Resuscitative Ultrasound and Protocols.

The management of patients in shock or arrest is a critical aspect of emergency medicine and critical care. Rapid and accurate assessment is paramount in determining the underlying causes and initiating timely interventions. This article provides a summary of essential ultrasound protocols for the critically ill patient including the extended focused assessment with sonography for trauma (EFAST), rapid ultrasound for shock and hypotension (RUSH), and sonography in hypotension and cardiac arrest in the emergency department (SHoC-ED).

Bictegravir/emtricitabine/tenofovir alafenamide as first-line treatment in naïve HIV patients in a rapid-initiation model of care: BIC-NOW clinical trial.

Objective: Multiple strategies have been utilised to reduce the incidence of HIV, including PrEP and rapid antiretroviral therapy initiation. The study objectives were to evaluate the efficacy, safety, satisfaction, treatment adherence, and system retention obtained with rapid initiation of bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) in naïve patients.

Methods: This phase IV, multicenter, open-label, single-arm, 48-week clinical trial enrolled patients between January 2020 and June 2022.

DOLAMA 200: Effectiveness and Safety of a Dual Therapy with Dolutegravir Plus Lamivudine in Treatment-Experienced HIV-1 Infected Real World Participants in Spain.

The continuous pharmacological advances in antiretroviral treatment (ART) and the increasing understanding of HIV drug resistance has led to a change in the paradigm of ART optimization in the setting of the viral suppression of treatment-experienced patients with the emerging evidence of the effectiveness and safety of dual therapies. The aim of this study is to determine the antiviral efficacy and safety of switching to Dolutegravir + Lamivudine in people living with HIV, and to analyze the rate of patients with virologic failure (VF). A total of 200 patients were included with a median age of 51 years, 189 cells/µL of nadir CD4+, 13 years on ART and four previous ART regimens.

Paramedic-Performed Prehospital Tele-Ultrasound: A Powerful Technology or an Impractical Endeavor? A Scoping Review.

Ultrasound with remote assistance (tele-ultrasound) may have potential to improve accessibility of ultrasound for prehospital patients. A review of recent literature on this topic has not been done before, and the feasibility of prehospital tele-ultrasound performed by non-physician personnel is unclear. In an effort to address this, the literature was qualitatively analyzed from January 1, 2010 - December 31, 2021 in the MEDLINE, EMBASE, and Cochrane online databases on prehospital, paramedic-acquired tele-ultrasound, and ten articles were found.

Rildo: Real-World Multicenter Study on the Effectiveness and Safety of Single-Tablet Regimen of Dolutegravir plus Rilpivirine in Treatment-Experienced People Living with HIV.

Two-drug regimens (2DRs) are emerging in clinical practice guidelines as treatment option for both naive and treatment-experienced people living with HIV (PLHIV). To determine the real-life effectiveness of 2DR with 25 mg RPV plus 50 mg DTG in a single-tablet regimen (RPV/DTG) and its impact on viral and immune status, lipid profile, and inflammatory markers. This observational study included 291 treatment-experienced PLHIV, starting 2DR with RPV/DTG between 29 January 2019 and 2 February 2022, who were followed up for at least six months.

Delta Lactate (Three-hour Lactate Minus Initial Lactate) Prediction of In-hospital Death in Sepsis Patients.

This study examines the relationship between serial serum lactate levels and in-hospital mortality in an adult cohort of emergency department patients with severe sepsis or septic shock. Of the 164 patients in the cohort, 130 also got three-hour lactate in addition to the initial one. The median initial lactate was 3.

Serum Procalcitonin Level Is Associated with Positive Blood Cultures, In-hospital Mortality, and Septic Shock in Emergency Department Sepsis Patients.

This study examines the accuracy of initial and subsequent serum procalcitonin (PCT) levels in predicting positive blood cultures, in-hospital mortality, and development of septic shock in emergency department (ED) patients with severe sepsis. This study includes all patients who presented to our ED with an admission diagnosis of severe sepsis over a period of nine months. The median initial PCT was 0.

Assembly Line Education: A Novel Educational Technique for Today's Learners.

Background Education is undergoing a transformation. The traditional passive lectures are failing to capture and inspire the new generation of learners who value more active and collaborative learning techniques. Objective We sought to create a novel educational technique to integrate into our curriculum that would be more personalized, employ more active learning and collaboration, and allow for an effective assessment of resident strengths and weaknesses.

Pericardial effusion with tamponade: bedside ultrasonography saves another life.

In these video clinical images, the authors present the cause for an elderly gentleman's shortness of breath. It was presumed to be an exacerbation of chronic obstructive pulmonary disease, a condition for which he was in the process of being evaluated. However, bedside ultrasonography revealed a large pericardial effusion with tamponade.

Transthoracic Echocardiographic Findings of Stanford Type A Aortic Dissection: A Case Report.

Aortic dissection is a well-known, but relatively uncommon diagnosis in the emergency department (ED). With a mortality rate as high as 30 percent, it is important to be able to diagnose quickly and accurately. Definitive diagnosis with imaging studies such as computed tomography angiogram (CTA) can be expensive and time-consuming and may not always be available in the community.

Emergency Department Approach to Testicular Torsion: Two Illustrative Cases.

We present two cases of young men with spontaneous nontraumatic testicular pain. While the differential diagnosis for scrotal or testicular pain can include less urgent causes, such as epididymitis, hydrocele, referred pain, idiopathic scrotal edema, and inguinal hernia, for example, the most feared etiology for acute scrotal pain is testicular torsion. The fact that a testicle can torse and detorse is also a confounding factor.

Incidental Left Ventricular Aneurysm Discovered after Chest Pain Following a Motor Vehicle Collision.

We report the case of a female with a history of coronary artery disease who came in with chest pain after a motor vehicle collision. Imaging revealed an incidental left ventricular aneurysm. The presentation and management of left ventricular aneurysms are discussed, along with imaging findings on computed tomography, plain radiography, and ultrasonography.

Diagnosing Appendicitis in Pregnancy Via Ultrasonography.

The authors present a case of acute appendicitis during a first trimester pregnancy. Appendicitis in pregnancy is especially dangerous because perforation of the appendix increases the likelihood of maternal and fetal morbidity significantly. For this reason, it is important to diagnose and treat suspected appendicitis in pregnancy as soon as possible.

The Role of Serial Ultrasounds in Diagnosing Suspected Deep Venous Thrombosis.

Venous thromboembolisms (VTE), which include deep venous thrombosis (DVT) and pulmonary embolism (PE), are a major cause of morbidity and mortality in the United States and globally. This often underdiagnosed medical condition has many known risk factors including pregnancy, malignancy, immobility, exogenous estrogen use, and hereditary factors. A significant portion of emergency department visits involves ruling out these diseases.

Sepsis Cards and Facts: A Simple Way to Increase Sepsis Bundle Compliance.

Objective The objective of this study was to improve sepsis bundle compliance via an educational intervention in our emergency department (ED). Methods This was a before and after study. Historical data on sepsis bundle compliance was obtained from our quality officer.

Non-traumatic Retinal Detachment Diagnosed via Bedside Ultrasonography.

The authors report a case of an elderly patient with left eye retinal detachment who presented to the emergency department (ED). Bedside ultrasonography of the retina revealed a hyperechoic, smooth, folded membrane within the vitreous, consistent with a diagnosis of retinal detachment. Ophthalmological consultation was obtained, and the patient healed well after surgical repair.

Effect of monotherapy with darunavir/cobicistat on viral load and semen quality of HIV-1 patients.

Many patients previously using darunavir/ritonavir (DRV/r) (800/100mg) have switched to darunavir/cobicistat (DRV/C) (800/150 mg) either as part of triple therapy (ART) or as monotherapy with DRV (mDRV). The latter approach continues to be used in some countries for patients receiving long-term treatment. However, to date, the behaviour of DRV/C in the seminal compartment has not been analysed.

Communicating Value in Simulation: Cost Benefit Analysis and Return on Investment.

Value-based health care requires a balancing of medical outcomes with economic value. Administrators need to understand both the clinical and economic effects of potentially expensive simulation programs to rationalize the costs. Given the often-disparate priorities of clinical educators relative to health care administrators, justifying the value of simulation requires the use of economic analyses few physicians have been trained to conduct.

Communicating Value in Simulation: Cost-Benefit Analysis and Return on Investment.

Value-based health care requires a balancing of medical outcomes with economic value. Administrators need to understand both the clinical and the economic effects of potentially expensive simulation programs to rationalize the costs. Given the often-disparate priorities of clinical educators relative to health care administrators, justifying the value of simulation requires the use of economic analyses few physicians have been trained to conduct.

Effect of Monotherapy with Darunavir/Ritonavir on Viral Load in Seminal Fluid, and Quality Parameters of Semen in HIV-1-Positive Patients.

Patients with human immunodeficiency virus type 1 (HIV-1) who receive antiretroviral therapy (ART) often achieve increased survival and improved quality of life. In this respect, monotherapy with darunavir/ritonavir (mDRV/r) can be a useful treatment strategy. This prospective study analyses the effect of mDRV/r on sperm quality and viral load in a group of 28 patients who had previously been given conventional ART and who had recorded a viral load <20 copies/mL for at least six months.

[Chronic pelvic pain as a complication of cystourethropexy with tension free vaginal tape. Case report].

Objective: To report an interesting case of a rare complication of cystourethropexy, as well as its precise diagnosis and results after treatment.

Methods: We reviewed the medical records of the patients as well as their operative report and she underwent outpatient follow-up for the following six months. We descriptively report the findings.