Difficult Intravenous Access Requiring Ultrasound in the Emergency Department: Associations With Delays in Care and Areas for Quality Improvement.

Background Patients with difficult intravenous access (DIVA) requiring ultrasound-guided intravenous (USGIV) access have been associated with delays in treatment, imaging, and disposition in academic emergency department (ED) patient populations. Our objective in this study was to characterize differences in time to intravenous access, imaging, and disposition between patients with DIVA versus those without DIVA requiring USGIV access in a community ED while also assessing for DIVA-associated comorbidities. Methods A cross-sectional, observational analysis was performed on admitted ED patients evaluated from September 2 to September 31, 2022, at a community ED.

Implementation of a Resident-Designed Procedure Cart in a Busy Emergency Department.

The authors present a description of the procedure cart they designed for their Emergency Department. This project was in response to the inefficiencies in having to gather supplies from various locations to get set up. A complete description including each of the drawer contents is provided to allow others to easily replicate a tool that saved the authors much time and frustration in daily practice.

Acute Upper Extremity Arterial Occlusion Diagnosed on POCUS in the Emergency Department.

Upper extremity acute limb ischemia (ALI) is a limb-threatening and potentially lethal pathology that is most commonly caused by vascular embolization. Outcomes of limb ischemia are time-sensitive due to the correlation between a longer time from symptom onset to intervention with a vastly higher risk of amputation. In this report, point of care ultrasound (POCUS) was utilized to rapidly diagnose a patient with a proximal right brachial artery embolic occlusion, prompting expedited surgical consultation and successful embolectomy.

Morel-Lavallée lesion of the distal thigh: Emergency department diagnosis with point-of-care ultrasound.

A Morel-Lavallée lesion (MLL) is a rare, closed traumatic soft-tissue degloving injury that is often misdiagnosed. The mechanism that results in this lesion involves a shearing force that separates the hypodermis from underlying fascia, thereby disrupting perforating vascular and lymphatic vessels and resulting in a hemolymphatic fluid collection prone to infection and pseudocyst formation. We describe a case of a 70-year-old male with an initially missed MLL despite CT imaging that was ultimately diagnosed on point-of-care ultrasound (POCUS) on a second emergency department visit.

Emergency department point-of-care ultrasound diagnosis of active bleeding into the intraluminal thrombus of an abdominal aortic aneurysm.

Rupture of an abdominal aortic aneurysm (AAA) is an immediately life-threatening phenomenon with substantial mortality. Although most AAAs are asymptomatic, an impending AAA rupture can be heralded by nonspecific symptoms and imaging findings on CT and point-of-care ultrasound (POCUS). In this report, we present a case of an 81-year-old male with an atypical presentation of an AAA with novel sonographic findings of imminent rupture on POCUS with Doppler that prompted successful emergent intervention.

Molar pregnancy presenting in the emergency department.

A 27-year-old female grava1 para 0 presented to the emergency department with complaints of intractable nausea and vomiting associated with fatigue and shortness of breath for the past 2 weeks with concerns for pregnancy. Physical exam was benign. Labs were significant for a β-hcg level of 348,260 mIU/mL.

Emergency Department Point-of-Care Ultrasound Diagnosis of a Large Bowel Obstruction Due to Metastatic Rectal Cancer: A Case Report.

Large bowel obstruction (LBO) is a life-threatening condition seen most often in the geriatric population. LBO can present with nonspecific abdominal pain that can overlap with other pathologies, such as abdominal infection, acute aortic disease, intestinal perforation, and atypical acute coronary syndrome in the geriatric population. Delays in diagnosis of colonic obstruction result in significant mortality due to complications involving bowel necrosis, perforation, and sepsis.

Penetrating Aortic Ulceration With Pseudoaneurysm and Intramural Hematoma: Emergency Department Management and Point-of-Care Ultrasound Diagnosis.

Penetrating aortic ulcer (PAU) complicated by an intramural hematoma is a rare and potentially life-threatening emergency department (ED) presentation that is defined by progressive ulceration through the intima layer into the media layer of the aorta. Symptomatic PAUs can be clinically indistinguishable from other life-threatening pathologies such as aortic dissection, acute coronary syndrome (ACS), intrabdominal catastrophes as well as less lethal processes such as musculoskeletal back pain. Given the potential of PAUs to result in lethal aortic rupture and dissection, the emergency provider should maintain a high index of suspicion in patients with risk factors for aortic pathologies and utilize diagnostic modalities such as point-of-care ultrasound (POCUS) to expedite diagnosis.

COVID-19 Vaccine Hesitancy Among Healthcare Providers.

Objective: Vaccine hesitancy among healthcare providers can compromise public confidence in vaccination during the ongoing COVID-19 global epidemic and increase susceptibility to life-threatening disease. We sought to investigate predictors of openness to vaccination among healthcare workers who choose not to be vaccinated against COVID-19 in order to explore potential solutions.

Methods: Physicians, physician assistants, and nurses who chose not to be vaccinated were surveyed to decipher reasons for vaccine refusal and personal loss due to the virus along with demographic variables.

Abnormal Bedside Ultrasound Findings in a Complex Patient With Kawasaki Disease.

We herein report a case of an 18-year-old female with Kawasaki disease who presented to the emergency department with epigastric abdominal pain and was subsequently found to have free fluid present in her abdomen visualized on bedside Focused Assessment with Sonography for Trauma (FAST) exam. Kawasaki disease is an acute vasculitis syndrome that primarily affects children and can have serious complications such as coronary artery aneurysms. The use of ultrasound in emergency departments is rapidly increasing, with the FAST being one of the most commonly performed bedside ultrasound examinations.

Acute Management of Trimalleolar Fracture.

Extremity trauma is a common emergency department presentation. The authors report a case of an elderly woman who sustained a trimalleolar ankle fracture. Emergency department care includes stabilization of the fracture with a splint, with careful assessment of neurovascular status.

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.

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.