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

ACEP Now

JULY 7, 2023

You perform a biliary ultrasound (US) in the ED (BUSED) which shows a gallbladder (GB) full of stones, some GB wall thickening and a positive Murphy’s sign. Background Ultrasound is typically the first-line imaging modality for the diagnosis of acute biliary disease. Click to enlarge. Reference: Hilsden, et al. 2022;7(1):e000944.

Ultrasounds 52

Ultrasounds Radiology Radiology Emergency Department 52

ALiEM

OCTOBER 30, 2024

Case A patient arrives via EMS from the bus station complaining of fever, vomiting, and back pain. Clinical impact: The patient’s DVT ultrasounds were negative. Our experience: It was not long ago that we instructed our staff that: ‘COWS >8, give ’em 8 (mg of buprenorphine).’ J Am Psychiatr Nurses Assoc.

Emergency Department 64

Emergency Department Operations Psychiatric Hospitals 64

ACEP Now

MAY 4, 2023

EMS recognized a chest wall deformity with movement of the chest wall, and a splint was devised and taped around his chest for what was suspected to be a flail chest. On hospital day 2, he was taken to the operating room for surgical rib fixation. The post Case Report: EMS Says Flail Chest, But Is It? J Surg Res.

EMS 52

EMS Fractures Operations Radiology 52

Pediatric EM Morsels

JUNE 16, 2023

Arch Orthop Trauma Surg 2013;133(5):635-640.23443527 The post Morel-Lavallée Lesion in Children appeared first on Pediatric EM Morsels. Shen 2013, Nickerson 2014, Scolaro 2016 ] Singh et al proposed an algorithm to guide treatment. Shen 2013, Nickerson 2014, Scolaro 2016 ] Singh et al proposed an algorithm to guide treatment.

Soft Tissue Injuries 154

Soft Tissue Injuries Dehydration Fractures Operations 154

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 98

Fractures Ultrasounds Research Outcomes 98

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. Rezaie, MD (Twitter/X: @srrezaie ) The post Don’t Forget About the IO in the Critically Ill Patient appeared first on REBEL EM - Emergency Medicine Blog.

Resuscitation 105

Resuscitation Administration Emergency Department Ultrasounds 105

Resus Review

APRIL 10, 2015

The ECMO ultrasound flow sensors require a conductive interface between the sensor and the circuit. While it is useful to use for ultrasound exams, when exposed to air it dries out quickly which interferes with the flow sensor operation. A better product to use is Em-tec Ultrasonic Coupling Paste.

Ultrasounds 52

Ultrasounds Operations Emergency Department EMS 52

RebelEM

SEPTEMBER 11, 2023

Background: Point of care ultrasound (POCUS) has a demonstrated sensitivity of 89.8% Point of care biliary ultrasound in the emergency department (BUSED) predicts final surgical management decisions. Similarly, surgeons might hesitate to operate on older patients with multiple comorbidities due to higher associated risks.

Ultrasounds 68

Ultrasounds Radiology Radiology Emergency Department 68

Don't Forget the Bubbles

MAY 17, 2023

Post-operative pain in children: Comparison of pain scores between parents and children. Minor head trauma in infants – how accurate is cranial ultrasound performed by trained radiologists? Hegeman EM, et al. Schwindt EM, et al. J Pediatr Gastroenterol Nutr. 2023 Apr 24. Cetinkaya PG, et al. Eur J Pediatr.

Pediatrics 72

Pediatrics X-Ray Interpretation Sepsis Fractures 72

Taming the SRU

AUGUST 4, 2024

The largest retrospective cohort study to date (Beyde et al.) shows that most will improve with empiric antibiotics.

Dislocations 85

Dislocations Emergency Department Documentation/Coding Burns 85

Dr. Smith's ECG Blog

SEPTEMBER 9, 2024

She took an oxycodone and called EMS. The cut points for what constitute OMI and not OMI as well as confidence levels are calibrated to maximize sensitivity and specificity according to the receiver operating characteristic. In a large proportion of cath labs, the operator would probably have ended the case at this point.

EKG/ECG 66

EKG/ECG Operations Wellness Ultrasounds 66

Dr. Smith's ECG Blog

DECEMBER 19, 2023

EMS obtained the following vital signs: pulse 50, respiratory rate 16, blood pressure 96/49. It appears EMS obtained two EKGs, but unfortunately these were not saved in the medical record. The EMS crew was only BLS certified, so EKG interpretation is not within their scope of practice. Fortunately, that is exactly what happened.

EKG/ECG 127

EKG/ECG EMS Wellness Operations 127

ACEP Now

NOVEMBER 16, 2023

emergency medicine (EM) residency training length has been a decades-long dilemma: four versus three years. First, is three years enough time to become an EM physician? But critical questions remain unanswered when it comes to specialization, career trajectory, and actual competence as an EM physician. percent versus 90.8

Academics 52

Academics EMS Telemedicine Research 52

RebelEM

NOVEMBER 30, 2022

History, physical examination and ultrasound are all flawed in making the diagnosis. History, physical examination and ultrasound are all flawed in making the diagnosis. Rezaie, MD (Twitter: @srrezaie ) The post REBEL Core Cast 91.0 – Testicular Torsion appeared first on REBEL EM - Emergency Medicine Blog. 10, (-) LR = 0.13

Ultrasounds 52

Ultrasounds Pediatrics Operations EMS 52

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 Late findings Fever Abdominal distension (+) LR: 5.64 – 16.8 (-) LR: 0.34 – 0.43

Operations 52

Operations Sepsis Resuscitation Ultrasounds 52

EB Medicine

MARCH 19, 2020

24:36 What are your surgeons, who cannot operate, currently doing? 26:36 How do you use ultrasound for COVID-19 patients in the ED? 31:00 EMS and their role in community screening. 32:20 What are you looking for on ultrasound examination? 31:00 EMS and their role in community screening. By what criteria?

PPE 40

PPE Emergency Department Ultrasounds Operations 40

EM Updates

MARCH 24, 2021

Video laryngoscopy uses a blade with a camera at the end; once the blade is positioned, the operator intubates looking at the screen. HAVL , which uses a blade that goes around the tongue, requires that the operator look at the screen. VL can employ either SG or HA blades.

Operations 52

Operations Airway Management EMS Wellness 52

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

PHEM Cast

DECEMBER 1, 2017

For example, here are the locations identified as ‘2nd ICS mid clavicular line’ amongst 25 EM physicians in a 2005 EMJ paper. Journal of Special Operations Medicine : a Peer Reviewed Journal for SOF Medical Professionals , 13 (4), 53–58. Ultrasound in Emergency Medicine. link] Harcke, H. L., & Mazuchowski, E.

Academics 52

Academics Radiology Radiology Resuscitation 52

The Skeptics' Guide to EM

MAY 28, 2017

His blood work shows an elevated WBC count and the ultrasound is consistent with acute uncomplicated appendicitis (AUA). This is called Non Operative Treatment of Appendicitis (N.O.T.A). REBEL EM covered the issue of N.O.T.A. Clinical Question: Is non-operative treatment (N.O.T.) We have covered N.O.T.A.

Pediatrics 40

Pediatrics Operations Emergency Department Ultrasounds 40

Dr. Smith's ECG Blog

DECEMBER 18, 2022

Submitted and written by Quinton Nannet, MD, peer reviewed by Meyers, Grauer, Smith A woman in her 70s recently diagnosed with COVID was brought in by EMS after she experienced acute onset sharp midsternal chest pain without radiation or dyspnea. Bedside ultrasound is another very important piece. Do you activate the Cath Lab?

Ultrasounds 40

Ultrasounds EKG/ECG EMS Radiology 40

Emergency Medicine Cases

JANUARY 4, 2022

What are the best strategies to efficiently get the patient in cardiogenic shock to definitive care, whether that be the cath lab or the operating room? How can we best pick up occult cardiogenic shock before it floured shock kicks in? Which patients with acute heart are safe to send home in general?

Shock 52

Shock Operations Ultrasounds Resuscitation 52

EB Medicine

JULY 8, 2019

Jeff: And while it’s not exactly core EM, we’re going to briefly discuss indications for bariatric surgery, as this is something we don’t often review even in academic training programs. Which again reiterates why this is such an important topic for us as EM clinicians to be well-versed in.

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 40

Dr. Smith's ECG Blog

NOVEMBER 30, 2022

This case was provided by Spencer Schwartz, an outstanding paramedic at Hennepin EMS who is on Hennepin EMS's specialized "P3" team, a team that receives extra training in advanced procedures such as RSI, thoracostomy, vasopressors, and prehospital ultrasound. Takotsubo is a sudden event, not one with crescendo angina.

EKG/ECG 52

EKG/ECG Emergency Department Ultrasounds Hospitals 52

Advanced Emergency Nursing from AENJ

NOVEMBER 24, 2016

While Point of Care Ultrasound has made limited entry in prehospital care, largely with physician-led services and some Advanced Paramedics; it has largely been as a proof of concept rather than everyday care. I am thankful for having a career of wonderful care at supportive institutions. Readers must verify validity to their own practice.

Emergency Nursing 40

Emergency Nursing Seizures CPR Wellness 40

EMDocs

NOVEMBER 18, 2023

We’ll keep it short, while you keep that EM brain sharp. 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? Vital signs: HR 118, BP 103/68, RR 20, T 99.8. LFTs are in the thousands.

EMS 96

EMS Ultrasounds Emergency Department Outcomes 96

Pediatric EM Morsels

JUNE 30, 2023

link] PMID: 36553274 The post Congenital Pulmonary Airway Malformation (CPAM) appeared first on Pediatric EM Morsels. I know we already know this, but it especially true when you are talking about trying to obtain images on a wiggling fetus somewhere around the size of a banana. Dec: 9 (12): 1830.

Ultrasounds 284

Ultrasounds Pediatrics Operations EMS 284

Pediatric EM Morsels

AUGUST 4, 2023

Oka, 2023) A systematic review linked SMA syndrome to the immediate post-operative period after surgery for scoliosis in pediatric patients, and found the mean days to onset of symptoms was 9. PMID: 31451453 The post Superior Mesenteric Artery Syndrome (SMA Syndrome) in Children appeared first on Pediatric EM Morsels. BMJ Case Rep.

Pediatrics 246

Pediatrics Burns Operations Ultrasounds 246

EMDocs

OCTOBER 23, 2023

Author: Kristine Jeffers, MD ( EM Physician , San Antonio Uniformed Services Health Education Consortium) // Reviewed by: Jessica Pelletier, DO (EM Education Fellow, Washington University in St. Operative complications requiring surgical intervention or hospitalization occur in about 3-6% of all hysterectomies (5).

OB/GYN 94

OB/GYN Operations EMS Ultrasounds 94

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

JULY 17, 2023

7 While post-operative adhesive disease is also a risk factor, it is far less commonly implicated in LBO compared to SBO. 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.

Operations 98

Operations EMS Fluid Resuscitation Resuscitation 98

RebelEM

JUNE 19, 2023

Patients were actively screened for DVT (all received lower extremity ultrasound on or around day 7). We should expect TXA to help in immediate stabilization and allow trauma teams the time to intervene (whether that be continued resuscitation, interventional or operative procedures). Demographics were well balanced in the two groups.

Blood Transfusions 105

Blood Transfusions Outcomes Administration Hyperthermia / Hypothermia 105

EMDocs

DECEMBER 18, 2023

Today, she would not get out of bed, prompting the facility to call EMS. When analyzing the receiver operating characteristic (ROC) curve of the pooled data, optimal diagnostic accuracy of MDW for sepsis prediction was seen (pooled sensitivity of 0.838 and specificity of 0.704 for Sepsis-3 criteria). She had a fever of 38.7 °C

Sepsis 93

Sepsis Fluid Resuscitation Resuscitation Shock 93

Advanced Emergency Nursing from AENJ

FEBRUARY 29, 2016

Farrington] Rebuilding of outdated hospitals put emergency rooms on ground level with nearby X-ray service, and, ideally, sometimes closer to the Blood Bank and the Operating Rooms. Advocacy for Trauma Care and EMS Development. Development of EM Residencies. EM begins to "Own the Airway" (emergent). EDNA->ENA.

Emergency Nursing 40

Emergency Nursing EMS Resuscitation Military 40

ACEP Now

JUNE 6, 2023

EMS is called and finds his blood pressure 175/100. POCUS: Point-of-care ultrasound for AD is highly specific, but operator-dependent, and lacking in sensitivity—although late–model units can have sensitivity as high as 80-85 percent. The murmur is readily auscultated. The patient is treated surgically and survives.

EKG/ECG 85

EKG/ECG Stroke Documentation/Coding Operations 85

Taming the SRU

MAY 30, 2023

hours earlier and went to OR 3.5 hours earlier and went to OR 3.5 hours earlier and went to OR 3.5 billion passengers annually 1 medical emergency per 604 flights Most common complaints: Syncope/presyncope: 37.4% Respiratory symptoms: 12.1% Nausea and vomiting: 9.5% Diversion occurs 7.3% of in-flight emergencies Deaths occurred 0.3%

OB/GYN 52

OB/GYN Ultrasounds Pediatrics Resuscitation 52