Thinking Critical Care

JANUARY 31, 2025

It was so great to meet, hang out and talk ECPR with Paris’ SAMU ECPR leader Lionel Lamhaut last month in Montreal, a city we are actively trying to bring pre-hospital ECPR to, thanks to the relentless work of Lawrence Leroux. Registration is 1,699 USD +tx. ECPR Indications ?

Hospitals 55

Hospitals CPR Ultrasounds 55

Pediatric EM Morsels

JUNE 30, 2023

Congential Cystic Adenomatoid Malformation: A Teritriay Care Hospital Experience. 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. Neonatology. Apr 110 (2): 101-15. J Clin Diagn Res. Nov: 10 (11): SC01-SC04.

Ultrasounds 284

Ultrasounds Pediatrics Operations EMS 284

EB Medicine

MARCH 12, 2025

Eckler, MD discuss the March 2025 Emergency Medicine Practice article, Emergency Department Management of Knee Pain Common Etiologies of Knee Pain Risk Factors and Statistics Infectious Causes of Knee Pain Pre-Hospital Care and EMS History and Physical Exam Imaging Guidelines Ottawa Knee Rule and X-Ray Necessity Imaging Modalities for Knee Effusion (..)

Emergency Department 61

Emergency Department Ultrasounds EMS Hospitals 61

Taming the SRU

OCTOBER 23, 2023

A bedside ultrasound is completed to assess the location of the pregnancy. A radiology performed ultrasound is ordered and has similar findings– Impression: no definitive IUP with a small amount of free fluid within physiologic limits. Laboratory evaluation reveals a hemoglobin and hematocrit of 12.6/37.1

Ultrasounds 98

Ultrasounds Operations Radiology Radiology 98

RebelEM

JANUARY 25, 2024

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).

Ultrasounds 125

Ultrasounds Outcomes COPD Hospitals 125

Taming the SRU

JULY 24, 2023

A bedside right upper quadrant ultrasound was performed, and the images are below. He was transitioned to cefdinir and fluconazole for a full 7-day course of antibiotics and discharged from the hospital on day three, with instructions to follow up with general surgery for an outpatient cholecystectomy. coli and rare budding yeasts.

Ultrasounds 79

Ultrasounds Sepsis Radiology Radiology 79

Pediatric EM Morsels

MARCH 1, 2024

Wojsyk-Banaszak, 2018 ) Mainstay of initial therapeutic management is: ( Wojsyk-Banaszak, 2018 ; Fernando, 2022 ) Prolonged course of IV antibiotics Chest physiotherapy Patients managed with medical strategies (compared to surgical) had lower complication rates and shorter hospitalizations. Life, after all, is complex. Pediatr Pulmonol.

Ultrasounds 173

Ultrasounds Pediatrics Operations Hospitals 173

Don't Forget the Bubbles

JANUARY 31, 2024

As a Trauma Unit within the Thames Valley Trauma Network, Wexham Park Hospital hosts trainees from across the spectrum of acute specialties. Two really important patient groups were excluded – those who were admitted to hospital and families who were not fluent in English. How sick the child was did not appear to play a role.

Hospitals 72

Hospitals Ultrasounds Emergency Department Pediatrics 72

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

Taming the SRU

OCTOBER 14, 2024

Ocular point-of-care-ultrasound (POCUS) was performed as seen below. The patient was transitioned to a 10 day course of cefpodoxime and was discharged on hospital day 3 with ENT and ophthalmology follow up. Our patient underwent anterior orbitotomy, but there are case reports in the literature of ultrasound-guided drainage (4).

Ultrasounds 52

Ultrasounds Urgent Care Emergency Department Documentation/Coding 52

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. AEM July 2022 Guest Skeptic: Dr. Kirsty Challen is a Consultant in Emergency Medicine at Lancashire Teaching Hospitals. specificity with ultrasound [1].

Ultrasounds 52

Ultrasounds Operations Documentation/Coding Outcomes 52

ACEP Now

JANUARY 4, 2025

1 Just one year prior, Dr. Clarke had begun an emergency medicine residency at what was then known as LA CountyUSC Hospital, Los Angeles. Firsthand Account An ambulance bay at the LA County-USC Hospital in 1978. Dr. Clarke was then hired as assistant director in the emergency department (ED) at Pomona Valley Hospital, Pomona, Calif.

Forensics 52

Forensics Urgent Care Hospitals Emergency Department 52

University of Maryland CC Project

NOVEMBER 7, 2021

Keith Boniface, Professor of Emergency Medicine and Chief of Emergency Ultrasound at George Washington University Hospital presents on the essentials of lung ultrasound as part of the DC5 lecture series.

Ultrasounds 40

Ultrasounds Hospitals 40

Greater Sydney Area HEMS

FEBRUARY 20, 2024

The cohort of patients that require this intervention in the pre-hospital setting are likely to be the most critically unwell patients we encounter. The evidence for improved safety and quality with the use of ultrasound for CVC implementation is well established [i]. One approach to obtaining BCV origin access (fig.1)

Ultrasounds 98

Ultrasounds Shock Research Operations 98

PulmCCM

FEBRUARY 5, 2024

Depends On the Patient, and Who You Ask The Centers for Disease Control and Prevention defines a fever (for general hospitalized patients) as >38°C. Ultrasound can quickly and more accurately identify significant biliary disease (e.g., You can read the document here. What’s a Fever? °C (100.9°F).

Best Practices 111

Best Practices Ultrasounds Infectious Diseases Sepsis 111

Don't Forget the Bubbles

JUNE 19, 2023

There were no issues during the pregnancy, and estimated fetal growth by ultrasound was constant. The centile used to define “small” may differ both by scientific study and by hospital. You could consider a cranial ultrasound, cytomegalovirus PCR, and maternal toxicology screening. Ultrasound Obstet Gynecol 2016;48:333-9.

Pediatrics 143

Pediatrics Ultrasounds Hyperthermia / Hypothermia Sepsis 143

The Skeptics' Guide to EM

AUGUST 17, 2024

He works in prehospital (EMS and HEMS), and at Morales Meseguer Hospital in public medical service in Murcia, Spain. Franciso has postgraduate Master's degrees in emergencies and urgent care, clinical ultrasound, and emergency and disaster management, from the University of Elche, the University of Madrid, and the University of Oviedo.

Urgent Care 102

Urgent Care Disaster Management Ultrasounds EMS 102

University of Maryland CC Project

SEPTEMBER 17, 2021

Mallia, Assistant Professor of Emergency Medicine and Associate Program Director of the Pulmonary and Emergency Medicine-Critical Care Fellowship at MedStar Washington Hospital presents on critical care ultrasound and the volume resuscitation dilemma as part of the DC5 lecture series.

Resuscitation 40

Resuscitation Ultrasounds Hospitals Sepsis 40

The Skeptics' Guide to EM

APRIL 20, 2024

Efficacy and safety of ultrasound-guided erector spinae plane block compared to sham procedure in adult patients with rib fractures presenting to the emergency department: A randomized controlled trial. Clinical Question: How effective and safe is an ultrasound-guided erector spinae plane block in patients with rib fractures?

Fractures 85

Fractures Ultrasounds Emergency Department CDC 85

Taming the SRU

APRIL 5, 2023

Given her age, history of nephrolithiasis, and frequent urinary tract infections, a bedside renal ultrasound was performed to assess for hydronephrosis due to concern her generalized weakness may be secondary to an infected stone or obstructive uropathy. She had a foley placed and was admitted to the hospital. Images are seen below.

Ultrasounds 52

Ultrasounds Pediatrics Radiology Radiology 52

EMDocs

DECEMBER 1, 2024

Treatment significantly shortens the duration of illness, and early initiation of therapy can prevent severe complications and reduce the length of hospitalization. The RUSH exam: Rapid Ultrasound in SHock in the evaluation of the critically lll. However, some experts recommend doxycycline even in pregnant patients. pregnant patients).

EMS 101

EMS Infectious Diseases Shock Airway Management 101

Taming the SRU

MAY 13, 2024

Acute stump appendicitis without evidence of perforation or abscess (Figure 1) HOSPITAL Course Acute Care Surgery was consulted from the ED and recommended admission for operative resection of a 3 cm remnant of the appendix. The patient was discharged on hospital day 5. The Ultrasound Journal, 11(1). No free intraperitoneal air.

Ultrasounds 98

Ultrasounds Emergency Department Wellness Operations 98

The Trauma Pro

OCTOBER 25, 2024

To sum up, both are equally effective in controlling hemorrhage, but the hospital costs for patients undergoing angioembolization are significantly less. The primary outcome was the development of VTE during the hospitalization. DVT was detected using duplex ultrasound, and PE was detected by CT angiography. DVT, and 1.9%

Fractures 113

Fractures Head Injuries Operations Ultrasounds 113

Sensible Medicine

JUNE 28, 2024

A 76-year-old woman presents to a community hospital after waking with garbled speech and right-sided weakness. Case 1: Excess An elderly woman is admitted to a community hospital with a minor stroke. The hospital does an excellent job. By the time she leaves the hospital, she has no residual symptoms. I love my job.

Stroke 105

Stroke Academics EKG/ECG Hospitals 105

ACEP Now

DECEMBER 7, 2024

Ekosonic Endovascular System (EKOS), a form of pharmacomechanical thrombolysis, uses a catheter to deliver thrombolytics directly to the target pulmonary artery in combination with high-frequency ultrasound to enhance lytic penetration and encourage thrombus fragmentation. Catheter Cardiovasc Interv. 2017;89(4):754-760.

Ultrasounds 52

Ultrasounds Radiology Radiology EKG/ECG 52

RebelEM

APRIL 29, 2024

Many clinicians don’t consider IO placement while others consider it a last resort or only a pre-hospital procedure. 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

Resuscitation 105

Resuscitation Administration Emergency Department Ultrasounds 105

Mind The Bleep

FEBRUARY 2, 2025

For example: “If ultrasound negative then reassure and discharge”, “If CRP normal then safety net and advise to see GP if symptoms recur” Treatment Escalation Plan/ DNACPR Clearly document if the patient has an existing DNACPR in place- they may come to hospital with a copy.

Documentation/Coding 95

Documentation/Coding COPD EKG/ECG Wellness 95

Taming the SRU

NOVEMBER 3, 2023

Ultrasound‐Guided Serratus Anterior Plane Block (SAPB) Improves Pain Control in Patients With Rib Fractures. Ultrasound Med. 41, 2695–2701 (2022). Materials and Methods It was an interventional study at a single tertiary care referral center with a level I trauma designation and an approximate annual ED census of 90,000.

Fractures 98

Fractures Ultrasounds Research Outcomes 98

RebelEM

JANUARY 29, 2024

Randomized, Controlled Trial of Ultrasound-Assisted Catheter-Directed Thrombolysis for Acute Intermediate-Risk Pulmonary Embolism. A prospective, Single-Arm Multicenter Trial of Ultrasound-Facilitated, Catheter-Directed, Low-Dose Fibrinolysis for Acute Massive and Submassive Pulmonary Embolism: The SEATTLE II Study. CHEST 2010.

Stroke 133

Stroke Outcomes Hospitals Administration 133

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. Ultrasound. 2011;31(1):1-5.

Ultrasounds 90

Ultrasounds Documentation/Coding Wellness EMS 90

Emergency Medicine Journal

MAY 23, 2023

Background Point-of-care (POC) lung ultrasound (LUS) is widely used in the emergency setting and there is an established evidence base across a range of respiratory diseases, including previous viral epidemics. Conclusion During a period of high prevalence, LUS had a sensitivity of 87% for the diagnosis of COVID-19 infection.

Ultrasounds 52

Ultrasounds Operations Research Hospitals 52

The Trauma Pro

OCTOBER 4, 2024

Clinical outcomes assessed at 60 days included an unplanned return to the emergency department (ED), re-admission, complications, and development of new bleeding confirmed by surgery, ultrasound, or computed tomography (CT) at 60 days post-injury. ” This means they probably did not. ” This means they probably did not.

Pediatrics 113

Pediatrics Outcomes Operations Emergency Department 113

EMDocs

MARCH 4, 2024

12 Ultrasound and computed tomography (CT) can both identify CBD and are available in most emergency departments. Ultrasound is cost-effective and radiation-sparing. Ultrasound has approximately 90% sensitivity for detecting common bile duct dilation. 13 CT is also superior to ultrasound in its ability to detect malignancy.

Emergency Department 103

Emergency Department Ultrasounds EMS Radiology 103

EM Ottawa

MAY 30, 2024

In this month’s PTM Journal Club, we explored the most recent literature on trauma care in the pre-hospital setting. If you missed last months PTM Journal Club, make sure to check-it out by clicking HERE.

Hospitals 110

Hospitals Ultrasounds 110

Sensible Medicine

DECEMBER 28, 2023

One makes an ultrasound device, the other a radiofrequency device. Here is Kaul again: My translation is that the Recor device (ultrasound) approval was very weak. The primary endpoint was a composite of death and total heart failure events (hospitalization for heart failure or urgent heart failure visit).

Stroke 141

Stroke Ultrasounds Outcomes Hospitals 141

Don't Forget the Bubbles

NOVEMBER 13, 2023

Should we use ultrasound to diagnose distal forearm fractures in children and adolescents? However, ultrasound is gaining popularity due to its portability, affordability, and lack of ionising radiation. However, ultrasound is gaining popularity due to its portability, affordability, and lack of ionising radiation.

Fractures 64

Fractures Ultrasounds Emergency Department Pediatrics 64

SheMD

APRIL 24, 2023

I waited until my 6 week ultrasound. On my ultrasound day, I had started to feel pregnant. A colleague met me at the hospital and performed an ultrasound once more to confirm. My friend did an ultrasound and we saw free fluid- a lot of it. My husband left the fire station and rushed to the hospital to be with me.

Ultrasounds 83

Ultrasounds Radiology Radiology Emergency Department 83