Novel use of ultrasound in the ED: ultrasound-guided hematoma block of a proximal humeral fracture Emily Lovallo, Daniel Mantuani, Arun Nagdev
DOI: http://dx.doi.org/10.1016/j.ajem.2014.06.035
The American Journal of Emergency Medicine , Vol. 33 , Issue 1 ,
Published online: July 1 2014
x Proximal humeral fractures are a common injury after falls, particularly in the elderly population. An ultrasound-guided hematoma block is a novel technique for analgesia in cases when standard intravenous analgesia is not efficacious. We present a case in which ultrasound-guided hematoma block was the ideal method for adjunctive pain control in a patient with a comminuted humeral head fracture.
Endobronchial ultrasound: an unusual diagnostic tool for pulmonary embolism Muzaffer Sariaydin, Sibel Günay, Ersin Günay, Sevinc Sarinc Ulasli
DOI: http://dx.doi.org/10.1016/j.ajem.2015.07.081
The American Journal of Emergency Medicine , Vol. 34 , Issue 3 ,
Published online: August 1 2015
x Pulmonary thromboembolism (PTE) is an emergent and common pulmonary vascular disease. The most common diagnostic method for PTE is computer-aided tomography angiography. Endobronchial ultrasonography (EBUS) is used in diagnosis and staging of lung cancer via transbronchial needle aspiration from mediastinal lymphadenopathies and central masses. Diagnosis of PTE with EBUS is not common, although this technique helps to monitor pulmonary vasculature. The present case, a 60-year-old female patient to whom EBUS was applied because of mediastinal lymphadenopathy, was diagnosed as incidental PTE.
Clinical application of real-time tele-ultrasonography in diagnosing pediatric acute appendicitis in the ED Changsun Kim, Bo Seung Kang, Hyuk Joong Choi, Tae Ho Lim, Jaehoon Oh, Youngjoon Chee
DOI: http://dx.doi.org/10.1016/j.ajem.2015.07.048
The American Journal of Emergency Medicine , Vol. 33 , Issue 10 ,
Published online: July 28 2015
x We investigated the effectiveness of tele-mentored ultrasonography between emergency medicine (EM) residents and remote experts in diagnosing acute appendicitis.
Predictive value of C-reactive protein, ultrasound and Alvarado score in acute appendicitis: a prospective pediatric cohort Mohamed Zouari, Mohamed Jallouli, Hamdi Louati, Rim Kchaou, Rahma Chtourou, Ahmed Kotti, Mahdi Ben Dhaou, Hayet Zitouni, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2015.10.004
The American Journal of Emergency Medicine , Vol. 34 , Issue 2 ,
Published online: October 12 2015
x To evaluate whether C-reactive protein (CRP) level and ultrasound (US) results on admission could aid the diagnostic accuracy of Alvarado score.
Point-of-care ultrasound in pediatric urolithiasis: an ED case series Amitabh Chandra, Jessica Zerzan, Alexandar Arroyo, Marla Levine, Eitan Dickman, Mark Tessaro
DOI: http://dx.doi.org/10.1016/j.ajem.2015.05.048
The American Journal of Emergency Medicine , Vol. 33 , Issue 10 ,
Published online: June 22 2015
x Urolithiasis is relatively uncommon in the pediatric population, but its incidence is increasing [1,2]. Urinary tract calculi are associated with significant morbidity in the pediatric population: compared to adults, children have a higher need for urologic intervention, more recurrences, and a higher association with chronic kidney disease [3-5].
Ultrasound-guided nerve blocks for intracapsular and extracapsular hip fractures Eitan Dickman, Illya Pushkar, Antonios Likourezos, Knox Todd, Ula Hwang, Saadia Akhter, Sean Morrison
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.016
The American Journal of Emergency Medicine , Vol. 34 , Issue 3 ,
Published online: December 14 2015
x To compare pain relief between patients with intracapsular and extracapsular hip fractures who received an ultrasound-guided femoral nerve block (USFNB).
Evaluation of the effectiveness of bedside point-of-care ultrasound in the diagnosis and management of distal radius fractures Nalan Kozaci, Mehmet Oguzhan Ay, Mehmet Akcimen, Gokcen Turhan, Ikbal Sasmaz, Sadullah Turhan, Ahmet Celik
DOI: http://dx.doi.org/10.1016/j.ajem.2014.10.022
The American Journal of Emergency Medicine , Vol. 33 , Issue 1 ,
Published online: October 20 2014
x The aim of the study was to compare the effectiveness of point-of-care ultrasound (POCUS) with direct radiography in diagnosis and management of the patients with distal radius fractures (DRFs).
Diagnosis of appendicitis by bedside ultrasound in the ED Michael Mallin, Philip Craven, Patrick Ockerse, Jacob Steenblik, Brayden Forbes, Karl Boehm, Scott Youngquist
DOI: http://dx.doi.org/10.1016/j.ajem.2014.10.004
The American Journal of Emergency Medicine , Vol. 33 , Issue 3 ,
Published online: October 9 2014
x Computed tomography (CT) has largely become standard of care for diagnosing appendicitis at the expense of increased patient radiation exposure, cost, and time to surgical intervention. To date, there are very limited data on the accuracy of bedside ultrasound (BUS) for the diagnosis of appendicitis in adults.
Omental torsion mimicking perforated appendicitis in a pediatric patient: emergency bedside sonography Jared Brazg, Lawrence Haines, Marla C. Levine
DOI: http://dx.doi.org/10.1016/j.ajem.2015.07.058
The American Journal of Emergency Medicine , Vol. 34 , Issue 3 ,
Published online: July 28 2015
x Omental torsion is a rare condition, with most cases described in the adult literature. Preoperative diagnosis of this disease process is challenging as radiographic findings are often variable and the clinical presentation often mimics other pathologic entities including acute appendicitis or acute abdomen of poorly defined origin. (See Figs. 1– 3.)
How do emergency medicine residency core faculty obtain their ultrasound training for credentialing? Dustin W. Anderson, Michael J. Vitto, David P. Evans
DOI: http://dx.doi.org/10.1016/j.ajem.2015.08.017
The American Journal of Emergency Medicine , Vol. 33 , Issue 12 ,
Published online: August 10 2015
x The evolution of emergency ultrasound (EUS) in resident education began in the early 1990s with the American College of Emergency Physicians (ACEP) publishing their first position statement supporting the use of ultrasound (US) by trained physicians [1]. Soon afterwards, The Society for Academic Emergency Medicine (SAEM) endorsed this statement and recommended formal EUS training for all emergency residency programs [2]. In 1994, Mateer et al published the “Model curriculum for physician training in emergency ultrasonography” that laid the template for standardized EUS education [3].
The bubble study: ultrasound confirmation of central venous catheter placement Petra E. Duran-Gehring, Faheem W. Guirgis, Kristin C. McKee, Susan Goggans, Huynh Tran, Colleen J. Kalynych, Robert L. Wears
DOI: http://dx.doi.org/10.1016/j.ajem.2014.10.010
The American Journal of Emergency Medicine , Vol. 33 , Issue 3 ,
Published online: October 10 2014
x The objective was to determine if ultrasound (US) can more rapidly confirm central venous catheter (CVC) position in comparison to chest radiography (CXR) in the emergency department.
Comparison of ultrasonography and surface landmarks in detecting the localization for cricothyroidotomy Günay Yıldız, Erkan Göksu, Aydan Şenfer, Atilla Kaplan
DOI: http://dx.doi.org/10.1016/j.ajem.2015.10.054
The American Journal of Emergency Medicine , Vol. 34 , Issue 2 ,
Published online: November 3 2015
x The aim of the study was to compare ultrasonography (US) and surface landmark techniques for detecting the cricothyroid membrane (CTM) to perform a cricothyroidotomy on healthy volunteers.
Point-of-care ultrasonography at the ED maximizes patient confidence in emergency physicians Pierre-Géraud Claret, Xavier Bobbia, Sébastien Le Roux, Yann Bodin, Claire Roger, Rémi Perrin-Bayard, Laurent Muller, Jean Emmanuel de La Coussaye
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.042
The American Journal of Emergency Medicine , Vol. 34 , Issue 3 ,
Published online: December 21 2015
x Point-of-care ultrasonography (POCUS) performed by emergency physicians (EPs) has become routine practice in emergency departments (EDs) [1] and is a required component of residency training in emergency medicine [2,3]. Previous studies about POCUS have largely focused on its accuracy, safety, efficiency, effect on outcomes, and optimal clinical use [4–10]. What has been less investigated in the literature is patient confidence in the clinician who performs the POCUS and patient feelings, or satisfaction, regarding POCUS.
Point-of-care ultrasonography in the detection of pediatric esophageal food impaction Laura Anna Simone, Jonathan Orsborn, Ron Berant, Mark O. Tessaro
DOI: http://dx.doi.org/10.1016/j.ajem.2015.08.020
The American Journal of Emergency Medicine , Vol. 34 , Issue 4 ,
Published online: August 13 2015
x Esophageal food impaction in children occurs most commonly at the level of the thoracic inlet, where ultrasonography of the anterior neck can visualize the esophagus. We describe a series of cases in which point-of-care ultrasound by pediatric emergency physicians was used to diagnose esophageal food impaction. This novel technique may expedite diagnosis for children with this distressing condition.
Ultrasound-guided pediatric forearm fracture reductions in a resource-limited ED Bobby M. Wellsh, Jerzy M. Kuzma
DOI: http://dx.doi.org/10.1016/j.ajem.2015.09.013
The American Journal of Emergency Medicine , Vol. 34 , Issue 1 ,
Published online: September 19 2015
x Pediatric forearm fractures are a common presentation in emergency departments in Papua New Guinea. Often these children undergo “blind” closed reduction with reduction adequacy assessed by standard radiographs. This study aims to demonstrate the safety and efficacy of ultrasound (US) in guiding closed reduction of pediatric forearm fractures in a resource-limited setting.
Ultrasound-guided dorsal penile nerve block for ED paraphimosis reduction Stefan Flores, Andrew A. Herring
DOI: http://dx.doi.org/10.1016/j.ajem.2014.12.041
The American Journal of Emergency Medicine , Vol. 33 , Issue 6 ,
Published online: December 26 2014
x Adequate anesthesia for emergency department management of painful penile conditions such as paraphimosis or priapism is often both technically challenging and inconsistent using traditional landmark-based techniques of the dorsal penile block (DPB). The pudendal nerves branch to form the paired dorsal nerves of the penis providing sensory innervation to the skin of both the dorsal and ventral aspects of the penis. “Blind” DPB techniques tend to rely on subtle tactile feedback from the needle and visual landmark approximation to identify the appropriate subpubic fascial compartment for injection.
Ultrasound evaluation of appendicitis: importance of the 3 × 2 table for outcome reporting Martin Fedko, Venkatesh R. Bellamkonda, M. Fernanda Bellolio, Erik P. Hess, Christine M. Lohse, Torrey A. Laack, Michael J. Laughlin Jr., Ronna L. Campbell
DOI: http://dx.doi.org/10.1016/j.ajem.2013.12.052
The American Journal of Emergency Medicine , Vol. 32 , Issue 4 ,
Published online: January 6 2014
x Despite a relatively high frequency of appendix nonvisualization when using ultrasound to diagnose appendicitis, many studies either fail to report these results or inconsistently analyze outcomes.
Think ultrasound first for peritonsillar swelling Michael Secko, Adam Sivitz
DOI: http://dx.doi.org/10.1016/j.ajem.2015.01.031
The American Journal of Emergency Medicine , Vol. 33 , Issue 4 ,
Published online: January 23 2015
x Peritonsillar abscess (PTA) is one of the most common deep neck space infections that can potentially have life-threatening complications if inadequately diagnosed and not treated promptly. The ability of clinicians to reliably differentiate PTA from peritonsillar cellulitis by physical examination alone is limited and blind needle aspiration, the typical method of diagnosis of PTA, is also unreliable. We review the available evidence supporting the use of ultrasound, either intraoral ultrasound or transcutaneous ultrasound to be the initial imaging modality of choice for evaluation of PTA and be used for real-time needle guidance.
The effectiveness of bedside point-of-care ultrasonography in the diagnosis and management of metacarpal fractures Nalan Kozaci, Mehmet Oguzhan Ay, Mehmet Akcimen, Ikbal Sasmaz, Gokcen Turhan, Ali Boz
DOI: http://dx.doi.org/10.1016/j.ajem.2015.06.052
The American Journal of Emergency Medicine , Vol. 33 , Issue 10 ,
Published online: June 22 2015
x We aimed to compare the effectiveness of point-of-care ultrasonography (POCUS) with direct radiography (DR) in the diagnosis and management of the patients with metacarpal fractures (MFs).
Modified carotid sinus massage using an ultrasonography for maximizing vagal tone: a crossover simulation study Seung Min Ha, Young Suk Cho, Gyu Chong Cho, Choong Hyun Jo, Ji Young Ryu
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.011
The American Journal of Emergency Medicine , Vol. 33 , Issue 7 ,
Published online: April 10 2015
Open Access x The aim of this study was to ascertain if a modified carotid sinus massage (CSM) using ultrasonography is superior to the conventional CSM for vagal tone generation.
Point-of-care ultrasound differentiates pyomyositis from cellulitis Allison Sauler, Turandot Saul, Resa E. Lewiss
DOI: http://dx.doi.org/10.1016/j.ajem.2014.08.064
The American Journal of Emergency Medicine , Vol. 33 , Issue 3 ,
Published online: August 29 2014
x Pyomyositis (PM) is an infection of skeletal muscle, often associated with an abscess. Patients typically have predisposing risk factors or are immune compromised. The disease is often misdiagnosed, mistreated, and goes undetected until late in the patient's clinical course. We present a case of a patient without obvious predisposing risk factors who complained of right thigh pain, swelling, redness, and fevers for 4 days. Point-of-care ultrasound revealed muscle edema and subcutaneous emphysema without signs of an overlying cellulitis.
Ultrasound-guided infraclavicular brachial plexus block for emergency management of a posterior elbow dislocation Thomas Heflin, Terry Ahern, Andrew Herring
DOI: http://dx.doi.org/10.1016/j.ajem.2015.06.019
The American Journal of Emergency Medicine , Vol. 33 , Issue 9 ,
Published online: June 13 2015
x We present the first description of an ultrasound-guided infraclavicular brachial plexus block (ICB) performed by emergency physicians for reduction of an elbow dislocation. Although there is increasing interest in regional anesthesia for emergency procedural anesthesia as a potential alternative to sedation, many emergency providers are justifiably concerned for the potential complications and technical difficulty. Herein, we describe in detail how to perform an ultrasound-guided ICB, which may be a superior alternative to interscalene or supraclavicular approaches to brachial plexus anesthesia for the arm below the midhumeral level.
Diagnostic performance of cardiopulmonary ultrasound performed by the emergency physician in the management of acute dyspnea Emeric Gallard, Jean-Philippe Redonnet, Jean-Eudes Bourcier, Dominique Deshaies, Nicolas Largeteau, Jeanne-Marie Amalric, Fouad Chedaddi, Jean-Marie Bourgeois, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2014.12.003
The American Journal of Emergency Medicine , Vol. 33 , Issue 3 ,
Published online: December 11 2014
x The etiologic diagnosis of acute dyspnea in the emergency department (ED) remains difficult, especially for elderly patients or those with previous cardiorespiratory medical history. This may lead to inappropriate treatment and potentially a higher mortality rate. Our objective was to evaluate the performance of cardiopulmonary ultrasound compared with usual care for the etiologic diagnosis of acute dyspnea in the ED.
Intracranial hematoma and midline shift detected by transcranial color-coded duplex sonography Pablo Blanco, José Luis Do Pico, Maximiliano Matteoda
DOI: http://dx.doi.org/10.1016/j.ajem.2015.03.040
The American Journal of Emergency Medicine , Vol. 33 , Issue 11 ,
Published online: March 19 2015
x Spontaneous intracerebral hemorrhage (ICH) is responsible for 9% to 27% of all strokes worldwide, with high early case fatality and poor functional outcome. Structural consequences secondary to ICH, especially the mass effects, are common and predictive of clinical deterioration and poor outcomes. Although cranial computed tomography is the reference imaging modality in diagnosis and monitoring of patients with ICH, it has some limitations in practice. By contrast, transcranial color-coded duplex sonography (TCCS) provides a useful and ideal method for diagnosis and monitoring purposes.
Prospective evaluation of ultrasound-guided short catheter placement in internal jugular veins of difficult venous access patients David Kiefer, S. Michael Keller, Anthony Weekes
DOI: http://dx.doi.org/10.1016/j.ajem.2015.11.069
The American Journal of Emergency Medicine , Vol. 34 , Issue 3 ,
Published online: December 4 2015
x Difficult vascular access (DVA) is a common problem. Placement of ultrasound-guided standard length catheters (ultrasound-guided peripheral intravenous [USPIV]) in the internal jugular (IJ) vein is a potential solution.
Mobile vitreous opacities on ocular ultrasonography are not always pathologic: a cross-sectional survey in an asymptomatic population Gavin Budhram, Jennifer Cronsell, Michele Schroeder, Jeremy Sautner, Elizabeth Schoenfeld, Tala Elia, Jennifer Friderici
DOI: http://dx.doi.org/10.1016/j.ajem.2015.09.017
The American Journal of Emergency Medicine , Vol. 33 , Issue 12 ,
Published online: September 19 2015
x Ultrasonography is often used in the evaluation of patients with ocular concerns; however, several pathologic conditions and even some age-related changes can have similar sonographic appearances. One approach that clinicians use is to assume that unilateral findings visible at normal gain are acute, whereas bilateral findings requiring high gain are chronic, especially in the elderly population. To date, no studies have systematically evaluated this assumption.
Accuracy of ultrasound-guided marking of the cricothyroid membrane before simulated failed intubation Michael Mallin, Keith Curtis, Matthew Dawson, Patrick Ockerse, Matthew Ahern
DOI: http://dx.doi.org/10.1016/j.ajem.2013.07.004
The American Journal of Emergency Medicine , Vol. 32 , Issue 1 ,
Published online: October 28 2013
x Interest in the use of dynamic ultrasound (US) for cricothyrotomy has sparked a debate regarding its applicability in a crash airway situation. Ultrasound-guided marking of the cricothyroid membrane (CTM) as a preintubation procedure may be better than the dynamic method. No prior study has evaluated the accuracy of using US to premark the CTM before attempted intubation.
Point-of-care ultrasound for assisting in needle aspiration of spontaneous pneumothorax in the pediatric ED: a case series Carrie Ng, James W. Tsung
DOI: http://dx.doi.org/10.1016/j.ajem.2013.11.011
The American Journal of Emergency Medicine , Vol. 32 , Issue 5 ,
Published online: November 18 2013
x There is controversy regarding needle aspiration for primary spontaneous pneumothorax (PSP), with contradictory recommendations between the American College of Chest Physicians consensus statement (2001), which suggests that needle aspiration has little place in the management of PSP, and the British Thoracic Society guidelines (2010), which recommend that needle aspiration be attempted first for all cases of PSP where drainage is deemed necessary. Studies have shown that there is no significant difference between needle aspiration and tube thoracostomy with regard to safety, rates of immediate success, and early failure and has the advantages of decreasing pain and reducing rates of hospital admission and duration of hospital stay compared with tube thoracostomy.
Effects of ultrasound-guided radial artery catheterization: an updated meta-analysis Yan-Bing Gao, Jun-Hong Yan, Fu-Quan Gao, Lei Pan, Xiao-Zhi Wang, Chang-Jun Lv
DOI: http://dx.doi.org/10.1016/j.ajem.2014.10.008
The American Journal of Emergency Medicine , Vol. 33 , Issue 1 ,
Published online: October 10 2014
x Previous meta-analyses have shown that ultrasound guidance is an effective technique for radial artery catheterization. However, these reports neglected to include several non–English language studies. Therefore, an updated meta-analysis including more eligible studies was performed to assess the effectiveness of ultrasound-guided radial artery catheterization.
Pitfalls in cervical ectopic pregnancy diagnosis by emergency physicians using bedside ultrasonography Dewi Chrestiana, Alfred B. Cheng, Nova L. Panebianco, Anthony J. Dean
DOI: http://dx.doi.org/10.1016/j.ajem.2013.10.055
The American Journal of Emergency Medicine , Vol. 32 , Issue 4 ,
Published online: November 11 2013
x Pelvic pain and vaginal bleeding are common complaints in pregnant women presenting to emergency department. Cervical ectopic pregnancy (EP) is a rare type of EP, with a higher likelihood of complications if missed. Its sonographic findings can be difficult to distinguish from normal pregnancy or an abortion in progress. In this report, we present a rare case of a cervical EP, diagnosed using bedside ultrasonography, and characterize the pitfalls associated with its diagnosis.
The accuracy of bedside ultrasonography as a diagnostic tool for the fifth metatarsal fractures Murat Yesilaras, Ersin Aksay, Ozge Duman Atilla, Mustafa Sever, Onder Kalenderer
DOI: http://dx.doi.org/10.1016/j.ajem.2013.11.009
The American Journal of Emergency Medicine , Vol. 32 , Issue 2 ,
Published online: November 14 2013
x Musculoskeletal ultrasonography is a technique that is becoming more popular in diagnosing injuries of emergency department (ED) patients especially for the diagnosis of fractures. In this study, we determined the reliability of ultrasonography for the diagnosis of fractures of the fifth metatarsal.
The effect of sonologist experience on the ability to determine endotracheal tube location using transtracheal ultrasound Robert Stuntz, Erik Kochert, Thompson Kehrl, Walter Schrading
DOI: http://dx.doi.org/10.1016/j.ajem.2013.11.032
The American Journal of Emergency Medicine , Vol. 32 , Issue 3 ,
Published online: December 2 2013
x Transtracheal ultrasound has been described as a method to evaluate endotracheal tube placement. Correlation between sonologist experience and the successful use of transtracheal ultrasound to identify endotracheal tube location has not been examined. Our objectives were to evaluate emergency physicians' ability to correctly identify endotracheal tube location using transtracheal ultrasound and to evaluate the role operator experience plays in successful identification of tube placement.
Implementation of a novel point-of-care ultrasound billing and reimbursement program: fiscal impact Srikar Adhikari, Richard Amini, Lori Stolz, Kathleen O'Brien, Austin Gross, Travis Jones, Albert Fiorello, Samuel M. Keim
DOI: http://dx.doi.org/10.1016/j.ajem.2014.02.051
The American Journal of Emergency Medicine , Vol. 32 , Issue 6 ,
Published online: March 17 2014
x The aim of this study was to determine the fiscal impact of implementation of a novel emergency department (ED) point-of-care (POC) ultrasound billing and reimbursement program.
Ultrasonography for foreign bodies in the soft tissue Sadiye Yolcu
DOI: http://dx.doi.org/10.1016/j.ajem.2015.03.060
The American Journal of Emergency Medicine , Vol. 33 , Issue 7 ,
Published online: April 6 2015
x Foreign bodies in the soft tissue are a common cause of emergency service admission. Plain radiographs are usually the first form of examination used to detect foreign bodies [1-5]. In cases where the object cannot be detected on plain radiographs or the exact location of the object needs to be identified, computed tomographic (CT) scans are helpful. Because CT scans are multiplanar and have high contrast, this method is the criterion standard in the detection of foreign bodies [6]. Most foreign bodies are pieces of metal, wood, and glass [7].
Image quality evaluation of a portable handheld ultrasound machine for the focused assessment with sonography for trauma examination Katherine M. Baugher, Brian D. Euerle, Sarah K. Sommerkamp, Michael D. Witting
DOI: http://dx.doi.org/10.1016/j.ajem.2013.12.034
The American Journal of Emergency Medicine , Vol. 32 , Issue 4 ,
Published online: December 23 2013
x Benefits of handheld ultrasound devices include ease of portability,1,2 lower cost,3,4 and potentially reduced examination time.5 However, questions have been raised about the quality of images obtained on these devices.4 We hypothesized that the overall image quality of the smaller handheld device would be inferior to that of a larger cart-mounted machine during the focused assessment with sonography for trauma (FAST) examination. For evaluation in this study, we compared the pocket-sized GE Vscan (GE VINGMED, Horten, Norway) to the cart-mounted ZONARE z.one ultra sp ultrasound device (ZONARE Medical Systems, Inc, Mountain View, CA).
Anterior chamber depth measurement using ultrasound to assess elevated intraocular pressure Getaw Worku Hassen, Brett Sweeney, Tania Portillo, Dinah Ali, Omer Nazeer, Rania Habal, Miguel Arbulu, Roger Chirurgi, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2014.11.042
The American Journal of Emergency Medicine , Vol. 33 , Issue 6 ,
Published online: December 1 2014
x Increased anterior chamber pressure also known as intraocular pressure can result from conditions such as glaucoma and trauma. The pressure in the anterior chamber is measured using tonometer. Measurement of the intraocular pressure is essential, as it requires immediate medical attention to alleviate pain and to avoid temporary or permanent damage to intraocular structures. Bedside ocular ultrasound (US) has gained popularity in recent years. It has been used to assess intracranial pressure via optic nerve sheath diameter (ONSD) and evaluate retinal detachment, vitreous hemorrhage, or pupillary reflex in a trauma patient.
Fast ultrasound is fine, but accuracy is everything Gaetano Rea, Cristiana Cipriani
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.019
The American Journal of Emergency Medicine , Vol. 33 , Issue 9 ,
Published online: April 16 2015
x The article by Nazerian et al
[1] claims to report the achievements of a “prospective study on an emergency department population complaining of respiratory symptoms of unexplained origin”, to define “the diagnostic performance of lung ultrasound (LUS) in detecting pulmonary consolidations with the morphologic characteristics of pneumonia, using chest computed tomography (CT) as the criterion standard.”
The accuracy of point-of-care ultrasound to diagnose long bone fractures in the ED Anna L. Waterbrook, Srikar Adhikari, Uwe Stolz, Carrie Adrion
DOI: http://dx.doi.org/10.1016/j.ajem.2013.06.006
The American Journal of Emergency Medicine , Vol. 31 , Issue 9 ,
Published online: July 29 2013
x To determine the diagnostic accuracy of emergency physician performed point-of care ultrasound (POCUS) for detecting long bone fractures compared to standard radiography.
High-frequency linear transducer improves detection of an intrauterine pregnancy in first-trimester ultrasonography Matthew Tabbut, Devin Harper, Diane Gramer, Robert Jones
DOI: http://dx.doi.org/10.1016/j.ajem.2015.11.001
The American Journal of Emergency Medicine , Vol. 34 , Issue 2 ,
Published online: November 3 2015
x The objective was to determine if the need for transvaginal ultrasonographic examination can be decreased by the addition of the transabdominal high-frequency, 12-4–MHz linear transducer after a failed examination with the 6-2–mHz curvilinear transducer when evaluating for an intrauterine pregnancy (IUP).
The utility of transvaginal ultrasound in the ED evaluation of complications of first trimester pregnancy Nova L. Panebianco, Frances Shofer, J. Matthew Fields, Kenton Anderson, Alessandro Mangili, Asako C. Matsuura, Anthony J. Dean
DOI: http://dx.doi.org/10.1016/j.ajem.2015.02.023
The American Journal of Emergency Medicine , Vol. 33 , Issue 6 ,
Published online: February 20 2015
x For patients with early intrauterine pregnancy (IUP), the sonographic signs of the gestation may be below the resolution of transabdominal ultrasound (TAU); however, it may be identified by transvaginal ultrasound (TVU). We sought to determine how often TVU performed in the emergency department (ED) reveals a viable IUP after a nondiagnostic ED TAU and the impact of ED TVU on patient length of stay (LOS).
Emergency ultrasonography for the early diagnosis of necrotizing fasciitis: a case series from the ED Lindsay Oelze, Stanley Wu, Jennifer Carnell
DOI: http://dx.doi.org/10.1016/j.ajem.2012.09.026
The American Journal of Emergency Medicine , Vol. 31 , Issue 3 ,
Published online: January 23 2013
x Necrotizing fasciitis is a rapidly progressing and life-threatening bacterial infection of deep subcutaneous tissues. Prompt diagnosis and surgical intervention decrease morbidity and improve patient survival [1]. A paucity of physical examination findings in early disease hinders timely diagnosis contributing to a high mortality rate of 25% to 30% [2]. Emergency department physicians rely on clinical suspicion to make the diagnosis in critically ill patients as advanced imaging modalities such as computed tomography or magnetic resonance imaging may result in an unacceptable delay to surgical intervention.
De Garengeot hernia: the ultrasound and computed tomographic findings in an 81-year-old woman Jianpeng Hao, Junchao Yao, Dawei Guo, Wenyu Sun, Jian Liang, Xiaofeng Jiang
DOI: http://dx.doi.org/10.1016/j.ajem.2013.11.003
The American Journal of Emergency Medicine , Vol. 32 , Issue 5 ,
Published online: November 11 2013
x The presence of appendix within a femoral hernia is a rare condition in an incarcerated femoral hernia. It has a characteristic groin mass, and the diagnosis of appendicitis is mainly made intraoperatively. A specific imaging appearance (ultrasonography, computed tomography [CT]) allows accurate prospective diagnosis. The recognition of this rare femoral hernia helps us to choose appropriate therapeutic approach. We report a case of an 81-year-old woman who present with painful and nonreducible groin mass.
An ultrasound training program's effect on central venous catheter locations and complications Tahisha Nicole Tolbert, Lawrence E. Haines, Victoria Terentiev, Lucas McArthur, Antonios Likourezos, Peter Homel, Corey Weiner, Eitan Dickman
DOI: http://dx.doi.org/10.1016/j.ajem.2014.07.025
The American Journal of Emergency Medicine , Vol. 32 , Issue 10 ,
Published online: August 2 2014
x Central venous catheter placement is frequently performed in emergency department (ED) patients. Multiple studies have shown that ultrasound-guided (USG) central venous catheter (CVC) placement decreases overall mechanical complication rate, number of attempts, and time to cannulation for the internal jugular (IJ) and femoral vein locations [1-9]. The Agency for Healthcare Research and Quality recommends the use of USG for CVC placement [10], Consequentially, we postulated that the subclavian site may be less preferred for CVCs, as the data supporting USG at this location are not as abundant or conclusive [1,11-16].
Clinical application of prelocalization with ultrasound during internal jugular vein cannulation in emergency surgical patients Chuanbao Han, Qinhai Zhou, Zhengnian Ding, Cunming Liu
DOI: http://dx.doi.org/10.1016/j.ajem.2014.08.018
The American Journal of Emergency Medicine , Vol. 32 , Issue 11 ,
Published online: August 7 2014
x Complications during internal jugular vein (IJV) catheterization occur 2% to 15% of the time in adults, and related injury can be severe [1]. The real-time ultrasound (US) via the IJV approach has decreased complication rates [2-4]. However, it is very cumbersome to protect the US probe during the aseptic procedure and needs the help of assistants [4]. Furthermore, the real-time US is unsuitable for everyday use, and there is also fear of large investments in hardware and training [5]. We investigated these techniques in IJV catheterization in respect of operator experience and complications.
Point-of-care ultrasound diagnoses acute decompensated heart failure in the ED regardless of examination findings Kenton L. Anderson, Katherine Y. Jenq, J. Matthew Fields, Nova L. Panebianco, Anthony J. Dean
DOI: http://dx.doi.org/10.1016/j.ajem.2013.12.025
The American Journal of Emergency Medicine , Vol. 32 , Issue 4 ,
Published online: December 20 2013
x We thank Dr Guglielmo M. Trovato for the comments about our article titled “Diagnosing heart failure among acutely dyspneic patients with cardiac, inferior vena cava, and lung ultrasound” [1]. In our article, we demonstrated that point-of-care ultrasound (US) is able to make the diagnosis of acutely decompensated heart failure (ADHF) among dyspneic patients in the emergency department (ED) if all 3 of the following were present: left ventricular ejection fraction (LVEF) less than 45%, inferior vena cava collapsibility index (IVC-CI) less than 20%, and B lines 10 or higher.
Initial accuracy of bedside ultrasound performed by emergency physicians for multiple indications after a short training period Juan Torres-Macho, Juan M. Antón-Santos, Isabel García-Gutierrez, María de Castro-García, Sergio Gámez-Díez, Pilar García de la Torre, Gonzalo Latorre-Barcenilla, Yolanda Majo-Carbajo, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2012.04.015
The American Journal of Emergency Medicine , Vol. 30 , Issue 9 ,
Published online: July 16 2012
x Emergency physician–performed ultrasonography holds promise as a rapid and accurate method to diagnose multiple diseases in the emergency department (ED). Our objective was to assess the initial diagnostic accuracy (first 55 explorations) of emergency physician–performed ultrasonography for multiple categories of ultrasound use after a short training period.
Anterior chamber depth measurement using ultrasound to assess elevated intraocular pressure Getaw Worku Hassen, Hossein Kalantari
DOI: http://dx.doi.org/10.1016/j.ajem.2014.12.047
The American Journal of Emergency Medicine , Vol. 33 , Issue 4 ,
Published online: December 30 2014
x We read the letter to the editor with interest, and we thank the author(s) for the information on the different causes of anterior chamber diameter (ACD) size variations and different causes of increased intraocular pressure (IOP). We agree that increased IOP results from several causes including trauma and traumatic or spontaneous hemorrhage within the anterior chamber and glaucoma. As it was stated in the letter, IOP can be elevated without change in the ACD. In cases of trauma to the eye, where it is not possible to measure the IOP, ultrasound can be used for detection of retinal detachment, globe rupture (IOP measurement contraindicated in this case), lens dislocation, hyphema, and optic nerve sheath diameter (ONSD) to indirectly assess the intracranial pressure (ICP).
Ultrasound-assisted triage of ankle trauma can decrease the need for radiographic imaging Henrik Hedelin, Lars-Åke Goksör, Jon Karlsson, Stina Stjernström
DOI: http://dx.doi.org/10.1016/j.ajem.2013.09.005
The American Journal of Emergency Medicine , Vol. 31 , Issue 12 ,
Published online: October 23 2013
x An ankle sprain is a common injury, and patients are usually examined with plain radiographs to rule out a fracture despite the fact that only a small minority actually have one.
Streamlined focused assessment with sonography for mass casualty prehospital triage of blunt torso trauma patients Hai Hu, Yarong He, Shu Zhang, Yu Cao
DOI: http://dx.doi.org/10.1016/j.ajem.2014.03.014
The American Journal of Emergency Medicine , Vol. 32 , Issue 7 ,
Published online: March 20 2014
x Without prompt medical attention and often expedient emergency surgery, earthquake victims having blunt torso trauma will experience increased mortality [1]. Rapid identification of necessary emergent medical vs surgical interventions is critically important. Accurate triage is a necessity, particularly with limited medical resources in the chaos after a mass casualty event. The Simple Triage and Rapid Treatment (START) triage method [2] sorts patients into 4 colored tag categories, dependent upon respiratory rate, perfusion (presence of radial pulse and capillary refill time), and mental status (response to commands): red (critically ill patients requiring immediate medical care), yellow (patients in urgent condition, which may receive delayed medical care), green (patients having minor injuries), and black (patients deceased or expectantly soon to be deceased) (Fig. 1).
Correlation of β -human chorionic gonadotropin with ultrasound diagnosis of ectopic pregnancy in the ED Amy J. Bloch, Scott A. Bloch, Matthew Lyon
DOI: http://dx.doi.org/10.1016/j.ajem.2013.01.009
The American Journal of Emergency Medicine , Vol. 31 , Issue 5 ,
Published online: March 13 2013
x Women with ectopic pregnancies tend to have lower β -human chorionic gonadotropin (β -hCG) levels than women with intrauterine pregnancies (IUP) [1]. Transvaginal ultrasound (TVUS) is capable of detecting IUPs when β -hCG levels are greater than 1500 mIU/mL, the so-called discriminatory zone [2–4]. When serum β -hCG levels are less than 1500 mIU/mL and no IUP is detected, possibility of ectopic pregnancy or early IUP exists. Because of the discriminatory zone, emergency physicians often opt not to perform ultrasound on patients whose β -hCG level is less than 1500 mIU/mL.
The role of bedside ultrasound in pretherapeutic and posttherapeutic lumbar puncture in patient with idiopathic intracranial hypertension Getaw Worku Hassen, Omer Nazeer, Fotini Manizate, Neal Patel, Hossein Kalantari
DOI: http://dx.doi.org/10.1016/j.ajem.2014.03.028
The American Journal of Emergency Medicine , Vol. 32 , Issue 10 ,
Published online: March 28 2014
x Idiopathic intracranial hypertension (IIH), also known as pseudotumor cerebri, is often a debilitating condition characterized by headaches, blurry vision, nausea, and vomiting. Lumbar puncture (LP) is an essential component of the diagnostic and therapeutic approach; however, the procedure itself can cause postlumbar puncture headache. In addition to the clinical presentation, the use of bedside ultrasound to measure the optic nerve sheath diameter may aid in differentiating the 2 conditions. We hereby report a case of a 33-year-old woman with known IIH who presented with recurrent headache after the initial therapeutic LP.
Questioning ultrasound diagnosis of pneumothorax: Based on what? Giovanni Volpicelli
DOI: http://dx.doi.org/10.1016/j.ajem.2014.08.031
The American Journal of Emergency Medicine , Vol. 32 , Issue 11 ,
Published online: August 22 2014
x I read with interest the case report by Aspler et al who describe the double lung point in a case of small traumatic pneumothorax [1]. It is a well-described and honest report of a real case in the emergency setting. This article certainly adds some knowledge and contributes to refine further the technique of bedside lung ultrasound for pneumothorax.
Utility of point-of-care ultrasound in acute management triage of earthquake injury Shu Zhang, Da Zhu, Zhi Wan, Yu Cao
DOI: http://dx.doi.org/10.1016/j.ajem.2013.10.009
The American Journal of Emergency Medicine , Vol. 32 , Issue 1 ,
Published online: November 11 2013
x Earthquake could leads to massive casualty and injury in a short period [1-3]. Rapid screening and proper initial management and transfer triage are critical for improving survival during earthquake [1,4,5]. Point-of-care (POC) ultrasound is a newly diagnostic method that has been widely applied during emergency practice [6,7]. Several reports have shown the potential role of POC ultrasound in evaluation earthquake injury [8-10]. In April 20, 2013, a 7.3 magnitude earthquake struck the Sichuan Lu-Shan city (Epicenter location), causing more than 200 deaths and 10 000 injuries.
Questioning the ultrasound diagnosis of pneumothorax Rea Gaetano, Maria D’Amato, Giorgia Ghittoni
DOI: http://dx.doi.org/10.1016/j.ajem.2014.08.025
The American Journal of Emergency Medicine , Vol. 32 , Issue 11 ,
Published online: August 22 2014
x We 3 MDs (a radiologist, a pneumologist, and an intervention ultrasound internist working also in the emergency department) practice in well-known, very active, and historical European cardiothoracic institutions. In our original letter [1], we very respectfully suggest a different interpretation of the published computed tomography (CT) images and of the ultrasound videoclip by Aspler et al [2]. The elegant answer of Aspler et al [3] to our letter [1] is constructive and contributory to the debate and the readers' understanding.
Are young physicians prepared to perform focused assessment with sonography in trauma examination? Zenon Truszewski, Lukasz Szarpak, Andrzej Kurowski, Piotr Adamczyk, Silvia Samarin, Lukasz Czyzewski
DOI: http://dx.doi.org/10.1016/j.ajem.2015.10.045
The American Journal of Emergency Medicine , Vol. 34 , Issue 2 ,
Published online: October 30 2015
x In a recent article, O'Dochartaigh and Douma [1] present a systematic review of prehospital ultrasound of the abdomen and thorax, which changes trauma patient management. This article prompted us to conduct a study on young physicians preparing for performing focused assessment with sonography for trauma (FAST).
Integration of point-of-care sonography during rapid sequence intubation in trauma resuscitation: will it make a difference? Sanjeev Bhoi, Prakash Ranjan Mishra
DOI: http://dx.doi.org/10.1016/j.ajem.2015.11.058
The American Journal of Emergency Medicine , Vol. 34 , Issue 2 ,
Published online: November 21 2015
x Airway management plays a critical role in resuscitation of trauma patients in the emergency department. Failure to secure an adequate airway can quickly lead to death or disability [1]. Rapid sequence intubation (RSI) is the cornerstone of emergency airway management [2,3]. Rapid sequence intubation includes 3 phases: preoxygenation, endotracheal intubation, and tube confirmation. It has been seen that airway problems such as tracheal injury, paratracheal hematoma, vocal cord paralysis, abnormal midline vessels, and soft tissue mass in the neck go unnoticed during RSI leading to fatal events in acute trauma patients.
Comparing diagnostic accuracy of bedside ultrasound and radiography for bone fracture screening in multiple trauma patients at the ED Shahram Bolandparvaz, Payman Moharamzadeh, Kazem Jamali, Mahboob Pouraghaei, Maryam Fadaie, Sepideh Sefidbakht, Kavous Shahsavari
DOI: http://dx.doi.org/10.1016/j.ajem.2013.08.005
The American Journal of Emergency Medicine , Vol. 31 , Issue 11 ,
Published online: September 23 2013
x Long bone fractures are currently diagnosed using radiography, but radiography has some disadvantages (radiation and being time consuming). The present study compared the diagnostic accuracy of bedside ultrasound and radiography in multiple trauma patients at the emergency department (ED).
Bedside ultrasound diagnosis of vitreous hemorrhage and traumatic lens dislocation Sarah E. Frasure, Turandot Saul, Resa E. Lewiss
DOI: http://dx.doi.org/10.1016/j.ajem.2013.02.013
The American Journal of Emergency Medicine , Vol. 31 , Issue 6 ,
Published online: April 22 2013
x We report a case where an emergency physician using bedside ocular ultrasound was able to diagnose vitreous hemorrhage and lens dislocation in an elderly patient. Bedside ultrasound performed by a physician trained in this imaging modality can diagnose ocular emergencies, facilitating appropriate consultation and treatment.
Liver trauma diagnosis with contrast-enhanced ultrasound: interobserver variability between radiologist and emergency physician in an animal study Je Sung You, Yong Eun Chung, Hye-Jeong Lee, Sung Phil Chung, Incheol Park, Myeong-Jin Kim, Mi-Suk Park, Joon Seok Lim, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2011.06.012
The American Journal of Emergency Medicine , Vol. 30 , Issue 7 ,
Published online: August 26 2011
x The purpose of our study was to evaluate interobserver variability between the radiologist and emergency physician in detecting blunt liver trauma by conventional and contrast-enhanced ultrasound (US) (CEUS).
Bedside ultrasound performed by novices for the detection of abscess in ED patients with soft tissue infections Tony Berger, Francisco Garrido, Jeffrey Green, Penelope Chun Lema, Jay Gupta
DOI: http://dx.doi.org/10.1016/j.ajem.2011.08.002
The American Journal of Emergency Medicine , Vol. 30 , Issue 8 ,
Published online: October 26 2011
x The objective was to compare bedside ultrasound (US) to clinical examination for the detection of abscess.
Emergency ultrasound in the diagnosis of traumatic extrathoracic lung herniation Stacey Marlow, Tabitha Campbell, Ashley Davis, Hershel R. Patel
DOI: http://dx.doi.org/10.1016/j.ajem.2012.09.030
The American Journal of Emergency Medicine , Vol. 31 , Issue 3 ,
Published online: January 24 2013
x Traumatic extrathoracic lung herniation is an extremely rare and poorly described complication of blunt trauma. Diagnosis has been limited to computed tomographic imaging, which takes both time and requires the patient to leave the emergency department (ED). Focused assessment with sonography in trauma has become routine in the evaluation of blunt trauma in the ED before obtaining computed tomographic imaging. We report a case on use of the extended focused assessment with sonography in trauma examination in aiding the immediate diagnosis of traumatic extrathoracic lung herniation in blunt trauma.
Three-view bedside ultrasound to differentiate acute decompensated heart failure from chronic obstructive pulmonary disease Daniel Mantuani, Arun Nagdev
DOI: http://dx.doi.org/10.1016/j.ajem.2012.11.028
The American Journal of Emergency Medicine , Vol. 31 , Issue 4 ,
Published online: February 4 2013
x Identifying the cause of acute dyspnea in the emergency department is often challenging, even for the most experienced provider. Distinguishing chronic obstructive pulmonary disease from acute decompensated heart failure in the acutely dyspneic patient who presents in respiratory distress is often difficult. Patients are often unable to give a detailed history when in extremis, yet primary management needs to be initiated before further testing can be completed. Bedside diagnostic ultrasound has emerged as a tool for emergency physicians to rapidly evaluate the cardiopulmonary status in patients presenting with undifferentiated shortness of breath [1-3].
Ultrasound detection of the sliding lung sign by prehospital critical care providers Matthew Lyon, Perry Walton, Valori Bhalla, Stephen A. Shiver
DOI: http://dx.doi.org/10.1016/j.ajem.2011.01.009
The American Journal of Emergency Medicine , Vol. 30 , Issue 3 ,
Published online: February 21 2011
x The presence of the sonographic sliding lung sign (SLS) is a sensitive indicator for the absence of a pneumothorax.
Analysis of lawsuits filed against emergency physicians for point-of-care emergency ultrasound examination performance and interpretation over a 20-year period Michael Blaivas, Richard Pawl
DOI: http://dx.doi.org/10.1016/j.ajem.2010.12.016
The American Journal of Emergency Medicine , Vol. 30 , Issue 2 ,
Published online: January 31 2011
x The study aims to define extent of lawsuits filed against emergency physicians (EPs) over point-of-care emergency ultrasound (US) during the last 20 years.
The effect of bedside ultrasound on diagnosis and management of soft tissue infections in a pediatric ED Katrina Iverson, Demetris Haritos, Ronald Thomas, Nirupama Kannikeswaran
DOI: http://dx.doi.org/10.1016/j.ajem.2011.09.020
The American Journal of Emergency Medicine , Vol. 30 , Issue 8 ,
Published online: November 21 2011
x Presentation of skin and soft tissue infections (SSTIs) to the pediatric emergency department (PED) has increased. Physical examination alone can be inadequate in differentiating cellulitis from an abscess. The purposes of this study were to determine the effect of bedside ultrasound (US) in improving diagnostic accuracy for SSTIs in the PED and to evaluate its effect on the management of patients with SSTIs.
Pitfalls of the ultrasound diagnosis of pneumothorax Gaetano Rea, Maria D’Amato, Giorgia Ghittoni
DOI: http://dx.doi.org/10.1016/j.ajem.2014.03.053
The American Journal of Emergency Medicine , Vol. 32 , Issue 9 ,
Published online: June 11 2014
x The case presentation by Aspler et al [1] seems to be biased by the lack of correspondence of the shown image; more importantly, it appears to display the limitations of thoracic ultrasound in the diagnosis of pneumothorax more than its merits.
Acute heart failure diagnosis by ultrasound: new achievements and persisting limitations Daniela Catalano, Guglielmo M. Trovato, Marco Sperandeo
DOI: http://dx.doi.org/10.1016/j.ajem.2013.12.026
The American Journal of Emergency Medicine , Vol. 32 , Issue 4 ,
Published online: December 19 2013
x The article by Anderson et al [1] elegantly addresses the problem of misdiagnosis of acutely decompensated heart failure (ADHF). Their approach is very comprehensive and, in our opinion, is an important advancement of the current evidence in emergency medicine, beyond the existing severe limitations of previous studies using lung ultrasound (LUS). Nonetheless, we can agree only partially with the statements, which are the background of this and similar reports and by which the subsequent statistical analysis is severely biased.
Implication of bedside cardiopulmonary ultrasound on health care cost: an additional advantage Lovely Chhabra, Vinod K. Chaubey
DOI: http://dx.doi.org/10.1016/j.ajem.2015.01.041
The American Journal of Emergency Medicine , Vol. 33 , Issue 3 ,
Published online: January 31 2015
x We read with great interest the work by Gallard et al [1]. Authors’ work is commendable in triaging and diagnosing patients with acute dyspnea with the use of bedside cardiopulmonary ultrasound. Indeed, the point-of-care (POC) cardiopulmonary ultrasound is not only an important diagnostic modality but also serves as an immensely useful guide during emergent cardiac procedures (such as pericardiocentesis) and resuscitation of critically ill patients [2]. This is especially true with the newest high-quality and easy-to-use handheld cardiac ultrasound devices.
Pocket mobile smartphone system for the point-of-care submandibular ultrasonography Jacek Wojtczak, Peter Bonadonna
DOI: http://dx.doi.org/10.1016/j.ajem.2012.09.013
The American Journal of Emergency Medicine , Vol. 31 , Issue 3 ,
Published online: November 19 2012
x Focused ultrasonography of the airway may be useful in the prediction of difficult intubation. The wider use of sonography in quantitative airway assessment may depend on the availability of highly portable, inexpensive, and accurate ultrasound systems. Pocket-sized ultrasound devices are emerging as a useful tool for point-of-care ultrasonography. The aim of this study was to evaluate the suprahyoid airway of healthy volunteers using a smartphone-based ultrasound imaging system in comparison with a platform-based machine.
ETCO2 and ultrasound fail to directly confirm the depth of ETT placement Hooman Hossein-nejad
DOI: http://dx.doi.org/10.1016/j.ajem.2013.10.052
The American Journal of Emergency Medicine , Vol. 32 , Issue 3 ,
Published online: November 6 2013
x We are pleased to respond to the reader's comments. As a matter of fact, esophageal intubation cannot be detected by chest x-ray (CXR), yet there are other possibilities of endotracheal tube (ETT) misplacement, such as inappropriate depth of the tube or bronchial intubation. End tidal CO2 (ETCO2 ) or ultrasonography is used to distinguish between esophageal and tracheal intubation. Nevertheless, they have not been useful for the direct confirmation of the appropriate tracheal depth of ETT [1,2]. References, including American Heart Association and American College of Emergency Physician guidelines , do not consider these methods alternatives to CXR to confirm the appropriate depth of the tube.
Another use of the ultrasound-guided transversus abdominis plane block in the ED Christian Landy, David Plancade, Ingrid Millot, Nicolas Gagnon, Julien Nadaud, Jean-Christophe Favier
DOI: http://dx.doi.org/10.1016/j.ajem.2011.12.012
The American Journal of Emergency Medicine , Vol. 30 , Issue 4 ,
Published online: February 10 2012
x We read with interest the article published by Herring et al [1], describing the interest of the transversus abdominis plane (TAP) block for analgesia in emergency situations.
Point-of-care ultrasound diagnosis of acute Achilles tendon rupture in the ED Srikar Adhikari, Jared Marx, Todd Crum
DOI: http://dx.doi.org/10.1016/j.ajem.2011.01.029
The American Journal of Emergency Medicine , Vol. 30 , Issue 4 ,
Published online: March 16 2011
x Patients with acute Achilles tendon injuries from sport-related activities are frequently seen in the emergency department (ED). Missed or delayed diagnosis of an Achilles tendon rupture can result in significant patient morbidity. However, the diagnosis of an Achilles tendon rupture is not always clear clinically. Physical examination maneuvers to assess for a tendon injury can be limited by pain and soft tissue swelling. Ultrasound has been shown to be very sensitive in detecting an Achilles tendon rupture.
Ultrasound-guided peripheral intravenous placement with standard-length catheters and long catheters Fu-Shan Xue, Rui-Ping Li, Yi Cheng, Xu Liao
DOI: http://dx.doi.org/10.1016/j.ajem.2012.08.012
The American Journal of Emergency Medicine , Vol. 31 , Issue 1 ,
Published online: September 12 2012
x In a prospective, randomized controlled trial comparing performance of standard-length catheters and long catheters for ultrasound (US)–guided peripheral intravenous cannulation (PIC) in acute hospitalized patients with difficult venous access, Elia et al [1] showed that compared with standard-length catheter US-guided PIC, long catheter US-guided PIC required a higher time but was associated with a lower risk of catheter failure. Their findings have potential implications for use of long catheters as a solution to low survival of US-guided peripheral catheters.
Novel use of ultrasound in the ED: ultrasound-guided hematoma block of a proximal humeral fracture Ümit Kaldırım, Ümit Yolcu, Şükrü Ardic, Serkan Bilgic
DOI: http://dx.doi.org/10.1016/j.ajem.2014.08.061
The American Journal of Emergency Medicine , Vol. 32 , Issue 11 ,
Published online: August 26 2014
x We have read your article entitled, “Novel use of ultrasound in the emergency department: ultrasound-guided hematoma block of a proximal humeral fracture” with great interest [1]. We think that this article reports a frequently seen case in emergency departments, and it consists valuable information. We would like to make a contribution to the article.
Diagnosis of metacarpal fracture with equivocal x-ray by point-of-care ultrasound: a case report Jennifer Ruskis, Tobias Kummer
DOI: http://dx.doi.org/10.1016/j.ajem.2014.01.018
The American Journal of Emergency Medicine , Vol. 32 , Issue 7 ,
Published online: January 23 2014
x Metacarpal fractures represent a very common injury among patients presenting to the emergency department. Diagnosis is of utmost importance given the high morbidity associated with lack of full hand function. We report a case of a 37-year-old man who sustained extremity trauma after a mechanical fall. He presented with an examination that revealed diffuse tenderness over the wrist and hand. X-ray of the hand was equivocal for a metacarpal fracture; however, point-of-care ultrasound revealed disruption of the bony cortex confirming the diagnosis.
A simplified ultrasound-based edema score to assess lung injury and clinical severity in septic patients Thiago M. Santos, Daniel Franci, Carolina M.G. Coutinho, Diego L. Ribeiro, Marcelo Schweller, José R. Matos-Souza, Marco A. Carvalho-Filho
DOI: http://dx.doi.org/10.1016/j.ajem.2013.08.053
The American Journal of Emergency Medicine , Vol. 31 , Issue 12 ,
Published online: October 11 2013
x Lung ultrasound (US) is an excellent tool to assess lung edema in a myriad of different clinical situations. We hypothesized that lung US might also be a good prognostic and management instrument in septic patients, regardless of disease severity.
Ultrasound-guided catheter-over-needle internal jugular vein catheterization Michael D. Zwank
DOI: http://dx.doi.org/10.1016/j.ajem.2011.08.013
The American Journal of Emergency Medicine , Vol. 30 , Issue 2 ,
Published online: October 28 2011
x I describe here a novel technique of inserting a 2.5-inch catheter into the internal jugular vein with ultrasound guidance using sterile technique but no barrier precautions.
Ultrasound detection of obstructive pyelonephritis due to urolithiasis in the ED Jennifer Carnell, Jason Fischer, Arun Nagdev
DOI: http://dx.doi.org/10.1016/j.ajem.2010.07.006
The American Journal of Emergency Medicine , Vol. 29 , Issue 7 ,
Published online: October 11 2010
x Identifying acute pyelonephritis (APN) with early obstructive uropathy is clinically important in the emergency department (ED) because obstructive urolithiasis is an independent risk factor for inpatient death, prolonged hospitalization, and failure of outpatient APN therapy. Furthermore, diagnosis of an early obstructive uropathy can be difficult when based solely on clinical findings. Clinicians may assume the cause of the patient's symptoms to be APN alone, without considering the concurrent presence of an obstructing stone.
Usefulness of guidewire visualization during ultrasound-guided internal jugular vein cannulation Pawel Andruszkiewicz, Dorota Sobczyk
DOI: http://dx.doi.org/10.1016/j.ajem.2014.08.037
The American Journal of Emergency Medicine , Vol. 32 , Issue 11 ,
Published online: August 20 2014
x Cannulation of the internal jugular vein (IVC) can result in rare but serious complications [1].
ED ultrasound diagnosis of a type B aortic dissection using the suprasternal view Hans Rosenberg, Khaled Al-Rajhi
DOI: http://dx.doi.org/10.1016/j.ajem.2011.11.012
The American Journal of Emergency Medicine , Vol. 30 , Issue 9 ,
Published online: January 13 2012
x Aortic dissection (AD) is one of the most challenging diagnoses in emergency medicine. This is due, in part, to its variable presentation, ranging from abrupt tearing chest pain in a hemodynamically unstable patient to back pain in a stable patient, as well as its high mortality rates. (1) With the expanding role of ultrasound (U/S) performed by emergency physicians, it is possible to make the diagnosis of AD at the bedside before any other imaging modality has been accessed. (2) In this case report, we describe the use of emergency department (ED) bedside U/S and specifically highlight the use of the suprasternal view in the diagnosis of AD.
Assessment of emergency physician–performed ultrasound in evaluating nonspecific abdominal pain Timothy Jang, Vijai Chauhan, Christopher Cundiff, Amy H. Kaji
DOI: http://dx.doi.org/10.1016/j.ajem.2014.01.004
The American Journal of Emergency Medicine , Vol. 32 , Issue 5 ,
Published online: January 21 2014
x The objective of this pilot study was to lay the groundwork for future studies assessing the impact of emergency physician–performed ultrasound (EPUS) on diagnostic testing and decision making in emergency department (ED) patients with nonspecific abdominal pain (NSAP).
Noninvasive detection of elevated intracranial pressure using a portable ultrasound system Bertrand Prunet, Yves Asencio, Guillaume Lacroix, Ambroise Montcriol, Arnaud Dagain, Jean Cotte, Pierre Esnault, Henry Boret, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2011.05.005
The American Journal of Emergency Medicine , Vol. 30 , Issue 6 ,
Published online: June 13 2011
x The aim of this study is to prospectively compare the accuracies of transcranial color-coded sonography (TCCS) and transcranial Doppler (TCD) in the diagnosis of elevated intracranial pressure.
Elongated left lobe of the liver mimicking a subcapsular hematoma of the spleen on the focused assessment with sonography for trauma exam Robert Jones, Matthew Tabbut, Diane Gramer
DOI: http://dx.doi.org/10.1016/j.ajem.2013.12.050
The American Journal of Emergency Medicine , Vol. 32 , Issue 7 ,
Published online: January 6 2014
x The focused assessment with sonography for trauma examination has assumed the role of initial screening examination for the presence or absence of hemoperitoneum in the patient with blunt abdominal trauma. Sonographic pitfalls associated with the examination have primarily been related to mistaking contained fluid collections with hemoperitoneum. We present a case in which an elongated left lobe of the liver was misdiagnosed as a splenic subcapsular hematoma. It is imperative that emergency physicians and trauma surgeons be familiar with this normal variant of the liver and its associated sonographic appearance on the perisplenic window in order to prevent nontherapeutic laparotomies or embolizations.
Physical examination combined with focused assessment with sonography for trauma examination to clear hemodynamically stable blunt abdominal trauma patients Donald Byars, Alicia Devine, Christopher Maples, Alexander Yeats, Krista Greene
DOI: http://dx.doi.org/10.1016/j.ajem.2013.06.042
The American Journal of Emergency Medicine , Vol. 31 , Issue 10 ,
Published online: September 3 2013
x The use of the focused assessment with sonography for trauma (FAST) examination has become standard practice over the past 10 years in the evaluation of patients with suspected abdominal trauma. It is generally accepted in trauma algorithms as an extension of the physical examination. Currently, it is used primarily to identify the need for an expedited emergency laparotomy in the hemodynamically unstable patient, unable to tolerate a computed tomographic (CT) scan. In hemodynamically stable patients, however, especially those with low-risk injury by history and physical examination, the role of the FAST examination to exclude further diagnostic testing is less studied.
Pitfalls in the ultrasound diagnosis of pneumothorax: the authors respond A. Aspler, M.B. Stone
DOI: http://dx.doi.org/10.1016/j.ajem.2014.03.044
The American Journal of Emergency Medicine , Vol. 32 , Issue 9 ,
Published online: April 4 2014
x The readers’ letter highlights accurately that the article by Aspler et al [1] raises challenges around the real-time diagnosis of pneumothorax with ultrasound.
The ultrasound-guided superficial cervical plexus block for anesthesia and analgesia in emergency care settings Andrew A. Herring, Michael B. Stone, Oron Frenkel, Annie Chipman, Arun D. Nagdev
DOI: http://dx.doi.org/10.1016/j.ajem.2011.06.023
The American Journal of Emergency Medicine , Vol. 30 , Issue 7 ,
Published online: October 26 2011
x The ultrasound-guided superficial cervical plexus (SCP) block may be useful for providers in emergency care settings who care for patients with injuries to the ear, neck, and clavicular region, including clavicle fractures and acromioclavicular dislocations. The SCP originates from the anterior rami of the C1-C4 spinal nerves and gives rise to 4 terminal branches—greater auricular, lesser occipital, transverse cervical, and suprascapular nerves—that provide sensory innervation to the skin and superficial structures of the anterolateral neck and sections of the ear and shoulder.
Comparison of bedside ultrasound and panorex radiography in the diagnosis of a dental abscess in the ED Srikar Adhikari, Michael Blaivas, Lina Lander
DOI: http://dx.doi.org/10.1016/j.ajem.2010.03.005
The American Journal of Emergency Medicine , Vol. 29 , Issue 7 ,
Published online: May 3 2010
x The purpose of the study was to compare bedside ultrasound (US) and panorex radiography in the diagnosis of a dental abscess in emergency department (ED).
Letter to Editor: the effectiveness of bedside point-of-care ultrasonography in the diagnosis and management of metacarpal fractures: Contribution for management of metacarpal fractures Harun Yasin Tuzun, Selim Turkkan, Arsen Arsenishvili
DOI: http://dx.doi.org/10.1016/j.ajem.2016.01.008
The American Journal of Emergency Medicine , Vol. 34 , Issue 3 ,
Published online: January 8 2016
x We read the published article by Kozacı et al [1]titled “The effectiveness of bedside point-of-care ultrasonography in the diagnosis and management of metacarpal fractures” with great interest. The objective of the study is noteworthy, and we would like to add several points about metacarpal fracture management in orthopedic practice. Metacarpal fractures, which require surgery, must be diagnosed with radiography, and follow-up imaging of these fractures must be done with radiography. In our practice, when we perform metacarpal fracture surgery, we use either fluoroscopy or radiography to determine the plate, K-wire, or screw placement and fracture reduction.
Accuracy of emergency physicians using ultrasound measurement of crown-rump length to estimate gestational age in pregnant females Caitlin Bailey, Jennifer Carnell, Farnaz Vahidnia, Sachita Shah, Michael Stone, Mickeye Adams, Arun Nagdev
DOI: http://dx.doi.org/10.1016/j.ajem.2011.12.002
The American Journal of Emergency Medicine , Vol. 30 , Issue 8 ,
Published online: February 10 2012
x The objective of this study is to evaluate the accuracy of emergency providers (EPs) of various levels of training in determination of gestational age (GA) in pregnant patients using bedside ultrasound measurement of crown-rump length (CRL).
Acute, simultaneous, bilateral rhegmatogenous retinal detachment diagnosed with bedside emergency ultrasound James Palma, Eric Schott
DOI: http://dx.doi.org/10.1016/j.ajem.2012.08.042
The American Journal of Emergency Medicine , Vol. 31 , Issue 2 ,
Published in issue: February 2013
x Retinal detachment is an acute vision-threatening condition that occurs when the neurosensory layer of the retina separates from the underlying retinal pigment epithelium. While uncommon in the general population, the diagnosis should be considered in any patient with acute visual changes such as flashes, floaters, or decreased visual acuity. The prompt diagnosis, referral, and treatment of retinal detachment are essential for the patient's best chance for restoration of vision. We present an extremely unusual case of simultaneous, nontraumatic, bilateral rhegmatogenous retinal detachment in which the diagnosis was confirmed using bedside ocular ultrasound upon presentation to the emergency department (ED).
Ultrasound assessment of optic disc edema in patients with headache Siri Daulaire, Lauren Fine, Margaret Salmon, Catherine Cummings, Otto Liebmann, Sachita Shah, Nathan Teismann
DOI: http://dx.doi.org/10.1016/j.ajem.2011.06.030
The American Journal of Emergency Medicine , Vol. 30 , Issue 8 ,
Published online: October 26 2011
x Point-of-care ocular ultrasonography is emerging as a powerful tool to evaluate emergency department (ED) patients at risk for ophthalmologic and intracranial pathology. We present cases of 3 patients in whom optic disc swelling was identified using ocular ultrasound. Causes for optic disc swelling in our patients included idiopathic intracranial hypertension, secondary syphilis, and malignant hypertension with associated hypertensive retinopathy. Because direct visualization of the optic disc may be challenging in an ED setting, ultrasound examination of the optic disc may represent an important adjunct to fundoscopy when assessing patients with headache or visual complaints.
Ultrasound to reduce cognitive errors in the ED Fabrizio Elia, Francesco Panero, Paola Molino, Giovanni Ferrari, Franco Aprà
DOI: http://dx.doi.org/10.1016/j.ajem.2012.04.008
The American Journal of Emergency Medicine , Vol. 30 , Issue 9 ,
Published online: July 16 2012
x Emergency medicine setting is intrinsically prone to a greater risk of medical errors than other specialties. Cognitive errors are particularly frequent when the clinical decision-making process heavily relies on heuristics. These could be defined as “mental shortcuts,” which enable physicians to rapidly overcome both time and efforts required by the normative reasoning. Our article demonstrates how emergency physicians' thinking may be affected by failed heuristics, through the description of 3 real clinical cases.
An atypical misplacement of a temporary pacing catheter diagnosed and resolved by ultrasound Pablo Blanco, Jason T. Nomura
DOI: http://dx.doi.org/10.1016/j.ajem.2014.03.013
The American Journal of Emergency Medicine , Vol. 32 , Issue 10 ,
Published online: March 20 2014
x Temporary transvenous pacing catheter placement is an important and critical procedure for emergency physicians. Ultrasound can be used to guide placement and to diagnosis correct or incorrect catheter placement. This case report discusses a patient with an acute ST elevation myocardial infarction leading to unstable arrhythmias requiring emergent transvenous cardiac pacing. The pacemaker was inserted using electrocardiographic monitoring through the bipolar pacing catheter. There was some difficulty placing the catheter, but successful capture with a left bundle-branch block pattern was obtained.
The role of emergency ultrasound for evaluating acute pyelonephritis in the ED Kuo-Chih Chen, Shih-Wen Hung, Vei-Ken Seow, Chee-Fah Chong, Tzong-Luen Wang, Yu-Chuan Li, Hang Chang
DOI: http://dx.doi.org/10.1016/j.ajem.2010.01.047
The American Journal of Emergency Medicine , Vol. 29 , Issue 7 ,
Published online: May 3 2010
x Controversy remains over the imaging method of choice for evaluating acute pyelonephritis (APN) in the emergency department (ED).
ED visits and spending by unauthorized immigrants compared with legal immigrants and US natives Jim P. Stimpson, Fernando A. Wilson, Leah Zallman
DOI: http://dx.doi.org/10.1016/j.ajem.2014.03.018
The American Journal of Emergency Medicine , Vol. 32 , Issue 6 ,
Published online: March 20 2014
x In light of the ongoing debate about immigration reform, a recent study found that contributions by immigrants to the Medicare Trust Fund outweigh their expenditures [1]. Another 2013 study found that health expenditures are lower for unauthorized immigrants and legal residents than US natives and naturalized citizens [2]. However, evidence for the emergency department (ED) setting is limited, where much of the debate on health service utilization of unauthorized immigrants is concentrated. The most recent study of ED utilization found that noncitizen immigrants used significantly less ED services compared with citizens [3].
Three-view bedside ultrasound for the differentiation of acute respiratory distress syndrome from cardiogenic pulmonary edema Daniel Mantuani, Arun Nagdev, Michael Stone
DOI: http://dx.doi.org/10.1016/j.ajem.2011.06.028
The American Journal of Emergency Medicine , Vol. 30 , Issue 7 ,
Published online: August 26 2011
x Bedside ultrasound is being increasingly used by emergency physicians (EPs) for the differentiation of acute dyspnea in critically ill patients [1]. Lung ultrasound is emerging as a highly sensitive tool in diagnosing alveolar interstitial edema with the presence of diffuse “B-lines” arising from the pleural line [2]. However, when used independently, lung ultrasound is unable to differentiate between cardiogenic and noncardiogenic causes of pulmonary edema [3]. This case report describes a rapid 3-view or “triple scan” sonographic examination to differentiate acute respiratory distress syndrome (ARDS) from cardiogenic pulmonary edema.
Anatomical distribution of traumatic pneumothoraces on chest computed tomography: implications for ultrasound screening in the ED Maria Mennicke, Kavita Gulati, Isabel Oliva, Katja Goldflam, Hicham Skali, Stephen Ledbetter, Elke Platz
DOI: http://dx.doi.org/10.1016/j.ajem.2011.06.020
The American Journal of Emergency Medicine , Vol. 30 , Issue 7 ,
Published online: September 12 2011
x We sought to assess the anatomical distribution of traumatic pneumothoraces (PTXs) on chest computed tomography (CT) to develop an optimized protocol for PTX screening with ultrasound in the emergency department (ED).
An alternate technique for assessing optic nerve in papilledema by ultrasound B scan Jyoti Matalia, Sheetal Shirke, Minal Kekatpure
DOI: http://dx.doi.org/10.1016/j.ajem.2015.03.027
The American Journal of Emergency Medicine , Vol. 33 , Issue 7 ,
Published online: March 17 2015
x We read with great interest the article entitled “Real-time optic nerve sheath diameter reduction measured with bedside ultrasound after therapeutic lumbar puncture in a patient with idiopathic intracranial hypertension” by Singleton et al [1]. They have described the use of ocular ultrasound in a case of idiopathic intracranial hypertension and demonstrated real-time change in the size of the optic nerve sheath diameter after a lumbar puncture.
Anterior chamber depth measurement using ultrasound to assess elevated ıntraocular pressure Ümit Yolcu, Abdullah Ilhan, Fatih Ç. Gundogan
DOI: http://dx.doi.org/10.1016/j.ajem.2014.12.046
The American Journal of Emergency Medicine , Vol. 33 , Issue 4 ,
Published online: December 30 2014
x We have read the article entitled “Anterior chamber depth measurement using ultrasound to assess elevated intraocular pressure” with great interest
[1]. The authors reported 2 cases with glaucoma and a case of trauma. They measured the anterior chamber depth (ACD) of patients and compared the results with the intraocular pressure (IOP) measurements using a tonometer.
Sonographic evaluation of a paralyzed hemidiaphragm from ultrasound-guided interscalene brachial plexus nerve block Daniel Mantuani, Arun Nagdev
DOI: http://dx.doi.org/10.1016/j.ajem.2012.02.004
The American Journal of Emergency Medicine , Vol. 30 , Issue 9 ,
Published online: March 30 2012
x The ultrasound-guided interscalene brachial plexus is becoming increasingly popular for anesthesia in the management of upper-extremity injuries by emergency physicians. Traditional high-volume injections of local anesthesia will also affect the phrenic nerve, leading to temporary paralysis of the ipsilateral hemidiaphragm. With direct ultrasound guidance, more precise needle placement allows for lower-volume injections that reduce inadvertent spread of local anesthetic to the phrenic nerve without decreasing the efficacy of onset of time and quality of the block.
