Mind The Bleep

FEBRUARY 2, 2025

For example: “If ultrasound negative then reassure and discharge”, “If CRP normal then safety net and advise to see GP if symptoms recur” Treatment Escalation Plan/ DNACPR Clearly document if the patient has an existing DNACPR in place- they may come to hospital with a copy.

Documentation/Coding 95

Documentation/Coding COPD EKG/ECG Wellness 95

Sensible Medicine

JUNE 17, 2024

Stroke occurred in 7 patients (0.12%). Notable also that in the main paper, there was one TIA in the PFA arm and one stroke in the thermal arm but neither of these were in the MRI subgroup of the study. We really can’t say much about safety when only 600 patients are randomized. We would call these silent brain lesions.

Shock 127

Shock Stroke Operations Ultrasounds 127

PulmCCM

NOVEMBER 17, 2023

For any given hemodynamic state, measure or estimate the P ra and CO [or stroke volume, SV] simultaneously and repeatedly after each intervention. ’ This could be done with the Venous Excess Ultrasound Score [VExUS] [5, 6]. The ultrasound journal 2020, 12(1):1-12. Ultrasound J 2022, 14(1):36. What does this mean?

Operations 132

Operations Ultrasounds Resuscitation Blood Transfusions 132

RebelEM

JANUARY 29, 2024

Randomized, Controlled Trial of Ultrasound-Assisted Catheter-Directed Thrombolysis for Acute Intermediate-Risk Pulmonary Embolism. A prospective, Single-Arm Multicenter Trial of Ultrasound-Facilitated, Catheter-Directed, Low-Dose Fibrinolysis for Acute Massive and Submassive Pulmonary Embolism: The SEATTLE II Study. CHEST 2010.

Stroke 133

Stroke Outcomes Hospitals Administration 133

Taming the SRU

AUGUST 7, 2023

The patient needs a transvaginal ultrasound w/ doppler with gynecology consult and possible laparotomy TVUS is not just for torsion, it can also be used for ectopic pregnancies or pregnancy of unknown location Acute Ischemic Stroke Updates WITH Drs.

Stroke 93

Stroke Outcomes EKG/ECG Research 93

ALiEM

JANUARY 29, 2024

It requires immediate consultation with ophthalmology as well as neurology as it is considered a stroke equivalent. Stroke workup for CRAO is necessary, and don’t forget about secondary prevention/risk stratification which must be part of the management. RBSS may predict poor response to systemic thrombolysis. 39,1 (2020): 197-202.

Stroke 64

Stroke Ultrasounds Academics Outcomes 64

Taming the SRU

NOVEMBER 3, 2023

Ultrasound‐Guided Serratus Anterior Plane Block (SAPB) Improves Pain Control in Patients With Rib Fractures. Ultrasound Med. 41, 2695–2701 (2022). Materials and Methods It was an interventional study at a single tertiary care referral center with a level I trauma designation and an approximate annual ED census of 90,000.

Fractures 98

Fractures Ultrasounds Research Outcomes 98

Taming the SRU

FEBRUARY 5, 2024

It is most helpful to do the ultrasound immediately before needle insertion, as movement of the patient may shift cutaneous landmarks from underlying bony structures. This resource offers additional information on ultrasound assisted LP’s. WHY - Why Not? REFERENCES 1. Zambito Marsala, S., Gioulis, M., & Pistacchi, M.

Infectious Diseases 97

Infectious Diseases Seizures Ultrasounds Sepsis 97

Dr. Smith's ECG Blog

APRIL 2, 2024

Bedside ED ultrasound showed exceedingly poor global LV function, and no B lines. No wall motion abnormality Decreased left ventricular systolic performance, severe Left ventricular enlargement, marked Dilated cardiomyopathy severe Est. stroke volume 52 cc at HR 70 = 3.64 Here is the initial ED ECG. What do you think?

EKG/ECG 134

EKG/ECG Shock CPR Stroke 134

EMDocs

MAY 15, 2024

Ultrasound Sensitivity 88-100%, specificity 68-94% Positive likelihood ratio of 14.6 (95% While chest radiograph is often the first-line imaging modality, lung ultrasound has higher sensitivity and can detect pulmonary abnormalities earlier; CT imaging should be considered if initial imaging is negative or if concern for PE is present.

Blood Transfusions 97

Blood Transfusions Fluid Resuscitation Dehydration Ultrasounds 97

ACEP Now

OCTOBER 29, 2024

Passively, I watch another clinician’s cursory examination of a critically ill patient to determine how they deem a patient “toxic-appearing” or their bedside neurological assessment to activate a code stroke. A testicular ultrasound confirmed restored blood flow. What do you think the prognosis is for that patient we achieved ROSC?

Emergency Department 59

Emergency Department Mass Casualty Incidents Documentation/Coding Sepsis 59

Dr. Smith's ECG Blog

JULY 5, 2024

But the duration of symptoms was prolonged and so to avoid the risk of stroke, AV nodal blockade (rate control) was preferred. We want to avoid a stroke. A formal ultrasound later showed reasonably good LV function, and so he later received carvedilol and diltiazem, Unfortunately, those led to hypotension at 80/40 with a HR 40.

EKG/ECG 114

EKG/ECG Stroke Administration Ultrasounds 114

RebelEM

MARCH 8, 2023

CRAO is a stroke of the eye; patients should be considered for a complete stroke work up. Signs Shafer’s sign (tobacco dust) May see a Weiss ring when the posterior vitreous (PV) detaches from the optic disc margin Visualization with ultrasound. Emergency Department Management: Emergency ophthalmology consultation. Read more

Stroke 52

Stroke Emergency Department Ultrasounds Outcomes 52

EMDocs

MAY 28, 2024

Ultrasound Sensitivity 88-100%, specificity 68-94% LR+ of 14.6 (95% While chest radiograph is often the first-line imaging modality, lung ultrasound has higher sensitivity and can detect pulmonary abnormalities earlier; CT imaging should be considered if initial imaging is negative or if concern for PE is present. pneumoniae, C.

Blood Transfusions 94

Blood Transfusions Fluid Resuscitation Dehydration Ultrasounds 94

RebelEM

JUNE 26, 2023

Severe acute traumatic coagulopathy = PT >1.5 to 3.33; P = 0.72 NOT STATISTICALLY SIGNIFICANT Also no difference in individual components given Thromboembolic Events: 4F-PCC: 35% Placebo: 24% Absolute Diff: 11%; 95% CI 1 to 21% Relative Risk 1.48; 95% CI 1.04 to 2.10; P = 0.03 Severe acute traumatic coagulopathy = PT >1.5 to 3.33; P = 0.72

Administration 139

Administration Outcomes Resuscitation Radiology 139

RebelEM

JUNE 19, 2023

SBP < 75 mm Hg: 39% SBP 76-89 mm Hg: 33% Critical Findings: No statistically significant difference in safety outcomes (DVT, PE, MI, Stroke) TXA Placebo RR (95% CI) Primary Outcome Good Functional Outcome (6 months) 53.7% Patients were actively screened for DVT (all received lower extremity ultrasound on or around day 7).

Blood Transfusions 105

Blood Transfusions Outcomes Administration Hyperthermia / Hypothermia 105

PulmCCM

JULY 10, 2023

Read in JAMA When to start anticoagulation after ischemic stroke from atrial fibrillation It’s been unclear when to start anticoagulation after an ischemic stroke presumed due to thromboembolism from atrial fibrillation. Aspirin is sometimes given during the waiting period. There were two intracranial hemorrhages in each group.

Stroke 52

Stroke Sepsis Infectious Diseases Outcomes 52

ACEP Now

JUNE 6, 2023

Notoriously elusive, with a high misdiagnosis rate, thoracic aortic dissection (AD) can mimic many conditions, including acute coronary syndrome (ACS, the most common), gastroesophageal reflux disease (GERD), stroke, and spinal-cord compression. 1 Opioids or anxiolytics are often given to patients whose diagnosis of AD is missed or delayed.

EKG/ECG 85

EKG/ECG Stroke Documentation/Coding Operations 85

EM Curious

SEPTEMBER 9, 2015

CUTTING EDGE ACUTE ISCHEMIC STROKE CARE [LECTURE]: Dr. Melissa Motta, a neuro-critical care expert breaks down current best practice in acute ischemic stroke in an excellent talk at Maryland CC Project. SEE YOU NEXT WEEK Online Advanced Ultrasound Education Northwestern EM Residency Education Coming soon.

Stroke 52

Stroke Pediatrics Best Practices EMS 52

Resus Review

OCTOBER 9, 2015

However, advancements in percutaneous coronary intervention (such as drug-eluting stents and techniques, risk stratification, and intravascular ultrasound) have increased the viability of this treatment option. The development of DES stents and second generation antiplatelet medications and reduced the incidence of in stent restenosis.

Stroke 52

Stroke Ultrasounds Outcomes 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

Taming the SRU

FEBRUARY 24, 2024

Providers should use ultrasound as early as possible to evaluate for cardiac dysfunction, pulmonary edema, and fluid status. They tend to be hypertensive, tachycardic, tachypneic, and hypoxic. Do not always appear volume overloaded on exam. Early recognition and prompt treatment is key.

Leadership 94

Leadership EMS Pediatrics Stroke 94

Taming the SRU

JUNE 3, 2024

Susan Wilcox Increasing regionalization due to: Growth of specialty centers Increasing development of healthcare systems Hub-and-spoke models Development of ECMO, trauma, transplant, and stroke centers The higher the acuity of the centers, the higher the acuity of the patient that needs to get there.

Shock 91

Shock Seizures Airway Management Stroke 91

Taming the SRU

AUGUST 4, 2024

In select patient populations (such as those with poor outpatient follow-up), screening with a BMP to evaluate their serum creatinine may be beneficial Patients with asymptomatic hypertension should be referred to their PCP for outpatient follow-up.

Dislocations 85

Dislocations Emergency Department Documentation/Coding Burns 85

Taming the SRU

OCTOBER 7, 2024

history of VTE, increased calf circumference, pain and swelling), then the next step is to attain a compressible ultrasound of the affected leg. However, if clinical suspicion is high enough, doppler ultrasound, MR venography, or serial compressive ultrasound imaging can all be considered. original drawing by dr zinter.

Ultrasounds 64

Ultrasounds CDC Research Stroke 64

Resus Review

OCTOBER 28, 2015

With hemodynamically significant regurgitation, a postdilation can often significantly reduce paravalvular regurgitation without increased risk of stroke or permanent pacemaker placement. The maximum regurgitation tends to occur between the intersection of the noncoronary cusp and along the left coronary coronary cusp. cm2 to 0.12

Stroke 52

Stroke Ultrasounds Outcomes 52

ACEP Now

MAY 9, 2024

6 The increasing mortality rate led to an additional emergency regulation in 2022 requiring the consenting physician to perform the critical steps of the case, limiting surgeons to three cases per day, and mandating continuous, recorded ultrasound guidance for gluteal AFT procedures. References Garcia SE. Butt Lifts Are Booming.

Emergency Department 52

Emergency Department Operations Ultrasounds Shock 52

Pediatric Emergency Playbook

OCTOBER 1, 2017

Also used for severe MS, stroke, TBI, chronic pain. Ultrasound-guided refilling of an intrathecal baclofen pump—a case report. Are VNS safe in everyday life? Intrathecal Pumps Used to infuse basal rate of drug, usually baclofen for spasticity, but pump may contain morphine, bupivicaine, clonidine. Pediatr Neurosurg. 2013; 49:138–144.

Pediatrics 52

Pediatrics Seizures Stroke Ultrasounds 52

Dr. Smith's ECG Blog

APRIL 26, 2017

My opinion was that it was not a cath lab case, but I did suggest they do a bedside ultrasound to look for an anterior wall motion abnormality. Notice also the very small LV cavity size at both diastole and systole (poor LV filling with good contractility) and apparent low stroke volume. I did not have more information at the time.

EKG/ECG 52

EKG/ECG Ultrasounds Dehydration Stroke 52

All Ohio EM

FEBRUARY 11, 2019

Dr. Mike Pallaci covered endovascular therapy for stroke with a quick review of some very relevant studies that put endovascular therapy on the map. Based on data from MR CLEAN, merely 1/110 screened strokes would meet inclusion criteria. Third, POCUS (point-of-care ultrasound) is your friend. Image from R.E.B.E.L

EMS 52

EMS Stroke Leadership Documentation/Coding 52

Dr. Smith's ECG Blog

NOVEMBER 15, 2023

Stroke-volume:50 ml. The problem is difficult to study because angiographic visualization of arteries is not perfect, and not all angiograms employ intravascular ultrasound (IVUS) to assess for unseen plaque or for plaque whose rupture and ulceration cannot be seen on angiogram. Left ventricular end-diastolic volume: 99 ml.

EKG/ECG 110

EKG/ECG Ultrasounds Wellness Stroke 110

Dr. Smith's ECG Blog

OCTOBER 28, 2023

There is very little filling, and thus very poor stroke volume. Further ultrasound showed no B-lines (no pulmonary edema). This is because of the large LV myocardial mass due to HOCM. The heart rate is too fast for this poor filling. Preload must be increased and the heart rate slowed in order to allow more LV filling.

EKG/ECG 58

EKG/ECG Stroke Ultrasounds Wellness 58

Dr. Smith's ECG Blog

MAY 30, 2023

Case continued A bedside ultrasound showed diminished LV EF and of course bradycardia. 1 mg of Atropine was given and the heart rate increased transiently to 60. RVMI explains part of the shock.

Shock 97

Shock EKG/ECG Academics Stroke 97

Downeast Emergency Medicine

APRIL 26, 2021

MI or stroke). Secondary outcomes were early head injury related death (within 24 hours after injury), all-cause and cause-specific mortality, disability, vascular occlusive events (MI, stroke, DVT, PE), seizures, complications, neurosurgery, days of ICU care, and adverse events within 28 days. in the TXA group and 9.9%

Head Injuries 52

Head Injuries Administration Outcomes Seizures 52

EB Medicine

AUGUST 6, 2019

Nachi: Specifically, we’ll be focusing on the use of DOACs for the indications of stroke prevention in atrial fibrillation and the treatment and prevention of recurrent venous thromboembolisms. Jeff: Rivaroxaban, trade name Xarelto, the second FDA approved DOAC, is used for stroke prevention in those with nonvalvular afib and VTE treatment.

Emergency Department 40

Emergency Department Stroke Wellness Outcomes 40

Stop and Think

OCTOBER 2, 2024

It is actually simple: you use an online calculator to get your 10-year risk of a heart attack or stroke. Their argument required high levels of trust in measurements from ultrasound images. Statin Use and the New Risk Calculator People overthink statin drugs. If the absolute risk reduction is to your liking, you take a daily pill.

Stroke 44

Stroke Academics Shock Ultrasounds 44

Pediatric Emergency Playbook

JUNE 1, 2016

Cardiogenic Shock: Act Use point-of-care cardiac ultrasound : Good Squeeze? It’s seen easily enough on point of care ultrasound. Tamponade: if any sign of shock, pericardiocentesis, preferentially ultrasound-guided. You will see cool, mottled extremities. Pericardial Effusion? Get ready to aspirate. Ventricle Size?

Shock 40

Shock Sepsis Pediatrics Ultrasounds 40