Technology in Emergency Care

Technology in Emergency Care

Ultrasound vs. Computed Tomography for Severity of Hydronephrosis and Its Importance in Renal Colic

Megan M. Leo, MD et al.

Supporting an “ultrasound-first” approach to evaluating renal colic in the emergency department (ED) remains important for improving patient care and decreasing healthcare costs. Our primary objective was to compare emergency physician (EP) ultrasound to computed tomography (CT) detection of hydronephrosis severity in patients with suspected renal colic.

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Half-dose Alteplase for Sub-massive Pulmonary Embolism Directed by Emergency Department Point-of-care Ultrasound

Volume 16, Issue 1, January 2015
Richard Amini, MD et al.

This report describes a patient with sub-massive pulmonary embolism (PE) who was successfully treated with half-dose thrombolytics guided by the use of point-of-care (POC) ultrasound. In this case, POC ultrasound was the only possible imaging since computed tomography was contraindicated.

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Improving Door-to-balloon Time by Decreasing Door-to-ECG time for Walk-in STEMI Patients

Volume 16, Issue 1, January 2015
Christopher J. Coyne, MD et al.

The American Heart Association/American College of Cardiology guidelines recommend rapid door-to-electrocardiography (ECG) times for patients with ST-segment elevation myocardial infarction (STEMI). Previous quality improvement research at our institution revealed that we were not meeting this benchmark for walk-in STEMI patients.

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Technology in Emergency Care

Ultrasound-Guided Diagnosis and Aspiration of Subdeltoid Abscess from Heroin Injection

Volume 15, Issue 7, November 2014
Amanda Clauson, MD et al.

A 49-year-old man presented to the emergency department (ED) with shoulder pain after intramuscular injection of heroin into his right deltoid muscle. Point-of-care (POC) ultrasound identified a subdeltoid abscess, and ultrasound-guided aspiration of the fluid collection was performed.

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Ultrasound Evaluation of an Inguinal Mass

Volume 15, Issue 7, November 2014
Jeffrey L. Wiswell, MD et al.

A 33 year-old female presented to the emergency department (ED) with of two weeks of diffuse abdominal pain, right flank pain, and a slowly enlarging right inguinal mass.

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Technology in Emergency Care

Ultrasound-Guided Small Vessel Cannulation: Long-Axis Approach Is Equivalent to Short-Axis in Novice Sonographers Experienced with Landmark-Based Cannulation

Volume 15, Issue 7, November 2014
Catherine S. Erickson, MD et al.

Our primary objective was to describe the time to vessel penetration and difficulty of long-axis and short-axis approaches for ultrasound-guided small vessel penetration in novice sonographers experienced with landmark-based small vessel penetration.

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Technology in Emergency Care

Ultrasound Distinguishes Ascites from a Large Ovarian Fluid-Filled Cyst

Volume 15, Issue 7, November 2014
Marissa Camilon, MD et al.

A 51-year-old woman with Hepatitis C was referred to the emergency department (ED) for “massive ascites.” She reported increasing abdominal girth for six months with intermittent abdominal pain. An outpatient ultrasound performed two weeks prior to ED presentation was interpreted by a radiologist as “massive ascites, no masses within the abdomen” on the paper report the patient brought with her. In the ED, the patient was afebrile with normal vital signs. Her abdomen was distended with mild right upper quadrant tenderness.

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Technology in Emergency Care

Accuracy of a Novel Ultrasound Technique for Confirmation of Endotracheal Intubation by Expert and Novice Emergency Physicians

Volume 15, Issue 7, November 2014
Michael Gottlieb, et al.

Recent research has investigated the use of ultrasound (US) for confirming endotracheal tube (ETT) placement with varying techniques, accuracies, and challenges. Our objective was to evaluate the accuracy of a novel, simplified, four-step (4S) technique.

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Technology in Emergency Care

USEFUL: Examen Sonográfico para Lesiones Subyacentes Incorporado al Examen Físico

Volume 15, Issue 3, May 2014
Steller J, MD et al.

El Examen de Cernimiento con Sonograma para la evaluación de Lesiones Subyacentes (USEFUL) fue desarrollado en un intento por establecer un rol para sonografía “bedside” en el marco de cuidado preventivo y primario. El propósito de nuestro estudio piloto era determinar si los estudiantes eran capaces de llevar a cabo todos los “scans” requeridos para USEFUL de manera que este examen físico asistido por sonografía complemente el examen físico estándar en la misma estructura de pies a cabeza. Nosotros también nos propusimos evaluar el tiempo necesario para un examen adecuado y analizar si los tiempos mejoraban con repetición y entrenamiento previo en sonografía.

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Mirror Image Artifact Mimicking Heterotopic Pregnancy on Transvaginal Ultrasound: Case Series

Volume 15, Issue 6, September 2014
Radhika Malhotra, MD et al.

Vaginal bleeding in early pregnancy is a common emergency department complaint. Point-of-care ultrasound is a useful tool to evaluate for intrauterine ectopic pregnancy. Emergency physicians performing these studies need to be cognizant of artifacts produced by ultrasound technology, as they can lead to misdiagnosis. We present two cases where mirror-image artifacts initially led to a concern for heterotopic pregnancies but were excluded on further imaging.

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Ultrasound Detection of Superior Vena Cava Thrombus

Volume 15, Issue 6, September 2014
Aaron Birch, MD et al.

Superior vena cava (SVC) syndrome is most commonly the insidious result of decreased vascular flow through the SVC due to malignancy, spontaneous thrombus, infections, and iatrogenic etiologies.
Clinical suspicion usually leads to computed tomography to confirm the diagnosis. However, when a patient in respiratory distress requires emergent airway management, travel outside the emergency department is not ideal. With the growing implementation of point-of-care ultrasound (POCUS), clinicians may make critical diagnoses rapidly and safely. We present a case of SVC syndrome due to extensive thrombosis of the deep venous system cephalad to the SVC diagnosed by POCUS.

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From the Heart: Interatrial Septal Aneurysm Identified on Bedside Ultrasound

Volume 15, Issue 6, September 2014
Michael Butterfield, MD, MS, MPH et al.

A 61 year-old man presented to the Emergency Department for one day of nonspecific chest pain. Bedside echocardiogram performed by the emergency physician revealed normal systolic cardiac function but also showed a large ( > 10mm) bicornuate interatrial septal aneurysm (IASA) projecting into the right atrium (Figure 1, Video 1). There was no evidence of intraatrial thrombus. A formal echocardiogram performed later that day confirmed the diagnosis and also detected a patent foramen ovale (PFO) with a left-to-right shunt that reversed with Valsalva maneuver.

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Technology in Emergency Care

Typed Versus Voice Recognition for Data Entry in Electronic Health Records: Emergency Physician Time Use and Interruptions

Volume 15, Issue 4, July 2014
Jonathan E. dela Cruz, MD et al.

Use of electronic health record (EHR) systems can place a considerable data entry burden upon the emergency department (ED) physician. Voice recognition data entry has been proposed as one mechanism to mitigate some of this burden; however, no reports are available specifically comparing emergency physician (EP) time use or number of interruptions between typed and voice recognition data entry-based EHRs. We designed this study to compare physician time use and interruptions between an EHR system using typed data entry versus an EHR with voice recognition.

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Technology in Emergency Care

Novel Ultrasound Guidance System for Real-time Central Venous Cannulation: Safety and Efficacy

Volume 15, Issue 4, July 2014
Robinson M. Ferre, MD et al.

Real-time ultrasound guidance is considered to be the standard of care for central venous access for non-emergent central lines. However, adoption has been slow, in part because of the technical challenges and time required to become proficient. The AxoTrack® system (Soma Access Systems, Greenville, SC) is a novel ultrasound guidance system recently cleared for human use by the United States Food and Drug Administration (FDA).

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Technology in Emergency Care

USEFUL: Ultrasound Exam for Underlying Lesions Incorporated into Physical Exam

Volume 15, Issue 3, Jon Steller, MD et al.

The Ultrasound Screening Exam for Underlying Lesions (USEFUL) was developed in an attempt to establish a role for bedside ultrasound in the primary and preventive care setting. It is the purpose of our pilot study to determine if students were first capable of performing all of the various scans required of our USEFUL while defining such an ultrasound-assisted physical exam that would supplement the standard hands-on physical exam in the same head-to-toe structure. We also aimed to assess the time needed for an adequate exam and analyze if times improved with repetition and previous ultrasound training.

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Prospective Analysis of Single Operator Sonographic Optic Nerve Sheath Diameter Measurement for Diagnosis of Elevated Intracranial Pressure

Volume 15, Issue 2, March 2014
Erica Frumin, MD et al.

The accurate diagnosis of elevated intracranial pressure (eICP) in the emergent setting is a critical determination that presents significant challenges. Several studies show correlation of sonographic optic nerve sheath diameter (ONSD) to eICP, while others show high inter-observer variability or marginal performance with less experienced sonographers. The objective of our study is to assess the ability of bedside ultrasound measurement of ONSD to identify the presence of eICP when performed by a single experienced sonographer. We hypothesize that ONSD measurement is sensitive and specific for detecting eICP and can be correlated with values obtained by external ventricular device (EVD).

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Technology in Emergency Care

Social Media Guidelines and Best Practices: Recommendations from the Council of Residency Directors Social Media Task Force

Volume XV, Issue 1, February 2014
Malford T. Pillow, MD, MEd et al.

Social media has become a staple of everyday life among over one billion people worldwide. A social networking presence has become a hallmark of vibrant and transparent communications. It has quickly become the preferred method of communication and information sharing. It offers the ability for various entities, especially residency programs, to create an attractive internet presence and “brand” the program. Social media, while having significant potential for communication and knowledge transfer, carries with it legal, ethical, personal, and professional risks. Implementation of a social networking presence must be deliberate, transparent, and optimize potential benefits while minimizing risks. This is especially true with residency programs. The power of social media as a communication, education, and recruiting tool is undeniable. Yet the pitfalls of misuse can be disastrous, including violations in patient confidentiality, violations of privacy, and recruiting misconduct. These guidelines were developed to provide emergency medicine residency programs leadership with guidance and best practices in the appropriate use and regulation of social media, but are applicable to all residency programs that wish to establish a social media presence.

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Contact Information

WestJEM/ Department of Emergency Medicine
UC Irvine Health

333 The City Blvd. West, Rt 128-01
Suite 640
Orange, CA 92868, USA
Phone: 1-714-456-6389
Email: editor@westjem.org

Our Philosophy

Emergency Medicine is a specialty which closely reflects societal challenges and consequences of public policy decisions. The emergency department specifically deals with social injustice, health and economic disparities, violence, substance abuse, and disaster preparedness and response. This journal focuses on how emergency care affects the health of the community and population, and conversely, how these societal challenges affect the composition of the patient population who seek care in the emergency department. The development of better systems to provide emergency care, including technology solutions, is critical to enhancing population health.