The Skeptics' Guide to EM

MARCH 25, 2023

Point of care biliary ultrasound in the emergency department (BUSED) predicts final surgical management decisions. Point of care biliary ultrasound in the emergency department (BUSED) predicts final surgical management decisions. Do they need surgery, an ERCP or just analgesia and non-operative care?

Ultrasounds 52

Ultrasounds Emergency Department Dislocations Radiology 52

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

Total Medical ComplianceHIPAA

OCTOBER 9, 2024

Mold buildup, sanitary sewer systems operating correctly, surfaces being free of microorganisms, equipment being cleaned/disinfected/sterilized properly, and supplies being free of damage are just a few other issues to look out for. There are several concerns that will need to be addressed when reopening following a prolonged shutdown.

Hazardous Materials 59

Hazardous Materials Infectious Diseases Shock PPE 59

Taming the SRU

MAY 27, 2024

Ultrasound in recent years has become a very helpful tool in diagnosing smaller effusions, and is noted to be almost 100% sensitive for effusions > 100 mL (2). This often is seen in trauma, cancer, post-operatively, and end-stage metabolic conditions with excessive colloid or protein leak.

Emergency Department 85

Emergency Department Ultrasounds Radiology Radiology 85

ACEP Now

MAY 4, 2023

On hospital day 2, he was taken to the operating room for surgical rib fixation. The direct movement of air into the chest wall was improved with the placement of a pigtail catheter and ultimately treated with operative repair. He is also system-wide clinical ultrasound co-chair at MetroHealth Medical Center in Cleveland, Ohio.

EMS 52

EMS Fractures Operations Ultrasounds 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

Taming the SRU

MAY 22, 2023

Point-of-care ultrasound (POCUS) can evaluate for Achilles tendon rupture with a high sensitivity (96-100%) and specificity (83-100%) [8,9]. weight-bearing status, operative vs. non-operative) If necessary/helpful to ensure adequate follow-up At time of discharge: Counsel on expected course of injury, supportive care (e.g.,

Fractures 76

Fractures Dislocations Operations Radiology 76

Pediatric Education

AUGUST 4, 2024

” Imaging may include ultrasound, computed tomography or magnetic resonance imaging depending on the patient age and circumstances. Recurrence can occur and also presentations on the contralateral side after operation have also been noted. MRI is often used as it can evaluate soft tissue, bone, neural and vascular structures.

Pediatrics 52

Pediatrics Radiology Radiology Operations 52

Dr. Smith's ECG Blog

DECEMBER 18, 2022

It was notable for a normal cardiac ultrasound with no pericardial fluid, normal LV and RV function (though the quality was not sufficient to evaluate for wall motion abnormalities) and normal IVC dynamics. Bedside ultrasound is another very important piece. Ultrasound can be very helpful to distinguish causes of hypotension.

Ultrasounds 52

Ultrasounds EKG/ECG EMS Radiology 52

PHEM Cast

DECEMBER 1, 2017

Journal of Special Operations Medicine : a Peer Reviewed Journal for SOF Medical Professionals , 13 (4), 53–58. Radiologic evaluation of alternative sites for needle decompression of tension pneumothorax. Ultrasound determination of chest wall thickness: implications for needle thoracostomy. Ultrasound in Emergency Medicine.

Academics 52

Academics Radiology Radiology Resuscitation 52

Northwestern EM Blog

DECEMBER 20, 2021

Management includes imaging studies, typical ultrasound to assess for a joint effusion, then a diagnostic arthrocentesis & antibiotics. Commonly hematogenous spread from bacteremia; clinical suspicion should prompt radiologic evaluation. Management is orthopedic consultation for operative stabilization [12].

Pediatrics 52

Pediatrics Ultrasounds Emergency Department Radiology 52

Taming the SRU

MAY 30, 2023

hours earlier Free fluid in the RUQ has been shown to have a LR of 112 of requiring operative management Risk Factors for Ectopic Pregnancy prior ectopic pregnancy surgery infection assisted reproductive technologies IUD However, 50% of patients with ectopic pregnancy have no risk factors High and Lows w/ Dr. hours earlier and went to OR 3.5

OB/GYN 52

OB/GYN Ultrasounds Pediatrics Resuscitation 52

ACEP Now

SEPTEMBER 3, 2024

While secrecy surrounds the operations of many PE-owned groups, Envision serves as a case study. Her primary interests are in ultrasound, machine learning, and health justice. Private equity firm, accused of trying to build a monopoly in radiology, dismissed as defendant in FTC lawsuit. Radiology Business. The New Yorker.

Hospitals 69

Hospitals Radiology Radiology Administration 69

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. Jeff: Next we have everybody’s favorite, the ultrasound. Sounds familiar. Jeff: We sure did!

Ultrasounds 40

Ultrasounds Radiology Radiology Sepsis 40

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. Will this be enough for the general surgeon, or will they want an US performed by the radiology department to make their surgical decision? Click to enlarge. 2022;7(1):e000944.

Ultrasounds 52

Ultrasounds Radiology Radiology Emergency Department 52

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. Rebuilding of EDs in proximity to Radiology, Blood Bank, OR, and ICU, becoming organic to the hospital. 1950s & 1960s Resuscitation Research.

Emergency Nursing 40

Emergency Nursing EMS Resuscitation Military 40

Pediatric Emergency Playbook

MARCH 1, 2016

Adults tolerate hypotension relatively well, and is sufficient until we send them to the OR or interventional radiology suite. Often children even with high-grade splenic and liver lacerations can be managed non-operatively. To avoid this, we target a MAP of 65 and look for clinical signs of sufficient perfusion.

Resuscitation 40

Resuscitation Pediatrics Hyperthermia / Hypothermia Operations 40

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 69

Ultrasounds Radiology Radiology Emergency Department 69

EB Medicine

JULY 8, 2019

Nachi: Unfortunately this procedure is associated with a relatively high re-operation rate – one study found 20% of patients required removal or revision. Jeff: Even more shockingly, some series showed a 52% repeat operation rate. These patients often require emergent operative intervention.

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 40

Don't Forget the Bubbles

FEBRUARY 7, 2024

One systematic review of 1283 patients showed that if you got to the operating room within 6 hours, you had a 97% chance of saving the testicle. Urgent senior review, decision making and operation 31.3% What is the role of ultrasound? This dropped to 79.3% of patients were first seen by a junior specialist trainee.

Pediatrics 111

Pediatrics Ultrasounds Operations Hospitals 111

Don't Forget the Bubbles

MARCH 4, 2024

Reviewed by: Kieran McDonnell Article 4: Diagnosing Paediatric Distal Forearm Fractures with Ultrasound Snelling PJ, Jones P, Bade D, Bindra R, Davison M, Gillespie A, et al. Diagnostic accuracy of point-of-care ultrasound versus radiographic imaging for pediatric distal forearm fractures: A randomized controlled trial.

Hospitals 78

Hospitals Sepsis Fractures Emergency Department 78

Pediatric Emergency Playbook

JUNE 1, 2017

Fontan Operation and the Single Ventricle. Cardiovasculr Ultrasound. Summary Acute MI is a challenging presentation in children: Easily missed: uncommon and atypical Varied etiology Respect vague symptoms with a non-reassuring H&P Try to detect it: CATH IT! References Congenital AboulHosn JA et al. Congenit Heart Dis. 2007; 2:2-11.

Pediatrics 52

Pediatrics EKG/ECG Wellness Seizures 52

Don't Forget the Bubbles

SEPTEMBER 23, 2024

suprapubic catheters, gastrostomy tubes, haemodialysis or peritoneal dialysis lines – may have been left in situ in the initial post-operative period), and central vascular catheters. Look for scars indicating previous central lines, peritoneal dialysis catheters or operations. If in doubt, ask. CAKUT, catheterization requirement).

Pediatrics 52

Pediatrics Fractures Dehydration Sepsis 52

EMDocs

JUNE 21, 2023

If thinking TA, share your concern with radiology, which improves sensitivity. Common operator errors Failing to enter joint capsule before injecting STS. Can Ultrasound Identify Traumatic Knee Arthrotomy in a Cadaveric Model? A 2013 study found a sensitivity of ~47% for TA of the knee using plain radiographs. J Orthop Trauma.

Soft Tissue Injuries 68

Soft Tissue Injuries Fractures Dislocations Radiology 68

EB Medicine

JANUARY 2, 2019

Jeff: Perhaps most importantly, no history or physical alone can rule in or out an ectopic pregnancy, for that you’ll need testing and imaging or operative findings. So to get us all on the same page, the discriminatory zone is the b-HCG at which an IUP is expected to be seen on ultrasound. Jeff: Up first is the urine pregnancy test.

Ultrasounds 40

Ultrasounds Radiology Radiology Infectious Diseases 40

EMDocs

NOVEMBER 13, 2023

26 With regards to penetrating neck injuries, particularly those in which the platysma is violated, CTA of the neck has allowed a shift away from mandatory operative exploration of Zone 2 neck wounds (those in the mid-neck). Semin Ultrasound CT MR 2017, 38 (4), 345-356. 32 Table 2 : Memphis Criteria. DOI: 10.1161/strokeaha.118.023173

Stroke 86

Stroke Radiology Radiology Emergency Department 86