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Emergency department ultrasound

Puneet Kapur, Melanie Baimel, Jordan Chenkin
Left ventricular outflow tract pseudoaneurysms are a rare but life-threatening disorder, often caused by complications of cardiac surgery or myocardial infarction. We present a case report of a patient with no prior risk factors who presented with a six-month history of progressive exertional dyspnea, bilateral leg swelling and cough. Point-of-care ultrasound revealed an unexpected outpouching of the left ventricle. He was diagnosed with a left ventricular outflow tract pseudoaneurysm and subsequently went into cardiogenic shock secondary to extension of pseudoaneurysm causing extrinsic compression of the coronary arteries...
March 16, 2018: CJEM
S Palthe, G A Dijkstra, M G Steffens
A spontaneous, non-traumatic, urinary bladder rupture is a rare condition. We describe a case of a 23-year-old male with a spontaneous bladder rupture secondary to urinary retention, due to an urethral stricture. He presented to the emergency department with voiding difficulties, severe abdominal pain and renal failure. Abdominal ultrasound revealed large amounts of ascites. After an unsuccessful attempt to place a Foley catheter a cystoscopy was performed which showed an urethral stricture. On CT-cystogram an intra-peritoneal bladder rupture was diagnosed and the patient underwent laparoscopic repair of the bladder wall...
March 2018: Urology Case Reports
Keith S Boniface, Maxine A LeSaux, Sohaib Mandoorah, Amit Patel, Kai L Neander, Hamid Shokoohi
PURPOSE: We evaluated the performance of an encapsulated guidewire designed for single-handed use with ultrasound-guided vascular access (SonoStik) with Seldinger technique, as compared with conventional intravenous catheters placed under ultrasound guidance in healthy subjects. METHODS: This is a prospective cohort trial in healthy subjects in which each subject served as his/her own control by having a SonoStik ultrasound intravenous cannulation placed in one arm and a conventionally placed, standard ultrasound intravenous cannulation placed in the other arm...
March 1, 2018: Journal of Vascular Access
Yogendra Amatya, Jordan Rupp, Frances M Russell, Jason Saunders, Brian Bales, Darlene R House
BACKGROUND: Lung ultrasound is an effective tool for diagnosing pneumonia in developed countries. Diagnostic accuracy in resource-limited countries where pneumonia is the leading cause of death is unknown. The objective of this study was to evaluate the sensitivity of bedside lung ultrasound compared to chest X-ray for pneumonia in adults presenting for emergency care in a low-income country. METHODS: Patients presenting to the emergency department with suspected pneumonia were evaluated with bedside lung ultrasound, single posterioranterior chest radiograph, and computed tomography (CT)...
March 12, 2018: International Journal of Emergency Medicine
Scott Meester, Sangil Lee
Spontaneous bilateral quadriceps tendon rupture is a rare finding in emergency departments. Thus, the pathophysiology is not well understood. Imaging for improved speed of diagnosis is rarely considered. We present a case of non-traumatic spontaneous bilateral quadriceps tendon rupture and examine current literature on the pathophysiology and imaging guidelines on the topic. The patient is a 49-year-old male that presented to the emergency department with bilateral thigh pain. He had been seen earlier with similar pain, but now presents with increased difficulty ambulating...
March 3, 2018: American Journal of Emergency Medicine
Michael Gottlieb, Brit Long, Alex Koyfman
INTRODUCTION: Aortic stenosis is a common condition among older adults that can be associated with dangerous outcomes, due to both the disease itself and its influence on other conditions. OBJECTIVE: This review provides an evidence-based summary of the current emergency department (ED) evaluation and management of aortic stenosis. DISCUSSION: Aortic stenosis refers to significant narrowing of the aortic valve and can be caused by calcific disease, congenital causes, or rheumatic valvular disease...
March 7, 2018: Journal of Emergency Medicine
Maria Viviana Carlino, Fiorella Paladino, Alfonso Sforza, Claudia Serra, Filomena Liccardi, Giovanni de Simone, Costantino Mancusi
BACKGROUND: Acute dyspnea is one of the main reasons for admission to Emergency Department (ED). Availability of ultraminiaturized pocket ultrasound devices (PUD) adds diagnostic power to the clinical examination. The aim of this study was to identify an integrated ultrasound approach for diagnosis of acute heart failure (acute HF), using PUD and combining evaluation from lung, heart and inferior vena cava (IVC). METHODS: We included 102 patients presenting to the ED of "Antonio Cardarelli" Hospital in Naples (Italy) for acute dyspnea (AD)...
March 9, 2018: Echocardiography
Elliot Long, Trevor Duke, Ed Oakley, Adam O'Brien, Bennett Sheridan, Franz E Babl
OBJECTIVE: The intent of fluid bolus therapy (FBT) is to increase cardiac output and tissue perfusion, yet only 50% of septic children are fluid responsive. We evaluated respiratory variation of inferior vena cava (IVC) diameter as a predictor of fluid responsiveness. METHODS: A prospective observational study in the ED of The Royal Children's Hospital, Melbourne, Australia. Patients were spontaneously ventilating children treated with FBT for sepsis-induced acute circulatory failure...
March 8, 2018: Emergency Medicine Australasia: EMA
Tishara Wijayanayaka, Jacob Davidson, Andreana Bütter
PURPOSE: The purpose of this study was to determine whether children with a positive ultrasound (US) for acute appendicitis but a negative clinical picture developed appendicitis requiring definitive management. METHODS: After obtaining IRB approval, we conducted a retrospective review of patients ≤17years who presented with possible acute appendicitis between April 1st, 2014, and December 31st, 2015. We included patients with a US suggestive of acute appendicitis based on size criteria but without concerning clinical features...
February 9, 2018: Journal of Pediatric Surgery
J Torres Macho, F J García Sánchez, P Garmilla Ezquerra, L Beltrán Romero, J Canora Lebrato, J M Casas Rojo, P Arribas Arribas, S López Palmero, S Pintos Martínez, J M Cepeda Rodrigo, D Luordo, M Beltrán López, M Méndez Bailón, E Rodilla Sala, L Manzano Espinosa, A Zapatero Gaviria, G García de Casasola
This positioning document describes the most important aspects of clinical ultrasonography in the internal medicine setting, from its fundamental indications to the recommended training period. There is no question as to the considerable usefulness of this tool in the standard clinical practice of internists in numerous clinical scenarios and settings (emergencies, hospital ward, general and specific consultations and home care). Ultrasonography has a relevant impact on the practitioner's ability to resolve issues, increasing diagnostic reliability and safety and providing important information on the prognosis and progression...
March 5, 2018: Revista Clínica Española
Babak Shekarchi, Seyed Zia Hejripour Rafsanjani, Nima Shekar Riz Fomani, Mojtaba Chahardoli
Introduction: Using bedside ultrasound in diagnosing acute cholecystitis in the emergency department (ED) can save time, help the decision making process and allocate resources wisely. This study aimed to evaluate the diagnostic accuracy of bedside right upper quadrant (RUQ) ultrasonography in detection of acute cholecystitis. Method: In this diagnostic accuracy study, patients presenting to ED, suffering from RUQ pain in favor of acute cholecystitis underwent RUQ ultrasonography in emergency and radiology departments and interrater agreement between reports was calculated...
2018: Emergency (Tehran, Iran)
Rein Ketelaars, Joram T Stollman, Evelien van Eeten, Ties Eikendal, Jörgen Bruhn, Geert-Jan van Geffen
BACKGROUND: The treatment of acute pain in the emergency department is not always optimal. Peripheral nerve blocks using "blind" or nerve stimulator techniques have substantial disadvantages. Ultrasound-guided regional anesthesia may provide quick, safe, and effective pain relief in patients with proximal femoral fractures with severe pain. However, no evidence exists on emergency physician-performed ultrasound-guided regional anesthesia in these patients in Dutch emergency departments...
March 2, 2018: International Journal of Emergency Medicine
Niccolò Parri, Bradley J Crosby, Lisa Mills, Zachary Soucy, Anna Maria Musolino, Liviana Da Dalt, Angela Cirilli, Laura Grisotto, Nathan Kuppermann
OBJECTIVES: To determine the accuracy of skull point-of-care ultrasound (POCUS) for identifying fractures in children younger than 2 years of age with signs of head trauma, and the ability of POCUS to identify the type and depth of fracture depression. STUDY DESIGN: This was a multicenter, prospective, observational study of children younger than 2 years of age with nontrivial mechanisms of injury and signs of scalp/skull trauma. Patients were enrolled if they underwent computed tomography (CT)...
February 28, 2018: Journal of Pediatrics
James Nonde, Ahmed Adam, Abdullah Ebrahim Laher
Objectives To validate the newly designed Ultra-Sound guided Suprapubic Catheter Insertion Trainer (US-SCIT) model against the real life experience, by enrolling participants with prior confidence in the technique of US-guided Supra-Pubic Catheter (SPC) insertion. Methods The US-SCIT was self-constructed from common disposables and equipment found in the Emergency Department (ED). A validation questionnaire was completed by all participants, after SPC insertion on the US-CIT model. Results Fifty participants enrolled in the study...
February 27, 2018: Urology
Daniel Rosenfield, Jason W Fischer, Charisse W Kwan
The first presentation of congenital heart disease can be a diagnostic challenge in the emergency department. We report on 2 cases where point-of-care ultrasound identified gross cardiac abnormalities in 2 children and expedited disposition and downstream care.
March 2018: Pediatric Emergency Care
Kelcy Higa, Stephen Irving, Richard J Cervantes, Jayce Pangilinan, Laura R Slykhouse, Dale P Woolridge, Richard Amini
This report highlights a presentation of urinary calculus impacted at the urethral meatus and bedside extraction after evaluation with point-of-care ultrasound (POCUS). Visualization of a stone at the urethral meatus prompted a point-of-care ultrasound of the penile shaft and glans. The ultrasound ruled out anatomic variations such as urethral diverticula and as a result bedside removal was expedited. The stone was successfully removed with traction and intraurethral lidocaine gel without urethral lesions or injury to the meatus...
December 20, 2017: Curēus
Andrew Cameron, Kosalan Akilan, David Carr
Infectious mononucleosis is typically a self-limited viral infection of adolescence and early adulthood that resolves in a period of weeks, causing no major sequelae. We describe a case of a healthy 18-year-old female diagnosed with infectious mononucleosis who also presented with right upper quadrant abdominal pain, moderate transaminitis, and cholestatic biochemistry. An ultrasound revealed acute acalculous cholecystitis, generally a condition seen in the context of critical illness. Further investigating emergency department patients with infectious mononucleosis is often not indicated, but may be important for those who present atypically...
March 1, 2018: CJEM
Hong Li, Yi-Dan Li, Wei-Wei Zhu, Ling-Yun Kong, Xiao-Guang Ye, Qi-Zhe Cai, Lan-Lan Sun, Xiu-Zhang Lu
Ultrasound lung comets (ULCs) are a nonionizing bedside approach to assess extravascular lung water. We evaluated a protocol for grading ULC score to estimate pulmonary congestion in heart failure patients and investigated clinical and echocardiographic correlates of the ULC score. Ninety-three patients with congestive heart failure, admitted to the emergency department, underwent pulmonary ultrasound and echocardiography. A ULC score was obtained by summing the ULC scores of 7 zones of anterolateral chest scans...
2018: BioMed Research International
Robert P Jamplis, Lucas Friedman, Srikar Adhikari
A 28-year-old male was brought to the emergency department by the Emergency medical services (EMS) after being found unconscious and unresponsive. Upon arrival, he was hypotensive, intubated with a Glasgow Coma Scale (GCS) 3T, without the signs of trauma or the evidence of bleeding. A focused assessment with sonography in trauma (FAST), point-of-care ultrasound (POCUS) was performed, obscuring part of the spleen from the distended stomach, which was filled with the heterogeneous contents, with the internal movement being identified...
December 17, 2017: Curēus
Yücel Yüzbaşıoğlu, Sema Yüzbaşıoğlu, Selçuk Coşkun, Ferhat İçme, Tolga Öz, Refik Kunt, Sinan Becel, Emine Akçay, Havva Şahin Kavaklı
Background/aim: We aimed to show the role of determination of optic nerve sheath diameter (ONSD) by bedside ultrasonography in an emergency department in the diagnosis of cerebrovascular disorders and its correlation with the clinical picture. Materials and methods: This prospective cross-sectional study included 55 patients with cerebrovascular disorders and 53 controls. Age, sex, ONSD, comorbid disease status, and multidetector computed tomography results of all subjects and application periods and National Institutes of Health Stroke Scale (NIHSS) scores of the patient group were evaluated...
February 23, 2018: Turkish Journal of Medical Sciences
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