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Emergency Ultrasound Section Newsletter - August 2016

Sonic Boom: Cases that Count, Studies that Stick, US News that you need to Hear!


Chair's Corner

Congratulations to Dr. Vivek Tayal and Dr. Chris Raio on completion of the 2016 ACEP US Guidelines. Over the last several months, Vivek and Chris tirelessly collaborated with numerous section leaders to update this landmark policy. The ACEP Board of Directors just approved the revisions which will be published in an upcoming edition of Annals of Emergency Medicine.

Please review this brief update from ABEM regarding subspecialty accreditation.

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Ask the Expert: TEE in the Emergency Department

Authored by:
Drs. Robert Arntfield and Drew Thompson
Division of Emergency Medicine, Department of Medicine
Western University
London, Ontario, Canada

TEE1Q: What is the utility of transesophageal echocardiography in the emergency department?

A: Point of care echo, typically done via the transthoracic approach (TTE), has transformed emergency care over the past 25 years. A routine part of the FAST exam in the assessment for traumatic hemopericardium, TTE is additionally used in cardiac arrest and is indicated for the focused assessment of LV and RV function, assessment of the IVC, and guiding procedures.(1) 

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FOAM Ultrasound: #FOAMus Highlight

Introduction to Bedside Ultrasound Volumes 1 and 2 on iBooks

Since 2013, an iBook authored by none other than Dr. Matt Dawson and Dr. Mike Mallin has been making waves in the world of ED Ultrasound and Point-of-Care Ultrasound. You may recognize their names from the The “Introduction to Bedside Ultrasound” represents the ideal of FOAM by being a free and easily downloadable text. You can find it on the iBooks store. While the text is well written and referenced, it is also jam packed with interactive diagrams, video loops, and narrated video demonstrations.

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Cardiac Journal Summary

Imagine the following phone call:

ED Physician: “Hey, I need to admit an elderly female for fever.”
Hospitalist: “What’s the source?”
ED Physician: “Hmmm … I don’t really have one. Urine and Chest X-Ray are negative, and the mental status is normal.”
Hospitalist: “Can’t they go home?”
ED Physician: “No, too high of a risk.”

I am certain that many of us have had the same conversation while working. Read through Tintinalli, Rosens, etc, and the cited mortality rates in the elderly are between 7 to 10%. With these poor outcomes, when do we order three blood cultures for the fever of unknown origin and presumptively treat for endocarditis?

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Tips & Tricks: The Big Squeeze - Cardiac Contractility and Right Ventricular Strain Assessment

EPSS1Leading to approximately 1.2 million annual visits, renal colic is a common presentation amongst emergency department patients (1). Nephrolithiasis remains the most common cause of renal colic. As computed tomography (CT) imaging is highly sensitive and specific for renal stones, many practitioners have adopted the routine use of CT in the initial evaluation of renal colic patients. However, in the younger patient population presenting with renal colic, the ionizing radiation associated with CT imaging is not necessary as an initial assessment.

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Peter’s Pet Peeves: Ultrasound Hygiene

“!#$@*&$%^!”. Yes, I have been known to utter more than my fair share of F-bombs, but some things make me go on a blitzkrieg. Bombarding the whole ED. Without concern for any collateral damage from my tirade, I rant on. “John Effen Jingleheimer Schmidt!”

What upsets me so much? See the two pics below. 

US Hygiene2US Hygiene1Who could leave the probe smeared in blood (or fluid from some bodily orifice)? Meanwhile, does anyone really think that a $2 bottle of gel is more important than a $10,000 linear array probe? Or why leave it unplugged, letting the battery drain dead? Now it won’t turn power on for that hypotensive patient in room 3! 

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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 to contribute to the next newsletter, then please contact Michael Zwank and Laleh Gharahbaghian.

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Cases That Count: Just another missed abortion?

PoCUS1Chief Complaint: Vaginal Bleeding


1) Identify the landmarks for the uterus. Do the below 
    clips represent a definitive intrauterine pregnancy?
2) What are your top two differential diagnoses and how
     do you differentiate between them? 
3) What risk factors should increase suspicion for this

Clip 1 & Clip 2

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Journal Summary

Point of Care Ultrasound quickly identifies source of sepsis and helps guide appropriate antibiotic selection
Review by Michael Boniface, MD

If you don’t use them, you will lose them - There was poor retention of cardiac ultrasound skills in residents who did not use them regularly.
Review by Tomislav Jelic, MD

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International Ultrasound

For this edition we are taking a break from our usual spotlight on the fantastic global ultrasound efforts of our membership to request more information from you! Please let us know if you or your department/organization are involved in global health and ultrasound projects by taking a few minutes to complete the survey “ACEP EUS International Teaching Opportunities.

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Fellow’s Spotlight: A Look at EUS Fellows’ Projects

Grace W. Wanjiku MD
Yale University, New Haven, CT

Grace Wanjiku Project
Grace, an EUS fellow at Yale, is collaborating with the Emergency Medicine Kenya Foundation to train Kenyan rural health care providers on E-FAST, focused echocardiography, and obstetric ultrasonography. This novel program begins with a pre-course self-study multimedia manual and pre-course testing. After completing a 3-day hands-on training session, a post-test is administered. Then, 3-months after the training session, an in-facility evaluation is performed and then the participants receive a scheduled refresher training.

Read about more projects by: 

John Eicken, MD, Brigham and Women’s Hospital
Dasia Esener, MD, MS, Kaiser Permanente San Diego
Joe Betcher, MD, University of Michigan 

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