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.
