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Emergency Ultrasound Section Newsletter - April 2015

Tips and Tricks: Ultrasound in the Diagnosis of Acute Appendicitis

Appendicitis1Acute appendicitis is one of the most common abdominal surgical emergencies. The diagnosis of acute appendicitis can be challenging, with a significant portion of patients initially misdiagnosed due to atypical clinical presentations and nonspecific laboratory tests. A delay in diagnosis increases the risk of perforation and, as a result, mortality rates.

The role of bedside ultrasound (US) by emergency physicians in the evaluation of appendicitis continues to evolve.

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Case Report: Seemingly Healthy College Student with Foot Pain

FootPain1Chief Complaint: Bilateral Foot Pain and Numbness


  1. Why did this otherwise young healthy male without chest pain have an abnormal electrocardiogram (EKG) and bilateral foot pain?
  2. Describe the abnormality on this patient’s parasternal short axis view.
  3. Describe the abnormality on this patient’s parasternal long axis view.

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Ask the Expert: 2014: A Banner Year for Point-of-Care, Clinician-Performed Ultrasound (PoCUS)

I always enjoy the New Year and look forward to the year ahead. Rarely do I wonder: Can we do better next year than this one? - 2014 will be challenging to top from the standpoint of PoCUS.

Just a few things that made 2014 special:

In 2014, we saw the start of a new organization, the P2 Group; P2 stands for Pediatric (EM) and PoCUS. In May, Jason Fischer at Toronto’s Sick Kids Hospital brought together many of the top pediatric sonologists in North America and beyond for the 1st P2 Conference. While many of our pediatric colleagues have trained many and completed fantastic scholarly activities, the advent of P2 is a watershed event that will herald a rapid expansion of the use of ultrasound in the care of children. In 2015, we will see the formal organization of P2 and the further expansion of PoCUS training in PEM programs, PICUs, and the general practice of pediatrics. If you think you have heard a lot about radiation mitigation (especially in kids) over the past few years…you ain’t heard nothin’ yet!

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Fellow’s Corner: Case Report - Right Hip Pain and Ultrasound-Guided Femoral Nerve Block

HipPain1Chief Complaint: Right hip pain after a fall  


What anatomy and pathology are shown in Figures 1-3?

  1. How can ultrasound be used in the treatment of this pathology?
  2. What are some of the advantages of using ultrasound to guide pain control for this condition?

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Chair’s Corner: Negotiation and Rejection

ResaLewissNegotiation and rejection have a tight relationship. If you fear rejection, you are less likely to ask for what you want in your position as an ultrasound faculty member, fellowship director or division director - you are less likely to negotiate. However, I believe negotiation within your leadership position can be learned and practiced, just as you can practice comfort with rejection. A recent read and a recent listen support my premise: “Women Don’t Ask: Negotiation and the Gender Divide” is a worthwhile book on why negotiation is different for men and women. Place this on your reading list if you want more protected time, resources, or even salary. These allow freedom to develop yourself, your division and your educator effectiveness. All of us are mentors and this will be useful in your mentoring relationships. NPR’s show “Invisibilia” recently ran an episode on Rejection Therapy ( The piece illustrates one man’s journey with gaining comfort with rejection. Take a listen. Get comfortable with rejection and you will find the courage to ask for the things you want for your job, for your career, and for your self-contentment.

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Journal Watch

Using Google Glass Remotely To Guide Ultrasound… Cool
Russell PM1, Mallin M, Youngquist ST, et al. First “glass” education: Telementored cardiac ultrasonography using Google Glass- a pilot study. Acad Emerg Med. 2014;21(11):1297-1299.

Ultrasound is quite sensitive for detecting distal radius fractures
Kozaci N1, Ay MO2,Akcimen M1, et al. Evaluation of the effectiveness of bedside point-of-care ultrasound in the diagnosis and management of distal radius fractures. Am J Emerg Med. 2015;33(1):67-71.

Ultrasound can help guide forearm fracture reduction
Dubrovsky AS1, Kempinska A2, Bank I3, et al. Accuracy of Ultrasonography for Determining Successful Realignment of Pediatric Forearm Fractures. Ann Emerg Med. 2015;65(3):260-5.

The Biggest Legal Risk of Point-of-Care Ultrasound is NOT Doing It
Stolz L, O’Brien KM, Miller ML, et al. Ethical and Legal Issues: A Review of Lawsuits Related to Point-of-Care Emergency Ultrasound Applications. West J Emerg Med. 2015; January, Vol XVI, No. 1: pp 1-4. 

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Want to get involved?

Many thanks to all our incredible section editors! If you have a great case, an article review, commentary, or tech update for the next newsletter, then please contact Laleh Gharahbaghian and John Bailitz.

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