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Background: The increased utility and accessibility of point-of-care ultrasound (POCUS) has allowed clinicians the freedom to rethink their diagnostic approach for many common diseases, including peritonsillar abscess (PTA). Test characteristics of ultrasound for the diagnosis of peritonsillar abscess: A systematic review and meta-analysis.
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.
emergency medicine (EM) residency training length has been a decades-long dilemma: four vs. 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. 11 What should we take away?
We’ll keep it short, while you keep that EM brain sharp. Management consists of intravenous antibiotics , and hand surgery should be consulted to consider operative debridement. A 41-year-old male with no significant past medical history presents with a deep hand laceration. There are no extensor tendon sheaths (A) in the hand.
Chest CT Demonstrates parenchymal disease better Allows for operative planning (if needed) Lung Abscess in Children: Management Rarity of the condition affects what is known (no randomized control trials on therapeutic options). Scrutinize that CXR for an Air-Fluid Level… and maybe use your Ultrasound to increase your sensitivity!!
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.
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.
Take the ALiEMU PEM POCUS: Soft Tissue Quiz Case Goals List the indications of performing a pediatric soft tissue point-of-care ultrasound (POCUS). Pediatric Soft Tissue POCUS Ultrasound Technique Figure 1. Linear ultrasound transducer Probe Use a linear, high-frequency transducer. Describe the limitations of soft tissue POCUS.
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).
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.
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.
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.
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.
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.
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.
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.
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.
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.
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%
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.
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
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
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.
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?
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.
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.
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.
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.
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.
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?
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%
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?
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.
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.
Nachi: And if the prehospital team is lucky enough, or maybe unlucky enough, i don’t know, to have a credentialed provider who can perform ultrasound for those suspected of having a blunt cardiac injury, the general prehospital data on ultrasound is sparse. Jeff: Great, let’s move onto ED care, beginning with the H&P.
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.
CT is good but you really should learn ultrasound, and lastly, sick patients need prompt consultation and resuscitation, not rapid trips to radiology. Nachi: Diagnosis of appendicitis, in a pregnant patient, ultrasound vs. mri. Jeff: Next we have everybody’s favorite, the ultrasound. Jeff: Indeed. Sounds familiar.
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.
Schedule follow up with orthopedics within 1 week for discussion of operative management vs early rehab protocols. Partial rupture of the proximal Achilles tendon: a differential diagnostic problem in ultrasound imaging. Total Achilles tendon rupture. Sports Med. 1998; 25(2): 79-100. PMID: 9519398 Kayser R et al. Br J Sports Med.
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.
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).
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.
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