Many thanks to Co-Editors Laleh Gharahbaghian and Michael Zwank on another great year of educational and entertaining ACEP US Newsletters. Congratulations to Dr. Sandy Schneider on her promotion to Associate Executive Director of Practice, Policy and Academic Affairs. Julie Rispoli is our Ultrasound Section Staff Liaison.Read More »
Ask The Expert
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Interview with Marek A. Radomski, DO, FACEP
Associate Chief of Emergency Services, UPMC-Presbyterian/Shadyside - Shadyside Campus
Director of Ultrasound Services, Department of Emergency Medicine - University of Pittsburgh Physicians
Assistant Professor of Emergency Medicine, University of Pittsburgh School of Medicine
Clinical Ultrasound: How do I work with other specialties?
Questions often arise among on how best to navigate the potential minefields that can exist between specialists and Emergency Physicians when performing clinical ultrasound studies in the point-of-care setting. The field of clinical ultrasound has expanded drastically over the course of the last several years with nearly all specialties using ultrasound in one capacity or another. The sentiment that only certain specialists should be performing ultrasound studies is obsolete and antiquated, but I find it especially important to have a good working relationship with as many other specialties as possible. Emergency Medicine as a discipline has outlined a specific fellowship in the field of clinical ultrasound, performs nearly every type of clinical ultrasound study, and has been performing these point-of-care studies as long as any other specialty -- positioning us to be leaders in the field.
Cases That Count: I Spy a Swollen Eye
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Chief Complaint: Eye trauma
Clip 1 - Ocular Ultrasound
- Identify the structures in Image 1 and Clip 1. What are the important landmarks to identify?
- What are your differential diagnoses and how do you differentiate between them?
- What are the potential complications of this clinical entity?
- In what other ways can point-of-care bedside ultrasound (POCUS) be helpful in the setting of ocular trauma?
Cases that Count: Use of POCUS for the Diagnosis and Management of Hypertrophic Obstructive Cardiomyopathy
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Hypertrophic obstructive cardiomyopathy (HOCM) is an occasionally encountered and under-recognized clinical entity in the critical and emergency care environment. Point-of-Care Ultrasound (POCUS) can be utilized to better recognize HOCM and tailor resuscitation.
A 49-year-old man with a history of decompensated cirrhosis secondary to alcoholic liver disease, complicated by hepatic encephalopathy, hepatorenal syndrome, recurrent pleural effusions, and ascites was admitted to the medical intensive care unit (ICU) for septic shock. The patient eventually required mechanical ventilation, blood transfusions, IR embolization, multiple vasopressor support and broad-spectrum antibiotics. Physical exam was notable for a systolic murmur, prompting further investigation. POCUS findings were consistent with HOCM.
FOAM Ultrasound: #FOAMus Highlight
Point-of-Care OB Ultrasound iBookRead More »
A product of an ACEP ultrasound section grant, the new ACEP Point-of-Care OB ultrasound book is bursting with crucial information that will be a huge aid to any bedside provider. This book bypasses the traditional method of book publishing by being available exclusively in iBook format.
Ultrasound GEL podcast
Ultrasound G.E.L. (Gathering Evidence from the Literature) is a new medical podcast featuring reviews of recent studies in point-of-care ultrasound (POCUS).
International Ultrasound: A view from the frontlines of international ultrasound: Interview with Dr. Laura Diegelmann
Q: Tell me about the path you have taken to become the physician you are today.Read More »
After completing residency at University of Maryland, I learned about a post-grad position to work with CareFlight in Australia. CareFlight employs physicians who work for aeromedical retrieval services, including the rotary wing Emergency Medicine Queensland (EMQ) and the fixed wing Royal Flying Doctor Services (RFDS). After that year working in remote parts of Australia without access to any reliable diagnostic imaging, I came back with a clear interest in ultrasound.
Tips & Tricks: Volume Status - Using the Internal Jugular Vein
1-5 Over or under fluid resuscitation can both be detrimental to critically ill patients or those with cardiovascular diseases.1-3 The gold standard was invasive monitoring with a central venous catheter, but due to the procedure’s inherent risks and potential to delay resuscitation, there has been ongoing research for noninvasive methods.1,4,6,7 Sonographic measurement of the inferior vena cava (IVC) has been widely studied and accepted as a tool to assess intravascular volume status.2,8-10 Multiple studies have demonstrated that respiratory variations of IVC measurements at 2cm from the right atrial-caval junction reliably reflects the central venous pressure.2,8-10 However, this technique is limited by body habitus, bowel gas, ascites, surgical scars, and wound dressing, thus providers have been searching for alternatives.3,6,8Central venous pressure (CVP) is crucial for evaluating the patient’s intravascular volume and hemodynamics, which has important indications on management for sepsis, congestive heart failure, pulmonary edema, trauma, and surgery.Read More »
Pediatric Emergency Ultrasound Update: Point-of-Care Ultrasound Evaluation for “Whiteout” Lung
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Chief Complaint: Fussiness
- What are common indications for lung ultrasound in the pediatric patient?
- What sonographic features are found with pleural effusions, and which features suggest simple vs. complex pleural effusion?
- What are common pitfalls encountered with lung ultrasound?