The Skeptics' Guide to EM

SEPTEMBER 18, 2021

His practice is in trauma, […] The post SGEM#345: Checking In, Checking Out for Non-Operative Treatment of Appendicitis first appeared on The Skeptics Guide to Emergency Medicine. His practice is in trauma, emergency general surgery, and critical care with an academic interest in ultrasound and medical simulation.

Operations 52

Operations Academics Ultrasounds Hospitals 52

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 130

Ultrasounds Outcomes COPD Hospitals 130

Greater Sydney Area HEMS

FEBRUARY 20, 2024

The evidence for improved safety and quality with the use of ultrasound for CVC implementation is well established [i]. How can this situation be rectified or has the use of ultrasound rendered this blind subclavian “trauma line” a thing of the past? One approach to obtaining BCV origin access (fig.1)

Ultrasounds 98

Ultrasounds Shock Research Operations 98

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 has no rashes or ecchymosis and otherwise her skin exam is unremarkable.

Ultrasounds 52

Ultrasounds Pediatrics Radiology Radiology 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. If not, then we still don’t know the answer.

Pediatrics 147

Pediatrics Outcomes Operations Emergency Department 147

Taming the SRU

MAY 13, 2024

The patient is a well-appearing male who is awake, alert, and oriented. There is also a well-appearing, healed surgical scar. There is also a well-appearing, healed surgical scar. The skin is warm and well perfused with brisk capillary refill. The Ultrasound Journal, 11(1). Notable diagnostics CBC : WBC 19.2,

Ultrasounds 97

Ultrasounds Emergency Department Wellness Operations 97

PulmCCM

FEBRUARY 5, 2024

Ultrasound Is Upvoted The panel weakly suggested bedside ultrasound for patients with fever and an abnormal chest radiograph, but only if an expert is available to interpret the often complex or borderline results. Ultrasound can quickly and more accurately identify significant biliary disease (e.g.,

Best Practices 111

Best Practices Ultrasounds Infectious Diseases Sepsis 111

PulmCCM

APRIL 1, 2024

That could (and should) change if improved functional outcomes, persisting for months after hospital discharge, are ever confirmed in large, well-conducted trials. ” But less than half of the included studies used ultrasound guidance during central line placements.

Ultrasounds 40

Ultrasounds Operations Outcomes Research 40

Dr. Smith's ECG Blog

SEPTEMBER 9, 2024

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. The diagonal branches are overlapping one another and not well visualized in this view. Next is RAO cranial shot.

EKG/ECG 66

EKG/ECG Operations Wellness Ultrasounds 66

Sensible Medicine

MAY 31, 2024

Second guessing, also called post-call quarterbacking, is alive and well in medicine and, when done thoughtfully, can be a great way to teach and learn. As part of his evaluation, a doppler ultrasound of his carotid arteries is ordered. ” When things run well, the person with the power has it for a reason. But not always.

Operations 67

Operations Wellness Academics Ultrasounds 67

ALiEM

SEPTEMBER 13, 2024

On arrival to our emergency department, the patient expressed continued eye pain with bloody discharge as well as blurry vision from his right eye. Tonometry and ocular ultrasound (US) are generally not recommended as you could squeeze more liquid out of the eye or increase the intraocular pressure even more, pushing the iris further out.

Emergency Department 64

Emergency Department Academics Hospitals Fractures 64

Pediatric EM Morsels

AUGUST 4, 2023

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. Positional changes after intake can also be helpful including the lateral decubitus position as well as knee to chest.

Pediatrics 246

Pediatrics Burns Operations Ultrasounds 246

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. This list is not all inclusive, there may be other challenges as well.

Hazardous Materials 59

Hazardous Materials Infectious Diseases PPE Shock 59

EMDocs

AUGUST 12, 2023

He presented to the emergency department because he is having numbness distal to the site of injury, as well as constant bleeding and some difficulty with flexing his finger. The patient states they were cutting an avocado when the knife pierced through and punctured his hand. Examination reveals the following: What is the diagnosis?

EMS 69

EMS Fractures Operations Ultrasounds 69

ACEP Now

MAY 4, 2023

The chest X-ray showed multiple displaced right rib fractures and chest wall subcutaneous emphysema without definitive evidence of a pneumothorax, as well as right lower lobe atelectasis versus contusion (Figure 1). On hospital day 2, he was taken to the operating room for surgical rib fixation. A chest tube was placed at that time.

EMS 52

EMS Fractures Operations Ultrasounds 52

Taming the SRU

NOVEMBER 3, 2023

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.

Fractures 97

Fractures Ultrasounds Outcomes Research 97

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

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. Despite being common practice, the necessity of routine prophylactic transfusions is now being called into question.

Ultrasounds 59

Ultrasounds Outcomes Wellness Research 59

Dr. Smith's ECG Blog

NOVEMBER 17, 2024

The operator performed intravascular ultrasound and visualized acute plaque rupture with thrombus formation and placed a stent. He did well. (It's the opposite of this case.) Fortunately, the patient underwent immediate angiography. There was an 80% lesion in the mid to distal RCA with TIMI 3 flow (meaning normal flow).

EKG/ECG 91

EKG/ECG Operations Ultrasounds Wellness 91

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

Sensible Medicine

JUNE 17, 2024

Europeans do PFA ablation in well under an hour. The bubbles seen on ultrasound imaging during PFA was enough for the proponents to write in 2018 that brain safety was an issue to be studied. What’s more, the lack of esophageal damage has encouraged PFA operators to deliver more (not less) ablation.

Shock 123

Shock Stroke Operations Ultrasounds 123

RebelEM

APRIL 29, 2024

CVC vs PIV The critically ill patient is often associated with pathology that makes IV access difficult such as shock state, hypovolemia, obesity, IV drug abuse, end-stage renal disease, cardiac arrest, as well as other conditions. Studies have compared IO to peripheral intravenous (PIV) and central venous (CVC) access for resuscitation.

Resuscitation 105

Resuscitation Administration Emergency Department Hospitals 105

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. While adenotonsillectomy may not directly impact cognitive functions, it can benefit other aspects of health and well-being in children with mild sleep-disordered breathing. Musolino AM, et al.

Pediatrics 98

Pediatrics Ultrasounds Blood Transfusions Sepsis 98

Taming the SRU

MAY 22, 2023

Use your exam to guide your initial management as well as your imaging decisions and differential diagnosis. Point-of-care ultrasound (POCUS) can evaluate for Achilles tendon rupture with a high sensitivity (96-100%) and specificity (83-100%) [8,9]. A comparison between pre-operative ultrasonography and surgical findings.

Fractures 76

Fractures Dislocations Operations Radiology 76

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

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 52

Documentation/Coding Operations Academics Ultrasounds 52

Taming the SRU

AUGUST 4, 2024

We discussed some practices to push learners outside of their comfort zone and promote learning, based on their level as well as their goals for the shift. The largest retrospective cohort study to date (Beyde et al.) shows that most will improve with empiric antibiotics.

Emergency Department 84

Emergency Department Dislocations Documentation/Coding Burns 84

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

RebelEM

JUNE 19, 2023

Demographics were well balanced in the two groups. 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).

Outcomes 105

Outcomes Blood Transfusions Administration Hyperthermia / Hypothermia 105

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

Pediatric Education

AUGUST 4, 2024

” Imaging may include ultrasound, computed tomography or magnetic resonance imaging depending on the patient age and circumstances. Angiography and/or venography may be considered as well. Recurrence can occur and also presentations on the contralateral side after operation have also been noted.

Pediatrics 52

Pediatrics Radiology Radiology Operations 52

Dr. Smith's ECG Blog

DECEMBER 18, 2022

Importantly, there is also STE in aVL, as well as V1. 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.

Ultrasounds 52

Ultrasounds EKG/ECG EMS Radiology 52

Don't Forget the Bubbles

OCTOBER 14, 2024

The government recognizes they cannot return to their country of origin owing to a well-founded fear of being persecuted for the reasons provided for in the United Nations Refugee Convention or European Convention on Human Rights (such as persecution due to race, sexuality, political opinions, or religion).

Documentation/Coding 59

Documentation/Coding Hospitals Wellness Operations 59

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. Current concepts in the evaluation and treatment of mallet finger injury. Plast Reconstr Surg. 2013;132(4):560e-566e. doi:10.1097/PRS.0b013e3182a0148c

EMS 78

EMS Fractures Soft Tissue Injuries Ultrasounds 78

Dr. Smith's ECG Blog

DECEMBER 19, 2023

Two thirds of MINOCA cases are due to atherosclerotic causes One way to prove the diagnosis in this case would have been with intravascular imaging such as optical coherence tomography (OCT) or intravascular ultrasound (IVUS). The patient did well afterward without any recurrence of symptoms. Fortunately, that is exactly what happened.

EKG/ECG 119

EKG/ECG EMS Wellness Operations 119

Northwestern EM Blog

DECEMBER 20, 2021

Typically well appearing with normal labs, however, this is a diagnosis of exclusion and a septic joint should be ruled out. Management includes imaging studies, typical ultrasound to assess for a joint effusion, then a diagnostic arthrocentesis & antibiotics. Management is orthopedic consultation for operative stabilization [12].

Pediatrics 52

Pediatrics Ultrasounds Emergency Department Radiology 52

Resus Review

FEBRUARY 12, 2015

The patient is positioned and prepped in the same way as for the standard operative tracheostomy. Elimination of scheduling difficulty associated with operating room and anesthesiology teams for critical care patients. Use ultrasound to identify an large vessels in the area. Only then should the endotracheal tube be removed.

Operations 52

Operations Documentation/Coding Ultrasounds Wellness 52