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Emergency Ultrasound Section Newsletter - March 2017

That Sounds Great! Updates, Clinical Cases and Pearls of Emergency Ultrasound

 

Chair’s Corner

Dear Section: 
I’ve enjoyed having the opportunity to serve you as chair for the first few months. Here are some notable items on which we have been working:

The FDA
Many of you may have heard about a letter sent from the FDA to multiple organizations and ultrasound companies. The letter states that the FDA has “concerns” about the marketing of ultrasound as “over-the-counter” where ultrasound is used and not interpreted by a “licensed practitioner”, citing ultrasound in this manner would be a violation of the Food and Drug Cosmetic Act.

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Cases That Count: 29-Year-Old Male with Fever

Chief Complaint: Fever

Clip 1 - Parasternal Long-Axis Cardiac Ultrasound
Clip 2 - Apical 4-Chamber Cardiac Ultrasound

Questions

1. What are the significant findings in the above ultrasound clips?
2. What is your approach and differential diagnosis for this pathology?
3. Can emergency physicians reliably use point of care ultrasound (POCUS) to screen for this
    diagnosis?

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FOAM Ultrasound: #FOAMus Highlight

RAPTIR_1Welcome back to your ACEP Ultrasound Newsletter! The FOAM community is continuing to grow and change, and we have a great new resource for the beginning of 2017. Check out Dr. Andrew Herring’s brainchild, the Highland EM Ultrasound Pain Management website. We know that standard practices for pain management and anesthesia leave many of us and our patients wanting. Nerve blocks have become more popular recently and give us an opportunity to provide excellent anesthesia with low complication rates. Ultrasound is just the icing on the top!

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Cardiac Journal Summary

Case

ARVCYou arrive for a midnight shift ready, when walk-in triage brings back a 28 year-old male patient in cardiac arrest. The police accompany the patient and inform you that he was out celebrating his birthday and while he and friends were driving from one bar to the next, he became short of breath, which quickly progressed to severe dyspnea. His friends drove him to the hospital, during which his dyspnea was unrelieved by an albuterol inhaler, then dropped him off unresponsive at the front door and left. You evaluate the patient in the resuscitation bay - he is unresponsive, pulseless, apneic, mildly obese. Cardiac monitor reveals a narrow complex, slow rhythm consistent with PEA. Nursing obtains an IV while you intubate the patient and begin ACLS measures. Review of the EMR reveals multiple ED visits for symptoms related to asthma, as well as one prior intubation and ICU admission for respiratory failure. Despite aggressive resuscitation measures, serial cardiac ultrasounds reveal no cardiac activity, and you pronounce the patient dead. What happened to this man?

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Peter’s Pet Peeves: Reds on the Board

To ultrasound or not ultrasound? Do you feel pressured to ultrasound patients yourself because you have the ability to do so? Do you feel you are less of an emergency physician for not doing the ultrasound?

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New! ACEP Ultrasound CME Collection

ACEP eCMEThis online course includes ultrasound cases that will open your eyes, broaden your differentials, and improve your practice. Get ACEP Ultrasound CME Collection and experience the new lecture features while learning about uses for ED ultrasound and imaging. This package includes 1.25x, 1.5x, and 2.0x speed options.

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Ask the Expert: Interview with Michael Felicetta, DO

Interview with Michael Felicetta, DO
Clinical Ultrasound Program Director, Good Samaritan Hospital Medical Center, Progressive Emergency Physicians

What are the challenges you face as a new ultrasound fellowship director?

When starting an emergency ultrasound division, there are many factors to consider and hurdles to overcome. These considerations may vary widely among different institutions, depending on the available resources, the culture of the institution, and practice setting. As a relatively new ultrasound fellowship director at an academic emergency department, I would like to share my experiences with this task.

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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, please contact Michael Zwank or Laleh Gharahbaghian.

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Journal Summary

Point-of-Care Ultrasound for Suspected Acute Appendicitis Performs Better than Radiology-Based Ultrasound… if You are Really Good at It
Review by Michael Boniface, MD

Strengthening the Case for Ultrasound versus Chest Radiography for Confirmation of Central Venous Catheter Placement
Review by Michael Boniface, MD

Lung Ultrasound in Pediatric Patients Reduces CXR Utilization, Without Missed Pneumonias!
Review by Joshua Guttman, MD

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International Ultrasound: Global Ultrasound with Local Relevance - Rheumatic Heart Disease

Last night on shift, you brought in the ultrasound to evaluate a 28-year-old male, originally from Ethiopia, presenting with signs and symptoms concerning for heart failure. As you try to evaluate his squeeze, you note the mitral valve doesn’t look quite right (as below). You recall the medical student who presented the patient noted a low-pitched, rumbling, decrescendo, diastolic murmur best auscultated at the left lower sternal border…hmm, rheumatic heart disease (RHD) is on your differential and you wish you knew how to get a better sense of this during your bedside echo…

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Tips & Tricks: “Normo-tensive” Tamponade with Tips for US-Guided Pericardiocentesis

A 51-year-old male with metastatic non-small cell lung cancer presented with shortness of breath and bloating. He was normotensive (blood pressure 123/93), tachycardic (heart rate 110), tachypneic (respiratory rate 32), and hypoxic (oxygen saturation 97% on two liters of nasal cannula). Bedside ultrasound revealed a large pericardial effusion (PCE) with tamponade (Image below, Video 1Video 2Video 3Video 4) and plethoric inferior vena cava (IVC, Video 5).

Tamponade1

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