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Emergency Ultrasound Section Newsletter - May 2016

Ultrasound Section Cutting Edge Learning (& News) 

 

Chair’s Corner

Thank you Michael Zwank and Laleh Gharahbaghian for another outstanding newsletter!

Regarding subspecialty accreditation for clinical ultrasound, ABEM received an update from the American Board of Medical Specialties (ABMS) on the possible Certificate for Focused Expertise (CFE) described at our section meeting last October. The time for public comment on CFE ended on January 15th. Additionally, ABEM and ABMS solicited input from other major EM and non-EM organizations. ABMS reports that there was considerable opposition outside of EM to a CFE pathway largely because of concerns about detrimental effects on existing specialties and the lack of oversight by the Accreditation Council for Graduate Medical Education (ACGME). At their February 24th board meeting, ABMS did not reach a final consensus, but instead decided to further explore the CFE option.

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Cases That Count (Cardiac Tamponade)

Questions:
1. What key features are shown in the ultrasound clips to suggest cardiac tamponade?
2. What additional sonographic findings would be consistent with tamponade physiology?
3. How can ultrasound help guide the treatment of cardiac tamponade?

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FOAM Ultrasound: #FOAMus Highlight

Over the last few months there has been a plethora of great ultrasound education and discussion online. One particular standout of the #FOAMus world is Dr. Ben C. Smith. He is the emergency ultrasound fellowship director at the University of Tennessee, Department of Emergency Medicine. Dr. Smith has created clean, simple and highly informative diagrams including the FASTgrades of hydronephrosisassessment of shock and advanced cardiac views. These images, which can be found on Twitter by following @ultrasoundjelly, have been retweeted and “liked” hundreds of times. If you want to learn more ultrasonography from Dr. Smith through weekly clinical cases, visit his website at http://www.ultrasoundoftheweek.com. Also, be on the lookout for an upcoming App or iBook from Dr. Smith, perfect for use during your next shift.

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International Ultrasound: View from the frontline: Ultrasound in Cambodia

Cambodia1

Drs. Rothsovann (“Sovann”) Yong & Chris Clingan

A bit of background:
Chris and Sovann grew up on different continents, but since meeting during fellowship at UMass in Worcester, MA, their professional paths have joined on two sides of the ocean: Lowell, MA and Phnom Penh, Cambodia. 

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Fellow’s Spotlight: A Look at EUS Fellows’ Educational Projects

Avila 2Wilson
Hunter-Behrend
Education

Jacob Avila, MD - University of Kentucky, Lexington 

Casey Wilson, MD - Johns Hopins, Baltimore 

Michelle Hunter-Behrend, MD - Stanford University

Schafer-WelwarthInternational Health

Jesse Schafer MD and Jeremy Welwarth DO 
Beth Israel Deaconess Medical Center, Boston   

 

RobinsonPare

Research
Kristine Robinson, MD, FACEP - West Virginia University, Morgantown 

Joseph Pare, MD - Yale University, New Haven

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Pediatric Emergency Ultrasound Update

Announcement – New Pediatric Point-of-Care Ultrasound Guidelines

The past few years have seen incredible growth in pediatric point-of-care ultrasound. In addition to the development of consensus educational guidelines,1 publication of the first pediatric point-of-care ultrasound textbook,2 and foundation of the P2Network, a landmark policy statement and technical report endorsing the use of point-of-care ultrasonography by pediatric emergency medicine (PEM) providers was published.3 As a collaborative effort between the American Academy of Pediatrics (AAP), Society for Academic Emergency Medicine, American College of Emergency Physicians (ACEP), and the World Interactive Network Focused on Critical Ultrasound, this policy statement garners consensus among the PEM community and provides the framework for point-of-care ultrasound development within pediatric emergency departments (EDs).

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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 to contribute to the next newsletter, then please contact Michael Zwank and Laleh Gharahbaghian.

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Ask The Expert

“What can I do to make it easier to drain a peritonsillar abscess using ultrasound?”

Bob Gekle, MD, RDMS, FACEP
Associate Program Director, Emergency Medicine Residency
Associate Director, Emergency Ultrasound
Assistant Professor, NY Institute of Technology
Good Samaritan Hospital Medical Center
Progressive Emergency Physicians, PLLC

Sonographic diagnosis of peritonsillar abscess is well established as a standard in emergency medicine. Typically these are diagnosed with an endocavitary probe. It is also recommended that the drainage of a peritonsillar abscess be done under dynamic ultrasound guidance when diagnosed. The reason for this is two-fold. 1. There is less of a chance of missing the abscess, which is a known possibility with a blind approach and 2. The carotid artery, which usually lies just posterior to the tonsil can be avoided.

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Journal Summary

STONE Plus Score to help assess patients with suspected renal colic
Review by Josh Guttman, MD

The ‘Triple Scan’ improves diagnosis in dyspneic patients
Review by Amit Bahl, MD

Defining a normal optic nerve sheath diameter
Review by Tomislav Jelic, MD

Consider lung ultrasound for your first (or only) diagnostic imaging in presumed pediatric pneumonia
Review by Michael Boniface, MD

Clinician performed duplex ultrasound for acute mesenteric ischemia: not yet ready for primetime
Review by Michael Boniface, MD

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Cardiac Journal Summary

Does size matter? Wait for it… Wait for it… Yes and no. Anyone who has listened to, or read LITFL, EmCrit, Ultrasound Podcast or taken an echo exam has undoubtedly spent time memorizing the IVC table (Table 1) to estimate right atrial pressures (RAP). According to the American Society of Echocardiography, an IVC diameter >21mm in conjunction with inspiratory collapse <50% is predictive of RAP >10 mm Hg. Yet, when has anything in medicine proven to be the gospel?

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Tips and Tricks: Renal Ultrasound

TT_3Leading to approximately 1.2 million annual visits, renal colic is a common presentation amongst emergency department patients (1). Nephrolithiasis remains the most common cause of renal colic. As computed tomography (CT) imaging is highly sensitive and specific for renal stones, many practitioners have adopted the routine use of CT in the initial evaluation of renal colic patients. However, in the younger patient population presenting with renal colic, the ionizing radiation associated with CT imaging is not necessary as an initial assessment.

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Peter’s Pet Peeves (Special Contribution)

ClubGripYou walk into the room and see the resident’s face grimacing as he struggles with the ultrasound machine. A 67 year old patient with COPD, CHF and CAD, status post total knee arthroplasty presenting with CP and dyspnea. Your resident is trying to impress you with his POC US skills. Unfortunately, he only catches a rare, brief look at the heart through the nanometer sized window that the hyperinflated lungs will afford. After a couple minutes, the resident sighs in exasperation. You grab the probe and a short while later, you are pointing out the RV dilation, D-shaped LV, plethoric IVC, absence of pericardial effusion and hyperdynamic activity.

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