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.
