Core Ultrasound

MARCH 25, 2024

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. There is no one dichotomous test that will tell you whether to give fluid or not. That is a holy grail that we have to stop chasing.

Administration 75

Administration Sepsis Ultrasounds Outcomes 75

EMDocs

MARCH 19, 2024

Ultrasound can miss this diagnosis (especially of the vertebral arteries, which are not easily visualized on US). If it’s ischemic, maintain BP < 185/110 mm Hg prior to administration of thrombolytics followed by < 180/105 mm Hg. Management Consult neurology. May need neurosurgery (SAH or LVO present).

Stroke 106

Stroke EMS Administration Ultrasounds 106

Dr. Smith's ECG Blog

JUNE 28, 2023

He arrived in the ED and had an immediate bedside cardiac ultrasound while this ECG was being recorded. The bedside ultrasound (video not available) reportedly showed only a slightly reduced LV function. The patient was given 6mg, then 12 mg, of adenosine, without a change in the rhythm. Here is the ECG: What do you think?

EKG/ECG 98

EKG/ECG Ultrasounds Administration EMS 98

The Skeptics' Guide to EM

AUGUST 24, 2024

More recently, the April 2024 SGEMHOP reviewed a trial on how effective and safe an ultrasound-guided erector spinae plane block (ESPB) in adult patients with rib fractures is. The block is typically performed under ultrasound guidance, which allows for precise placement of the anesthetic and minimizes the risk of complications.

Fractures 54

Fractures Emergency Department Ultrasounds Radiology 54

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? All of which leads to easier image acquisition. Accredited trainers are currently lacking.

Hospitals 72

Hospitals Ultrasounds Emergency Department Pediatrics 72

The Skeptics' Guide to EM

MARCH 28, 2020

Will you order an x-ray or perform a point-of-care ultrasound to confirm the diagnosis? Point-of-care ultrasound (POCUS) has previously been studied for the use of the diagnosis of shoulder dislocations with most prior data suggesting that POCUS is highly sensitive and specific for the diagnosis of shoulder dislocations [3-4].

Dislocations 52

Dislocations Ultrasounds Research Emergency Department 52

EM Curious

JULY 22, 2015

ULTRASOUND CASE OF THE WEEK [BLOG]: A 38 year old male presents from jail with the pathology seen below. Find out here at Ultrasound Of The Week. Excellent teaching videos from George Kovacs. Check you his Youtube page for more content. Which nerve block will facilitate drainage?

Infectious Diseases 52

Infectious Diseases EMS Ultrasounds Emergency Department 52

Don't Forget the Bubbles

MAY 17, 2023

Minor head trauma in infants – how accurate is cranial ultrasound performed by trained radiologists? Finding the most suitable puncture site for intraosseous access in term and preterm neonates: an ultrasound-based anatomical pilot study. Hypohydration, functional constipation, and physical activity in elementary school students.

Pediatrics 72

Pediatrics X-Ray Interpretation Sepsis Fractures 72

EMDocs

APRIL 10, 2024

While not specifically reviewed in this post, check out the methemoglobinemia tox card for more information about one of the other known events that can occur with local anesthetic administration. 3] If performing a nerve block with ultrasound guidance, always know where the tip of your needle is. [5]

Advances Cardiac Life Support (ACLS) 111

Advances Cardiac Life Support (ACLS) Seizures EMS Poisoning 111

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.

EKG/ECG 112

EKG/ECG Stroke Administration Ultrasounds 112

The Skeptics' Guide to EM

JANUARY 25, 2020

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. He has worsening work of breathing and a decreasing level of consciousness.

EMS 40

EMS Airway Management Administration Resuscitation 40

Taming the SRU

JUNE 3, 2024

Common venomous snakes in the United States include: Coral Snakes ( Elapidae family) which produces a neurotoxin Rattlesnake, Cottonmouth, Copperhead ( Viperidae family) which produces a hematologic toxin resulting in significant local tissue damage and coagulopathy Field treatment involves splinting the extremity, immobilizing the patient as possible, (..)

Shock 91

Shock Seizures Airway Management Stroke 91

Don't Forget the Bubbles

DECEMBER 25, 2023

In the BUCKLED trial that looked at whether ultrasound was non-inferior to X-ray in diagnosing forearm fractures, the primary outcome was physical function of the affected arm at four weeks. They found that epinephrine administration was associated with higher survival at 30 days ( 3.2% We love POOs. vs. 2.4% ). vs. 1.9% ).

Research 83

Research Outcomes Fractures Pediatrics 83

PEMBlog

OCTOBER 26, 2023

Ultrasound and CT may not differentiate it from normal bowel. It has a long and non-branching course and ends toward the right lower quadrant.

Radiology 64

Radiology Radiology Administration Resuscitation 64

Pediatric Emergency Playbook

AUGUST 1, 2017

Hypertrophic pyloric stenosis: tips and tricks for ultrasound diagnosis. J Ultrasound. The non-diagnostic ultrasound in appendicitis: is a non-visualized appendix the same as a negative study? Utility of MRI After Inconclusive Ultrasound in Pediatric Patients with Suspected Appendicitis. Semin Pedaitr Surg. Dias SC et al.

Pediatrics 52

Pediatrics Ultrasounds Resuscitation Sepsis 52

The Skeptics' Guide to EM

SEPTEMBER 11, 2021

He is interested and experienced in healthcare informatics, previously worked with ED-directed EMR design, and is involved in the New York City Health and Hospitals Healthcare Administration Scholars Program (HASP). Five Rules of the SGEM Journal Club Case: A 70-year-old woman is found unresponsive and apneic at home by her partner.

EKG/ECG 52

EKG/ECG Academics EMS CPR 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. Renal outcomes following intravenous contrast administration in patients with acute kidney injury: a multi-site retrospective propensity-adjusted analysis. Emerg Med J. Epub ahead of print.

Sepsis 52

Sepsis Ultrasounds Hospitals Fractures 52

SheMD

JULY 23, 2023

Another emergency medicine colleague I knew did a 2-week rotation in South America to teach ultrasound to physicians. Therefore, he worked with the primary care innovation department and learned hospital administration and clinical operations during his residency. Common Question #3: Where do you see yourself in 10 years?

Research 98

Research Academics Hospitals Operations 98

Don't Forget the Bubbles

SEPTEMBER 5, 2024

Children with complex medical conditions are at higher risk of morbidity and mortality, and this may be compounded by inaccurate weight estimation and leading to inaccurate medication dose administration. Point-of-care ultrasound for monitoring catheter tip location during umbilical vein catheterization in neonates: a prospective study.

Ultrasounds 52

Ultrasounds Research Emergency Department Outcomes 52

Dr. Smith's ECG Blog

NOVEMBER 30, 2019

On arrival, the patient was in shock, was intubated, and had an immediate cardiac ultrasound. What does a heart look like on ultrasound when the EKG looks like that? Here you go: It's not the world's greatest cardiac ultrasound video, but it does appear to show poor function and low volume. They transported to the ED.

Shock 40

Shock EKG/ECG Resuscitation Ultrasounds 40

RebelEM

JANUARY 25, 2023

2.3 – 5.4) (-) LR: 0.18 (0.09 – 0.35) Ultrasound Findings Dilated loops of bowel (diameter > 2.5 2.3 – 5.4) (-) LR: 0.18 (0.09 – 0.35) Ultrasound Findings Dilated loops of bowel (diameter > 2.5 3.6 – 55.6) (-) LR: 0.13 (0.08 – 0.20) ED US (+) LR: 9.5 (2.1

Operations 52

Operations Sepsis Resuscitation Ultrasounds 52

PulmCCM

OCTOBER 16, 2023

Most central lines in the ICU are placed under ultrasound guidance in the internal jugular vein, representing a perceived middle ground of risk for pneumothorax and infection prevention. Peripherally-inserted central catheters (PICCs) are inserted through the skin into an arm vein, and advanced under ultrasound into large central veins.

CDC 52

CDC Hospitals Ultrasounds Documentation/Coding 52

Dr. Smith's ECG Blog

MAY 19, 2020

The ways to tell for certain include intravascular ultrasound (to look for extra-luminal plaque with rupture) or "optical coherence tomography," something I am entirely unfamiliar with. The authors recommend using optical coherence tomography or intravascular ultrasound imaging in patients with evidence of nonobstructive CAD by angiogram.

CPR 52

CPR EKG/ECG Shock Ultrasounds 52

EB Medicine

AUGUST 6, 2019

Make sure to get the name, dose, and time of last administration of any DOAC. But next we should talk about ultrasound. High dose infusions for those on rivaroxaban doses of >10 mg or apixaban doses >5 mg within the last 8 hours and for unknown doses and unknown time of administration.

Emergency Department 40

Emergency Department Stroke Wellness Outcomes 40

RebelEM

JUNE 26, 2023

Interventions such as early application of hemorrhage control, tranexamic acid, reduction of crystalloid fluid administration and balanced ratio blood product transfusion have improved many patients’ outcomes. However, mortality still remains high due to trauma-induced coagulopathy. Severe acute traumatic coagulopathy = PT >1.5

Administration 143

Administration Outcomes Resuscitation Radiology 143

Don't Forget the Bubbles

NOVEMBER 1, 2023

Reviewed by: Dr Lizzie Binham Article 3: Does early administration of IV magnesium result in fewer PICU admissions for patients with severe asthma? Forster, B, Thomas, F, Arnold, S et al Early Intravenous Magnesium Sulfate Administration in the Emergency Department for Severe Asthma Exacerbations. There was no control group.

Emergency Department 140

Emergency Department Hospitals Resuscitation Administration 140

Taming the SRU

FEBRUARY 7, 2024

Ultrasound: Make “windows of access”. For blood product administration, PROPPR showed that 1:1:1 platelet, plasma, and pRBC administration led to earlier hemostasis along with less death due to blood loss and whole blood compared to separate blood product administration led to decreased death at 24 hours.

PPE 98

PPE Administration Ultrasounds Poisoning 98

EMDocs

NOVEMBER 4, 2023

An ultrasound of the testes reveals the following: What is the diagnosis? He reports approximately one month of dysuria, and around two weeks ago noticed a dull aching sensation in his testicles that has progressively gotten worse. He came to the ED because he now has a fever, chills, and nausea along with his testicular pain.

EMS 94

EMS Ultrasounds Emergency Department Infectious Diseases 94

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. The Accu-Chek was 214, and there was no response to empiric Narcan administration. Introduction to Bedside Ultrasound, iBook Ch 2, Basic Cardiac, Pg 27. Epub 2022 Jun 30.

Ultrasounds 98

Ultrasounds Advances Cardiac Life Support (ACLS) EKG/ECG Resuscitation 98

RebelEM

JANUARY 29, 2024

PMID: 37188358 Clinical Question: What is the efficacy and safety of low-dose (25mg) prolonged administration (over 6hrs) of alteplase in patients with massive PE? Randomized, Controlled Trial of Ultrasound-Assisted Catheter-Directed Thrombolysis for Acute Intermediate-Risk Pulmonary Embolism. Clin Exp Emerg Med 2023. CHEST 2010.

Stroke 136

Stroke Outcomes Hospitals Administration 136

Northwestern EM Blog

MAY 16, 2022

What is your initial imaging test of choice, ultrasound (US) or non-contrast CT, and why? Would you be confident in a point-of-care-ultrasound evaluation or a formal ultrasound? Many patients in the ultrasound groups did get additional imaging, but this was not the majority. How do you proceed? In this study, 40.7%

Ultrasounds 52

Ultrasounds Radiology Radiology Outcomes 52

EMDocs

DECEMBER 18, 2023

Furthermore, since the 2021 guidelines, multiple RCTs have shown that utilizing IVC respiratory variation, assessed by bedside ultrasound, as a guide to fluid resuscitation can result in less fluid administered. Current SSC guidelines recommend the time from presentation to antibiotic administration as one hour. units/minute.

Sepsis 90

Sepsis Fluid Resuscitation Resuscitation Shock 90

Broome Docs

MARCH 28, 2024

If you want to see Justin in the video format and his new Youtube series then click here: [link] If you would like to check out my current ultrasound training project then click here: WACHS Ultrasound Otherwise – enjoy the show and see you in a few weeks. Peripheral pressors: not only safe, but beneficial? doi: 10.1016/j.chest.2023.08.019.

PPE 96

PPE Ultrasounds Resuscitation Emergency Department 96

RebelEM

JUNE 19, 2023

PMID: 37314244 Clinical Question: In advanced trauma systems, does prehospital administration of TXA increase the rate of survival with a favorable neurologic outcome in patients at risk for trauma-induced coagulopathy? Patients were actively screened for DVT (all received lower extremity ultrasound on or around day 7).

Blood Transfusions 105

Blood Transfusions Outcomes Administration Hyperthermia / Hypothermia 105

EMDocs

JANUARY 16, 2024

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. Be careful with excessive medication administration.

Hyperthermia / Hypothermia 109

Hyperthermia / Hypothermia Resuscitation CPR EMS 109

Taming the SRU

MAY 5, 2023

Despite the complexity and heterogeneity of patients with sepsis, there have been few interventions which have been demonstrated to decrease mortality: early antimicrobial and fluid administration (Levy, Evans et al. 2018, Kuttab, Lykins et al. 2019, Evans, Rhodes et al. 2021, Im, Kang et al. vs 33.2%; OR, 0.42; 95% CI 0.32-0.55;

Sepsis 52

Sepsis Shock Administration Resuscitation 52

Dr. Smith's ECG Blog

AUGUST 9, 2024

However the patient continued to have chest pain and bedside ultrasound showed hypokinesis of the septum with significantly reduced LVEF. Although recognition of OMI was not affected by administration of morphine in this case, use caution with analgesia in ongoing ACS without a definitive plan for angiography.

EKG/ECG 106

EKG/ECG EMS Emergency Department Wellness 106