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Emergency Ultrasound Section Newsletter - September 2015

Beyond Artifact: Lung Ultrasound in Your ED!


Chair’s Corner

ResaLewissWriting well can be a struggle. As physicians, we tell ourselves that we aren’t good because we are math and science types, not language writer types. However, just as everyone can be a runner, everyone can be a writer. About three years ago, I read a piece that really synthesized how to write and provided me with quality basic tenets. One idea per sentence. Simple language. Avoid redundancy. Another piece, which builds upon these tenets, offers that health care providers have a story-telling imperative. It actually may be necessary that we write to keep balance and to stay healthy. We should read, edit, and write as regularly as possible. We will improve and we will feel better.

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In mid September, we will be sending out a call for nominations for the following positions:

Chair Elect
Secretary/Newsletter Editor
Alternate Councillor

Once we have a slate of candidates, we will send out an e-ballot via SurveyMonkey (beginning of October) and you will have a chance to vote. The winners will be announced at the Section meeting at ACEP15.

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Tips and Tricks: LUNG LINES!

Lung1In recent years, point-of-care (POC) lung ultrasound (US) has gained significant popularity as a diagnostic tool in the acutely dyspneic patient. Several studies have shown the efficacy of lung US in diagnosing pulmonary pathology, with increased sensitivity compared to that of chest x-ray in many cases. Numerous pathologies can be detected at the bedside with POC lung US. The sensitivity of US for diagnosis of pulmonary edema approaches 94% with a specificity of 92%.(1) Diagnoses of COPD, asthma, pulmonary embolism, pneumothorax, and pneumonia can also be made with POC lung US with a positive predictive value ranging from 83% to 100%.(2)

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Journal Watch

Ultrasound confirmation of central line placement instead of CXR? We are getting there...
Gekle R, Dubensky L, Haddad S, Bramante R, Cirilli A, Catlin T, Patel G, D'Amore J, Slesinger TL, Raio C, Modayil V, Nelson M.
Saline Flush Test: Can Bedside Sonography Replace Conventional Radiography for Confirmation of Above-the-Diaphragm Central Venous Catheter Placement?
J Ultrasound Med
. 2015

Ultrasound is useful for evaluating metacarpal fractures but don’t throw out the x-ray yet.
Kozaci N, Ay MO, Kesapli M, Akcimen M, Sasmaz I, Turhan G, Boz A.
The effectiveness of bedside point-of-care ultrasonography in the diagnosis and management of metacarpal fractures.
Am J Emerg Med
. 2015 Jun 23. pii: S0735-6757(15)00538-0. doi: 10.1016/j.ajem.2015.06.052. [Epub ahead of print] PMID: 26175338

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Fellows Corner

FellowsCornerImagine this possible scenario: A 70 year-old male with pneumonia and sepsis develops hypotension, and your team wants to place a central venous catheter to give pressors.

Femoral vein access is precluded by a candidal skin infection under the abdominal pannus. He cannot tolerate lying fully recumbent due to dyspnea and thoracic kyphosis, and has very collapsible internal jugular veins on your pre-procedure ultrasound scan. Additionally, he has a large beard, and it seems likely to be difficult to optimally sterilize the skin of the neck for an internal jugular cannulation. You decide to obtain subclavian access, and start reviewing the landmark approach with your residents, but they ask you if there is a better way. How can ultrasound assist the placement of a subclavian line? Is it better than the landmark technique, and if so, how? Is it faster? Does it have shortcomings? What evidence can guide your decision? Darn medical students...

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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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Section Meeting

Dr. Lewiss has structured the Emergency Ultrasound Section meeting a little different this year. We will start out with a choice between two breakout sessions at 1:00 pm and then from 2:00pm – 4:00 pm, everyone will gather in Grand Ballroom AB for the Emergency Ultrasound Section meeting.

On Tuesday, October 27, 2015 at 1:00 pm please arrive at the Westin Waterfront Hotel and choose the topic that interests you.

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International Ultrasound: A view from the frontlines of international ultrasound. An Interview with Dan Kaminstein, MD

Intl_1Q: How did you come to be aware of and interested in ultrasound use in the international setting?

A: “Although I did not do a ton of traveling as a kid, I knew in medical school that I would want to work overseas. I chose residency at MCG (Medical College of Georgia) largely because of one individual, Dr. Ted Kuhn. He runs the International Fellowship at MCG and makes international experiences available to residents.  I took advantage of these offerings during my residency and did several 2-3 week trips, to places such as Mali, Guinea, Senegal, and Bangladesh.

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Ask the Expert: ACEP Clinical Ultrasound Accreditation Program (CUAP)

What is CUAP?

The Clinical Ultrasound Accreditation Program is a program dedicated to quality and safety created by the ACEP Emergency Ultrasound Section and ACEP staff.

Initially presented to the ACEP Board in 2008 subsequent to the approval of the ACEP 2008 Emergency Ultrasound Guidelines, the CUAP was thought to be a response to payors and other specialties trying to exclude clinicians from reimbursement for point-of-care ultrasound examinations. CUAP has now evolved into a comprehensive program to demonstrate to the public and others that Emergency Medicine and other clinicians performing ultrasound examinations are dedicated to high standards of quality and safety.

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Case Report: Diabetic Pain

DiabeticPain1Chief Complaint:
Thigh Pain


1. What are the findings
    in the Video?
2. How do these findings
    differ from simple
    cellulitis and abscess?
3. How reliable is point-
    of-care ultrasound for
    diagnosing this

Click Here for Video

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