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

Sensible Medicine

APRIL 24, 2024

Even MRI and ultrasound do not. Are the extra breast tumors found by MRI or ultrasound the kind that would otherwise kill you? The answer is: no one knows because proponents of MRI and ultrasound, whether in dense or regular breasts, are not conducting the appropriate studies to figure this out.

Ultrasounds 137

Ultrasounds Outcomes 137

PHEM Cast

JULY 27, 2021

Some useful videos: Hopefully you found the podcast interesting, but since this is quite a visual topic we have put together some videos to demonstrate some of the pathologies discussed and what they look like on ultrasound: How does ultrasound work? Want to know how to use ultrasound? Kenji Inaba. 2015 Marik PE, Cavallazzi R.

Ultrasounds 52

Ultrasounds Fractures Resuscitation EMS 52

EMDocs

DECEMBER 1, 2024

The disease is generally mild, but in untreated cases, it can lead to more severe outcomes, especially in patients with underlying conditions such as glucose-6-phosphate dehydrogenase deficiency. Even though the disease often resolves spontaneously, prompt antibiotic therapy is essential for optimal outcomes. pregnant patients).

EMS 105

EMS Infectious Diseases Shock Airway Management 105

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. The ultrasound journal 12: 1-12 2. Jon-Emile S. Echocardiography 7.

Ultrasounds 84

Ultrasounds Operations Research Outcomes 84

The Skeptics' Guide to EM

MARCH 1, 2025

Chest x-ray shows no pneumonia or pneumothorax and bedside ultrasound reveals no B-lines or effusion. Intervention: Age-adjusted or standard (<500) cut off for d-dimer Comparison: None Outcome: She has a swollen left leg that is tender but neurovascularly intact, without signs of cellulitis.

Allergic Reactions 77

Allergic Reactions Research Emergency Department Ultrasounds 77

Broome Docs

SEPTEMBER 9, 2023

In this episode we do a deep dive into the BUCKLED trial that looked at the use of bedside ultrasound vs. plain film X-rays for the initial investigation of paediatric forearm fractures. Bottom line: ultrasound appears to be non-inferior to X-ray when used as a first line investigation in terms of functional, patient-oriented outcomes.

Fractures 99

Fractures Ultrasounds Outcomes 99

Ultrasound Gel

JUNE 24, 2019

It is great to see more and more research on ultrasound in cardiac arrest. Here is a nice study that looks to see if ultrasound is associated with increased resuscitation efforts or better survival outcomes. link] It is great to see more and more research on ultrasound in cardiac arrest.

Outcomes 52

Outcomes Ultrasounds Resuscitation Research 52

Emergency Medicine Journal

JULY 22, 2024

Background and objectives The ability to rule appendicitis in or out using ultrasound is limited by studies where the appendix is not visualised. For those patients who had formal ultrasound, direct and indirect findings of ultrasound were abstracted from the ultrasound report. 95% CI 1.7 95% CI 3.8 95% CI 1.4

Ultrasounds 52

Ultrasounds Radiology Radiology Emergency Department 52

ACEP Now

MAY 10, 2024

While waiting for laboratory investigations, including troponin and d-dimer, you wonder if a quick point-of-care ultrasound (POCUS) examination looking for three sonographic findings could help determine the likelihood of this being an AoD. They received a four-hour introductory course taught by emergency ultrasound faculty.

Ultrasounds 52

Ultrasounds Outcomes Academics 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. Point-of-Care Ultrasound-First for the Evaluation of Small Bowel Obstruction: National Cost Savings, Length of Stay Reduction, and Preventable Radiation Exposure.

Ultrasounds 52

Ultrasounds Operations Documentation/Coding Outcomes 52

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

Don't Forget the Bubbles

JUNE 19, 2023

There were no issues during the pregnancy, and estimated fetal growth by ultrasound was constant. Differential diagnosis of small babies The differential diagnosis for SGA and growth-restricted babies is extensive: The diagnosis of growth restriction in utero has improved because of the better use of ultrasound but still remains challenging.

Pediatrics 143

Pediatrics Ultrasounds Hyperthermia / Hypothermia Sepsis 143

Mind The Bleep

FEBRUARY 2, 2025

Ensure you management plan includes how you plan to rule out any immediate concerns and what the outcome is likely to be if normal. Document main findings from any imaging including if normal Differential Diagnoses You can use the surgical sieve approach to identify appropriate differential diagnoses.

Documentation/Coding 95

Documentation/Coding COPD EKG/ECG Wellness 95

Emergency Medicine Journal

SEPTEMBER 27, 2023

Background Serial point-of-care ultrasound (PoCUS) can potentially improve acute patient care through treatment adjusted to the dynamic ultrasound findings. Methods This was a randomised, controlled, blinded-outcome trial conducted in three EDs in Denmark between 9 October 2019 and 26 May 2021.

Ultrasounds 52

Ultrasounds Outcomes 52

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

RebelEM

JUNE 26, 2023

Interventions such as early application of hemorrhage control, tranexamic acid, reduction of crystalloid fluid administration and balanced ratio blood product transfusion have improved many patients’ outcomes. However, mortality still remains high due to trauma-induced coagulopathy. Severe acute traumatic coagulopathy = PT >1.5

Administration 145

Administration Outcomes Resuscitation Radiology 145

Sensible Medicine

NOVEMBER 6, 2023

Today I will tell you about one-year results of the SWISS-APERO trial—which compared outcomes with the two most common types of closure devices. This study report included only 45-day outcomes. They main outcome measure was patency of the left atrial appendage. This is a decidedly bad outcome. Pause there.

Stroke 133

Stroke Outcomes Ultrasounds Wellness 133

PulmCCM

FEBRUARY 5, 2024

Also, many patients with infection won’t have fevers, and those that don’t may be at the highest risk for poor outcomes. But thoracic ultrasounds on every febrile ICU patient with a mildly abnormal chest film would likely result in many unhelpful thoracenteses of harmless effusions, and some avoidable pneumothoraces.

Best Practices 111

Best Practices Ultrasounds Infectious Diseases Sepsis 111

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).

Fractures 98

Fractures Ultrasounds Research Outcomes 98

ACEP Now

DECEMBER 7, 2024

3,4 In addition, for patients with contraindications or those who have failed thrombolysis, catheter-directed thrombolysis and surgical thrombectomy are useful treatment modalities that are associated with low major complication rates and improved patient outcomes. 6 The second common catheter-directed approach is mechanical thrombectomy.

Ultrasounds 52

Ultrasounds Radiology Radiology EKG/ECG 52

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 105

Blood Transfusions Outcomes Administration Hyperthermia / Hypothermia 105

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 101

Operations Ultrasounds Fractures Outcomes 101

Emergency Medicine Journal

JULY 24, 2023

Ultrasound could be a reliable, cheap and radiation free alternative to diagnose fractures and ligamentous injuries. The purpose of this systematic review was to investigate the accuracy of ultrasound in diagnosing ankle injuries. No restrictions were applied for date and language.

Ultrasounds 40

Ultrasounds Fractures Outcomes 40

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

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

Sensible Medicine

AUGUST 19, 2024

One of the core ideas in cardiology is that improving blood flow to a heart with severe reduction of flow due to coronary stenoses will improve outcomes. The addition of patients with a weak heart muscle makes it even more likely that improvement of blood flow should improve outcomes— over medical therapy. The median EF was 28%.

Outcomes 106

Outcomes Ultrasounds Wellness 106

EMDocs

AUGUST 8, 2023

Bimodal age of distribution: at birth and 12-18 years 14% of cases occur in adults; older patients have worse outcomes Bell clapper deformity – bilateral in 80% of patients Prior episode of torsion Family history Trauma (can be minor) Clinical Presentation: Sudden/severe testicular pain Often unilateral, may radiate.

Ultrasounds 94

Ultrasounds Documentation/Coding Outcomes Emergency Department 94

Emergency Medicine Journal

NOVEMBER 28, 2023

Point-of-care ultrasound has been used to guide ED manipulations but its effect on the quality of fracture reduction or subsequent need for surgical fixation is unknown. This study aims to assess the feasibility of conducting a definitive randomised controlled trial to assess the use of ultrasound to guide these fracture manipulations.

Fractures 40

Fractures Ultrasounds Outcomes Research 40

ACEP Now

OCTOBER 29, 2024

4 However, emergency physicians rely on gestalt to predict outcomes well. The externally validated Canadian Syncope Risk Score (CSRS) demonstrated no better prediction of 30-day adverse outcomes for “very low” and “low” risk patients than clinical judgment alone of emergency physicians. Urology took him for orchiopexy.

Emergency Department 59

Emergency Department Mass Casualty Incidents Documentation/Coding Sepsis 59

The Trauma Pro

OCTOBER 25, 2024

The primary outcome was the development of VTE during the hospitalization. DVT was detected using duplex ultrasound, and PE was detected by CT angiography. If pulmonary clots were seen without concomitant DVT, they were not considered to be of embolic origin.

Fractures 113

Fractures Head Injuries Operations Ultrasounds 113

RebelEM

FEBRUARY 19, 2024

of cases) Catheter ultrasound confirmation: 49.8% (i.e. Not met in 16.7% of cases) Catheter location: 66.5% (i.e. Not met in 33.5% Not met in 50.2% of cases) Appropriate vasopressor dose: 84.3% (i.e. Not met in 15.7% No Extravasation Event vs Extravasation Event Age: 63 vs 67 years BMI: 28.3 All Catheter Criteria Met: 44.3%

Administration 137

Administration Sepsis EMS Shock 137

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

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? Early hepatic artery thrombosis after liver transplantation: a systematic review of the incidence, outcome and risk factors. Pediatr Radiol.

EMS 95

EMS Ultrasounds Emergency Department Outcomes 95

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. Longer term data (3 years) found higher rates of poor outcomes. III Renal Denervation for high blood pressure. This was a recent FDA approval.

Stroke 138

Stroke Ultrasounds Outcomes Hospitals 138

EMDocs

JANUARY 16, 2024

Patients can have excellent outcomes despite prolonged resuscitation. VF/asystole), a pulse cannot be identified via Doppler ultrasound for a full minute, or if lack of organized cardiac activity is confirmed on bedside echocardiogram. This is a good time to utilize an arterial line or use the ultrasound to find a central pulse.

Hyperthermia / Hypothermia 109

Hyperthermia / Hypothermia Resuscitation CPR EMS 109

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 Pediatrics 83