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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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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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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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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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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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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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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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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Betrayed Mood in Public View: Taking a MySpace History

Volume XV, Issue 1, February 2014
Vinodinee L. Dissanayake, MD et al.

Social networking sites (SNS), the modern mainstay of adolescent expression, may provide vital information to physicians. The emergency department (ED) is a setting where SNS may be helpful. A reticent 19-year-old in the ED prompted a search for pertinent information on the Internet, where a profile on www.myspace.com relayed a troubled post. The patient was admitted for psychiatric evaluation due to intentional overdose. These SNS may provide a venue for physicians to learn about risky behaviors and life stressors that would help identify underlying medical issues in young adults. We provide a guideline on how to utilize SNS with privacy rights in mind.

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Electronic Medical Record Utopia May Be Right Before Our Eyes

Volume XV, Issue 1, February 2014
Clark Rosenberry, MD et al.

The quantitative and qualitative demand for medical care burdened to every provider seems only to increase. I encourage you to push us to this bright, more efficient, and more capable future. Advise your electronic medical record carrier to mold their interface into new applications for hardware such as the Google Glass and inevitable subsequent comparable models, integrate highly useful software adjuncts, and foster the adoption of these progressing technologies.

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Sensitivity of Emergency Bedside Ultrasound to Detect Hydronephrosis in Patients with Computed Tomography-proven Stones

Volume XV, Issue 1, February 2014
Jeff RIddell, MD et al.

Non-contrast computed tomography (CT) is widely regarded as the gold standard for diagnosis of urolithiasis in emergency department (ED) patients. However, it is costly, time-consuming and exposes patients to significant doses of ionizing radiation. Hydronephrosis on bedside ultrasound is a sign of a ureteral stone, and has a reported sensitivity of 72–83% for identification of unilateral hydronephrosis when compared to CT. The purpose of this study was to evaluate trends in sensitivity related to stone size and number.

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Prognostic Value of Emergency Physician Performed Echocardiography in Patients with Acute Pulmonary Thromboembolism

Author Affiliation Maurizio Zanobetti, MD Department of Critical Care Medicine and Surgery, University of Florence, Florence, Italy Cristiano Converti, MD Department of Critical Care Medicine and Surgery, University of Florence, Florence, Italy Alberto Conti, MD Department of Critical Care Medicine and Surgery, University of Florence, Florence, Italy Gabriele Viviani, MD Department of Critical Care Medicine […]

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Accuracy of Handheld Point-of-Care Fingertip Lactate Measurement in the Emergency Department

Introduction: We examined the accuracy and time-saving effect of a handheld Point-of-care (POC) device for the measurement of fingertip and whole blood lactate as compared with reference laboratory testing in critically ill ED patients.

Conclusion: Fingertip POC lactate measurement is an accurate method to determine lactate levels in infected ED patients with normal or modestly elevated lactate values and significantly decreases time to test results.

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Ultrasound Diagnosis of Urethral Calculi

A 35-year-old man presented to the emergency department (ED) for acute urinary retention and penile pain for 4 hours. The patient denied any significant medical history or history of trauma. Physical exam revealed testicles that were nontender, without masses. However,…

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Thyroid Evaluation in a Patient with Thyrotoxicosis with Bedside Ultrasound

This case demonstrates how EUS can be used as a rapid and helpful tool in the diagnosis of thyrotoxicosis. An enlarged thyroid gland with hypervascular flow on Doppler ultrasound can corroborate clinical data and lead to the correct diagnosis in a timelier manner.

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