Technology in Emergency Care Archives - The Western Journal of Emergency Medicine

Point-of-Care Ultrasound for Intubation Confirmation of COVID-19 Patients

Gottlieb, M.

The novel coronavirus disease of 2019 (COVID-19) is associated with significant morbidity and mortality, as well as large numbers of patients requiring endotracheal intubation. While much of the literature has focused on the intubation technique, there is scant discussion of intubation confirmation. Herein, we discuss the limitations of traditional confirmatory approaches, summarize the literature supporting a role for point-of-care ultrasound in this application, and propose an algorithm for intubation confirmation among COVID-19 patients.

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Tricuspid Annular Plane of Systolic Excursion (TAPSE) for the Evaluation of Patients with Severe Sepsis and Septic Shock

Lahham, MD, et al.

Sepsis is a systemic infection that can rapidly progress into multi organ failure and shock if left untreated. Previous studies have demonstrated the utility of point of care ultrasound (POCUS) in the evaluation of patients with sepsis. However, limited data exists on the evaluation of the tricuspid annular plane of systolic excursion (TAPSE) in patients with sepsis.

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Comparison of Ultrasound-Guided Vs Traditional Arterial Cannulation by Emergency Medicine Residents

Wilson, MD, et al.

We sought to determine whether ultrasound-guided arterial cannulation (USGAC) is more successful than traditional radial artery cannulation (AC) as performed by emergency medicine (EM) residents with standard ultrasound training.

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Does Orally-Administered Radiocontrast Impair Ultrasound Image Quality in Pediatric Patients?

Patel, MD, et al.

The objective of this study was to evaluate whether early administration of ORC in children with abdominal pain receiving abdominal CT for possible appendicitis obscures subsequent abdominal US image quality.

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Single Versus Double Tourniquet Technique for Ultrasound-Guided Venous Catheter Placement

Price, MD, et al.

Prior research has demonstrated decreased compressibility under double tourniquet technique (DT) compared with single tourniquet (ST). We hypothesized that catheters inserted under DT method would have a higher first-stick success rate compared with those inserted under ST method.

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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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Bedside Echocardiography for Undifferentiated Hypotension: Diagnosis of a Right Heart Thrombus

Volume 16, Issue 1, January 2015
James F. Kenny, MD et al.

A free-floating right heart thrombus is often a harbinger of a massive pulmonary embolism and must be diagnosed and treated rapidly in order to avoid significant adverse sequelae. We present the case of an 84-year-old female who presented with two days of dyspnea and was hypotensive on arrival.

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Validation of a Decision Rule for Selective TSH Screening in Atrial Fibrillation

Volume 16, Issue 1, January 2015
Shawna D. Bellew, MD et al.

Atrial fibrillation (AF) is the most common cardiac dysrhythmia. Current guidelines recommend obtaining thyroid-stimulating hormone (TSH) levels in all patients presenting with AF.

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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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Factors Influencing Rate of Testicular Salvage in Acute Testicular Torsion at a Tertiary Pediatric Center

Volume 16, Issue 1, January 2015
Puneeta Ramachandra, MD et al.

Studies have demonstrated that variables other than duration of symptoms can affect outcomes in children with acute testicular torsion. We examined demographic and logistical factors, including inter-hospital transfer, which may affect outcomes at a tertiary pediatric referral center.

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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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Optimizing Neurologically Intact Survival from Sudden Cardiac Arrest: A Call to Action

Volume 15, Issue 7, November 2015
Jeffrey M. Goodloe, MD et al.

The U.S. national out-of-hospital and in-hospital cardiac arrest survival rates, although improving recently, have remained suboptimal despite the collective efforts of individuals, communities, and professional societies.

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Bedside Ultrasonography as an Adjunct to Routine Evaluation of Acute Appendicitis in the Emergency Department

Volume 15, Issue 7, November 2014
Samuel H.F. Lam, MD et al.

Appendicitis is a common condition presenting to the emergency department (ED). Increasingly emergency physicians (EP) are using bedside ultrasound (BUS) as an adjunct diagnostic tool.

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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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Gastrointestinal Manifestations of Hereditary Angioedema Diagnosed by Ultrasound in the Emergency Department

Volume 15, Issue 7, November 2014
Christine Riguzzi, MD et al.

Abdominal angioedema is a less recognized type of angioedema, which can occur in patients with hereditary angioedema (HAE). The clinical signs may range from subtle, diffuse abdominal pain and nausea, to overt peritonitis.

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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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False Positive Appendicitis on Bedside Ultrasound

Volume 15, Issue 7, November 2014
Caleb P. Canders, MD et al.

A 27-year-old woman presented with sharp, right lower quadrant abdominal pain for six hours. The pain was colicky, non-migratory, and non-radiating.

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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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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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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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Evaluation of Karl Storz CMAC Tip™ Device Versus Traditional Airway Suction in a Cadaver Model

Volume 15, Issue 4, July 2014
Demis N. Lipe, MD et al.

We compared the efficacy of Karl Storz CMAC Tip™ with inline suction to CMAC with traditional suction device in cadaveric models simulating difficult airways, using media mimicking pulmonary edema and vomit.

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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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