RebelEM

APRIL 17, 2023

While operator dependent, the dynamic ability of POCUS augments bedside diagnosis and can assist with drainage. Additionally, potential increases in resource utilization, healthcare expense, and ED length of stay are also essential considerations. Ultrasound has become an extended part of our physical exam.

Ultrasounds 127

Ultrasounds Radiology Radiology Operations 127

Don't Forget the Bubbles

MARCH 11, 2024

Craniosynostosis needs urgent referral and is usually corrected operatively before a child’s first birthday. Craniosynostosis, The Radiology Assistant. The Radiology Assistant: Craniosynostosis Accessed 10.01.2024 Mawji, A., Craniosynostosis can lead to raised intracranial pressure and failure to thrive. Vollman, A. McNeil, D.

Radiology 59

Radiology Radiology Pediatrics Documentation/Coding 59

The Skeptics' Guide to EM

MARCH 25, 2023

Do they need surgery, an ERCP or just analgesia and non-operative care? Many small trials have compared the accuracy of POCUS to the “gold standard” of “Radiology-performed ultrasound”. A focused Biliary US in the ED (BUSED) may be all that is required to guide the surgeon’s decision-making for this patient.

Ultrasounds 52

Ultrasounds Emergency Department Dislocations Radiology 52

ACEP Now

MAY 4, 2023

On hospital day 2, he was taken to the operating room for surgical rib fixation. The direct movement of air into the chest wall was improved with the placement of a pigtail catheter and ultimately treated with operative repair. The patient continued to have an oxygen requirement and significant pain.

EMS 52

EMS Fractures Operations Ultrasounds 52

Taming the SRU

MAY 22, 2023

weight-bearing status, operative vs. non-operative) If necessary/helpful to ensure adequate follow-up At time of discharge: Counsel on expected course of injury, supportive care (e.g., A comparison between pre-operative ultrasonography and surgical findings. RICE), and symptomatic management (e.g., 2001;220:406-12. Acta Radiol.

Fractures 69

Fractures Dislocations Operations Radiology 69

Intensive Blog

MARCH 11, 2024

Current ventilator settings Recent pathology, radiology and ABG results What central access does the patient have? They are staffed by Ambulance attendants to help operate specialized bariatric equipment. multi organ dysfunction, severe sepsis, age, frailty, co-morbidities) What investigations and treatment has the patient had to date?

Hospitals 69

Hospitals Radiology Radiology Sepsis 69

EMergucate

APRIL 19, 2015

The following frontal chest x-ray from a 80 year old was obtained as part of a pre-operative work up prior to lower limb surgery. What radiological sign can be noted?

Radiology 40

Radiology Radiology Operations EMS 40

EMDocs

MARCH 25, 2024

o Difficulty obtaining biliary views due to patient body habitus or pain o Operator dependent o Consultants requesting radiology performed ultrasound How to Perform a Biliary Ultrasound The preferred ultrasound probe for biliary ultrasound is the curvilinear probe due to its wider field of view and lower frequency.

Ultrasounds 86

Ultrasounds Radiology Radiology Operations 86

ACEP Now

MARCH 14, 2024

18 The finger is inserted through the stoma alongside the endotracheal tube and, while 90 percent success rate has been reported with this method in controlling bleeding, the pressure must be maintained until the patient is transferred to the operating room. Operative technique for trachea-innominate artery fistula repair. J Vasc Surg.

Operations 52

Operations Pediatrics Airway Management Radiology 52

Mount Sinai EM

DECEMBER 27, 2022

Lisfranc injury x-rays Management Depends on the severity of injury, so consult with your orthopedic surgeon to determine operative vs nonoperative management. Patients with stable nondisplaced injuries can be discharged with immobilization in a short leg cast, NWB status, crutches, RICE management and orthopedic surgery follow up.

Dislocations 130

Dislocations Fractures Operations Radiology 130

The Skeptics' Guide to EM

JUNE 4, 2017

However, when we assess major trauma that includes chest, abdominal and pelvic trauma, the initial radiologic evaluation is left to the treating physician’s judgement. Many studies (most retrospective) have assessed the use of pan scanning as an initial radiologic evaluation.

Radiology 52

Radiology Radiology CPR Hospitals 52

Don't Forget the Bubbles

MAY 22, 2023

These can be operated and maintained by patients and their families at home. Once he is medically stable, with improving inflammatory markers, resolving radiological changes, and lessening secretions, plans will be made for discharge. Advances in technology have also led to more portable ventilators. You go to see Robin.

Radiology 98

Radiology Radiology Hospitals Wellness 98

PHEM Cast

DECEMBER 1, 2017

Journal of Special Operations Medicine : a Peer Reviewed Journal for SOF Medical Professionals , 13 (4), 53–58. Radiologic evaluation of alternative sites for needle decompression of tension pneumothorax. Radiologic assessment of potential sites for needle decompression of a tension pneumothorax. [link] Harcke, H. Branco, B.

Academics 52

Academics Radiology Radiology Resuscitation 52

ALiEM

MAY 13, 2024

63M with an Erythematous Abdomen Limitations of POCUS As with all ultrasound applications, soft tissue POCUS is operator dependent. Di Coneybeare) For additional reading on ultrasounding necrotizing fasciitis, see these ALiEM articles: QI Series: Cellulitis vs Necrotizing Fasciitis Ultrasound For The Win! – 97.4%) 85.4% (78.9-90.2%)

Ultrasounds 64

Ultrasounds Pediatrics Emergency Department Wellness 64

RCEM Learning

NOVEMBER 28, 2022

Operative management is required with either External Fixation or Open Reduction with Internal Fixation (ORIF). Learning bite All unstable pelvic fractures require operative management. Case courtesy of Dr Paul Clarke Learning bite Avoid unnecessary movement of the patient. Usually managed conservatively.

Fractures 52

Fractures Blood Transfusions Sepsis Operations 52

Taming the SRU

APRIL 5, 2023

Operators should take care to obtain clear images of the upper renal poles with the understanding that inferior pole evaluation will be limited from the isthmus. Horseshoe Kidney: Radiology Reference Article. A midline approach, with the transducer over the umbilicus, is useful for identifying the isthmus itself [4]. Clinical imaging.

Ultrasounds 52

Ultrasounds Pediatrics Radiology Radiology 52

Medagadget

OCTOBER 17, 2023

Recent studies have also demonstrated a benefit in recurrence-free survival after pre-operative embolization. Preoperative embolization occludes blood flow to the tumor bed and can result in reduced blood loss during surgery. Medgadget: How does Neocast differ from pre-existing embolic technologies? What are its advantages?

Operations 69

Operations Radiology Radiology 69

Northwestern EM Blog

DECEMBER 20, 2021

Commonly hematogenous spread from bacteremia; clinical suspicion should prompt radiologic evaluation. Management is orthopedic consultation for operative stabilization [12]. X-rays may be likely to be normal/inconclusive early in the disease course and MRI may be often indicated. References Smith E, Anderson M, Foster H.

Pediatrics 52

Pediatrics Ultrasounds Emergency Department Radiology 52

Pediatric Emergency Playbook

MARCH 1, 2016

Adults tolerate hypotension relatively well, and is sufficient until we send them to the OR or interventional radiology suite. Often children even with high-grade splenic and liver lacerations can be managed non-operatively. To avoid this, we target a MAP of 65 and look for clinical signs of sufficient perfusion.

Resuscitation 40

Resuscitation Pediatrics Hyperthermia / Hypothermia Operations 40

Dr. Smith's ECG Blog

DECEMBER 18, 2022

The operative report and radiology reads do not comment specifically as to whether the dissection flap was partially or fully obstructing coronary flow, or whether it was obstructing the left main or the RCA. Intraoperative TEE noted "Type A aortic dissection arising 1.0 cm distal to the non-coronary cusp of the aortic valve."

Ultrasounds 52

Ultrasounds EKG/ECG EMS Radiology 52

ACEP Now

JULY 7, 2023

Will this be enough for the general surgeon, or will they want an US performed by the radiology department to make their surgical decision? Clinical Question What is the value of radiology-performed US (RUS) compared to BUSED in terms of the surgical decision-making in acute biliary disease? Click to enlarge. Reference: Hilsden, et al.

Ultrasounds 52

Ultrasounds Radiology Radiology Emergency Department 52

ALiEM

AUGUST 9, 2023

The lung POCUS is also operator-dependent, and it has a steep learning curve. Limitations Lung pathology may be missed without a complete lung POCUS scanning protocol, as you will only see pathology located directly under the probe. False Negative: POCUS can’t visualize a centrally located pneumonia not extending to the pleural surface.

Ultrasounds 98

Ultrasounds Pediatrics Emergency Department Operations 98

Advanced Emergency Nursing from AENJ

FEBRUARY 29, 2016

Farrington] Rebuilding of outdated hospitals put emergency rooms on ground level with nearby X-ray service, and, ideally, sometimes closer to the Blood Bank and the Operating Rooms. Rebuilding of EDs in proximity to Radiology, Blood Bank, OR, and ICU, becoming organic to the hospital. 1950s & 1960s Resuscitation Research.

Emergency Nursing 40

Emergency Nursing EMS Resuscitation Military 40

RebelEM

NOVEMBER 20, 2023

Patients with torso hemorrhage present a clinical conundrum often requiring interventional radiology or surgery, both of which take time to mobilize. Case volume for operative hemorrhage control is much lower in UK compared to other countries, reflecting better road safety standards and low levels of interpersonal violence.

Resuscitation 91

Resuscitation Outcomes Operations Hospitals 91

The Trauma Pro

JULY 10, 2023

This stream of information continues after the patient leaves the trauma bay for CT, imaging, interventional radiology, operating room, ICU, or floor bed. All of these occur during a relatively brief period of time. Several are simultaneous.

Resuscitation 100

Resuscitation Radiology Radiology Operations 100

EMDocs

OCTOBER 30, 2023

2 In response to the constrained availability of contrast media, emergency medicine (EM) and radiology departments were compelled to enact modifications in their imaging techniques. In most cases, the radiology team functioned as the main decision-maker playing a key role in drafting institutional protocols. 11 Table 1.

Radiology 72

Radiology Radiology Emergency Department Hospitals 72

Northwestern EM Blog

MAY 16, 2022

Follow up CT should depend on the patient and ultrasound operator. Lastly the POCUS operators were ED physicians with training “recommended by ACEP.” It is worth mentioning that this study was a multicenter study based in the US with representation from ED, Radiology, and Urology. were hospitalizations during f/u period; 26.4%

Ultrasounds 52

Ultrasounds Radiology Radiology Outcomes 52

EB Medicine

JUNE 6, 2019

CT is good but you really should learn ultrasound, and lastly, sick patients need prompt consultation and resuscitation, not rapid trips to radiology. Unstable patients do not belong in a radiology suite - they belong in the ED resus bay to be resuscitated first. Nachi: All valid points, but let’s dive in too some actual detail.

Ultrasounds 40

Ultrasounds Radiology Radiology Sepsis 40

Pediatric Emergency Playbook

FEBRUARY 1, 2016

REBOA If you have access to resuscitative endovascular balloon occlusion of the aorta or REBOA, this may be an option to temporize the child to get him to the relative control of the operating room. After balloon occlusion, blood pressure improved sufficiently to take the patient either to interventional radiology or to the OR.

Resuscitation 40

Resuscitation Pediatrics Fractures Emergency Department 40

EMDocs

JUNE 3, 2023

4 This is the framework the ED resuscitationist should be operating under, as hemodynamically unstable pelvic trauma patients require a different approach compared to stable patients who will undergo CT, routine pelvic fixation, and definitive surgical repair. Note placement over the greater trochanters.

Fractures 54

Fractures Resuscitation Operations EMS 54

RebelEM

JANUARY 25, 2023

Late findings Fever Abdominal distension (+) LR: 5.64 – 16.8 (-) LR: 0.34 – 0.43 Absent bowel sounds Peritoneal signs (i.e. rebound and guarding) Diagnostics Laboratory Tests Commonly ordered lab tests (i.e. 2.3 – 5.4) (-) LR: 0.18 (0.09 – 0.35) Ultrasound Findings Dilated loops of bowel (diameter > 2.5

Operations 52

Operations Sepsis Resuscitation Ultrasounds 52

EB Medicine

JULY 8, 2019

Nachi: Unfortunately this procedure is associated with a relatively high re-operation rate – one study found 20% of patients required removal or revision. Jeff: Even more shockingly, some series showed a 52% repeat operation rate. These patients often require emergent operative intervention. J Gastrointest Surg.

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 40

EMDocs

OCTOBER 17, 2023

In patients with suspected ALCD, we suggest a complete assessment of the patients using clinical history, signs, laboratorial inflammation markers, and radiological findings (weak recommendation based on very low-quality evidence, 2D).” “In American College of Radiology ACR Appropriateness Criteria (2023) Left lower quadrant pain.

Radiology 67

Radiology Radiology Operations Best Practices 67

RebelEM

SEPTEMBER 11, 2023

Outcomes: Primary: Percent change in management decisions after introducing the Radiology Department RUQ US. A change in clinical course resulting from a discrepancy between POCUS and radiology department imaging only occurred in 2% of patients (not 10%).

Ultrasounds 65

Ultrasounds Radiology Radiology Emergency Department 65

EMDocs

JUNE 21, 2023

If thinking TA, share your concern with radiology, which improves sensitivity. Common operator errors Failing to enter joint capsule before injecting STS. A 2013 study found a sensitivity of ~47% for TA of the knee using plain radiographs. Based on the data, a normal x-ray couldn’t rule it out. Not injecting enough STS into the joint.

Soft Tissue Injuries 68

Soft Tissue Injuries Fractures Dislocations Radiology 68

Don't Forget the Bubbles

MARCH 4, 2024

Another point in favour of investing in point-of-care ultrasound is that it’s a viable alternative when radiology is not available, e.g. out of hours. Participants were randomised to enhanced suctioning with a battery-operated device or minimal suction with a bulb device for 72 hours before all feeds.

Hospitals 78

Hospitals Sepsis Fractures Emergency Department 78

EMDocs

NOVEMBER 13, 2023

26 With regards to penetrating neck injuries, particularly those in which the platysma is violated, CTA of the neck has allowed a shift away from mandatory operative exploration of Zone 2 neck wounds (those in the mid-neck). Journal of the American College of Radiology 2019, 16 (5, Supplement), S26-S37. 60) Radiology, A.

Stroke 85

Stroke Radiology Radiology Emergency Department 85