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? 1.00 (0.9 – 1.12) Secondary Outcome Mortality 24h 9.7% Prehospital Tranexamic Acid for Severe Trauma.

Blood Transfusions 104

Blood Transfusions Outcomes Administration Hyperthermia / Hypothermia 104

Taming the SRU

NOVEMBER 3, 2023

Ultrasound‐Guided Serratus Anterior Plane Block (SAPB) Improves Pain Control in Patients With Rib Fractures. Ultrasound Med. The primary outcome in this study was a change in pain score at rest 60 minutes after block. 41, 2695–2701 (2022). Mean and median pain score at rest prior to SAPB were 5.4 (SD SD 3.28) and 6.5,

Fractures 98

Fractures Ultrasounds Outcomes Research 98

ACEP Now

JUNE 21, 2023

The lack of differences in the observed outcomes do not suggest one EM training length is superior. The additional year may improve career trajectory or longevity, entrance into fellowship or academic practice, or other longer-term outcomes including successful development of a niche in the specialty. 11 What should we take away?

EMS 114

EMS Academics Telemedicine Operations 114

Emergency Medicine Journal

NOVEMBER 28, 2023

Manipulation performed under ultrasound guidance has the potential to decrease the number of reduction attempts. Patients aged ≥16 years presenting to the ED with a distal radius fracture requiring closed reduction were randomised to either point-of-care ultrasound (PoCUS)-guided or standard reduction.

Fractures 40

Fractures Ultrasounds Emergency Department Operations 40

Don't Forget the Bubbles

JANUARY 1, 2024

However, children who had an operation experienced improvements in behaviour, symptoms, and quality of life and had lower blood pressure. Lung ultrasound for the sick child: less harm and more information than a radiograph. Outcomes From a Randomized Clinical Trial. They enrolled 459 children aged 3 to 12.9 Musolino AM, et al.

Pediatrics 98

Pediatrics Ultrasounds Blood Transfusions Sepsis 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. We were not able to identify a study specifically comparing US-guided CVC compared to IO placement.

Resuscitation 105

Resuscitation Administration Emergency Department Ultrasounds 105

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? Do outcomes for patients with suspected nephrolithiasis differ based on the initial imaging? How do you proceed?

Ultrasounds 52

Ultrasounds Radiology Radiology Outcomes 52

Sensible Medicine

MAY 31, 2024

This is not to say that I always agree with the process or outcomes of medical decision-making. As part of his evaluation, a doppler ultrasound of his carotid arteries is ordered. Some of these disagreements will be critical: what drug needs to be given, does this person need to go the operating room, does JD need a chest tube?

Operations 76

Operations Wellness Academics Ultrasounds 76

ACEP Now

MAY 9, 2024

A search for Brazilian Butt Lift (BBL) on any social media platform will yield thousands of before-and-after images, faja sales, operating room videos, recovery tips, and patients praising their plastic surgeon. These questionable practices led to a rash of bad outcomes.

Emergency Department 52

Emergency Department Operations Ultrasounds Shock 52

PulmCCM

APRIL 24, 2024

Perc trachs do not require operating room time or a surgeon, and can significantly shorten ICU stays. Now, a few intensivists are going for the gut, with a new bedside ultrasound-guided Seldinger-style procedure that could displace percutaneous endoscopic gastrostomy tubes (PEGs) placed by gastroenterologists or interventional radiologists.

Ultrasounds 52

Ultrasounds Hospitals Operations Outcomes 52

PulmCCM

APRIL 1, 2024

Physical therapy is probably under-provided to critically ill patients, and improving this might improve outcomes for many. That could (and should) change if improved functional outcomes, persisting for months after hospital discharge, are ever confirmed in large, well-conducted trials.

Ultrasounds 40

Ultrasounds Operations Outcomes Research 40

The Skeptics' Guide to EM

MAY 11, 2019

His practice is in trauma, emergency general surgery, and critical care with an academic interest in ultrasound and medical simulation. His practice is in trauma, emergency general surgery, and critical care with an academic interest in ultrasound and medical simulation. first appeared on The Skeptics Guide to Emergency Medicine.

Documentation/Coding 40

Documentation/Coding Operations Academics Ultrasounds 40

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. Primary Outcome – Bleeding (Grade 2 to 4) Transfusion 4.8% Non-inferiority margin was set at 2.5% g/dl vs 8.5

Ultrasounds 58

Ultrasounds Outcomes Wellness Research 58

Taming the SRU

MAY 22, 2023

Certain injuries carry risks of further injury, injury-related complications, and poor outcomes which are exacerbated if they are inappropriately managed in the ED. Point-of-care ultrasound (POCUS) can evaluate for Achilles tendon rupture with a high sensitivity (96-100%) and specificity (83-100%) [8,9]. MRI can be used in place of CT.

Fractures 77

Fractures Dislocations Operations Radiology 77

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

ACEP Now

JULY 7, 2024

2,3 In this case, aortic dissection was visualized neither on initial bedside nor on repeat inpatient TTE, despite operator knowledge of a known lesion and extensive operator training. 1,3 Temporizing measures are not always possible for critically ill Grade IV patients, and outcomes are usually much worse. Click to enlarge.)

Operations 59

Operations Hospitals Administration Outcomes 59

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? Finding the most suitable puncture site for intraosseous access in term and preterm neonates: an ultrasound-based anatomical pilot study.

Pediatrics 72

Pediatrics X-Ray Interpretation Sepsis Fractures 72

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

The Skeptics' Guide to EM

FEBRUARY 2, 2018

Might his examination be enough to convince the urologists to take him straight to the operating room without a preceding diagnostic ultrasound? Ultrasound imaging of the scrotum is the gold standard for diagnosis of testicular torsion, however can lead to delays in definitive care. Time is testis. Reference: Frohlich LC, et al.

Pediatrics 40

Pediatrics Ultrasounds Emergency Department Research 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

ACEP Now

NOVEMBER 16, 2023

The lack of differences in the observed outcomes do not suggest one EM training length is superior. The additional year may improve career trajectory or longevity, entrance into fellowship or academic practice, or other longer-term outcomes, including successful development of a niche in the specialty. 11 What Should We Take Away?

Academics 52

Academics EMS Telemedicine Research 52

Taming the SRU

FEBRUARY 19, 2024

This has been the central question of many research projects with variable outcomes. 12) Axillary While axillary arterial line placement has been uncommon, in the age of facile ultrasound operators it may become a more advantageous and accessible site particularly in patients with high BMIs. But are they good enough?

Shock 59

Shock Resuscitation Ultrasounds Research 59

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. These indices would have reinforced the clinical decision progress and avoided bad outcomes from unsuccessful estimates.

Emergency Nursing 40

Emergency Nursing Seizures CPR Wellness 40

Rural Doctors Net

AUGUST 30, 2013

Smart retrieval services have a presence in the Emergency Operations Centre and will be ‘on standby’ as the initial ambulance call comes through – a much more proactive approach than the usual sequence of calls from first responder-ambulance-local hospital-doctor-retrieval service. How to intubate?

Burns 52

Burns Hospitals Wellness Ambulance Services 52

PulmCCM

SEPTEMBER 4, 2024

Kenny MD [ @heart_lung ] Since its first description [1], the Venous Excess Ultrasound Score [VExUS] has received much research attention. Subsequently in the late 1970s, Sivaciyan and Ranganathan [9] confirmed these findings with Doppler ultrasound of the IJV. OP1 is operating point 1 at baseline. Jon-Emile S.

Ultrasounds 84

Ultrasounds Operations Research Outcomes 84

EMDocs

NOVEMBER 18, 2023

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? Liver Transplantation: Operative Techniques and Medical Management. Vital signs: HR 118, BP 103/68, RR 20, T 99.8. Pediatr Radiol.

EMS 81

EMS Ultrasounds Emergency Department Outcomes 81

RebelEM

JANUARY 24, 2024

Schedule follow up with orthopedics within 1 week for discussion of operative management vs early rehab protocols. 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.

Operations 86

Operations Ultrasounds Fractures Outcomes 86

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. Adherence to guidelines was assessed by a follow-up phone call two months after injury.

Pediatrics 113

Pediatrics Outcomes Operations Emergency Department 113

Don't Forget the Bubbles

JANUARY 17, 2024

Abdominal ultrasound, used in 34 cases, was able to visualize a rounded intraluminal image corresponding to a bead in 28 patients. Point-of-care ultrasound may show well-demarcated, round, and hypoechoic material in the stomach and first part of the duodenum, though it can underestimate the number of beads present. Kim, Y.B.,

Pediatrics 111

Pediatrics Poisoning Ultrasounds Dehydration 111

ACEP Now

SEPTEMBER 3, 2024

These stakeholders are similarly shielded in court when adverse patient outcomes, such as negligent deaths, occur under their management or when the bought-out companies are challenged for anticompetitive business practices overseen by the PE firm. Her primary interests are in ultrasound, machine learning, and health justice.

Hospitals 113

Hospitals Radiology Radiology Administration 113

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. World J Gastroenterol. 2007 Jan 21;13(3):432-7.

Operations 89

Operations EMS Fluid Resuscitation Resuscitation 89

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. Outcomes: Primary: Percent change in management decisions after introducing the Radiology Department RUQ US. 2022;7(1):e000944.

Ultrasounds 68

Ultrasounds Radiology Radiology Emergency Department 68

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

Don't Forget the Bubbles

JULY 5, 2023

Furthermore, educating both patients and their families is important in order to achieve good treatment compliance and better clinical outcomes. Afro-Caribbean patients should be screened for sickle cell before anaesthesia for possible pre-operative transfusion. What could be the differential diagnosis?

Blood Transfusions 126

Blood Transfusions Stroke Dehydration Sepsis 126

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

EMDocs

SEPTEMBER 9, 2023

The value of ultrasound for detecting hand fractures: A meta-analysis. Results of primary extensor tendon repair in relation to the zone of injury and pre-operative outcome estimation. Plast Reconstr Surg. 2013;132(4):560e-566e. doi:10.1097/PRS.0b013e3182a0148c 0b013e3182a0148c Zhao W, Wang G, Chen B, et al. 2019;98(44):e17823.

EMS 90

EMS Fractures Soft Tissue Injuries Ultrasounds 90

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. References: 1.

EKG/ECG 52

EKG/ECG Emergency Department Ultrasounds Hospitals 52