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).
