound (POCUS) can evaluate for Achilles tendon rupture with a high sensitivity (96-100%) and specificity (83-100%) [8,9]. MRI can be used in place of CT.

Fractures 75

Fractures Dislocations Operations Radiology 75

Dr. Smith's ECG Blog

JANUARY 23, 2023

2021 Dec 7;10(23):e022866. Epub 2021 Nov 15. PMID: 34775811; PMCID: PMC9075358 A bedside ultrasound was performed, shown here: Parasternal short axis view demonstrating inferior LV wall motion akinesis Apical 2 chamber view again demonstrating inferior LV wall akinesis The cath lab was not activated based on the ECG and bedside echo.

EKG/ECG 52

EKG/ECG Shock Emergency Department Ultrasounds 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.

Ultrasounds 52

Ultrasounds Outcomes 52

RebelEM

FEBRUARY 19, 2024

The 2021 Surviving Sepsis Campaign Guidelines suggest starting vasopressors peripherally rather than delaying infusion until a CVC is placed [2]. of cases) Catheter ultrasound confirmation: 49.8% (i.e. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. Crit Care Med 2021.

Administration 134

Administration Sepsis EMS Shock 134

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 81

Shock EKG/ECG Academics Stroke 81

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 68

Ultrasounds Outcomes Documentation/Coding Emergency Department 68

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? Scand J Trauma Resusc Emerg Med 29, 170 (2021) What’s it about? Hetmann, F.,

Hospitals 72

Hospitals Ultrasounds Emergency Department Pediatrics 72

Northwestern EM Blog

DECEMBER 27, 2021

Congratulations to all of the authors with the most popular posts of 2021! Take-Home Point: Bedside pericardiocentesis is a rare but important procedure that can be performed emergently using ultrasound or landmark guidance. Combined with active rewarming strategies, tPA use results in significantly improved outcomes.

Dislocations 52

Dislocations Emergency Department Burns Shock 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. 2022 Dec 16:emermed-2021-211946. doi: 10.1136/emermed-2021-211946. Clinical Outcomes After Intensifying Antihypertensive Medication Regimens Among Older Adults at Hospital Discharge.

Sepsis 52

Sepsis Ultrasounds Hospitals Outcomes 52

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]. J Med Virol.

Infectious Diseases 86

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 86