Taming the SRU

JULY 24, 2023

THE CASE A male in his 60s presented to the emergency department for right upper quadrant abdominal pain. A bedside right upper quadrant ultrasound was performed, and the images are below. Ultrasound is the gold standard for diagnosing cholelithiasis because it is more sensitive for detecting gallstones. Indian J Surg.

Ultrasounds 76

Ultrasounds Sepsis Radiology Radiology 76

ALiEM

SEPTEMBER 13, 2024

A 32-year-old male with no significant past medical history presented to the emergency department (ED) from an outside hospital for further management of right eye pain and vision loss sustained after he was struck by a metal wire while at work. An emergent ophthalmology consult is needed to plan for operative repair.

Emergency Department 64

Emergency Department Hospitals Academics Fractures 64

PEMBlog

OCTOBER 16, 2023

This case was submitted by… A 12-year-old female was brought to your emergency department by her mother for 1 month of diffuse abdominal and back pain. She also had a pelvic ultrasound with relevant image seen here: Based on those findings, she then got a CT with relevant images seen here: A. This is the first of the four cases.

Ultrasounds 69

Ultrasounds Emergency Department Pediatrics 69

Don't Forget the Bubbles

NOVEMBER 13, 2023

Should we use ultrasound to diagnose distal forearm fractures in children and adolescents? X-ray (radiography) is the standard imaging technique used in emergency departments. However, ultrasound is gaining popularity due to its portability, affordability, and lack of ionising radiation. 2023 Jun 1;388(22):2049-2057.

Fractures 64

Fractures Ultrasounds Emergency Department Pediatrics 64

ALiEM

AUGUST 26, 2024

A 27-year-old male with no past medical history presents to the Emergency Department with right eye pain. A vitreous hemorrhage OD was also identified on bedside ultrasound. Iridodialysis Traumatic iridodialysis is an uncommon ocular emergency with very distinct findings that we can encounter in the Emergency Department.

Emergency Department 70

Emergency Department Academics Ultrasounds 70

Broome Docs

JANUARY 30, 2023

Covered or uncovered: A randomized control trial of Tegaderm versus no Tegaderm for ocular ultrasound. Am J Emerg Med. Association of Chest Pain Protocol-Discordant Discharge With Outcomes Among Emergency Department Patients With Modest Elevations of High-Sensitivity Troponin. Am J Emerg Med. 2022 Nov;61:87-89.

Emergency Department 52

Emergency Department Outcomes Ultrasounds Pediatrics 52

ALiEM

AUGUST 30, 2024

A 5-year-old female presented to the emergency department (ED) with a one-year history of gradually increasing anterior neck swelling. NG/DL) Ultrasound of the neck revealed an enlarged thyroid gland with lobular contours and diffuse hypoechoic echogenicity, without noticeable nodules, fluid collection, or lymphadenopathy.

Pediatrics 64

Pediatrics Ultrasounds Academics Emergency Department 64

ACEP Now

FEBRUARY 13, 2024

A 77-year-old man presented to the emergency department (ED) with hip pain following a fall. In the January issue of Annals of Emergency Medicine , Merz-Herrara, et al., published a study, “Safety and Pain Reduction in Emergency Practitioner Ultrasound-Guided Nerve Blocks: A One-Year Retrospective Study.”

Ultrasounds 52

Ultrasounds Emergency Department Hospitals Wellness 52

The Skeptics' Guide to EM

MARCH 25, 2023

Date: March 22, 2023 Reference: Hilsden et al. Point of care biliary ultrasound in the emergency department (BUSED) predicts final surgical management decisions. Casey […] The post SGEM#398: Another Ab Gets BUSED – POCUS in the ED for Biliary Disease first appeared on The Skeptics Guide to Emergency Medicine.

Ultrasounds 52

Ultrasounds Emergency Department Dislocations Radiology 52

Taming the SRU

APRIL 14, 2024

2) Management: Confirmed by CT Surgical consult Utility of Ultrasound Ultrasound can be helpful in identifying hernias and in assisting in reduction. 8) “Ultrasound may decrease the emergency surgery rate of incarcerated inguinal hernia” by Chen et al. (1) The results revealed a rate of emergency surgery of 9.8%

Ultrasounds 91

Ultrasounds Emergency Department Pediatrics Radiology 91

ALiEM

OCTOBER 2, 2023

A 6-year-old male presented to the pediatric emergency department (PED) for scalp lesions. An outpatient ultrasound was performed showing “multiple scalp echogenic nodular lesions measuring from 0.5 A point-of-care ultrasound (POCUS) using a high-frequency, linear transducer was performed during the PED visit (Image 2).

Ultrasounds 75

Ultrasounds Pediatrics Academics Emergency Department 75

ALiEM

FEBRUARY 2, 2024

Laboratory Data Ultrasound reveals a 1.7 Because of the concern for malignancy, a biopsy was performed in the emergency department after the ultrasound and CT scan confirmed there was no extension into the thorax. It is soft with some slight nodularity on palpation, and only mild tenderness noted. There is no fluctuance.

Ultrasounds 67

Ultrasounds Academics Emergency Department 67

ACEP Now

AUGUST 22, 2023

Regardless of the domain, somewhere an expert panel has convened to issue a pronouncement informing all of the ideal care of patients under their specialty umbrella, indirectly extending to their care in the emergency department. 2-4 A fourth is planned for publication in late 2023, and will address non-opioid substance dependence.

Emergency Department 98

Emergency Department Academics Critical Access Research 98

ALiEM

APRIL 14, 2023

After carefully reviewing all relevant posts in the past 12 months from the top 50 sites of the Social Media Index, the ALiEM AIR Team is proud to present the highest quality online content related to related to procedures in the Emergency Department. More specifically, we identified 2 AIR and 4 Honorable Mentions.

EMS 98

EMS Ultrasounds Academics Fractures 98

Dr. Smith's ECG Blog

JUNE 17, 2024

Written by Bobby Nicholson, MD 67 year old male with history of hypertension and hyperlipidemia presented to the Emergency Department via ambulance with midsternal nonradiating chest pain and dyspnea on exertion. Cardiac Ultrasound may be a surprisingly easy way to help make the diagnosis Answer: pulmonary embolism.

EKG/ECG 139

EKG/ECG Emergency Department Shock Ultrasounds 139

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. World J Emerg Surg 2023 PMID: 36918947 3. Intraosseous vascular access in adults using the EZ-IO in an emergency department. Int J Emerg Med 2009 PMID: 20157465 4.

Resuscitation 102

Resuscitation Administration Emergency Department Hospitals 102

ALiEM

OCTOBER 23, 2023

A 32-year-old man with a history of traumatic globe rupture from a stab wound two months ago, status post repair, presented to the emergency department for worsening right eye pain and green malodorous drainage for the past three days. On ultrasound, it appears as a heterogeneous isoechoic collection that abuts the right globe.

Academics 111

Academics Emergency Department Ultrasounds Wellness 111

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]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Accessed April 6, 2023.

Emergency Department 98

Emergency Department Ultrasounds Wellness EMS 98

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? Accessed April 21, 2023. UpToDate; 2023. Accessed May 7, 2023 5) Oh SY, Lee JM, Lee H, et al. Am J Emerg Med.

EMS 69

EMS Ultrasounds Emergency Department Outcomes 69

EMDocs

DECEMBER 4, 2023

Johnson, MD ( Community EM, Salina Regional Health Center) // Reviewed by: Joshua Lowe, MD (EM Attending Physician, USAF); Marina Boushra, MD (Cleveland Clinic Foundation, EM-CCM); Brit Long, MD (@long_brit) Case A 40-year-old woman presents to a rural emergency department (ED) with left leg pain and swelling for the past 5 days.

Ultrasounds 71

Ultrasounds Documentation/Coding Wellness EMS 71

Don't Forget the Bubbles

MAY 8, 2024

2024 Apr 25:archdischild-2023-326533. A silent scream in the pediatric emergency department: child abuse and neglect. 2024 Apr 18:fetalneonatal-2023-326679. 2024 Apr 16:archdischild-2023-326247. 2024 Apr 16:archdischild-2023-326331. 2024 Apr 8:archdischild-2023-326175. JAMA Pediatr. Wong J, et al.

Pediatrics 69

Pediatrics Emergency Department Outcomes Research 69

EMDocs

AUGUST 12, 2023

He presented to the emergency department because he is having numbness distal to the site of injury, as well as constant bleeding and some difficulty with flexing his finger. The Atlas of Emergency Medicine, 5e. Accessed June 24, 2023. Treasure Island (FL): StatPearls Publishing; February 5, 2023. In: StatPearls.

EMS 69

EMS Fractures Operations Ultrasounds 69

Taming the SRU

MAY 27, 2024

Shortness of breath is one of the most common complaints presenting to emergency departments. Ultrasound in recent years has become a very helpful tool in diagnosing smaller effusions, and is noted to be almost 100% sensitive for effusions > 100 mL (2). Overview - what is a pleural effusion and how can i fix it?

Emergency Department 84

Emergency Department Ultrasounds Radiology Radiology 84

EMDocs

NOVEMBER 4, 2023

An ultrasound of the testes reveals the following: What is the diagnosis? Accessed April 26, 2023. aureus infections among patients in the emergency department. Skin and Soft Tissue Infections in the Emergency Department. Emerg Med Clin North Am. Accessed May 2, 2023. Ann Emerg Med.

EMS 68

EMS Ultrasounds Emergency Department Infectious Diseases 68

Dr. Smith's ECG Blog

OCTOBER 18, 2023

If you were working in a busy emergency department, would you like to be interrupted to interpret these ECGs or can these patients safely wait to be seen because of the normal computer interpretation? Emergent cardiac outcomes in patients with normal electrocardiograms in the emergency department. Am J Emerg Med.

EKG/ECG 121

EKG/ECG Documentation/Coding Emergency Department Outcomes 121

EMDocs

JANUARY 16, 2024

Louis) // Reviewed by: Alex Koyfman, MD (@EMHighAK); Brit Long, MD (@long_brit) Case You are working in the trauma/critical care pod of your emergency department (ED). You receive a page for a cardiac arrest and take report from emergency medical services (EMS). link] Published February 12, 2023. Am J Emerg Med.

Hyperthermia / Hypothermia 84

Hyperthermia / Hypothermia Resuscitation CPR EMS 84

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 Emergency Department Radiology 70

EMDocs

SEPTEMBER 9, 2023

The Atlas of Emergency Medicine, 5e. Accessed June 24, 2023. Accessed June 8, 2023. Accessed June 6, 2023. The value of ultrasound for detecting hand fractures: A meta-analysis. 2021.0052 Emergency Department Management of Extensor Tendon Lacerations – Page 3 of 4. Accessed June 7, 2023.

EMS 78

EMS Fractures Soft Tissue Injuries Ultrasounds 78

EMDocs

MAY 11, 2024

Reference article, Radiopaedia.org (Accessed on 28 Aug 2023) [link] Ortiz de Mendivil A, Alcalá-Galiano A, et al. Semin Ultrasound CT MR. 2013 Apr;34(2):131-41. Updated 2023 Jun 24]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Updated November 9, 2023. Accessed November 19, 2023. Ann Emerg Med.

Stroke 89

Stroke EMS EKG/ECG Radiology 89

The Skeptics' Guide to EM

JANUARY 14, 2023

Date: January 13, 2023 Reference: Razi et al. first appeared on The Skeptics Guide to Emergency Medicine. Date: January 13, 2023 Reference: Razi et al. Case: A 38-year-old female presents to the emergency department (ED) with a five-hour history of acute onset left flank pain.

Emergency Department 52

Emergency Department Ultrasounds 52

EMDocs

JULY 29, 2023

A 75-year-old male with past history of HTN, CVA, DM II presents to the emergency department with right facial swelling since last night. Transoral Ultrasound in the Diagnosis of Obstructive Salivary Gland Pathologies. Ultrasound Med Biol. WikEM, The Global Emergency Medicine Wiki. Accessed March 27, 2023.

EMS 71

EMS Dehydration Ultrasounds Emergency Department 71

EMDocs

APRIL 22, 2024

4 In an emergency department (ED) presentation of cardiac arrest, the diagnosis of PE is challenging without the use of CT angiography. Point-of-Care-Ultrasound (POCUS) is a bedside modality that can assist Emergency Physicians (EPs) in differentiating PE from other causes of cardiac arrest. 2023 May 27;35(2):135-143.

Ultrasounds 82

Ultrasounds Advances Cardiac Life Support (ACLS) EKG/ECG Resuscitation 82

Taming the SRU

MAY 22, 2023

Point-of-care ultrasound (POCUS) can evaluate for Achilles tendon rupture with a high sensitivity (96-100%) and specificity (83-100%) [8,9]. role of consulting services, emergent closed reduction, need for vascular imaging). Most frequent reasons for emergency department visits, 2018. Accessed March 5, 2023.

Fractures 75

Fractures Dislocations Operations Radiology 75

Don't Forget the Bubbles

FEBRUARY 5, 2024

2024 Jan 12:archdischild-2023-326225. 2024 Jan 23:archdischild-2023-325984. 2024 Jan 11:fetalneonatal-2023-325829. 2024 Jan 11:fetalneonatal-2023-326383. Assessing fluid responsiveness with ultrasound in the neonatal intensive care setting: the mini-fluid challenge. 2024 Jan 17:fetalneonatal-2023-326099.

Pediatrics 52

Pediatrics Research Resuscitation Outcomes 52

Don't Forget the Bubbles

JANUARY 17, 2024

Curious Ken is brought into your emergency department. Abdominal ultrasound, used in 34 cases, was able to visualize a rounded intraluminal image corresponding to a bead in 28 patients. Journal of The Korean Society of Emergency Medicine , 33 (1), pp.134-138. Clinical and Experimental Emergency Medicine , 7 (4), p.330.

Pediatrics 111

Pediatrics Poisoning Ultrasounds Dehydration 111

Dr. Smith's ECG Blog

SEPTEMBER 3, 2023

This was sent by anonymous The patient is a 55-year-old male who presented to the emergency department after approximately 3 to 4 days of intermittent central boring chest pain initially responsive to nitroglycerin, but is now more constant and not responsive to nitroglycerin. It is unknown when this pain recurred and became constant.

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EKG/ECG Resuscitation CPR Emergency Department 133

ACEP Now

FEBRUARY 11, 2024

1,2 In the emergency department (ED), the focus of treatment is pain control and immobilization unless there is a clear indication for surgery, such as open fractures, skin tenting, or neurovascular compromise. The ultrasound-guided clavipectoral plane block (CPB) is a newly described technique in the emergency medicine literature.

Ultrasounds 52

Ultrasounds Fractures Emergency Department Hospitals 52