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Emergency Ultrasound Section Newsletter - June 2014

Tips and Tricks: First Trimester Pregnancy Ultrasound – Trans-abdominal Pelvis

Fig1Because ultrasound is the imaging modality of choice in the evaluation of pregnancy, it is an integral skill for an emergency physician (EP) to be proficient with. The overwhelming majority of these evaluations in the emergency department are in patients presenting with abdominal pain or vaginal bleeding in the first trimester. The primary goal for an EP in this scenario is to identify an intrauterine pregnancy and rule out an ectopic pregnancy. Bedside ultrasound in first trimester pregnancy is not a comprehensive examination and it is essential to convey this to the patient and also to consider a radiology-performed complete ultrasound if the patient’s presentation dictates it.

We will review a few tips and tricks on how to acquire and interpret images of first trimester pregnancy and how to optimize those views. We will also briefly discuss recent changes in management with relation to beta-hCG levels.

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Technical Updates – Best Apps Part 2: EM, Procedures, MSK and General US!

UltraAppsFor this newsletter, I’ll be highlighting those apps designed specifically for emergency medicine, as well as several others addressing ultrasound-guided procedures, MSK ultrasound, and general radiology. (Echocardiography and critical care ultrasound apps will be covered in the 3rd and final part of this series.) 

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Great Case! Just another case of DOE...

Fig13Chief Complaint: Dyspnea on exertion

Questions
1. What anatomy and pathology are shown in the images?
2. Name the four sonographic findings in patients with this condition?
3. How do these ultrasound findings correlate to physical exam findings?

Case Presentation: A 60 year old female presented to the emergency department with a chief complaint of dyspnea on exertion. This had been slowly but progressively worsening over the 2 weeks leading up to her presentation. She also noted a viral-like syndrome shortly before symptom onset. 

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Quick Bits: Does this patient have intra-orbital pathology?

 Click here to watch the Video

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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 John Bailitz.

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Journal Watch

Articles reviewed:

US doesn’t help routine LP’s
Article: Peterson MA, Pisupati D, Heyming TW, et al. Acad Emerg Med. 2014;21(2):130-136. Ultrasound for Routine Lumbar Puncture.

EPSS to assess LV function validated again
Article
: McKaigney CJ, Krantz MJ, La Rocque CL, et al. Am J Emerg Med. 2014;32(6):493-7. E-point septal separation: a bedside tool for emergency physician assessment of left ventricular ejection fraction.

If the gallbladder and labs are normal, don’t sweat the common bile duct…
Article: Becker BA, Chin E, Mervis E, et al. J Emerg Med. 2014;46(1):54-60. Emergency biliary sonography: utility of common bile duct measurement in the diagnosis of cholecystitis and choledocholithiasis.

Bedside ultrasound machines and gel don’t carry a lot of BAD germs!
Article: Lawrence MW, Blanks J, Ayala R, et al. J Ultrasound Med. 2014;333:457-62. Hospital-Wide Survey of Bacterial Contamination of Point-of-Care Ultrasound Probes and Coupling Gel.

One small step closer to an ACGME certified fellowship
Article
: Lewiss RE, Tayal VS, Hoffmann B, et al. Acad Emerg Med. 2014;21(4):456-461. The Core Content of Clinical Ultrasonography Fellowship Training. 

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Ask the Expert: How do you evaluate trainee competency in Point of Care Ultrasound? An interview with Resa Lewiss

Resa Lewiss MD, FACEP
Chair-elect, ACEP Emergency Ultrasound Section
Chief, Emergency Ultrasound Division
St. Luke’s Roosevelt of Mount Sinai Hospital Center
New York City

Assessing competency through high quality, well-validated methods remains a challenge in graduate medical education. With ultrasound emerging as one of the twenty-three Milestones in Emergency Medicine [1], a demand now exists for proven assessment methods in competency for both diagnostic and procedural ultrasound. While numerous assessment methods have been developed, no single format can fully evaluate for competency in highly complex practices (eg, integration of knowledge into clinical decision-making and patient care) [2]. Therefore, before proceeding in answering this question it is important to first define the level of competency assessment we are trying to achieve.

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