Search Results

Figure

Sensitivity analyses contour plot of significant results for TC I vs NTC.

OR1 denotes association between the confounding factor and TC designation; OR2 denotes association between the confounding factor and ED mortality.

Each line indicates the significance point (P = .05) at which qualitative conclusions of significant results change. All points including and superior to each line represent magnitudes of confounding, which if present, have the strength to overturn the conclusion. For example, in ISS 16 to 24, the presence of a confounding factor with an OR of 2 between both TC designation and ED mortality has the strength to overturn the conclusion in this group. Whereas in ISS 25 to 75, H1, a confounding factor with an OR of 7 between both TC designation and ED mortality is required to overturn the conclusion in this group. Sensitivity analyses of significant results for TC II vs NTC were not plotted because conclusions were not overturned at any range of magnitude tested.

Fig. 1

Kaplan-Meier estimates of the time to death from any cause during the entire study period or future hospitalizations for worsening heart failure. Fig. 1A shows patients divided into 3 groups according to admission LVEF. Patients with preserved (>50%) LVEF are shown in green color; patients with mild and moderate (31% ≤ LVEF ≤ 50%) LV dysfunction, in blue color; and patients with severe (LVEF ≤30%) LV dysfunction, in red color. Fig. 1B shows patients divided into 2 groups according to admission serum hemoglobin levels. Patients with normal (>120 g/L) hemoglobin level are shown in green color; and patients with anemia (hemoglobin level ≤120 g/L), in red color.

Fig. 2

Top panel: ultrasound image of the penis in longitudinal axis (sagittal imaging plane) after local anesthetic for penile block. Buck fascia, symphisis pubis, and CC are labeled for identification. The asterisk indicates the spread of local anesthetic injectate underneath the Buck fascia, above the tunica albuginea of the CC. Bottom panel: ultrasound image of the penis in cross section (coronal imaging plane) after local anesthetic for penile block showing the superficial dorsal vein above Buck fascia with the components of the dorsal neurovascular complex—dorsal nerves, arteries, and deep veins—beneath Buck fascia surrounded by local anesthetic.

Fig. 2

A, The distribution of the cutaneous innervation of the SCP is outlined in white. Key surface landmarks include the (1) sternal notch, (2) superior pole of the thyroid cartilage, (3) the mastoid process, and (dashed line) the posterolateral border of the SCM muscle. The injection site is marked (⁎). B, Probe positioning for the in-plane approach in the lateral decubitus position. C, Survey ultrasound scan showing the tapering posteriolateral border of the SCM, the carotid artery (CA), and the LSM. The greater auricular nerve can be identified as an hypoechoic structure above the SCM muscle (arrow) and the cervical plexus just deep to the muscle (arrow heads).

Fig. 4

A, Ultrasound-guided injection of local anesthetic begins with insertion of the needle 1 to 3 cm under the tapering posterolateral border of the SCM muscle just deep to the muscle belly but superficial to the deep fascia. The needle shaft is marked (arrowheads) with the needle tip beneath the greater auricular nerve (arrow). B, With injection of local anesthetic, the fascial plane should be observed in real time to distend. Generally, 8 to 10 mL is a sufficient volume. The local anesthetic will spread toward to carotid sheath but should remain superficial to the deep fascia if injected in the correct plane.

Fig. 1

Simple Triage and Rapid Treatment protocol.

Based on respiratory rate, perfusion (radial pulse presence and capillary refill time), and mental status (ability to obey command), the START procedure sorts patients into 4 triage categories, which include (1) Red tag: Victim requires immediate intervention and transport. Medical attention is required within (60) minutes for survival; (2) Yellow tag: Victim’s transport may be delayed. Serious and potentially life-threatening injuries are included in this strata, but patient status is not expected to deteriorate significantly over several hours; (3) Green tag: Victim had relatively minor injuries and may be able to assist in his/her own care. A proportion will require additional secondary triage; (4) Black tag: Victim is unlikely to survive given severity of injuries, level of available care, or both. Palliative care and pain relief should be provided.

Fig. 3

Setup and needle approach for the ultrasound-guided ICB. A, The patient is positioned supine, the operator is at the head of the bed with an unobstructed line of sight to the ultrasound display near the patient's waist. B, A linear or small footprint curvilinear probe is placed in the parasagittal plane just medial to the coracoid process and inferior to the clavicle. At this position, the pectoralis major and minor muscles are identified with the axillary vein and artery underneath. The brachial cords of the plexus clustered around the artery.

Fig. 2

Emergency management and transfer triage of 38 patients based on the basic status (vital sign) and POC ultrasound examination. In the first step, vital sign were quickly evaluated. In the second step, POC ultrasound was used for further screening of patients (vital sign unstable was screened first). In the third step, immediate management was done according to the results provided by POC ultrasound. Then in the fourth step, transfer triage was made according to POC screening results—vital sign unstable first (after targeted initial management) > stable patient with positive POC ultrasound result > stable patient with negative echo result.

Fig. 1

A theoretical explanation of the lung point. Left: At expiration, the pneumothorax has a defined volume on computed tomography. A probe placed at a point slightly superior to the lung level will display a pneumothorax pattern. Right: At inspiration, the lung volume should slightly increase, therefore increasing the surface of the lung in contact with the wall. The probe remaining at the same location will thus display a fleeing pattern of lung, that is, lung sliding and/or “B lines.” With permission from Intensive Care Med 2000;26(10):1434-40.

Fig. 4

These are optic nerve US images from a 70-year-old male patient with a history of diabetes, cardiac disease, and hypertension presenting to the ED with chest pain, blurry vision, and a blood pressure of 251/117 mm Hg. Initial fundoscopic examination was negative. The patient was treated with a nitroglycerin drip. The left image represents a pretreatment optic nerve US at a blood pressure of 251/117 mm Hg, and the right image represents a posttreatment optic nerve US at a blood pressure of 170/90 mm Hg.

Fig. 1

A, On conventional US, a faint, ill-defined hypoechoic lesion was noted (arrows). The radiologist detected this lesion as a minor liver trauma, whereas the emergency physician did not detect this lesion. B, After contrast enhancement, the lesion showed more clearly (arrows), and the radiologist and emergency physician both detected this lesion as a minor liver trauma. C, On a CT scan, a wedge-shaped, low-attenuating lesion involving less than 10% of the left lobe of the liver was seen (arrowheads). D, A photograph of the gross specimen showed a minor liver laceration in the left lobe (arrow).

Fig. 3

Forest plot of the meta-analysis of RCTs. Ultrasound guidance techniques are compared with traditional palpation techniques in terms of the rate of first-attempt success. Each block represents a study, and the area of each block is proportional to the precision of the mean treatment effect in that particular study. The horizontal line represents the 95% CI for the treatment effect in a study. The center of the diamond represents the average treatment effect across studies. The width of the diamond denotes its 95% CI. US, ultrasound.

Fig. 2

A, Conventional US showed no definitely abnormal lesions in this liver. Both the radiologist and emergency physician found no trauma. B, On CEUS, diffuse, poorly enhanced areas were noted in the left lobe of the liver (arrowheads). This lesion was diagnosed as trauma of severe degree by both radiologist and emergency physician. C, Computed tomography showed ill-defined low-attenuating lesions involving more than half of the left lobe of the liver, suggesting severe liver trauma. D, Photograph of the gross specimen showed diffuse blunt trauma in the left lobe of the liver (arrowheads).

Fig. 1

A sagittal transvaginal ultrasound shows the retroflexed uterus. The fundus is outlined by white arrowheads. The elongated gestational sac containing a yolk sac can be seen extending from the lower extent of the endometrium into the endocervical canal (black arrowheads), which also contains a small amount of fluid. A small amount of free fluid can be seen between the posterior wall of the cervix and some loops of bowel. Abbreviations: GS, gestational sac; YS, yolk sac; EM, endometrium; F, fluid; B, bowel.

Fig. 1

The SCP emerges from the posterior lateral border of the SCM muscle innervating the anterolateral neck and superior and posterior aspects or “cape” of the shoulder. The 4 terminal branches of the SCP are illustrated here: A, greater auricular nerve; B, lesser occipital nerve; C, suprascapular nerve; and D, the transverse cervical nerve. Figure drawn by Diana Herring based on Fig. 17-2 from Morgan GE, Mikhali MS, Murray MJ, Clinical Anesthesiology, 4th Edition, 2006.

Fig. 1

Top panel: cross-sectional anatomy at the base of the penis showing the injection site for an UDPB. The UDBP involves a single injection beneath Buck fascia (dotted line). Once Buck fascia is penetrated, local anesthetic readily spreads circumferentially to reach both dorsal and ventral aspects of the penis. Bottom panel: sonogram showing needle tip placement underneath Buck fascia with hypoechoic (black) local anesthetic displacing the CC downward.

Figure

Ultrasound images of the medial upper arm show the basilic vein (Bv) and brachial veins (arrows) in short axis. The US field depth setting is 2 cm. The US image on the right shows IJ vein in short axis with US field setting to a depth of 3 cm. The anterior wall of the IJ is 1 cm below the skin surface. The carotid is located below and medial to the IJ.

Fig. 2

Streamlined FAST protocol.

1) Ambulatory status is determined first. Green tag is assigned to those able to ambulate independently.

2) FAST is performed. Any positive finding in any quadrant of the FAST obviates the need for completion of scan. A positive FAST assigns red tag status to the patient (suggestive of low volume status, abdominal free fluid, pericardium effusion, intrathoracic fluid, or pneumothorax). Focused Assessment with Sonography for Trauma negative patients were assigned yellow tag status.

Fig. 1

Example of a good quality examination (quality score, 4), with diagnostic confidence present, of low ejection fraction and left atrial enlargement. Note that the anterior leaflet of the mitral valve does not encroach upon the left ventricular outflow tract (LVOT), that is, a large (>1cm) EPSS is present (double-headed arrow) and that the left atrial diameter (dashed line) appears larger than the aortic diameter (dotted line), even at its minimum, in diastole.

Fig. 2

Example of a lesser quality examination (quality score, 3), with presence of diagnostic confidence for a normal left ventricular ejection fraction and left atrium (LA) size, that addresses the robust nature of the diagnostic criteria. E-point-to-septum separation is small (solid line) as the anterior mitral leaflet encroaches on the left ventricular outflow tract, and the LA diameter (dashed line) is smaller than the aortic diameter (dotted line) in diastole.