Archives

Systemwide Clinical Ultrasound Program Development: An Expert Consensus Model

Strony, DO, et al.

Clinical ultrasound (CUS) is integral to the practice of an increasing number of medical specialties. Guidelines are needed to ensure effective CUS utilization across health systems. To meet this need, a group of CUS subject matter experts, who have been involved in institution- and/or systemwide clinical ultrasound (SWCUS) program development convened. The purpose of this paper was to create a model for SWCUS development and implementation.

Read More

Appendicitis Diagnosed by Emergency Physician Performed Point-of-Care Transvaginal Ultrasound: Case Series

Author Affiliation Robert Bramante, MD  North Shore University Hospital, Department of Emergency Medicine, Manhasset, New York Marek Radomski, DO  North Shore University Hospital, Department of Emergency Medicine, Manhasset, New York Mathew Nelson, DO  North Shore University Hospital, Department of Emergency Medicine, Manhasset, New York Christopher Raio, MD  North Shore University Hospital, Department of Emergency Medicine, […]

Read More

Bedside Ultrasound in a Case of Blunt Scrotal Trauma

This case study describes a patient who suffered blunt force trauma to the scrotum. Use of bedside emergency ultrasound facilitated early diagnosis of a ruptured testicle and allowed for prompt urological consultation and timely surgical repair. The utility of bedside emergency ultrasound in the evaluation of testicular trauma, as well as the outcome of our case, is discussed here.

Read More

Ultrasound Detection of a Renal Mass in a Patient with Flank Pain and Hematuria

Flank pain with hematuria is a common chief complaint in the emergency department (ED). Patients are often diagnosed with renal calculi or pyelonephritis and discharged with analgesics or antibiotics and follow-up. This case study describes a patient who presented to the ED with a 1 week history of flank pain and hematuria and was subsequently found to have a large renal mass on bedside ultrasound.

Read More

Ultrasound Detection of a Molar Pregnancy in the Emergency Department

A 32 year-old female presented to the emergency department (ED) with complaints of mild vaginal spotting accompanied by uterine cramping. She was referred to the ED for an “abnormal pregnancy.” She was a G1P0 and her last menstrual period was 7 weeks 5 days prior. Physical examination demonstrated a well appearing female with normal vital signs.

Read More

Hepatic Abscess: Case Report And Review

Hepatic abscess is an uncommon occurrence in North America, but can be a diagnostic challenge for emergency department physicians. The clinical signs and symptoms may vary, leading to delays in diagnosis and higher morbidity. We present a case of a 35-year old male with a hepatic abscess initially misdiagnosed as pneumonia. On subsequent return to the ED for back pain complaints, a bedside ultrasound led to the appropriate diagnosis. This case report and discussion will attempt to review the literature on the etiology, diagnosis and treatment of hepatic abscess for the emergency physician.

Read More

Clinician-performed Beside Ultrasound for the Diagnosis of Traumatic Pneumothorax

Intro: Prior studies have reported conflicting results regarding the utility of ultrasound in the diagnosis of traumatic pneumothorax (PTX) because they have used sonologists with extensive experience. This study evaluates the characteristics of ultrasound for PTX for a large cohort of trauma and emergency physicians.
Conclusion: In a large heterogenous group of clinicians who typically care for trauma patients, the sonographic evaluation for pneumothorax was as accurate as supine chest radiography. Thoracic ultrasound may be helpful in the initial evaluation of patients with truncal trauma.

Read More

Transjugular Intrahepatic Portosystemic Shunt (TIPS) Migration to the Heart Diagnosed by ED Ultrasound

A 57-year-old man presented to our emergency department with altered mental status. He had a past medical history significant for cirrhosis and previous placement of a transjugular intrahepatic portosystemic shunt (TIPS). On cardiac auscultation, a new heart murmur and an unexpected degree of cardiac ectopy were noted. On the 12-lead electrocardiogram, the patient was…

Read More

Sonographic Consensual Pupillary Reflex

Patients suffering from severe orbital trauma are at risk for numerous complications, including orbital compartment syndromes. This can result in an afferent pupillary defect, which must be evaluated for on physical examination. Unfortunately, these at-risk patients are often challenging to examine properly due to surrounding edema. Point-of-care ultrasonography can be used as an adjunct to the standard examination in this situation.

Read More

Bladder Bulge: Unifying Old and New Sonographic Bladder Wall Abnormalities in Ureterolithiasis

Approximately 1% of all emergency department (ED) visits are for treatment of urinary tract stone disease (renal colic, kidney stones, urolithiasis). Renal colic is a common condition affecting approximately 7–13% of the population during their lifetime and those who are afflicted are likely to have recurrent attacks throughout their lives. Through the following case series, we present sonographic bladder wall findings in patients with renal colic.

Read More

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,…

Read More

Ultrasound-Guided Hip Arthrocentesis in a Child with Hip Pain and Fever

Children presenting to the emergency department with hip pain and fever are at risk for significant morbidity due to septic arthritis. Distinguishing between septic arthritis and other causes of hip pain may be challenging. Sonographic visualization of the hip with real-time ultrasound-guided arthrocentesis may allow faster differentiation between etiologies, hastening definitive therapy and improving analgesia. This report describes the use of hip sonography in a case of Lyme arthritis. The authors review the medical literature in support of bedside hip sonography and discuss how to perform ultrasound-guided hip arthrocentesis. Clinical findings in septic and Lyme arthritis are also described.

Read More

Emergency Ultrasound Identification of a Cornual Ectopic Pregnancy

Typically, clinicians think of ectopic pregnancies as occurring outside of the uterus. This case is important in underscoring the fact that there are variants of ectopic pregnancies that exist within the uterus. One classic type is the cornual ectopic pregnancy, which occurs in a congenital bicornate uterus. The shape of this uterus may allow for implantation to occur high in one of the cornual limbs.

Read More

Tuberculous Pleural Effusion

Pleural effusions are a common finding in emergency departments, with cytologic analysis traditionally required for definitive diagnosis. This article describes a classic sonographic appearance of tuberculous pleural effusion.

Read More

Sonographic Identification of Tube Thoracostomy Study (SITTS): Confirmation of Intrathoracic Placement

Thoracostomy tubes (TT) are commonly placed in the management of surgical, emergency, and trauma patients and chest radiographs (CXR) and computed tomography (CT) are performed to confirm placement. Ultrasound (US) has not previously been used as a means to confirm intrathoracic placement of chest tubes. This study involves a novel application of US to demonstrate chest tubes passing through the pleural line, thus confirming intrathoracic placement.

Read More

Evaluation of Breast Disorders with Ultrasound

This case demonstrates that the potential use of bedside ultrasound by emergency physicians can be a rapid and helpful diagnostic tool in differentiating an uncomplicated infectious condition, mastitis, from more complex pathology, such as breast cancer, that was ultimately diagnosed in this patient.

Read More

Bedside Ultrasound Diagnosis of Acalculous Cholecystitis from Ebstein-Barr Virus

Acalculous cholecystitis is thought to occur in patients with a severe systemic illness or during long periods of intravenous nutrition. We discuss a case of acalculous cholecystitis secondary to Epstein-Barr virus detected by bedside ultrasound. We hope to alert clinicians who are actively using bedside ultrasound of an important, yet not commonly discussed, association.

Read More

“Playboy Bunny” Sign of Congestive Heart Failure

In emergency, ultrasound has been widely used as a noninvasive and effective examination to evaluate congestive heart failure. We highlight “Playboy Bunny” sign as a reliable marker and an important clue to the diagnosis of passive hepatic congestion, caused by congestive heart failure.

Read More

Impending Airway Compromise due to Cystic Hygroma

We report on a 3-month-old infant, who arrived in the pediatric emergency department (ED) with a cervical cystic hygroma causing an impending compromise of the airway. We recognize that such a lesion can rapidly progress, and the judicious use of imaging in the ED may help to avoid airway compromise and possibly fatal complications.

Read More

Patellar Tendonitis

A 51-year-old female with a history of gout, hypertension and diabetes presented to the emergency department with one week of increasing pain and swelling of her left knee, just below the patella. She denied trauma, fever and calf pain.

Read More

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: westjem@gmail.com

CC-BY_icon.svg

WestJEM
ISSN: 1936-900X
e-ISSN: 1936-9018

CPC-EM
ISSN: 2474-252X

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.