Ultrasound in ED

BACKGROUND: Patients with severe erectile dysfunction (ED) remain the most challenging group in terms of available noninvasive treatment modalities. AIM: The study sought to assess the role of combination therapy with low-intensity shockwave therapy (LiST) and daily tadalafil 5 mg in a highly select group of patients with severe vasculogenic ED through a double-blind, randomized trial. METHODS: Forty-eight sexually active men were randomly assigned to 12 sessions of LiST 3 times weekly and tadalafil 5 mg once daily (n = 34) or sham therapy and tadalafil (n = 17) for 4 weeks...

BACKGROUND: The shift towards outpatient total knee arthroplasties (TKAs) has led to a demand for effective perioperative pain control methods. A surgeon-performed "low"-adductor canal block (ACB) technique, involving an intraoperative adductor canal block, is gaining popularity due to its efficiency and early pain control potential. This study examined the transition from traditional preoperative anesthesiologist-performed ultrasound-guided adductor canal blocks ("high-ACB") to low-ACB, evaluating pain control, morphine consumption, first physical therapy visit gait distance, hospital length-of-stay, and complications...

STUDY OBJECTIVE: We propose a novel method of evaluating right ventricular (RV) dysfunction in the emergency department (ED) using RV "bubble time"-the duration of time bubbles from a saline solution flush are visualized in the RV on echocardiography. The objective was to identify the optimal cutoff value for RV bubble time that differentiates patients with RV dysfunction and report on its diagnostic test characteristics. METHODS: This prospective diagnostic accuracy study enrolled a convenience sample of hemodynamically stable patients in the ED...

No abstract text is available yet for this article.

INTRODUCTION: Point-of-care ultrasound (POCUS) performed by emergency physicians (EP) has emerged as an effective alternative to radiology department ultrasounds for the diagnosis of lower extremity deep vein thrombosis (DVT). Systematic reviews suggested good sensitivity and specificity overall for EP-performed POCUS for DVT diagnosis, yet high levels of heterogeneity were reported. METHODS: In this systematic review and meta-analysis, we aimed to provide the most up-to-date estimates of the accuracy of EP-performed POCUS for diagnosis of DVT and to explore potential correlations with test performance...

INTRODUCTION: The use of a reliable scoring system for quality assessment (QA) is imperative to limit inconsistencies in measuring ultrasound acquisition skills. The current grading scale used for QA endorsed by the American College of Emergency Physicians (ACEP) is non-specific, applies irrespective of the type of study performed, and has not been rigorously validated. Our goal in this study was to determine whether a succinct, organ-specific grading scale designed for lung-specific QA would be more precise with better interobserver agreement...

PURPOSE: Using point-of-care ultrasound (POCUS) to diagnose abdominal aortic aneurysm (AAA) is an essential skill in emergency medicine (EM). While simulation-based POCUS education is commonly used, the translation to performance in the emergency department (ED) is unknown. We investigated whether adding case-based simulation to an EM residency curriculum was associated with changes in the quantity and quality of aorta POCUS performed by residents in the ED. METHODS: A case-based simulation was introduced to resident didactics at our academic, Level I trauma center...

Post-traumatic compartment syndrome in the lower extremity has been commonly associated with fractures of the tibia. Only in rare cases, this critical condition might be related to isolated fibular fractures. We present a rare case of delayed onset of acute compartment syndrome after a solitary fracture of the fibula. A 40-year-old man with a history of coagulation disorders due to hepatic cirrhosis was admitted to a neighboring hospital after a car accident with left-sided fractures to ribs 9 and 10 and a transverse fracture in the mid-shaft of the left fibula...

OBJECTIVES: To evaluate the efficacy of a novel approach to achieve the optimal penile erection during the penile doppler ultrasound (PDU) examination, which was oral sildenafil combined alprostadil injection. MATERIALS AND METHODS: A total of 60 ED patients were enrolled in our prospective study, and they were randomly assigned to two group with different PDU order. The approaches assisted the PDU included two models, mode A meaning injection of 15 μg alprostadil and model B meaning oral sildenafil 100 mg plus injection of 15 μg alprostadil...

BACKGROUND: Ultrasound has established utility within pediatric emergency medicine and has an added benefit of avoiding excessive radiation exposure. The serial focused assessment with sonography in trauma (sFAST) examination is a potential alternative to improve pediatric trauma evaluation. We sought to evaluate the accuracy of sFAST in pediatric patients with blunt abdominal trauma. METHODS: We performed a multicenter, retrospective observational study of electronic medical records, trauma registry data, and image archiving records of previous sFAST examinations...

INTRODUCTION AND IMPORTANCE: Chromophobe renal cell carcinoma (CHRCC) is a rare subtype of renal cancer, accompanied by subcapsular renal hematoma (SRH) without a history of traumatic or hemorrhagic disease, which is clinically rare. The reason for CHRCC with SRH may be caused by tumor rupture or vascular rupture. In the early stage, it is often asymptomatic and can be easily overlooked and misdiagnosed, leading to delayed treatment and serious consequences. CASE PRESENTATION: A 39-year-old female patient was admitted to the emergency department due to sudden dull pain and discomfort in the lower back...

INTRODUCTION: Cervical lymphadenopathy in children is typically self-limited; however, the management of persistent lymphadenopathy remains unclear. This study aimed to evaluate the management and outcomes of patients with persistent cervical lymphadenopathy. METHODS: Single-institution, retrospective review of children <18 years undergoing ultrasound (US) for cervical lymphadenopathy from 2013 to 2021 was performed. Patients were stratified into initial biopsy, delayed biopsy, or no biopsy groups...

OBJECTIVES: Early diagnosis of relative afferent pupillary defects (RAPDs) in patients with ocular trauma is crucial for timely management and improved outcomes. However, clinical examination can be challenging for patients with periorbital ecchymosis. This study aimed to compare the diagnostic accuracy of point-of-care ultrasound (POCUS) and clinical examination by emergency physicians for detecting RAPD in adult ocular trauma patients and to evaluate the proportion of RAPD in patients with ocular trauma who presented to the ED...

Appendicectomy, or the removal of the appendix, is an emergency procedure following symptomatic acute appendicitis. Diagnosis is made on clinical examination but can be confirmed on imaging if other abnormalities are suspected. A few variants of appendix anatomical position exist that can be difficult to manage. In addition, secondary findings during surgery can come unexpectedly. We report a case of a 14-year-old male, who presented to the emergency department at our government institution with abdominal pain and vomiting...

An electrical storm also known as a ventricular tachycardia storm (VT storm) tends to recur and form a vicious cycle, eventually leading to a refractory electrical storm, refractory to electrical and pharmacological cardioversion. The treatment of refractory VT storm is challenging. Here we discuss the case of a middle-aged gentleman who presented to our emergency department 6 months apart with a refractory VT storm. When all the anti-arrhythmic agents and multiple cardioversion attempts failed in terminating the storm, we attempted ultrasound-guided stellate ganglion block...

A 9-year-old boy presented to the emergency department after noticing a painless mass on the right testicle during self-examination in the shower. On physical examination, both testes were mobile and painless, with the right testis twice as big as the left and exhibiting palpable resistance. Sonographic examination revealed a uniformly demarcated mass with a ventral protrusion on the right testis. Tumor markers and blood tests were normal. The testis was exposed inguinally and the tumor was enucleated, which revealed a dermoid cyst...

OBJECTIVE: We describe a case series of regional nerve blocks, which comprise an adapted framework for the pediatric emergency setting and were performed by pediatric emergency medicine physicians. METHODS: A case series of 8 different ultrasound-guided nerve blocks and 1 anatomical block, performed in 11 pediatric patients, aged 7 weeks to 17 years. RESULTS: All blocks resulted in adequate analgesia. No procedural complications were observed...

Neck stiffness is a common clinical sign in children presenting to the emergency department that may indicate a wide variety of diagnoses. Acute suppurative thyroiditis (AST) is an infection of the thyroid gland caused by a bacterium, virus, or, less commonly, fungus. It presents as an acute or subacute development of an anterior cervical mass, with associated inflammatory signs. The pressure upon neck muscles may be reflected as a limitation of cervical mobility. AST is often preceded by an upper respiratory tract infection, and pyriform sinus fistula is the most common predisposing factor...

BACKGROUND: Point-of-care ultrasonography (POCUS) enables access to cardiac imaging directly at the bedside but is limited by brief acquisition, variation in acquisition quality, and lack of advanced protocols. OBJECTIVE: To develop and validate deep learning models for detecting underdiagnosed cardiomyopathies on cardiac POCUS, leveraging a novel acquisition quality-adapted modeling strategy. METHODS: To develop the models, we identified transthoracic echocardiograms (TTEs) of patients across five hospitals in a large U...

Anisakiosis, also known as Anisakis larvae infestation, is an increasing parasitic infestation due to the worldwide spread of raw fish and shellfish consumption habits. We present a rare presentation of intestinal intussusception as a preoperative diagnosis and noticed it postoperatively due to Anisakis larvae. A 43-year-old man presented to the emergency department with abdominal pain around the umbilicus and vomiting for several hours. On physical examination at presentation, he had tenderness in the lower abdomen...