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Emergency Ultrasound Section Newsletter - June 2015

ACEP US News - Airway US, TEE, intussusception and More!

Chair’s Corner: Making Meetings Matter

ResaLewissMeetings. Good in moderation, like most things. Something I think about and have read about is how to run a meeting. There are many books dedicated to this topic. One I would suggest as a start: How to Make Meetings Work by Michael Doyle and David Straus. A few aspects that are important to consider. The agenda, the recorder, the time allotted, the summary notes. These items can be modified based upon the formality or informality of the get together. People like structure and people like their time to be respected; consequently, the shorter and more focused the meeting, the more pleased people seem. I often designate someone to take notes ahead of time. This helps me to concentrate on leading the discussion, moving the conversation along, and tracking time. Send your summary notes as close to the meeting completion as possible. Otherwise momentum is lost and the action items fall to the bottom of people’s priority list. Play around with running your meetings. I think you will see a difference.

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International Ultrasound: Update from East Africa

ConeUgandaThe need for ultrasound education around the globe continues, and in this quarter’s newsletter we provide an update on the efforts occurring in East Africa to educate local healthcare professionals in point-of-care ultrasound. The PURE initiative (Point-of-care Ultrasound in Resource-limited Environments), led by Dr. Trish Henwood, continues to expand its training initiatives across Africa. This spring another successful training cycle was completed in both Mbarara, Uganda and in Kigali, Rwanda.

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Case Report: Tender Tummy with a Twist

Chief Complaint: Abdominal painCASE-1

Questions 

1. What are the significant findings in the above
    ultrasound images?
2. Describe the ultrasound technique to assess for this
    condition.
3. Can emergency physicians reliably use point of care
    ultrasound (PoC US) to detect this condition?

Case Presentation: A previously healthy 7-year-old female presented with 1 day of intermittent abdominal pain associated with nausea. Her parents reported she was tolerating oral liquids, and denied any associated fever, vomiting, diarrhea, bloody stools, dysuria, urinary frequency, rash, cough, chest pain, or dyspnea. She was seen at her pediatrician’s office earlier that day and treated with ondansetron and ibuprofen. She was subsequently brought to the emergency department because of persistent and worsening pain.

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Ask the Expert: How Do You See the Economics of Point-of-Care Ultrasound Changing with the Evolving Healthcare Environment?

Healthcare economics is an applied field of study that allows for the systematic and rigorous examination of the problems faced in promoting healthcare for all. Complicating the situation is the fact that healthcare is different from other goods and services. The health care product [treatment of disease or injury] is not consistently well-defined and not generally desirable, the outcome of care is uncertain, the industry includes for-profit and nonprofit providers, and payments are made by third parties [leaving patients and providers with little knowledge of actual costs]. Many of these factors are present in other industries as well, but in no other industry are they all present; and it is the interaction of these factors that tends to make health care unique.

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Fellows Corner: TEE anyone?

Just Last Week from Mike Mallin:

Fellows-1A 75 year old male is brought in from the field in cardiac arrest. He had witnessed V-Fib arrest by EMS and received 3 total shocks en route with intermittent return of spontaneous circulation. On arrival to the ED, the patient is intubated and not receiving compressions, reported to be in sinus rhythm. After moving him over to the gurney, the airway is confirmed but a pulse cannot be palpated. “Restart chest compressions” says the physician as the patient is hooked up to a monitor and the provider attempts to visualize the heart with a bedside transthoracic echo (TTE) during the 2 minute pulse check, which elicits a narrow complex rhythm at 70. The provider struggles with the TTE for 10 seconds during the pulse check, but cannot obtain a view. No one can feel a pulse.

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ACEP Launches Clinical Ultrasound Accreditation Program!

CUAPLogoWe are pleased to announce that ACEP is providing accreditation of clinical ultrasound programs through the Clinical Ultrasound Accreditation Program (CUAP) as of June 15, 2015. First approved for development by the ACEP Board in 2008, this program is the culmination of years of discussion, work and implementation by the Emergency Ultrasound Section and ACEP staff. For an application and more information go to https://cuap.acep.org/

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Tips and Tricks: Airway Ultrasound

US_ETTIn recent years, the use of ultrasound (US) for confirmation of endotracheal tube (ETT) placement has gained increasing popularity. Several techniques already exist to confirm endotracheal tube placement. However, every tool has its limitations, and some are not always available in the emergency department (ED). The likely reason that airway US has gained attention is the ease at which images can be obtained. Airway US for ETT confirmation is best used when the end-tidal CO2 monitor is not accurate, radiology is unavailable, the patient arrives intubated and requires airway confirmation, or the patient does not respond as expected after intubation. There are some tips and tricks that can assist in obtaining the best view.

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Journal Watch

A great review of focused cardiac ultrasound (FOCUS) with a catchy mnemonic to help remember it. 
The "5Es" of Emergency Physician-performed Focused Cardiac Ultrasound: A Protocol for Rapid Identification of Effusion, Ejection, Equality, Exit, and Entrance.
Kennedy Hall M, Coffey EC, Herbst M, Liu R, Pare JR, Andrew Taylor R, Thomas S, Moore CL. Acad Emerg Med. 2015 Apr 22. doi: 10.1111/acem.12652. [Epub ahead of print]

Add some confidence to the evaluation and management of peritonsillar abscesses.
The use of ultrasound imaging in evaluation of peritonsillar infections.
Nogan S, Jandali D, Cipolla M, DeSilva B. Laryngoscope. 2015 May 6. doi: 10.1002/lary.25313. [Epub ahead of print]

You don’t have to be an expert to perform bedside lung ultrasound for CHF. 
Comparison of Expert and Novice Sonographers' Performance in Focused Lung Ultrasonography in Dyspnea (FLUID) to Diagnose Patients With Acute Heart Failure Syndrome.
Chiem AT, Chan CH, Ander DS, Kobylivker AN, Manson WC. Acad Emerg Med. 2015 Apr 22. doi: 10.1111/acem.12651. [Epub ahead of print]

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Make a Difference: Write that Council Resolution!

Many College members introduce new ideas and current issues to ACEP through Council resolutions. This may sound daunting to our newer members, but the good news is that only takes two ACEP members to submit a resolution for Council consideration. In just a few months the ACEP Council will meet and consider numerous resolutions.

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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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