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Ultrasound in Emergency Medicine

Beau M Bailey, Kenneth S Ramos, Alice Johnson, Charlene Mitchell
Systemic lupus erythematosus (SLE) is an autoimmune disease known to affect a variety of organ systems. Patients with SLE are more prone to developing common infections that can mimic the complications of SLE. As such, it is essential to differentiate complications of SLE from infection to ensure appropriate management and to improve morbidity and mortality of this patient population. Here we present a 24-year-old, Hispanic male, with SLE complicated by dialysis-dependent end-stage renal disease and dilated cardiomyopathy...
September 2018: Journal of Clinical Medicine Research
Greg S Zahn, Matt A Rutz
Evaluation of posterior ocular pathology remains a challenging yet vital skill in the practice of emergency medicine. Accurate diagnosis and patient disposition has sight-saving implications. Present day skill and comfort with ophthalmoscopic exam is often limited for many providers. Dilated examination often needed for adequate visualization is not commonly performed as part of the emergency department ocular evaluation. This article is protected by copyright. All rights reserved.
August 15, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Daozheng Huang, Huan Ma, Zhiyuan Xiao, Michael Blaivas, Ying Chen, Jianyi Wen, Weixin Guo, Jun Liang, Xiaolong Liao, Zhonghua Wang, Hanbiao Li, Jie Li, Yangong Chao, Xiao Ting Wang, Yan Wu, Tiehe Qin, Ke Su, Shouhong Wang, Ning Tan
BACKGROUND: Lung ultrasound and echocardiography are mainly applied in critical care and emergency medicine. However, the diagnostic value of cardiopulmonary ultrasound in elderly patients with acute respiratory distress syndrome (ARDS) is still unclear. METHODS: Consecutive patients admitted to ICU with the diagnosis of suspected ARDS based on clinical grounds were enrolled. Cardiopulmonary ultrasound was performed as part of monitoring on day 1, day 2 and day 3...
August 13, 2018: BMC Pulmonary Medicine
David P Evans, Jordan Tozer, Michael Joyce, Michael J Vitto
OBJECTIVES: We sought to determine whether US-guided lumbar puncture reduced the rate of lumbar puncture failures for providers at an academic teaching hospital with variable lumbar puncture and US experience compared to the traditional landmark-based technique. METHODS: We conducted a prospective randomized controlled trial to compare US-guided lumbar puncture to the traditional landmark technique in an academic emergency department. Thirty-five patients were randomized to either have their lumbar puncture performed either via the landmark or US-guided technique...
August 12, 2018: Journal of Ultrasound in Medicine: Official Journal of the American Institute of Ultrasound in Medicine
Jonathan D Auten, John H Naheedy, Nicole D Hurst, Andrew T Pennock, Kathryn A Hollenbach, John T Kanegaye
OBJECTIVE: Emergency department (ED) reduction of pediatric fractures occurs most commonly in the forearm and can be challenging if fluoroscopy is not available. We sought to assess the ability of point of-care ultrasonography (POCUS) to predict adequacy of reduction by fluoroscopy. METHODS: We prospectively enrolled ED patients 0-17 years of age with radial and/or ulnar fractures requiring reduction under fluoroscopic guidance. Post-reduction POCUS (probe dorsal, volar, and coronal) and fluoroscopic (AP and lateral) fracture images were recorded...
July 27, 2018: American Journal of Emergency Medicine
Rein Ketelaars, Gabby Reijnders, Geert-Jan van Geffen, Gert Jan Scheffer, Nico Hoogerwerf
Prehospital point-of-care ultrasound used by nonradiologists in emergency medicine is gaining ground. It is feasible on-scene and during aeromedical transport and allows health-care professionals to detect or rule out potential harmful conditions. Consequently, it impacts decision-making in prioritizing care, selecting the best treatment, and the most suitable transport mode and destination. This increasing relevance of prehospital ultrasonography is due to advancements in ultrasound devices and related technology, and to a growing number of applications...
August 8, 2018: Critical Ultrasound Journal
Melissa Barnett, M Tyson Pillow, Jennifer Carnell, Anita Rohra, Stephanie DeSandro, Aimee K Gardner
PURPOSE: We performed a needs assessment to understand how existing physician assistant (PA) program curricula and clinical training affect students' ultrasound knowledge, skills, and competence and prepare students for performing ultrasound techniques in clinical practice. METHODS: Students graduating from a PA program completed a 23-item questionnaire examining their ultrasound training experiences, their self-assessment of competency, and their demographics. Students also completed a 15-item ultrasound knowledge assessment...
August 6, 2018: Journal of Physician Assistant Education
A Michon, S Jammal, A Passeron, G De Luna, C Bomahou, V Jullien, J Pouchot, J-B Arlet, B Ranque
INTRODUCTION: Point of care ultrasound (POCUS) is routinely used by intensivists and emergency physicians for many years. Its interest is not arguable any more for these specialists, despite the large variety of diseases they care. Hospitalists and internists also should find some interest in POCUS, which convenience and wide range of indications responds well to the variety of their practice. However, it is still not widely used in internal medicine departments. METHODS: We here report our experience of using a pocket-sized ultrasound device in a French internal medicine department...
August 2, 2018: La Revue de Médecine Interne
Julien Le Coz, Silvia Orlandini, Luigi Titomanlio, Victoria Elisa Rinaldi
IMPORTANCE: Point-of-care ultrasonography (POCUS) allows to obtain real-time images to correlate with the patient's presenting signs and symptoms. It can be used by various specialties and may be broadly divided into diagnostic and procedural applications. OBJECTIVE: We aimed at reviewing current knowledge on the use of POCUS in Pediatric Emergency Departments (PEDs). FINDINGS: US diagnostic capacity in paediatric patients with suspected pneumonia has been studied and debated whereas literature regarding the usefulness of point-of-care echocardiography in the pediatric setting is still limited...
July 27, 2018: Italian Journal of Pediatrics
Enyo A Ablordeppey, Anne M Drewry, Daniel L Theodoro, LinLin Tian, Brian M Fuller, Richard T Griffey
PURPOSE: Although routine chest radiographs (CXR) to verify correct central venous catheter (CVC) position and exclude pneumothorax is commonly performed, emerging evidence suggests that this practice can be replaced by point of care ultrasound (POCUS). POCUS is advantageous over CXR because it avoids radiation while verifying correct placement and lack of pneumothorax without delay. We hypothesize that a knowledge translation gap exists in this area. We aim to describe the current clinical practice regarding POCUS alone for CVC position confirmation and pneumothorax exclusion as compared to chest radiography...
July 25, 2018: Shock
Aalap Shah
Background: Deliberate practice of invasive procedures on simulation phantoms has been recommended to teach trainees. For many departments, these task trainers can be prohibitively expensive. Sometimes, phantoms for specialized procedures are not commercially available at all. There are currently are no commercially available simulation phantoms for the purpose of ultrasound (US)-guided glenohumeral joint injection. Objectives: The objective was to create a low-cost, reusable, homemade simulation phantom for US-guided glenohumeral joint injection using easily obtainable materials as well as to determine whether use of such a homemade model by novice learners is associated with increased self-reported comfort level and knowledge of the procedure...
April 2018: AEM education and training
Jan Shoenberger, Sangeeta Lamba, Rebecca Goett, Paul DeSandre, Kate Aberger, Suzanne Bigelow, Todd Brandtman, Garrett K Chan, Robert Zalenski, David Wang, Mark Rosenberg, Karen Jubanyik
Objectives: Emergency medicine (EM) physicians commonly care for patients with serious life-limiting illness. Hospice and palliative medicine (HPM) is a subspecialty pathway of EM. Although a subspecialty level of practice requires additional training, primary-level skills of HPM such as effective communication and symptom management are part of routine clinical care and expected of EM residents. However, unlike EM residency curricula in disciplines like trauma and ultrasound, there is no nationally defined HPM curriculum for EM resident training...
April 2018: AEM education and training
Casey Lee Wilson, Devin Keefe, Michael R Ehmann
Background: The use of ultrasound for procedural guidance is an essential skill in emergency medicine (EM) and a required Accreditation Council for Graduate Medical Education (ACGME) competency for residents. Resident learners develop their skill set through hands-on training and may benefit from an intervention that encourages proper technique, bolsters confidence, and improves procedural success. Clear Guide ONE, a Food and Drug Administration-approved technology, overlays real-time virtual instrument navigation onto ultrasound displays to allow visualization of expected instrument trajectory prior to needle puncture, ensuring alignment with the target...
October 2017: AEM education and training
Delia L Gold, Jennifer R Marin, Demetris Haritos, L Melissa Skaugset, Jennifer M Kline, Rachel M Stanley, David P Way, David P Bahner
Objectives: Point-of-care ultrasound (POCUS) has been identified as a critical skill for pediatric emergency medicine (PEM) physicians. The purpose of this study was to profile the current status of PEM POCUS in pediatric emergency departments (EDs). Methods: An electronic survey was distributed to PEM fellows and attending physicians at four major pediatric academic health centers. The 24-item questionnaire covered professional demographics, POCUS experience and proficiency, and barriers to the use of POCUS in pediatric EDs...
October 2017: AEM education and training
Colin R Bell, Conor J McKaigney, Matthew Holden, Gabor Fichtinger, Louise Rang
Objectives: The Focused Assessment with Sonography in Trauma (FAST) is a point-of-care ultrasound (PoCUS) study that is routine in trauma patient assessment. Many organizations have published training guidelines, which grant competency through the completion of a fixed number of observed scans. This approach is incongruent with current trends in competency-based medical education. We aim to objectively quantify probe motion and user accuracy to differentiate groups of PoCUS operators...
October 2017: AEM education and training
Di Shi, Joseph H Walline, Xuezhong Yu, Jun Xu, Priscilla P Song, Huadong Zhu
Background: To survey the prevalence of bedside ultrasound assessment in emergency departments (EDs) in China. Methods: We designed an online survey for emergency physicians based in the China. The questionnaire included sixteen items querying common ED bedside ultrasound practices. Respondents were recruited via weblinks sent through social media and a popular Chinese emergency medicine website. Survey data was collected from April through June, 2016. Results: Four hundred and twenty-eight physicians responded to this survey; more than 80% of respondents reported working clinically in the ED...
May 2018: Journal of Thoracic Disease
Michael Wagner, Joy Shen-Wagner, Kang X Zhang, Timothy Flynn, Kevin Bergman
Although the use of point-of-care ultrasound (POCUS) is well established in the emergency department (ED) and intensive care unit, the use of POCUS in the outpatient clinic setting is still emerging. General practitioners and specialists alike have increasing access to smaller and less expensive US devices that can assist in making timely diagnoses, guiding procedures, and monitoring patients. In this case-based review, we highlight some of the literature on simple-to-apply POCUS applications relevant to ambulatory medicine...
July 2018: Southern Medical Journal
Megan A Musisca, Mark I Neuman, Cynthia A Gravel, Michael C Monuteaux, Rachel G Rempell
OBJECTIVE: We sought to determine which interventions have effectively increased point-of-care ultrasound (US) use in a pediatric emergency department (ED). DESIGN/METHODS: We evaluated the impact of specific interventions conducted over a 5-year period (2010-2015) on point-of-care US performance in a tertiary care pediatric ED. Ultrasound use by attending physicians and fellows was ascertained from a departmental database. Interventions assessed included the following: (1) initiation of an US fellowship, (2) acquisition of a second US machine, (3) performance of an US-related research project in the department, (4) initiation of faculty US curriculum, (5) earlier introduction of US education for pediatric emergency medicine fellows, and (6) administrative mandate dictating faculty requirements for credentialing...
July 2018: Pediatric Emergency Care
Muhammad Azharuddin, Maria Amanda Delacruz, Derek Baughman, Patton Chandler
This is a case of a 53-year-old male patient with a history of hypertension who developed sudden onset of right lower quadrant pain. On arrival, chest X-ray showed prominent aortic arch without cardiomegaly. CT of the abdomen/pelvis showed aortic dissection in descending aorta without rupture. CT of the chest displayed sparing of ascending and aortic arch. Ultrasound Doppler of the kidney displayed mild renal artery stenosis. Differential diagnosis was acute appendicitis, acute ureteric and severe gastroenteritis...
June 29, 2018: BMJ Case Reports
Erden Erol Unluer, Togay Evrin, Burak Katipoglu, Serdar Bayata
Fluid therapy is one of the main issues for hemodynamic resuscitation. Tissue Doppler imaging (TDI) of the right ventricle (RV) with bedside ultrasound (BUS) technique is a new dynamic method to identify fluid responsiveness in patients with hypotension. Here, we present the case of a hypotensive patient monitored with TDI measurements of RV. A 75-year-old male patient was admitted to the emergency department (ED) with the complaint of diarrhea. He was in severe hypovolemia, with hypotension, tachycardia, and tachypnea...
December 2017: Interventional Medicine & Applied Science
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