Sonographer Educator in the Emergency Department to Prevent POCUS Skills Attrition: A Novel Education Intervention.

Background: Point-of-care ultrasound (POCUS) is a pivotal diagnostic tool for emergent conditions, yet the variable proficiency of emergency physicians (EPs) poses challenges. Inadequate skills may lead to care delays and suboptimal patient evaluation. This manuscript explores an innovative educational intervention deploying a Registered Diagnostic Medical Sonographer (RDMS) credentialed sonographer educator (SE) in a large academic Emergency Department (ED).

Focused cardiac ultrasound with mitral annular plane systolic excursion (MAPSE) detection of left ventricular dysfunction.

Objectives: Detecting reduced left ventricular ejection fraction (LVEF) by an emergency physician (EP) is an important skill. The subjective ultrasound assessment of LVEF by EPs correlates with comprehensive echocardiogram (CE) results. Mitral annular plane systolic excursion (MAPSE) is an ultrasound measure of vertical movement of the mitral annulus, which correlates to LVEF in the cardiology literature, but has not been studied when measured by an EP.

A Multicenter, Prospective Study Comparing Subxiphoid and Parasternal Views During Brief Echocardiography: Effect on Image Quality, Acquisition Time, and Visualized Anatomy.

Background: Recent literature has suggested echocardiography (echo) may prolong pauses in chest compressions during cardiac arrest.

Objectves: We sought to determine the impact of the sonographic approach (subxiphoid [SX] vs. parasternal long [PSL]) on time to image completion, image quality, and visualization of cardiac anatomy during echo, as performed during Advanced Cardiac Life Support.

Point-of-care Ultrasound Identification of Iliopsoas Abscess in Emergency Department: A Case Report.

Introduction: The iliopsoas muscle is a rare place for an abscess to collect. While these abscesses can have high mortality, they are often misdiagnosed. The use of point-of-care ultrasound (POCUS) can aid in earlier diagnosis.

Loop Drainage Is Noninferior to Traditional Incision and Drainage of Cutaneous Abscesses in the Emergency Department.

Background: There is limited research on loop drainage (LD) compared to incision and drainage (I&D) for treatment of cutaneous abscesses. We investigated whether LD was noninferior to I&D for abscess resolution and whether there was any difference in repeat ED visits or complication rates between these techniques.

Methods: We performed a prospective randomized controlled trial, using a convenience sample at an urban academic emergency department (ED).

Body mass index and B-lines on lung ultrasonography in chronic and acute heart failure.

Aims: Increased body mass index (BMI) is common in heart failure (HF) patients and is associated with lower levels of N-terminal pro-brain natriuretic peptide (NT-proBNP). We evaluated the influence of BMI on lung ultrasonography (LUS) findings indicative of pulmonary congestion (i.e.

Increased Sensitivity of Focused Cardiac Ultrasound for Pulmonary Embolism in Emergency Department Patients With Abnormal Vital Signs.

Background: Focused cardiac ultrasound (FOCUS) is insensitive for pulmonary embolism (PE). Theoretically, when a clot is large enough to cause vital sign abnormalities, it is more likely to show signs of right ventricular dysfunction on FOCUS, although this has not been well quantified. A rapid bedside test that could quickly and reliably exclude PE in patients with abnormal vital signs could be of high utility in emergency department (ED) patients.

Right atrial structure and function in patients with hypertension and with chronic heart failure.

Background: Prior studies have shown that both heart failure (HF) and atrial fibrillation (AF) are factors that impact left atrial function and structure. However, right atrial (RA) function measured as RA emptying fraction (RAEF) on echocardiography has not been analyzed systematically in a chronic HF population. The aim of this study was to assess RA volume index (RAVI) and RAEF in patients with chronic HF and patients with hypertension (HTN) and to relate these findings to other cardiopulmonary ultrasound parameters and 12-month outcomes.

Pulmonary Congestion by Lung Ultrasound in Ambulatory Patients With Heart Failure With Reduced or Preserved Ejection Fraction and Hypertension.

Background: Although pulmonary congestion can be quantified in heart failure (HF) by means of lung ultrasonography (LUS), little is known about LUS findings (B-lines) in different HF phenotypes. This prospective cohort study investigated the prevalence and clinical and echocardiographic correlates of B-lines in ambulatory HF patients with preserved (HFpEF) or reduced (HFrEF) ejection fraction compared with hypertensive patients. We related LUS findings to 12-month HF hospitalizations and all-cause mortality.

Diagnosing centrally located pulmonary embolisms in the emergency department using point-of-care ultrasound.

Objective: The study objective was to investigate the combined accuracy of right heart strain on focused cardiac ultrasound (FOCUS) and deep vein thrombosis (DVT) on compression ultrasound (CUS) for identification of centrally located pulmonary embolism (PE) diagnosed on computed tomography pulmonary angiography (CTPA).

Methods: This was a prospective observational study using a convenience sample of patients undergoing CTPA in the emergency department (ED) for evaluation of PE. Patients received a FOCUS looking for right heart strain (McConnell's sign, septal flattening, right ventricular enlargement or tricuspid annular plane systolic ejection (TAPSE) <17mm) and a CUS looking for DVT.

Ten Strategies for Optimizing Ultrasound Instruction for Group Learning.

Ultrasound use is rapidly increasing in clinical care and as an educational modality. While there is widespread interest in training health-care professionals to incorporate ultrasound into their daily practice, there are few resources available to guide instructors in the design of impactful and efficient training sessions. We present 10 practical strategies to optimize the educational value of ultrasound workshops for any audience.

Analysis of Emergency Department Length of Stay for Mental Health Patients at Ten Massachusetts Emergency Departments.

Study Objective: Prolonged boarding times in the emergency department (ED) disproportionately affect mental health patients, resulting in patient and provider dissatisfaction and increased patient morbidity and mortality. Our objective is to quantify the burden of mental health boarding and to elucidate the effect of insurance together with demographic, social, and comorbid factors on length of stay.

Methods: We conducted a cross-sectional observational study of 871 consecutive patients requiring an ED mental health evaluation at one of 10 unaffiliated Massachusetts hospitals.

Emergency Department-based Opioid Harm Reduction: Moving Physicians From Willing to Doing.

Objectives: Develop and internally validate a survey tool to assess emergency department (ED) physician attitudes, clinical practice, and willingness to perform opiate harm reduction (OHR) interventions and to identify barriers and facilitators in translating willingness to action.

Methods: This study was an anonymous, Web-based survey based on the Theory of Planned Behavior of ED physicians at three tertiary referral centers. Construction and internal validation of scaled questions was assessed through principal component and Cronbach's alpha analyses.

Opioid education and nasal naloxone rescue kits in the emergency department.

Introduction: Emergency departments (EDs) may be high-yield venues to address opioid deaths with education on both overdose prevention and appropriate actions in a witnessed overdose. In addition, the ED has the potential to equip patients with nasal naloxone kits as part of this effort. We evaluated the feasibility of an ED-based overdose prevention program and described the overdose risk knowledge, opioid use, overdoses, and overdose responses among participants who received overdose education and naloxone rescue kits (OEN) and participants who received overdose education only (OE).