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

Greater Sydney Area HEMS

FEBRUARY 20, 2024

The evidence for improved safety and quality with the use of ultrasound for CVC implementation is well established [i]. How can this situation be rectified or has the use of ultrasound rendered this blind subclavian “trauma line” a thing of the past? One approach to obtaining BCV origin access (fig.1) 2020;35(3):303-321.

Ultrasounds 98

Ultrasounds Shock Research Operations 98

ACEP Now

FEBRUARY 11, 2024

The ultrasound-guided clavipectoral plane block (CPB) is a newly described technique in the emergency medicine literature. Ultrasound Survey Scan FIGURE 1A: Ultrasound probe should be placed at the clavicle with the probe marker facing cephalad (toward the head). FIGURE 1B: Ultrasound image with labeled relevant anatomy.

Ultrasounds 52

Ultrasounds Fractures Emergency Department Hospitals 52

Don't Forget the Bubbles

JANUARY 1, 2024

Data from the Nurse-Family Partnership program involving 60,171 families were analysed across four cohorts, including pre-pandemic and three pandemic cohorts (from July 2022 to October 2023). 2023 Dec 22. Lung ultrasound for the sick child: less harm and more information than a radiograph. 2023 Dec 21. 2023 Dec 19.

Pediatrics 98

Pediatrics Ultrasounds Blood Transfusions Sepsis 98

Broome Docs

APRIL 6, 2023

2023 Jan 21. Clinical risk factors for testicular torsion and a warning against falsely reassuring ultrasound scans: a 10-year single-centre experience. 2023 Feb;64:206.e1-206.e3. 2023 Jan 30. 2023 Jan 13;76(2):185-191. 2023 Feb;30(2):144-146. 2023 Jan 17;329(3):224-234. 2023 Mar 17;380:p601.

Sepsis 52

Sepsis Ultrasounds Hospitals Fractures 52

ALiEM

OCTOBER 23, 2023

There was a well-healed scar on the bottom eyelid. On ultrasound, it appears as a heterogeneous isoechoic collection that abuts the right globe. The hyperdense foreign body is again seen on CT, as well as a small focus of air within the anterior chamber. The lateral canthus appeared inferiorly displaced.

Academics 111

Academics Emergency Department Ultrasounds Wellness 111

Taming the SRU

APRIL 14, 2024

You may place cold packs or ice packs to the hernia site to help reduce inflammation and swelling, as well as to assist in local analgesia. Symptoms include persistent tenderness in the area, as well as symptoms of obstruction including nausea, vomiting, and pain, despite reduction. (2) 1) In a study performed by Chen et al.

Ultrasounds 92

Ultrasounds Emergency Department Pediatrics Radiology 92

Don't Forget the Bubbles

JULY 17, 2023

Reviews and opinion articles Point-of-care ultrasound in pediatric nephrology. 2023 Jun;38(6):1733-1751. 2023 May 16;28(3):172-183. 2023 Jun 6;28(4):205-251. 2023 Jun 6;28(4):252-266. 2023 Jun 1;177(6):559-560. 2023 Jun;182(6):2785-2792. 2023 May 16;28(3):184-202. 2023 Jun 15.

Pediatrics 98

Pediatrics Emergency Department Outcomes Fractures 98

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 90

Emergency Department Ultrasounds Administration Burns 90

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

ALiEM

OCTOBER 28, 2024

She was well during the interval until more recently, the patient began to complain of persistent abdominal pain and would point to the epigastric area. The patient had been tolerating oral intake well, passing adequate urine, having normal bowel movements, and behaving at baseline. 2023 May 30. No scleral icterus. Wilms Tumor.

Pediatrics 64

Pediatrics Ultrasounds Academics Wellness 64

RebelEM

JUNE 26, 2023

4F-PCC contains factors II, VII, IX, X as well as Proteins S and C. 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. Severe acute traumatic coagulopathy = PT >1.5

Administration 140

Administration Outcomes Resuscitation Radiology 140

Dr. Smith's ECG Blog

SEPTEMBER 23, 2024

Answer : Bedside ultrasound! Smith : RV infarct may also have this appearance on ultrasound. So hypoxia without B lines on lung ultrasound strongly weights toward PE. _ Here are some representative stills with red arrows pointing to the emboli. Instead, IR performed pulmonary thrombectomy and the patient did well.

EKG/ECG 111

EKG/ECG Ultrasounds Shock EMS 111

RebelEM

APRIL 29, 2024

CVC vs PIV The critically ill patient is often associated with pathology that makes IV access difficult such as shock state, hypovolemia, obesity, IV drug abuse, end-stage renal disease, cardiac arrest, as well as other conditions. World J Emerg Surg 2023 PMID: 36918947 3. 2023 PMID: 37502742 11 Schwalbach KT et al. Healthcare.

Resuscitation 105

Resuscitation Administration Emergency Department Ultrasounds 105

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. What findings make a DVT more likely?

Ultrasounds 71

Ultrasounds Documentation/Coding Wellness EMS 71

ALiEM

JANUARY 29, 2024

It requires immediate consultation with ophthalmology as well as neurology as it is considered a stroke equivalent. Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine vol. 39,1 (2020): 197-202. doi:10.1002/jum.15073

Stroke 64

Stroke Ultrasounds Academics Outcomes 64

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? Article 1: What predicts parental anxiety in the Paediatric Emergency Department?

Hospitals 72

Hospitals Ultrasounds Emergency Department Pediatrics 72

Mount Sinai EM

OCTOBER 11, 2024

2023) of 17 studies with 812 patients (all cohort studies aside from one small RCT), intraoral US was 91% sensitive and 75% specific for PTA, while transcervical US was 80% sensitive and 81% specific. Hennepin Ultrasound has a blog post on how to perform this both statically and dynamically–visualizing the needle as it aspirates the PTA.

Ultrasounds 100

Ultrasounds Wellness Outcomes Hospitals 100

Dr. Smith's ECG Blog

SEPTEMBER 18, 2024

Bedside cardiac ultrasound with no obvious wall motion abnormalities. For more on MINOCA — See My Comment in the November 16, 2023 post in Dr. Smith's ECG Blog ). He had a previous ECG on file: Proving the findings are new The cath lab was activated. He was given aspirin and sublingual nitro and the pain resolved.

EKG/ECG 112

EKG/ECG Ultrasounds Documentation/Coding Wellness 112

ACEP Now

FEBRUARY 13, 2024

See below: Fascia iliaca Serratus anterior Erector spinae The risks of opioid medications, especially in the elderly, has been well described. published a study, “Safety and Pain Reduction in Emergency Practitioner Ultrasound-Guided Nerve Blocks: A One-Year Retrospective Study.” 2023 Sep 2;15(9):e44583. mean) to 2.8

Ultrasounds 52

Ultrasounds Emergency Department Hospitals Wellness 52

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 97

Fractures Ultrasounds Outcomes Research 97

Dr. Smith's ECG Blog

JUNE 17, 2024

There are well preserved R-waves in Wellens waves. Cardiac Ultrasound may be a surprisingly easy way to help make the diagnosis Answer: pulmonary embolism. Now another, with ultrasound. I refer to My Comment in the March 4, 2023 post — in which I included a Table with ECG Findings of Acute PE. What is the Diagnosis?

EKG/ECG 135

EKG/ECG Emergency Department Shock Ultrasounds 135

Medagadget

JUNE 8, 2023

However, the esophagus lies pretty close as well, often just a couple of millimeters away. How to safely protect the esophagus has been a well-recognized problem for at least 15 years,” said Daoud. See a video about the technology: The study was presented at the Heart Rhythm Society’s 2023 meeting.

Research 73

Research Patient Safety Ultrasounds Wellness 73

ALiEM

SEPTEMBER 13, 2024

On arrival to our emergency department, the patient expressed continued eye pain with bloody discharge as well as blurry vision from his right eye. Tonometry and ocular ultrasound (US) are generally not recommended as you could squeeze more liquid out of the eye or increase the intraocular pressure even more, pushing the iris further out.

Emergency Department 64

Emergency Department Fractures Academics Hospitals 64

ALiEM

SEPTEMBER 29, 2023

Additional Images Physical Exam General : Well-appearing male in no distress Neck : Hemostatic wound to his left neck. Copyright Images and cases from the Society of Academic Emergency Medicine (SAEM) Clinical Images Exhibit at the 2023 SAEM Annual Meeting | Copyrighted by SAEM 2023 – all rights reserved.

Radiology 70

Radiology Radiology Academics Ultrasounds 70

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. Accessed June 24, 2023. Treasure Island (FL): StatPearls Publishing; February 5, 2023. Accessed June 10, 2023. The Atlas of Emergency Medicine, 5e.

EMS 70

EMS Fractures Operations Ultrasounds 70

PulmCCM

JUNE 26, 2023

They announced this at the American Thoracic Society meeting in May 2023. Cervical and pancreatic cancer patients often do as well with less invasive surgery, and some patients with rectal cancer or Hodgkin lymphoma can safely get less radiation. An expert panel broadened the definition of acute respiratory distress syndrome (ARDS).

Outcomes 98

Outcomes Ultrasounds Hospitals Wellness 98

Dr. Smith's ECG Blog

JANUARY 2, 2025

Bedside cardiac ultrasound showed moderately decreased LV function. Clinically, it is well to remember that this variation in QTc estimation is greater at faster heart rates ( with faster heart rates being common in "sicker" patients, for whom we are most likely to need to assess the QTc ). She was intubated.

EKG/ECG 100

EKG/ECG Sepsis Wellness Documentation/Coding 100

Dr. Smith's ECG Blog

OCTOBER 1, 2023

You can see that she is not only "looking" at the ST segment, but the majority of the T wave itself, and factoring in the QRS as well (just like expert humans do). Gallbladder ultrasound was negative for stones. Back to the case: Unfortunately, the ECG was not understood by the provider. Chest x-ray was normal.

EKG/ECG 126

EKG/ECG EMS Ultrasounds Wellness 126

EMDocs

SEPTEMBER 9, 2023

Accessed June 24, 2023. Accessed June 8, 2023. Accessed June 6, 2023. The value of ultrasound for detecting hand fractures: A meta-analysis. Accessed June 7, 2023. Rosh Review Website Link References Park CW, Juliano ML, Woodhall D. Tendon Lacerations. In: Knoop KJ, Stack LB, Storrow AB, Thurman R. Dec 21, 2022.

EMS 78

EMS Fractures Soft Tissue Injuries Ultrasounds 78

ACEP Now

AUGUST 22, 2023

2-4 A fourth is planned for publication in late 2023, and will address non-opioid substance dependence. While “low-risk” chest pain is more easily described using scoring systems, undifferentiated abdominal pain is less well-defined. Accessed July 14, 2023. 1 To date, there have been three GRACE publications. About SAEM.

Emergency Department 98

Emergency Department Academics Critical Access Research 98

RebelEM

AUGUST 31, 2023

CVC placement under ultrasound guidance has decreased overall complication rates and there is increased awareness of transfusion reactions, alloimmunization, acute lung injury, circulatory overload, as well as infection. Despite being common practice, the necessity of routine prophylactic transfusions is now being called into question.

Ultrasounds 58

Ultrasounds Outcomes Wellness Research 58

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 115

EKG/ECG EMS Wellness Operations 115

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 82

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

RebelEM

JUNE 19, 2023

Demographics were well balanced in the two groups. Patients were actively screened for DVT (all received lower extremity ultrasound on or around day 7). The PATCH-trauma researchers sought to address this critique. Article: PATCH-Trauma Investigators and ANZICS Clinical Trial Group. Prehospital Tranexamic Acid for Severe Trauma.

Outcomes 105

Outcomes Blood Transfusions Administration Hyperthermia / Hypothermia 105

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. Kim, Y.B.,

Pediatrics 111

Pediatrics Poisoning Ultrasounds Dehydration 111

Taming the SRU

MAY 22, 2023

Use your exam to guide your initial management as well as your imaging decisions and differential diagnosis. Point-of-care ultrasound (POCUS) can evaluate for Achilles tendon rupture with a high sensitivity (96-100%) and specificity (83-100%) [8,9]. Accessed March 5, 2023. Updated 2023 Apr 22]. Updated 2023 Feb 26].

Fractures 76

Fractures Dislocations Operations Radiology 76