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Ultrasound in Emergency Medicine

Valliappan Muthu, Inderpaul Singh Sehgal, Sahajal Dhooria, Kuruswamy T Prasad, Nalini Gupta, Ashutosh N Aggarwal, Ritesh Agarwal
Intrathoracic lymphadenopathy is a common problem encountered in clinical practice and is caused by a wide variety of diseases. Traditionally, the mediastinal lymph nodes were sampled using conventional transbronchial needle aspiration (TBNA), or surgical methods such as mediastinoscopy, and thoracotomy (open or video-assisted thoracoscopy). However, surgical modalities including mediastinoscopy are invasive, expensive, and not universally available. Moreover, they are associated with considerable morbidity and mortality...
January 2019: Journal of Cytology
Joshua R Radparvar, George Lim, Alan T Chiem
OBJECTIVES: As point of care ultrasound (POCUS) has become more integrated into emergency and critical care medicine, there has been increased interest in utilizing ultrasound to assess volume status. However, recent studies of carotid POCUS on volume status and fluid responsiveness fail to recognize the effect insonation angle has on their results. To address this, we studied the effect of insonation angle on peak systolic velocity (PSV) change associated with respiratory variation (RV) and passive leg raise (PLR)...
January 29, 2019: American Journal of Emergency Medicine
E C Constantinescu, C Nicolau, A Săftoiu
A long-standing trend that will continue to grow in healthcare is providing high quality services for all the patient, no matter the distance and no matter the place. One approach currently being used to increase population access to healthcare services is telemedicine. This narrative review presents one branch of e-health, in particular the use of teleultrasonography (TUS) in clinical practice, the challenges and barriers encountered. Current advances in ultrasound technology, including the growth of portable and small ultrasound devices have increased the range of applications of TUS, from traumatic patients in emergency medicine, maternal ultrasound and even for monitoring and screening for chronic illnesses...
April 2018: Current Health Sciences Journal
Lori A Stolz, Richard Amini, Elaine Situ-LaCasse, Josie Acuña, Steven C Irving, Lucas Friedman, Albert B Fiorello, Nicholas Stea, Heinrich Fan, Srikar Adhikari
Introduction The objectives of this study were to determine if a multimodular introductory ultrasound course improved emergency medicine intern confidence in performing a point-of-care ultrasound and if our educational objectives could be met with our chosen structure. Methods This is a prospective, observational study evaluating three consecutive incoming emergency medicine residency classes from three residency programs. A one-day introductory ultrasound course was delivered. The course consisted of 1) flipped classroom didactics, 2) in-person, case-based interactive teaching sessions, and 3) check-listed, goal-driven, hands-on instruction...
November 15, 2018: Curēus
Nicola Wade, Farah Shahi, Damian Mawer, Nicholas Brown
We present a rare cause for cutaneous furuncular myiasis in a 55-year-old British traveller returning from Uganda. Initially presenting with what appeared to be a cellulitic furuncle on her forehead, she returned to the emergency department 3 days later with extensive preseptal periorbital swelling and pain. Occlusive treatment with petroleum jelly was applied and one larva manually extracted and sent to London School of Tropical Medicine for examination. It was identified as Lund's Fly ( Cordylobia rodhaini ), a rare species from the rainforests of Africa with only one other case reported in the UK since 2015...
January 22, 2019: BMJ Case Reports
Zachary Risler, Mark A Magee, Jacob M Mazza, Kelly Goodsell, Arthur K Au, Resa E Lewiss, Robert S Pugliese, Bon Ku
Anterior shoulder dislocations are the most common, large joint dislocations that present to the emergency department (ED). Numerous studies support the use of intraarticular local anesthetic injections for the safe, effective, and time-saving reduction of these dislocations. Simulation training is an alternative and effective method for training compared to bedside learning. There are no commercially available ultrasound-compatible shoulder dislocation models. We utilized a three-dimensional (3D) printer to print a model that allows the visualization of the ultrasound anatomy (sonoanatomy) of an anterior shoulder dislocation...
November 2, 2018: Curēus
Manjush Karthika, Duane Wong, Suresh G Nair, Lalitha V Pillai, Chris Sara Mathew
Lung ultrasound is a point-of-care imaging tool that is routinely used in acute care medicine. Traditionally, radiology physicians were the primary practitioners of diagnostic ultrasound, but with the recognition of its importance in intensive care medicine, critical care physicians have also adopted this practice. Within the intensive care unit inter-professional team is the respiratory therapist, who participates actively in the care of ventilated patients. Their scope of responsibility is expanding with newer technologies being brought into clinical use on a regular basis...
February 2019: Respiratory Care
F Domenici, F Brasili, L Oddo, B Cerroni, A Bedini, F Bordi, G Paradossi
HYPOTHESIS: One of the main assets of crosslinked polymer-shelled microbubbles (MBs) as ultrasound-active theranostic agents is the robustness of the shells, combined with the chemical versatility in modifying the surface with ligands and/or drugs. Despite the long shelf-life, subtle modifications occur in the MB shells involving shifts in acoustic, mechanical and structural properties. EXPERIMENTS: We carried out a long-term morphological and acoustic evolution analysis on elastomeric polyvinyl-alcohol (PVA)-shelled MBs, a novel platform accomplishing good acoustic and surface performances in one agent...
January 2, 2019: Journal of Colloid and Interface Science
Pierre Perrier, J Leyral, O Thabouillot, D Papeix, G Comat, A Renard, N Cazes
INTRODUCTION: To evaluate the usefulness of point-of-care ultrasound (POCUS) performed by young military medicine residents after short training in the diagnosis of medical emergencies. METHODS: A prospective study was performed in the emergency department of a French army teaching hospital. Two young military medicine residents received ultrasound training focused on gall bladder, kidneys and lower limb veins. After clinical examination, they assigned a ' clinical diagnostic probability '  (CP) on a visual analogue scale from 0 (definitely not diagnosis) to 10 (definitive diagnosis)...
January 13, 2019: Journal of the Royal Army Medical Corps
Alyssa M Abo, Kiyetta H Alade, Rachel G Rempell, David Kessler, Jason W Fischer, Resa E Lewiss, Christopher C Raio, Jennifer R Marin
As point-of-care ultrasound (POCUS) becomes standard practice in pediatric emergency medicine (PEM), it is important to have benchmarks in place for credentialing PEM faculty in POCUS. Faculty must be systematically trained and assessed for competency in order to be credentialed in POCUS and granted privileges by an individual institution. Recommendations on credentialing PEM faculty are needed to ensure appropriate, consistent, and responsible use of this diagnostic and procedural tool. It is our intention that these guidelines will serve as a framework for credentialing faculty in PEM POCUS...
January 7, 2019: Pediatric Emergency Care
Klaus Dirks, Emma Calabrese, Christoph F Dietrich, Odd Helge Gilja, Trygve Hausken, Antony Higginson, Alois Hollerweger, Giovanni Maconi, Christian Maaser, Dieter Nuernberg, Kim Nylund, Nadia Pallotta, Tomas Ripolles, Laura Romanini, Adrian Saftoiu, Carla Serra, Matthias Wüstner, Ioan Sporea
An interdisciplinary task force of European experts summarizes the value of gastrointestinal ultrasound (GIUS) in the management of acute appendicitis and diverticulitis. Based on an extensive literature review, clinical recommendations for these highly common diseases in visceral medicine are presented.In patients with acute appendicitis, preoperative sonography has been established as a routine procedure in most European countries for medical and legal reasons. Routine sonography in these patients may reduce the rate of unnecessary surgery by half...
January 7, 2019: Ultraschall in der Medizin
Priya Sharma, Faisal Al-Sani, Sidharth Saini, Tais Sao Pedro, Peter Wong, Yousef Etoom
Diagnostic dilemmas are ubiquitous in pediatric emergency medicine because of the varied and often insidious presentations of many pediatric conditions. Point-of-care ultrasound (POCUS) in emergency departments is being used for some of these diagnostic challenges and can often provide rapid and valuable information to supplement a physician's clinical assessment. Intussusception is a pediatric condition that may be challenging to recognize because of its subtle and varied presenting symptoms. An unrecognized or delayed diagnosis of intussusception can be catastrophic, with complications including bowel obstruction, bowel perforation, and death...
January 2019: Pediatric Emergency Care
Saeed Abbasi, Hossein Shaker, Fariba Zareiee, Davood Farsi, Peyman Hafezimoghadam, Mahdi Rezai, Babak Mahshidfar, Mani Mofidi
Introduction: Chest ultrasonography is routinely used in evaluation of chest trauma for diagnosis of pulmonary injury. This study aimed to evaluate the accuracy of B-Lines for diagnosing lung contusion in patients with blunt trauma of the chest. Methods: Trauma patients who met the inclusion criteria were enrolled in the study and underwent ultrasonography by trained emergency medicine residents. Ultrasound results were recorded in terms of number of B-lines and the existence of peripheral parenchymal lesion (PPL)...
2018: Emergency (Tehran, Iran)
Mauricio Baca, Mark Newberry
BACKGROUND: Cardiac amyloidosis is an underdiagnosed cause of restrictive cardiomyopathy resulting from the infiltration of the myocardium by amyloid proteins. CASE REPORT: We report the case of an 83-year-old woman who presented with increasing dyspnea and lower-extremity swelling. She reported a medical history of unspecified heart failure. Evaluation in the Emergency Department (ED) revealed evidence of heart failure on physical examination, low-voltage electrocardiogram, chest x-ray study with mild pulmonary edema, and laboratory evaluation with elevated brain natriuretic peptide and troponin...
December 12, 2018: Journal of Emergency Medicine
German Devia Jaramillo, Jenny Castro Canoa, Emiro Valverde Galván
Sepsis and septic shock constitute a complex disease condition that requires the engagement of several medical specialties. A great number of patients with this disease are constantly admitted to the emergency department, which warrants the need for emergency physicians to lead in the recognition and early management of septic patients. Timely and appropriate interventions may help reduce mortality in a disease with an unacceptably high mortality rate. Poor control of cellular hypoperfusion is one of the most influential mechanisms contributing to the high mortality rate in these patients...
2018: Open Access Emergency Medicine: OAEM
Rosemary Thomas-Mohtat, Craig Sable, Kristen Breslin, Jacqueline G Weinberg, Aparna Prasad, Lauren Zinns, Joanna S Cohen
BACKGROUND: Focused cardiac ultrasound (FOCUS) is a core competency for pediatric emergency medicine (PEM) fellows. The objectives of this study were (1) to evaluate test characteristics of PEM-fellow-performed FOCUS for pericardial effusion and diminished cardiac function and (2) to assess image interpretation independent of image acquisition. METHODS: PEM fellows performed and interpreted FOCUS on patients who also received cardiology service echocardiograms, the reference standard...
December 9, 2018: Critical Ultrasound Journal
Carlos Guillén Astete, Sara Rodrigo González, Desiree Alfonso Pérez, Mónica Luque Alarcón, Roberto Penedo Alonso, María Jesús Estévez Rueda
For the purpose of assessing the impact of ultrasound in patients with acute shoulder pain, we conducted an analysis of quality health care indicators: need for reevaluation of the pain, rate of referral to specialized medicine and length of time in the emergency department. We reviewed the 1,433 records of patients attended to between 2015 and 2016. Thirty days after the first examination, 90 patients (10.1%) had returned to the control group (56 through the emergency department and 34 because of the), whereas, in the ultrasound (US) group, 14 (2...
December 5, 2018: Reumatología Clinica
Brit Long, Jennifer Robertson, Alex Koyfman
BACKGROUND: Small bowel obstruction (SBO) is a commonly diagnosed disease in the emergency department (ED). Recent literature has evaluated the ED investigation and management of SBO. OBJECTIVE: This review evaluates the ED investigation and management of adult SBO based on the current literature. DISCUSSION: SBO is most commonly due to occlusion of the small intestine, resulting in fluid and gas accumulation. This may progress to mucosal ischemia, necrosis, and perforation...
December 6, 2018: Journal of Emergency Medicine
M Priyanga Jayamal Dharmaratne, Amirthasingam Manoraj, Vasanthi Thevanesam, Asela Ekanayake, Nimal Savitri Kumar, Veranja Liyanapathirana, Eranga Abeyratne, B M Ratnayake Bandara
BACKGROUND: Identification of novel sources for developing new antibiotics is imperative with the emergence of antibiotic resistant bacteria. The fruits of Terminalia bellirica (Gaertn) Roxb., widely used in traditional medicine, were evaluated for antibacterial activity against multidrug-resistant (MDR) bacteria, antioxidant activity and cytotoxicity. METHODS: Twelve solvent extracts of T. bellirica fruits were prepared by direct aqueous extraction and sequential extraction with dichloromethane, methanol and water using Soxhlet, bottle-shaker and ultrasound sonicator methods...
December 7, 2018: BMC Complementary and Alternative Medicine
Quentin Daffos, Erwin Hansconrad, Patrick Plaisance, Dominique Pateron, Youri Yordanov, Anthony Chauvin
INTRODUCTION: Interest in ultrasonography in emergency medicine has increased in recent years, as reflected by a marked increase in publications on the topic. The aim of this study was to 1) describe and evaluate methodological characteristics of randomized controlled trials (RCTs) evaluating an ultrasound intervention in emergency department and 2) estimate whether the reports adequately described the intervention to allow replication. METHODS: We searched MEDLINE via PubMed for RCTs published in 2015 assessing an ultrasound intervention, regardless of type, that were performed in an emergency department or evaluated in an emergency situation...
November 17, 2018: American Journal of Emergency Medicine
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