Don't Forget the Bubbles

NOVEMBER 13, 2023

Should we use ultrasound to diagnose distal forearm fractures in children and adolescents? Distal forearm fractures are common in children and adolescents, but the best method for diagnosing them is still debatable. However, ultrasound is gaining popularity due to its portability, affordability, and lack of ionising radiation.

Fractures 64

Fractures Ultrasounds Emergency Department Pediatrics 64

RebelEM

JANUARY 29, 2024

in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 to 4.0mg/hr typically given in EKOS therapy (See Below). to 4.0mg/hr typically given in EKOS therapy (See Below).

Stroke 136

Stroke Outcomes Hospitals Administration 136

The Skeptics' Guide to EM

DECEMBER 10, 2022

One-year outcome of surgery compared with immobilization in a cast for adults with an undisplaced or minimally displaced scaphoid fracture: A meta-analysis of randomized controlled trials. X-rays demonstrate a minimally displaced midwaist fracture of the scaphoid. The LR- to rule out a scaphoid fracture was 0.15

Operations 52

Operations Fractures Military Emergency Department 52

Emergency Medicine Journal

NOVEMBER 28, 2023

Background During closed reduction of displaced distal radius fractures, physical examination is used to determine the need for further manipulation before radiographic confirmation and cast application. Manipulation performed under ultrasound guidance has the potential to decrease the number of reduction attempts. to 6.45).

Fractures 40

Fractures Ultrasounds Emergency Department Operations 40

The Skeptics' Guide to EM

MAY 7, 2017

Point-of-care ultrasound for non-angulated distal forearm fractures in children: test performance characteristics and patient-centered outcomes. Point-of-care ultrasound for non-angulated distal forearm fractures in children: test performance characteristics and patient-centered outcomes.

Fractures 40

Fractures Pediatrics Ultrasounds Academics 40

Don't Forget the Bubbles

DECEMBER 25, 2023

Interpreting Research Outcomes with a Little Bathroom Humour You have learned a method for how to read a research paper , and now you are faced with a bunch of outcomes. There are primary, secondary, composite , and safety outcomes. What are these outcomes? We know there is a bias towards reporting positive outcomes.

Research 83

Research Outcomes Fractures Hospitals 83

Emergency Medicine Journal

JULY 24, 2023

Although fractures can be ruled out using the Ottawa Ankle Rules, the specificity is low, which means many patients may still receive unnecessary radiographs. Ultrasound could be a reliable, cheap and radiation free alternative to diagnose fractures and ligamentous injuries. No restrictions were applied for date and language.

Ultrasounds 40

Ultrasounds Fractures Outcomes 40

Emergency Medicine Journal

NOVEMBER 28, 2023

Aims and Objectives Rib fractures account for over 15% of all trauma attendances in the Emergency Department. Among patients with multiple rib fractures, the mortality rate can reach a staggering 33%, and this risk doubles for individuals above the age of 65. ED Physicians are already well-versed in the use of ultrasound.

Fractures 40

Fractures Anaphylaxis Emergency Department Ultrasounds 40

Taming the SRU

MAY 22, 2023

Ankle fractures are the third most common fracture in the ED [2] and more than 20,000 patients are seen in the ED for ankle sprains each day [3]. Certain injuries carry risks of further injury, injury-related complications, and poor outcomes which are exacerbated if they are inappropriately managed in the ED.

Fractures 77

Fractures Dislocations Operations Radiology 77

EMDocs

SEPTEMBER 9, 2023

The value of ultrasound for detecting hand fractures: A meta-analysis. Open Fracture. Current concepts in the evaluation and treatment of mallet finger injury. Plast Reconstr Surg. 2013;132(4):560e-566e. doi:10.1097/PRS.0b013e3182a0148c 0b013e3182a0148c Zhao W, Wang G, Chen B, et al. Medicine (Baltimore). 2019;98(44):e17823.

EMS 78

EMS Fractures Soft Tissue Injuries Ultrasounds 78

Don't Forget the Bubbles

JULY 17, 2023

Reviews and opinion articles Point-of-care ultrasound in pediatric nephrology. Original clinical studies Distribution and pattern of hand fractures in children and adolescents. Clinical Outcomes of COVID-19 in Newborns and Infants: A Multicenter Experience of 576 Cases. Sethi SK, et al. Pediatr Nephrol. 2023 Jun;38(6):1733-1751.

Pediatrics 98

Pediatrics Emergency Department Outcomes Fractures 98

Taming the SRU

FEBRUARY 24, 2024

Providers should use ultrasound as early as possible to evaluate for cardiac dysfunction, pulmonary edema, and fluid status. They tend to be hypertensive, tachycardic, tachypneic, and hypoxic. Do not always appear volume overloaded on exam. Early recognition and prompt treatment is key.

Leadership 93

Leadership EMS Pediatrics Stroke 93

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. This study also showed the median time for IO placement was only 1.2 minutes compared to a mean placement time of 10.7 minutes CVC group.

Resuscitation 105

Resuscitation Administration Emergency Department Hospitals 105

Taming the SRU

JANUARY 10, 2024

R4 Case Follow-up: SCAD WITH dr. Martella Spontaneous Coronary Artery Dissection (SCAD) is a diagnosis confirmed via imaging: Coronary Angiography, Optical Coherence Tomography, Intravascular Ultrasound Therefore, treatment in the ED is the same as atherosclerotic ACS: ASA, heparin gtt and possible statin.

EKG/ECG 93

EKG/ECG Shock Fractures Emergency Department 93

EM Curious

JULY 8, 2015

ULTRASOUND GOODIE BAG ULTRASOUND FOR LATE PREGNANCY [PODCAST]: While not a routine exam we perform other than confirming fetal heart tones, definitely some great pearls on more advanced US topic. US GUIDED ULNAR NERVE BLOCK [BLOG]: Boxer's fracture need a reduction? Consider an ultrasound guided ulnar nerve block.

Infectious Diseases 52

Infectious Diseases Disaster Management Sepsis Ultrasounds 52

Taming the SRU

OCTOBER 1, 2023

As these patients are typically already at a high risk for poor health outcomes, secondary spontaneous PTX is often more serious in presentation and management more complex [11]. Blunt trauma can cause rib fracture or dislocation that may injure the visceral pleura. The "lung point": an ultrasound sign specific to pneumothorax.

Fractures 96

Fractures COPD Hospitals Emergency Department 96

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. Early Antibiotic Use and Neonatal Outcomes Among Preterm Infants Without Infections.

Pediatrics 72

Pediatrics X-Ray Interpretation Sepsis Fractures 72

Taming the SRU

AUGUST 25, 2023

doxycycline Consider a splint/cast window to allow direct monitoring mainly used for fracture blisters and/or open wounds yet takes away from the strength of the splint/cast Case #3 43yo with FOOSH injury and closed wrist deformity, yet no x-ray machine is available to you Least likely injuries to need an x-ray in a resource-limiting setting?

Seizures 75

Seizures Fractures EKG/ECG Resuscitation 75

The Skeptics' Guide to EM

DECEMBER 17, 2022

EMS have already splinted an obvious mid-shaft femoral fracture, but he continues to be tachycardic and hypotensive. After a bedside ultrasound shows fluid in the right hemithorax, you insert an intercostal drain which immediately fills with one litre of blood.

Blood Transfusions 52

Blood Transfusions Fractures EMS Hospitals 52

Taming the SRU

OCTOBER 16, 2024

Ultrasound can be used to support the diagnosis by identifying anechoic or hypoechoic fluid within the flexor tendon sheath. Patients are unable to actively flex their DIP and x-ray imaging often will reveal and avulsion fracture. X-ray imaging should be obtained to evaluate for avulsion fracture.

Airway Management 74

Airway Management Fractures CDC Pediatrics 74

EM Curious

JULY 1, 2015

ULTRASOUND IN CHEST PAIN: [BLOG]: It is never a bad idea to throw an ultrasound probe on your patient with chest pain. Onto the FOAMed WEINGART ON HFNC [PODCAST]: The new oxygen wonder child is taking critical care by storm. Should we all be jumping on board? Weingart discusses some background, the evidence and his opinions here.

EMS 52

EMS Ultrasounds EKG/ECG Fractures 52

Taming the SRU

SEPTEMBER 15, 2023

ultrasound grand rounds: bedside dvt studies - family presence in the ed/icu - r1 clinical knowledge: aicd - r3 small groups: difficult airway management Ultrasound grand rounds: DVT studies WITH Dr. minges Why should we perform bedside DVT studies in the ED? ETT onto a fiberoptic scope.

CPR 89

CPR Burns Airway Management Wellness 89

ACEP Now

MAY 9, 2024

These questionable practices led to a rash of bad outcomes. Classically associated with long bone fractures, a PFE may also occur when fat is injected or absorbed into a blood vessel during the reinjection phase of an AFT procedure. 7 The impact of this latest set of regulations on the complication rate has yet to be reported.

Emergency Department 52

Emergency Department Operations Ultrasounds Hospitals 52

Don't Forget the Bubbles

MAY 8, 2024

An interesting study (JAMA Pediatrics) shows the benefits of newborn screening for spinal muscular atrophy (SMA), as initiating disease-modifying therapy earlier improves clinical outcomes. These findings advocate for expanding newborn screening programs to enhance outcomes for children with SMA. Dell KM, et al. Koenis MM et al.

Pediatrics 69

Pediatrics Emergency Department Outcomes Research 69

The Skeptics' Guide to EM

SEPTEMBER 14, 2019

He is interested in ultrasound and international emergency medicine. In an attempt to improve resource utilization, emergency department length of stay, limit cost and improve outcomes, there have been multiple Clinical Decision Rules (CDRs) created to help guide clinicians in their decision-making process.

Head Injuries 52

Head Injuries Emergency Department Seizures EMS 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 Outcomes 52

Taming the SRU

MARCH 17, 2023

mepivacaine (1-3 h) 1% lidocaine +/- epi (2-3h) 0.25% bupivacaine (2-3 h) 0.25-0.5% mg/kg IV Versed: 0.2 mg/kg IM, 0.2 mg/kg IN (may repeat to max of 0.4 mg/kg IN), 0.2

Seizures 40

Seizures Fractures Burns Pediatrics 40

The Skeptics' Guide to EM

JULY 2, 2017

Impact of Thrombolytic Therapy
 on the Long-Term Outcome of Intermediate-Risk Pulmonary Embolism. Impact of Thrombolytic Therapy
 on the Long-Term Outcome of Intermediate-Risk Pulmonary Embolism. She takes the oral contraceptive pill and was placed in a below-knee plaster cast for a fibula fracture 2 weeks ago.

Fractures 40

Fractures Outcomes Emergency Department Ultrasounds 40

Don't Forget the Bubbles

SEPTEMBER 5, 2024

Obesity is considered a contributing factor for some musculoskeletal outcomes. A recent systematic review found that children with obesity at school entry are more likely to experience back pain, slipped capital femoral epiphysis or fractures during childhood. PMID: 38471744 What’s it about? Front Pediatr. 2023 Aug 23;11:1225087.

Ultrasounds 52

Ultrasounds Research Emergency Department Outcomes 52

EB Medicine

MARCH 1, 2019

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. of cases and contributed to the death of 45.2% of those patients.

Emergency Department 40

Emergency Department EKG/ECG Operations Fractures 40

EB Medicine

JUNE 6, 2019

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. Which is reasonable, as that is the crux of our job as emergency physicians. Jeff: Indeed. Sounds familiar.

Ultrasounds 40

Ultrasounds Radiology Radiology Sepsis 40

Taming the SRU

AUGUST 30, 2023

Significantly elevated CRP (>122mg/L) and PCT (>0.5ng/mL) levels are predictors of bad outcomes, and are useful for tracking therapy progress, but are not specific enough to rule-in infectious endocarditis [38-39]. Instead, they strongly advocated for the use of lung ultrasound to diagnose bacterial CAP [45]. Cleve Clin J Med.

Infectious Diseases 88

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 88

Rural Doctors Net

AUGUST 30, 2013

Intubation for humanitarian reasons is also reasonable – he’ll be in pain and this is not the time to be faffing around with the ultrasound or nerve stimulator doing blocks! Pull straight any fractures & splint them. How to intubate? Wrap the pelvis – use a proper binder if there is ANY concern re: a pelvic injury.

Burns 52

Burns Hospitals Wellness Ambulance Services 52

Don't Forget the Bubbles

MARCH 4, 2024

This was a secondary outcome embedded in the Travel Fever study – a multi-centre, retrospective diagnostic accuracy study for imported malaria. Safety and efficacy of a nitrous oxide procedural sedation programme in a paediatric emergency department: a decade of outcomes. Emerg Med J. 2024 Jan 22;41(2):76-82. PMID: 38123983.

Hospitals 78

Hospitals Sepsis Fractures Emergency Department 78

RebelEM

JANUARY 24, 2024

Wallace 2011 ) If addressed early and appropriately, most patients have good self-reported long-term outcomes regardless of the treatment modality Links Orthobullets: Achilles Tendon Rupture Resources: Sheth U et al. Partial rupture of the proximal Achilles tendon: a differential diagnostic problem in ultrasound imaging. Sports Med.

Operations 104

Operations Ultrasounds Fractures Outcomes 104

Don't Forget the Bubbles

OCTOBER 4, 2023

In this issue of the Archives , we read a large retrospective study about gastric acid suppression in infancy and the increased risk of fractures. The intriguing finding of this study was the fact that non-fracture injuries increased, which could suggest that another factor (the temperament of the child rather than gastrin or VitB metabolism?)

Pediatrics 111

Pediatrics Fractures Outcomes Research 111

Don't Forget the Bubbles

JUNE 21, 2023

Being LGA and/or having macrosomia is associated with adverse health outcomes and is, therefore, a reason for a closer look. Problems due to obstructed delivery such as shoulder dystocia, associated fractures of the collar bone and femur, among others, and brachial plexus injury. Ultrasound Obstet Gynecol 2019;54:308-18.

Outcomes 119

Outcomes Ultrasounds Fractures Pediatrics 119