Technology in Emergency Medicine

Initial Standardized Framework for Reporting Social Media Analytics in Emergency Care Research

Roland, PhD, et al.

While tools exist to standardize the reporting of clinical studies and systematic reviews, there is no agreed framework for examining social media–based research. This article presents a publication and appraisal checklist for such work and invites further collaboration in the form of a Delphi technique to clarify, expand, improve, and validate the proposal.

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Characterizing New England Emergency Departments by Telemedicine Use

Zachrison, MD, et al.

Telemedicine connects emergency departments (ED) with resources necessary for patient care; its use has not been characterized nationally, or even regionally. Our primary objective was to describe the prevalence of telemedicine use in New England EDs and the clinical applications of use. Secondarily, we aimed to determine if telemedicine use was associated with consultant availability and to identify ED characteristics associated with telemedicine use.

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Ultrasound-Guided Peripheral Intravenous Line Placement: A Narrative Review of Evidence-based Best Practices

Gottlieb, MD, et al.

Peripheral intravenous line placement is a common procedure in emergency medicine. Ultrasound guidance has been demonstrated to improve success rates, as well as decrease complications and pain. This paper provides a narrative review of the literature focusing on best practices and techniques to improve performance with this procedure. We provide an evidence-based discussion of preparation for the procedure, vein and catheter selection, multiple techniques for placement, and line confirmation.

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Diagnostic Accuracy of Ultrasound for Identifying Shoulder Dislocations and Reductions: A Systematic Review of the Literature

Gottlieb, MD, et al.

Patients with shoulder dislocations commonly present to the emergency department. Ultrasound has the potential to save time, radiation exposure, healthcare costs, and possible need for re-sedation. We conducted this systematic review to compare the diagnostic accuracy of ultrasound compared with plain radiography in the assessment of shoulder dislocations.

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Impact of Internally Developed Electronic Prescription on Prescribing Errors at Discharge from the Emergency Department

Hitti, MD, et al.

Medication errors are common, with studies reporting at least one error per patient encounter. At hospital discharge, medication errors vary from 15%–38%. We assessed the impact of introducing an internally developed, low-cost E-prescription system, with a list of commonly prescribed medications, on prescription error rates at discharge from the ED, compared to handwritten prescriptions.

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Caudal Edge of the Liver in the Right Upper Quadrant (RUQ) View Is the Most Sensitive Area for Free Fluid on the FAST Exam

Viveta Lobo, MD

The focused assessment with sonography in trauma (FAST) exam is a critical diagnostic test for intraperitoneal free fluid (FF). Current teaching is that fluid accumulates first in Morison’s pouch. The goal of this study was to evaluate the “sub-quadrants” of traditional FAST views to determine the most sensitive areas for FF accumulation.

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Ultrasound Detection of Patellar Fracture and Evaluation of the Knee Extensor Mechanism in the Emergency Department

Kiersten Carter, MD et al.

Traumatic injuries to the knee are common in emergency medicine. Bedside ultrasound (US) has benefits in the rapid initial detection of injuries to the patella. In addition, US can also quickly detect injuries to the entire knee extensor mechanism, including the quadriceps tendon and inferior patellar ligament, which may be difficult to diagnose with plain radiographs.

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Role of Ultrasound in the Identification of Longitudinal Axis in Soft-Tissue Foreign Body Extraction

Al Lulla, MD et al.

Identification and retrieval of soft-tissue foreign bodies (STFB) poses significant challenges in the emergency department. Prior studies have demonstrated the utility of ultrasound (US) in identification and retrieval of STFBs, including radiolucent objects such as wood. We present a case of STFB extraction that uses US to identify the longitudinal axis of the object. With the longitudinal axis identified, the foreign body can be excised by making an incision where the foreign body is closest to the skin. The importance of this technique as it pertains to minimizing surrounding tissue destruction and discomfort for patients has not been previously reported.

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Point-of-Care Sonographic Findings in Acute Upper Airway Edema

Michael Schick, DO, MA et al.

We describe a case where a patient presented with acute angiotensin-converting enzyme inhibitor (ACE-I) induced angioedema without signs or symptoms of upper airway edema beyond lip swelling. Point-of-care ultrasound (POCUS) was used as an initial diagnostic test and identified left-sided subglottic upper airway edema that was immediately confirmed with indirect fiberoptic laryngoscopy. ACE-I induced angioedema and the historical use of ultrasound in evaluation of the upper airway is briefly discussed. To our knowledge, POCUS has not been used to identify acute upper airway edema in the emergency setting. Further investigation is needed to determine if POCUS is a sensitive and specific-enough tool for the identification and evaluation of acute upper airway edema.

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Point-of-Care Ultrasound to Diagnose a Simple Ranula

Ili Margalit, MD et al.

An 11-year-old previously healthy girl presented to the emergency department (ED) with three weeks of a rapidly progressive swelling underneath her tongue, causing difficulty in talking and eating. Physical examination revealed a 4.5 × 3 cm sublingual mass arising from the base of the tongue, around the midline (Figure 1). The mass was soft, movable and non-tender. The contents had a bluish hue, which was covered with normal appearing mucosa. A point-of-care ultrasound (POCUS) revealed a well-circumscribed homogenous cystic mass, separated from the muscular fibers of the tongue, without extravasation towards the neck (Figure 2) and without intra-cystic flow. A diagnosis of simple ranula was made.

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Emergency Department Operations

Mobile COWs (Computer on Wheels): Hamburger or VEAL?

Mobile COWs (Computer on Wheels): Hamburger or VEAL?
Maxwell Jen, MD, et al.

The HITECH (Health Information Technology for Economic and Clinical Health) Act of 2009 galvanized the universal adoption of electronic health record (EHR) systems to improve the quality, delivery, and coordination of patient care.1 Initial results demonstrated improvement in population health outcomes and increased transparency.2-3 Through the HITECH Act’s Meaningful Use (MU) incentives, EHR adoption also promised shorter hospital stays, reduced costs and improved access to healthcare data.4 These promises, however, never materialized; studies have demonstrated that EHR adoption causes decreased rates of patients seen per hour, highly variable documentation times, and increased order entry times.

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Optic Nerve Sheath Diameter Measurement During Diabetic Ketoacidosis: A Pilot Study

Optic Nerve Sheath Diameter Measurement During Diabetic Ketoacidosis: A Pilot Study
Bergmann, DO, MS, et al.

Diabetic ketoacidosis-related cerebral edema (DKA-CE) occurs in up to 1% of children with type 1 diabetes (T1D),1 with approximately 20% displaying neurologic symptoms at presentation.2,3 Similarly, up to 54% have a mild form of subclinical DKA-CE identified by extracellular fluid measurements on magnetic resonance imaging (MRI), which is associated with alterations in neuronal function and cerebral injury on MR spectroscopy.2-6 This suggests that DKA-CE occurs along a continuum, ranging from asymptomatic imaging changes, mild neurologic injury, to cerebral herniation and death.

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Body Mass Index is a Poor Predictor of Bedside Appendix Ultrasound Success or Accuracy

Volume 17, Issue 4, July 2016
Samuel Lam, MD, et al.

In recent years studies have been published on the use of beside ultrasound (BUS) to diagnose appendicitis in the emergency department (ED). Its popularity is likely due to the improving ultrasound skills of emergency physicians, as well as the obvious BUS advantages of no ionizing radiation emission, and ease of performance and interpretation at the bedside. Use of ultrasound in suspected appendicitis is also supported by American College of Radiology recommendations, especially in the pediatric population.

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Check the Head: Emergency Ultrasound Diagnosis of Fetal Anencephaly

Volume 17, Issue 4, July 2016
John Hall, MD, et al.

Early pregnancy complaints in emergency medicine are common. Emergency physicians (EP) increasingly employ ultrasound (US) in the evaluation of these complaints. As a result, it is likely that rare and important diagnoses will be encountered. We report a case of fetal anencephaly diagnosed by bedside emergency US in a patient presenting with first-trimester vaginal bleeding.

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Pilot Study to Determine Accuracy of Posterior Approach Ultrasound for Shoulder Dislocation by Novice Sonographers

Volume 17, Issue 3, May 2016.
Shadi Laham, MD, MS, et al.

Introduction: The goal of this study was to investigate the efficacy of diagnosing shoulder
dislocation using a single-view, posterior approach point-of-care ultrasound (POCUS) performed
by undergraduate research students, and to establish the range of measured distance that
discriminates dislocated shoulder from normal.
Methods: We enrolled a prospective, convenience sample of adult patients presenting to
the emergency department with acute shoulder pain following injury. Patients underwent
ultrasonographic evaluation of possible shoulder dislocation comprising a single transverse
view of the posterior shoulder and assessment of the relative positioning of the glenoid fossa
and the humeral head. The sonographic measurement of the distance between these two
anatomic structures was termed the Glenohumeral Separation Distance (GhSD). A positive GhSD
represented a posterior position of the glenoid rim relative to the humeral head and a negative
GhSD value represented an anterior position of the glenoid rim relative to the humeral head. We
compared ultrasound (US) findings to conventional radiography to determine the optimum GhSD
cutoff for the diagnosis of shoulder dislocation. Sensitivity, specificity, positive predictive value,
and negative predictive value of the derived US method were calculated.
Results: A total of 84 patients were enrolled and 19 (22.6%) demonstrated shoulder dislocation
on conventional radiography, all of which were anterior. All confirmed dislocations had a negative
measurement of the GhSD, while all patients with normal anatomic position had GhSD>0. This
value represents an optimum GhSD cutoff of 0 for the diagnosis of (anterior) shoulder dislocation.
This method demonstrated a sensitivity of 100% (95% CI [82.4-100]), specificity of 100% (95% CI
[94.5-100]), positive predictive value of 100% (95% CI [82.4-100]), and negative predictive value
of 100% (95% CI [94.5-100]).
Conclusion: Our study suggests that a single, posterior-approach POCUS can diagnose anterior
shoulder dislocation, and that this method can be employed by novice ultrasonographers, such as
non-medical trainees, after a brief educational session. Further validation studies are necessary
to confirm these findings.

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Point-of-Care Ultrasound Diagnosis of Left-Sided Endocarditis

Author Affiliation Charles W. Bugg, MD, PhD Keck School of Medicine, LAC+USC Medical Center, Department of Emergency Medicine, Los Angeles, California Kristin Berona, MD Keck School of Medicine, LAC+USC Medical Center, Department of Emergency Medicine, Los Angeles, California Supplementary information A 56-year-old male presented to the emergency department (ED) with fatigue, generalized weakness, cough without […]

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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: westjem@gmail.com

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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.