Sensible Medicine

APRIL 24, 2024

Even MRI and ultrasound do not. Are the extra breast tumors found by MRI or ultrasound the kind that would otherwise kill you? The answer is: no one knows because proponents of MRI and ultrasound, whether in dense or regular breasts, are not conducting the appropriate studies to figure this out.

Ultrasounds 133

Ultrasounds Outcomes 133

Emergency Medicine Journal

JULY 24, 2023

Ultrasound could be a reliable, cheap and radiation free alternative to diagnose fractures and ligamentous injuries. The purpose of this systematic review was to investigate the accuracy of ultrasound in diagnosing ankle injuries. No restrictions were applied for date and language.

Ultrasounds 40

Ultrasounds Fractures Outcomes 40

Broome Docs

SEPTEMBER 9, 2023

In this episode we do a deep dive into the BUCKLED trial that looked at the use of bedside ultrasound vs. plain film X-rays for the initial investigation of paediatric forearm fractures. Bottom line: ultrasound appears to be non-inferior to X-ray when used as a first line investigation in terms of functional, patient-oriented outcomes.

Fractures 120

Fractures Ultrasounds Outcomes 120

Ultrasound Gel

JUNE 24, 2019

It is great to see more and more research on ultrasound in cardiac arrest. Here is a nice study that looks to see if ultrasound is associated with increased resuscitation efforts or better survival outcomes. link] It is great to see more and more research on ultrasound in cardiac arrest.

Outcomes 52

Outcomes Ultrasounds Resuscitation Research 52

Emergency Medicine Journal

NOVEMBER 28, 2023

Manipulation performed under ultrasound guidance has the potential to decrease the number of reduction attempts. Patients aged ≥16 years presenting to the ED with a distal radius fracture requiring closed reduction were randomised to either point-of-care ultrasound (PoCUS)-guided or standard reduction.

Fractures 40

Fractures Ultrasounds Emergency Department Operations 40

Don't Forget the Bubbles

NOVEMBER 13, 2023

Should we use ultrasound to diagnose distal forearm fractures in children and adolescents? However, ultrasound is gaining popularity due to its portability, affordability, and lack of ionising radiation. However, ultrasound is gaining popularity due to its portability, affordability, and lack of ionising radiation.

Fractures 64

Fractures Ultrasounds Emergency Department Pediatrics 64

PulmCCM

FEBRUARY 5, 2024

Also, many patients with infection won’t have fevers, and those that don’t may be at the highest risk for poor outcomes. But thoracic ultrasounds on every febrile ICU patient with a mildly abnormal chest film would likely result in many unhelpful thoracenteses of harmless effusions, and some avoidable pneumothoraces.

Best Practices 111

Best Practices Ultrasounds Infectious Diseases Sepsis 111

PulmCCM

APRIL 1, 2024

Physical therapy is probably under-provided to critically ill patients, and improving this might improve outcomes for many. That could (and should) change if improved functional outcomes, persisting for months after hospital discharge, are ever confirmed in large, well-conducted trials.

Ultrasounds 40

Ultrasounds Operations Outcomes Research 40

Don't Forget the Bubbles

DECEMBER 25, 2023

Interpreting Research Outcomes with a Little Bathroom Humour You have learned a method for how to read a research paper , and now you are faced with a bunch of outcomes. There are primary, secondary, composite , and safety outcomes. What are these outcomes? We know there is a bias towards reporting positive outcomes.

Research 83

Research Outcomes Fractures Hospitals 83

PulmCCM

APRIL 24, 2024

Now, a few intensivists are going for the gut, with a new bedside ultrasound-guided Seldinger-style procedure that could displace percutaneous endoscopic gastrostomy tubes (PEGs) placed by gastroenterologists or interventional radiologists. Accessing the esophagus will be new to most intensivists, but certainly not difficult.)

Ultrasounds 52

Ultrasounds Hospitals Operations Outcomes 52

Don't Forget the Bubbles

JUNE 19, 2023

There were no issues during the pregnancy, and estimated fetal growth by ultrasound was constant. Differential diagnosis of small babies The differential diagnosis for SGA and growth-restricted babies is extensive: The diagnosis of growth restriction in utero has improved because of the better use of ultrasound but still remains challenging.

Pediatrics 143

Pediatrics Ultrasounds Hyperthermia / Hypothermia Outcomes 143

Mind The Bleep

NOVEMBER 7, 2023

HPV 16 and 18 are the highest risk types. If the sample is positive for HPV, it is then examined under a microscope for the presence of abnormal cells (dyskaryosis).

Ultrasounds 52

Ultrasounds Outcomes 52

Sensible Medicine

NOVEMBER 6, 2023

Today I will tell you about one-year results of the SWISS-APERO trial—which compared outcomes with the two most common types of closure devices. This study report included only 45-day outcomes. They main outcome measure was patency of the left atrial appendage. This is a decidedly bad outcome. Pause there.

Stroke 128

Stroke Outcomes Ultrasounds Wellness 128

RebelEM

JANUARY 24, 2024

Wallace 2011 ) If addressed early and appropriately, most patients have good self-reported long-term outcomes regardless of the treatment modality Links Orthobullets: Achilles Tendon Rupture Resources: Sheth U et al. Partial rupture of the proximal Achilles tendon: a differential diagnostic problem in ultrasound imaging. Sports Med.

Operations 74

Operations Ultrasounds Outcomes Fractures 74

RebelEM

JUNE 19, 2023

PMID: 37314244 Clinical Question: In advanced trauma systems, does prehospital administration of TXA increase the rate of survival with a favorable neurologic outcome in patients at risk for trauma-induced coagulopathy? 1.00 (0.9 – 1.12) Secondary Outcome Mortality 24h 9.7% Prehospital Tranexamic Acid for Severe Trauma.

Outcomes 99

Outcomes Blood Transfusions Administration Hyperthermia / Hypothermia 99

Don't Forget the Bubbles

JANUARY 1, 2024

Lung ultrasound for the sick child: less harm and more information than a radiograph. Point-of-care ultrasound for non-vascular invasive procedures in critically ill neonates and children: current status and future perspectives. Outcomes From a Randomized Clinical Trial. Musolino AM, et al. Eur J Pediatr. 2023 Dec 22.

Pediatrics 98

Pediatrics Ultrasounds Blood Transfusions Sepsis 98

ACEP Now

MAY 9, 2024

These questionable practices led to a rash of bad outcomes. 6 Theoretically, ultrasound guidance should decrease this risk, which formed the basis for the 2022 Florida Medical Board regulation. 7 The impact of this latest set of regulations on the complication rate has yet to be reported. References Garcia SE. Butt Lifts Are Booming.

Emergency Department 52

Emergency Department Operations Ultrasounds Hospitals 52

Pediatric Education

FEBRUARY 4, 2024

A right-sided suprarenal mass had been identified on routine ultrasound during the third trimester that was thought to likely be an adrenal hemorrhage. The radiologic evaluation of an ultrasound examination showed a small hypoechoic mass in the area of right adrenal gland that was smaller than previously recorded prenatally.

Ultrasounds 52

Ultrasounds Pediatrics Radiology Radiology 52

RebelEM

AUGUST 31, 2023

CVC placement under ultrasound guidance has decreased overall complication rates and there is increased awareness of transfusion reactions, alloimmunization, acute lung injury, circulatory overload, as well as infection. Primary Outcome – Bleeding (Grade 2 to 4) Transfusion 4.8% Non-inferiority margin was set at 2.5% g/dl vs 8.5

Ultrasounds 57

Ultrasounds Outcomes Wellness Research 57

EM Literature of Note

JULY 27, 2023

Enrolled patients included those undergoing in-hospital, ultrasound-guided CVC placement, primarily “regular” CVCs, placed into the internal jugular and subclavian veins. The primary outcome was CVC-related bleeding, graded on a scale of 0 to 4, where Grade 3 and 4 bleeding was associated with significant intervention.

Allergic Reactions 74

Allergic Reactions Outcomes Ultrasounds Hospitals 74

Cook County EM Blog

MAY 1, 2023

A point-of-care ultrasound was performed, which identified thickening of the skin overlying the elbow with a cobblestone appearance, and an underlying fluid collection consistent with an olecranon bursitis. Ultrasound is often a more useful imaging modality and is readily available at the bedside. and ESR 26. 2017 Dec;45(6):781-786.

Ultrasounds 52

Ultrasounds Emergency Department Hospitals Outcomes 52

EB Medicine

APRIL 30, 2017

Topics covered in this episode of EMplify include Basics of acute decompensated heart failure Key differences in the pathophysiology of heart failure with reduced ejection fraction and heart failure with preserved ejection fraction Prehospital Care Initial ED Evaluation of acute decompensated heart failure Narrowing down the differential Physical exam (..)

Outcomes 40

Outcomes Best Practices Burns Ultrasounds 40

Don't Forget the Bubbles

OCTOBER 4, 2023

In the same journal , we learned that in fetuses with transposition of great arteries (TGA), a better prenatal diagnosis led to poorer early postoperative outcomes. A Randomized Controlled Trial of a NICU Language Intervention for Parents of Preterm Infants and Two-Year Language Outcomes. As always, more research seems needed.

Pediatrics 111

Pediatrics Fractures Outcomes Research 111

Taming the SRU

AUGUST 7, 2023

The patient needs a transvaginal ultrasound w/ doppler with gynecology consult and possible laparotomy TVUS is not just for torsion, it can also be used for ectopic pregnancies or pregnancy of unknown location Acute Ischemic Stroke Updates WITH Drs. hours increased the NNT for a good outcome to 20. The expanded window of 3-4.5

Stroke 84

Stroke Outcomes EKG/ECG Research 84

EMDocs

MAY 15, 2024

Ultrasound Sensitivity 88-100%, specificity 68-94% Positive likelihood ratio of 14.6 (95% While chest radiograph is often the first-line imaging modality, lung ultrasound has higher sensitivity and can detect pulmonary abnormalities earlier; CT imaging should be considered if initial imaging is negative or if concern for PE is present.

Blood Transfusions 69

Blood Transfusions Fluid Resuscitation Dehydration Ultrasounds 69

EMDocs

NOVEMBER 18, 2023

A point of care ultrasound of the liver reveals the following: Image 1: Ultrasound of the liver showing abnormal hepatic artery flow and resistance index 1 Question: What is the diagnosis? Early hepatic artery thrombosis after liver transplantation: a systematic review of the incidence, outcome and risk factors. Pediatr Radiol.

EMS 67

EMS Ultrasounds Emergency Department Outcomes 67

RebelEM

APRIL 29, 2024

The current standard of practice has moved away from landmark-based central line placement given the efficacy and safety of ultrasound-based techniques. This study also showed the median time for IO placement was only 1.2 minutes compared to a mean placement time of 10.7 minutes CVC group.

Resuscitation 102

Resuscitation Administration Emergency Department Hospitals 102

Core Ultrasound

MARCH 25, 2024

The IVC is unable to reliably tell you anything about fluid responsiveness but fluid responsiveness is a flawed outcome and we have to start taking a more holistic view on the administration of fluid. If one is going to access the collapsibility of the IVC one should probably look at it in the transverse plane as well 3.

Administration 98

Administration Sepsis Ultrasounds Outcomes 98

The Skeptics' Guide to EM

NOVEMBER 23, 2019

Increased Sensitivity of Focused Cardiac Ultrasound for Pulmonary Embolism in Emergency Department Patients With Abnormal Vital Signs. Increased Sensitivity of Focused Cardiac Ultrasound for Pulmonary Embolism in Emergency Department Patients With Abnormal Vital Signs. Date: November 21st, 2019 Reference: Daley et al.

Ultrasounds 52

Ultrasounds Emergency Department Academics Outcomes 52

EMDocs

JANUARY 16, 2024

Patients can have excellent outcomes despite prolonged resuscitation. VF/asystole), a pulse cannot be identified via Doppler ultrasound for a full minute, or if lack of organized cardiac activity is confirmed on bedside echocardiogram. This is a good time to utilize an arterial line or use the ultrasound to find a central pulse.

Hyperthermia / Hypothermia 83

Hyperthermia / Hypothermia Resuscitation CPR EMS 83

Ultrasound Gel

SEPTEMBER 2, 2019

We know that the carotid arteries are easily seen on ultrasound, but usually we think of this scan in the context of comprehensive sonography. These authors had an idea - maybe measuring the Carotid Intima-Media Thickness (CIMT), could be a predictor of the outcomes of a cardiac stress test. Is this brilliance or craziness?

Ultrasounds 52

Ultrasounds Outcomes 52

PulmCCM

JUNE 26, 2023

No outcomes regarding the delirium itself were reported (i.e., Private equity-backed firms are buying and expanding physician practices and squeezing them for profit, with little regard for patient outcomes, professional standards, or ethics. whether haloperidol actually reduced delirium).

Outcomes 98

Outcomes Hospitals Ultrasounds Wellness 98

The Skeptics' Guide to EM

DECEMBER 10, 2022

One-year outcome of surgery compared with immobilization in a cast for adults with an undisplaced or minimally displaced scaphoid fracture: A meta-analysis of randomized controlled trials. Other imaging modalities like bone scan, ultrasound and CT scan have been used but found to be lacking in accuracy. 0.23) * Ultrasound 0.27 (0.13–0.56)

Operations 52

Operations Fractures Military Emergency Department 52

RebelEM

MARCH 8, 2023

Rapid diagnosis and emergency referral improves outcomes of ophthalmologic interventions. Signs Shafer’s sign (tobacco dust) May see a Weiss ring when the posterior vitreous (PV) detaches from the optic disc margin Visualization with ultrasound. Rapid diagnosis and emergency referral improves outcomes of ophthalmologic interventions.

Stroke 52

Stroke Emergency Department Ultrasounds Outcomes 52

Don't Forget the Bubbles

MAY 8, 2024

An interesting study (JAMA Pediatrics) shows the benefits of newborn screening for spinal muscular atrophy (SMA), as initiating disease-modifying therapy earlier improves clinical outcomes. These findings advocate for expanding newborn screening programs to enhance outcomes for children with SMA. Dell KM, et al. Koenis MM et al.

Pediatrics 69

Pediatrics Emergency Department Outcomes Research 69

JournalFeed

MAY 7, 2022

Airway POCUS Spoon Feed: Upper airway ultrasound (UA-US) may eventually help us predict if a patient will have a difficult laryngoscopy ahead of time. These are summaries from just 2 of the 5 article we cover every week! For access to more, please visit JournalFeed.org for details about becoming a member.

Advances Cardiac Life Support (ACLS) 40

Advances Cardiac Life Support (ACLS) Resuscitation Ultrasounds Outcomes 40

Sensible Medicine

DECEMBER 28, 2023

One makes an ultrasound device, the other a radiofrequency device. Here is Kaul again: My translation is that the Recor device (ultrasound) approval was very weak. Longer term data (3 years) found higher rates of poor outcomes. III Renal Denervation for high blood pressure. This was a recent FDA approval.

Stroke 125

Stroke Ultrasounds Outcomes Hospitals 125