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Emergency Ultrasound Section Newsletter - February 2016

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

 

Chair’s Corner February 2016

First, I want to give a BIG thank you to Julie Rispoli, Dr. Sandy Schneider, and Dr. Resa Lewiss for coordinating an outstanding section meeting in Boston.

In keeping with prior years, the chair elect, Dr. Fields, immediate past chair Dr. Lewiss and I have reached out to each Committee co-chair to discuss annual goals and resources needed. To create a leadership structure to best serve our dynamic section, we have also formed a Special Committee of current Committee co-chairs to review and edit the Section's Operational Guidelines. Revisions will be sent via email to all section members next summer for discussion, followed by a vote at the October 2016 Section Meeting, with likely Board Approval at Scientific Assembly.

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Ask The Expert: “Should I/how can I get more involved in the ACEP Ultrasound Section”

Regularly this question arises from residents, medical students and colleagues who are interested in getting more involved and often have some good ideas for advancing our field. However, the individuals who may be very active in their institution or locally do not know how to go about taking this knowledge and experience to the next level - whether it be regionally or nationally. Personally, the worst thing to hear from our colleagues is the belief they do not have anything to offer. The most important thing is to recognize that everyone has something to offer. Whether it be a new technique, an idea for improving membership, newsletter section topics, ACEP Council resolutions, grant writing ability, research questions, or an interest in learning more about Clinical Ultrasound.

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Cases That Count: Young Female with Lower Abdominal Pain and Vaginal Bleeding

Abdominal PainChief Complaint: Abdominal pain with vaginal bleeding

Clip 1 - Watch on YouTube 
Clip 2 - Watch on YouTube

Questions
1. What anatomy and pathology are shown in the
     image and clips above?
2. What are the possible sonographic findings in
    patients with such conditions?
3. What risk factors should increase suspicion for this pathology?

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International Ultrasound: A View from the Frontlines: Point-of-care ultrasound in Kenya with Dr. Greg Bell

Kenya1Q: You have a key role in increasing the use of point-of-care ultrasound in Kenya. How did that happen?

A: I definitely did not have that as a goal of mine, but found it to happen by serendipity. From early in my medical training, I knew I wanted to do some volunteer work overseas but had no preference for location or nature of the work. I had gone to med school at Ohio State, completed an EM residency at the Medical College of Wisconsin, did a research fellowship at the University of Colorado and ended up in North Carolina for my first ‘real’ job after training. A friend in North Carolina had a friend of a friend in Kenya so that’s where I went.

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Tips and Tricks: Big Red - The Aorta and How to Improve Your Image

Aorta1Abdominal aortic aneurysms (AAA) are relatively common amongst older men, with a prevalence of 12.5% for men 75-84 years old, decreasing in prevalence with decreased age, and are uncommon in women.1 When ruptured, the mortality rate is high, between 50-80% for those who survive to the hospital making the diagnosis of ruptured AAA time sensitive. Early detection and diagnosis in the emergency department can decrease mortality from 75% to 35%.2 Although the gold standard for diagnosis is CT angiogram, it is not appropriate for the unstable patient. Unfortunately, with physical exam alone, a ruptured AAA is misdiagnosed in 32% of patients, usually as ureteral colic and myocardial infarction, with only 61% of patients presenting with the classic triad of abdominal pain, hypotension, and a pulsatile mass.3

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Want to Contribute?

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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ACEP Scientific Assembly Ultrasound Section Meeting Minutes

ACEP15The ACEP Emergency Ultrasound Section held its annual meeting in Boston on October 27, 2015. The meeting minutes are available to the members. 

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Cases That Count: Elderly Female from Home Found Unresponsive in Bathroom

Chief Complaint: Unresponsive

Clip 1 - Watch on YouTube
Clip 2 - Watch on YouTube

Questions
1. What anatomy and pathology are shown in the clips
    above?
2. What are some additional sonographic findings that may
    be seen in patients with this condition?
3. How can ultrasound findings help emergency physicians
    make clinical decisions pertaining to this disease?

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Journal Summary

Velocity Time Index
Reviewed by Joshua Guttman, MD

FAST & Thoracotomy
Reviewed by Tomislav Jelic, MD

DVT, Gallbladder, Paracentesis
Reviewed by Michael Boniface, MD

Carotid Flow Time & Blood Loss
Reviewed by Amit Bahl, MD

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Cardiac Journal Summary

Ehrman RR, Russell FM, Ansari AH, et al. Can emergency physicians diagnose and correctly classify diastolic dysfunction using bedside echocardiography?Am J Emerg Med. 2015; 33: 1178-1183.

Landesberg G, Gilon D, Meroz Y, et al. Diastolic dysfunction and mortality in severe sepsis and septic shock. Eur Heart J. 2012;33:895-903.

“They are just septic, give them some IV fluids,” said by any admitting physician. These same words are spoken at many hospitals, yet may seem humorous or even laughable by a clinician with point-of-care ultrasound experience. Why not make a positive impact on patient outcomes?

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The Use of Lung Ultrasound in the Critical Care and Emergency Settings to Identify Pleural Effusions

Vi Am Dinh 2016KEYWORDS: Lung Ultrasound, Critical Care, Pleural Effusions

ABSTRACT
Lung ultrasonography is a sensitive and specific bedside test to detect pleural effusions in critically ill patients. The technique to detect pleural effusions, as well as terminology of common findings within pleural effusions is discussed. One method of measuring and quantifying pleural effusions is provided.

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