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. Horseshoe Kidney: Radiology Reference Article. Images are seen below.

Ultrasounds 52

Ultrasounds Pediatrics Radiology Radiology 52

RebelEM

FEBRUARY 12, 2024

The panel included physicians from Emergency Medicine, Urology and Radiology and was published in major journals of all three specialities. Research from our very own SIUH department of radiology recommended that contrast-enhanced CT scans can safely exclude obstructive urolithiasis just as well as noncontrast CTs.

Radiology 69

Radiology Radiology Emergency Department Ultrasounds 69

SheMD

APRIL 24, 2023

Well there were two other ones that were in morula phase but needed to progress to blastocyst. I waited until my 6 week ultrasound. On my ultrasound day, I had started to feel pregnant. Well that night, I had the residency over for a wellness Thanksgiving dinner. I waited in radiology for my formal ultrasound.

Ultrasounds 83

Ultrasounds Radiology Radiology Emergency Department 83

ALiEM

SEPTEMBER 29, 2023

Additional Images Physical Exam General : Well-appearing male in no distress Neck : Hemostatic wound to his left neck. doi: 10.1148/radiology.216.2.r00jl25356. He now presents requesting “Neosporin.” ” His tetanus status is out of date. No significant pain, no hematoma, no bruits. 2000 Aug;216(2):356-62. r00jl25356.

Radiology 70

Radiology Radiology Academics Ultrasounds 70

RebelEM

JUNE 26, 2023

4F-PCC contains factors II, VII, IX, X as well as Proteins S and C. Some clinicians have advocated for early administration of 4-factor prothrombin complex concentrate (4F-PCC) based on limited observational data. High-quality studies are needed to determine the utility of this intervention. Severe acute traumatic coagulopathy = PT >1.5

Administration 140

Administration Outcomes Resuscitation Radiology 140

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. What findings make a DVT more likely?

Ultrasounds 71

Ultrasounds Documentation/Coding Wellness EMS 71

Don't Forget the Bubbles

NOVEMBER 8, 2023

Tilly is normally fit and well, with no significant past medical history. The Shera Score Children with a low Shera score (less than 3) who are otherwise systemically well may be suitable for discharge home with safety netting advice , whereas patients with high scores (8 or more) warrant immediate surgical referral. 155 (7): p.

Emergency Department 105

Emergency Department Ultrasounds Pediatrics Best Practices 105

Taming the SRU

SEPTEMBER 15, 2023

ultrasound grand rounds: bedside dvt studies - family presence in the ed/icu - r1 clinical knowledge: aicd - r3 small groups: difficult airway management Ultrasound grand rounds: DVT studies WITH Dr. minges Why should we perform bedside DVT studies in the ED?

CPR 88

CPR Burns Airway Management Wellness 88

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

Pediatric Education

JUNE 9, 2024

She said she hadn’t felt well for a couple hours before that and had had some nausea and emesis before the pain. She had eaten the same food as her college roommates who were all well. The radiologic evaluation of ultrasound showed an enlarged right ovary with a large follicular cyst and decreased blood flow in the pedicle.

Pediatrics 52

Pediatrics Ultrasounds Radiology Radiology 52

Taming the SRU

OCTOBER 1, 2023

This topic is additionally complicated by the development of multiple diagnostic tools now available for diagnosis as well as variable sizing algorithms used around the world. doi:10.1148/radiology.144.4.7111716 The "lung point": an ultrasound sign specific to pneumothorax. AJR Am J Roentgenol. 1995;165(5):1127-1130.

Fractures 95

Fractures COPD Hospitals Emergency Department 95

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). He is also system-wide clinical ultrasound co-chair at MetroHealth Medical Center in Cleveland, Ohio.

EMS 52

EMS Fractures Operations Radiology 52

Total Medical ComplianceHIPAA

OCTOBER 9, 2024

This list is not all inclusive, there may be other challenges as well. Maintenance should be performed on any equipment before using in the delivery of patient care, this includes autoclaves, suction lines, ultrasounds, radiology equipment, etc. Determine if water is deemed safe to use and there is a sufficient supply of water.

Hazardous Materials 59

Hazardous Materials Infectious Diseases PPE Shock 59

SheMD

NOVEMBER 22, 2023

For those who like radiology, I perform my own thyroid ultrasounds and personally review all of my pituitary and adrenal imaging as well. I am energized at the possibilities that a career in Endocrinology has to offer, as well as the countless opportunities for future contributions to the field.

Radiology 52

Radiology Radiology Wellness Ultrasounds 52

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]. Respect, but do not rely upon, the mechanism. MRI can be used in place of CT.

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. Angiography and/or venography may be considered as well. MRI is often used as it can evaluate soft tissue, bone, neural and vascular structures.

Pediatrics 52

Pediatrics Radiology Radiology Operations 52

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

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 40

Ultrasounds EKG/ECG EMS Radiology 40

Dr. Smith's ECG Blog

JUNE 27, 2021

A chest X-ray was obtained: This was read by radiology as "Bilateral lower lobe interstitial opacities. A bedside ultrasound was done, with dozens of clips, and was even done with Speckle Tracking. We should not have been fooled by the radiology reading of "pneumonia". The initial troponin I returned at 0.67

EKG/ECG 40

EKG/ECG Radiology Radiology Ultrasounds 40

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. Affects ages 3-8, males to females 2:1 [3].

Pediatrics 52

Pediatrics Ultrasounds Emergency Department Radiology 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 Radiology US 90% 96% 14.1 Late findings Fever Abdominal distension (+) LR: 5.64 – 16.8 (-) LR: 0.34 – 0.43 Absent bowel sounds Peritoneal signs (i.e. 0.27 – 0.83 0.34 – 0.43 Abdominal X-ray 75% 66% 1.6

Operations 52

Operations Sepsis Resuscitation Ultrasounds 52

Taming the SRU

MAY 30, 2023

hours earlier and went to OR 3.5 hours earlier and went to OR 3.5

OB/GYN 52

OB/GYN Ultrasounds Pediatrics Resuscitation 52

Advanced Emergency Nursing from AENJ

FEBRUARY 29, 2016

A natural one, and especially suited for increasing capability without regard to physician residency program output of graduates, and in less-well-served rural areas. Rebuilding of EDs in proximity to Radiology, Blood Bank, OR, and ICU, becoming organic to the hospital. EM makes a strong push into bedside use of ultrasound sonography.

Emergency Nursing 40

Emergency Nursing EMS Resuscitation Military 40

Mind The Bleep

FEBRUARY 29, 2024

This may well seem daunting given how unwell and complex the patients might be but a thorough, well-structured A-E will give you most of the information you need to progress that patient’s care. Hb drop, with bloodstaining of the CSF from their EVD and a difficult-to-manage ICP?

Documentation/Coding 52

Documentation/Coding Hospitals Wellness Best Practices 52

Pediatric Emergency Playbook

JUNE 1, 2017

This child is at risk for expected complications, as well as overdiagnosis and iatrogenia. These children depend on their preload to run blood passively into the pulmonary circuit; afterload reduction is also important to compensate for a poor left ejection fraction, as well as to avoid the development of pulmonary hypertension.

Pediatrics 52

Pediatrics EKG/ECG Wellness Seizures 52

EB Medicine

JULY 8, 2019

Jeff: Well that’s kind worrisome. Which again reiterates why this is such an important topic for us as EM clinicians to be well-versed in. For the sake of completeness, just be aware that there is also the biliopancreatic diversion with or without a duodenal switch, as well as a vertical banded gastroplasty.

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 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. In other words, feel free to use ultrasound – especially for things that we in the ED will react to and intervene on – but CT may help to manage the traumatized child non-operatively.

Resuscitation 40

Resuscitation Pediatrics Hyperthermia / Hypothermia Operations 40

The Trauma Pro

SEPTEMBER 26, 2023

Well, here is just what you need. The American College of Radiology notes that exposures less than 100 mGy are “probably too subtle to be clinically detectable.” There are some alternatives available to us, including the good old physical exam, conventional x-rays, and ultrasound. 10 days Pelvis x-ray 0.1

Radiology 221

Radiology Radiology Ultrasounds Wellness 221

Don't Forget the Bubbles

SEPTEMBER 20, 2023

Although there are guidelines from leading organisations, and the potentially harmful effects of unnecessary radiation exposure are well known, AXRs are widely used in practice. The interpretation of radiological findings is subjective. What is the evidence for avoiding abdominal X-rays? of cases. 2017;191:179-183. 2012;161(1):44–50.e502.

Pediatrics 133

Pediatrics Emergency Department Radiology Radiology 133

PEMBlog

SEPTEMBER 20, 2023

Special thanks to Dr. Stephen Freedman, from the University of Calgary, for reviewing this post as well – he brought some practical feedback to the table. Value of abdominal radiography, colonic transit time, and rectal ultrasound scanning in the diagnosis of idiopathic constipation in children: a systematic review.

Pediatrics 123

Pediatrics Emergency Department Hospitals Ultrasounds 123

Downeast Emergency Medicine

MARCH 13, 2022

rebound tenderness), getting an EKG if you have a high suspicion for cardiac involvement, or using ultrasound to assess for free fluid. Discuss treatment options as well as disposition for your patient once labs and imaging have returned. Radiology , RSNA, 1 Oct. Build a differential (and keep it broad!) Silverio, Luz.

Ultrasounds 52

Ultrasounds EKG/ECG Radiology Radiology 52

Don't Forget the Bubbles

SEPTEMBER 23, 2024

This is particularly crucial in younger children who have received a large adult kidney and typically have relatively low creatinine levels when stable and well. An ultrasound scan of the graft is usually sufficient to rule out these complications. Creatinine is the primary biochemical marker for assessing renal function.

Pediatrics 52

Pediatrics Fractures Dehydration Sepsis 52

EB Medicine

JANUARY 2, 2019

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. Nachi: Definitely concerning, but this is all the more reason you need to employ our favorite imaging modality… the ultrasound. For a threatened abortion, the os would be closed with an IUP seen on ultrasound.

Ultrasounds 40

Ultrasounds Radiology Radiology Infectious Diseases 40

EB Medicine

FEBRUARY 1, 2019

Gabrielle Procopio, a PharmD, have done a fantastic job parsing through the literature, which included over 500 abstracts, 89 full text articles, guidelines from ACEP and the American Academy of Neurology, as well as canadian and european neurology guidelines, to summarize the best evidence based recommendations for you all.

Emergency Department 40

Emergency Department Stroke Outcomes Ultrasounds 40

EMDocs

NOVEMBER 13, 2023

2019) argue against a minimum NIHSS score to trigger the use of CTA, instead purporting that clinical suspicion of acute ischemic stroke presenting within 24 hours of the last known well was sufficient evidence to order the study. Semin Ultrasound CT MR 2017, 38 (4), 345-356. 8 The data in Mayer et al. positivity rate on CTA for BCVI.

Stroke 87

Stroke Radiology Radiology Emergency Department 87

Taming the SRU

JUNE 10, 2024

She was seen by her midwife provider for evaluation of this issue several days ago, at which time she underwent an ultrasound that was suggestive of uterine incarceration. Examination reveals a well-appearing woman reclining on the hospital bed, in no acute distress. She was then discharged home.

Ultrasounds 89

Ultrasounds Emergency Department Radiology Radiology 89