Comparison of outcomes between pulseless electrical activity by electrocardiography and pulseless myocardial activity by echocardiography in out-of-hospital cardiac arrest; secondary analysis from a large, prospective study.

Objective: To measure prevalence of discordance between electrical activity recorded by electrocardiography (ECG) and myocardial activity visualized by echocardiography (echo) in patients presenting after cardiac arrest and to compare survival outcomes in cohorts defined by ECG and echo.

Methods: This is a secondary analysis of a previously published prospective study at twenty hospitals. Patients presenting after out-of-hospital arrest were included.

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.

A retrospective study of pulseless electrical activity, bedside ultrasound identifies interventions during resuscitation associated with improved survival to hospital admission. A REASON Study.

Objective: Our objective was to determine whether organized or disorganized cardiac activity is associated with increased survival in patients who present in pulseless electrical activity (PEA) treated with either 1) standard advanced cardiac life support (ACLS) medications or 2) other interventions.

Methods: This was a secondary analysis of a prospective, multi-center observational study utilizing ultrasound in out-of-hospital or inemergency department PEA arrest. Bedside ultrasound was performed as ACLS protocol started and during pulse checks.

Emergency department point-of-care ultrasound in out-of-hospital and in-ED cardiac arrest.

Background: Point-of-care ultrasound has been suggested to improve outcomes from advanced cardiac life support (ACLS), but no large studies have explored how it should be incorporated into ACLS. Our aim was to determine whether cardiac activity on ultrasound during ACLS is associated with improved survival.

Methods: We conducted a non-randomized, prospective, protocol-driven observational study at 20 hospitals across United States and Canada.

Ultrasound-guided forearm nerve blocks in kids: a novel method for pain control in the treatment of hand-injured pediatric patients in the emergency department.

Objectives: Ultrasound-guided forearm nerve blocks have been shown to safely reduce pain for emergency procedures in the adult emergency department (ED). Although ultrasonography is widely used for forearm nerve blocks in the adult ED and in the pediatric operating room, no study to date has examined its use in the pediatric emergency setting.

Methods: We conducted a prospective nonblinded descriptive study of ultrasound-guided ulnar, median, and radial nerve blocks in a convenience sample of pediatric patients with hand injuries requiring procedural intervention who presented to a freestanding pediatric ED.

The BUDDY (Bedside Ultrasound to Detect Dehydration in Youth) study.

Background: Prior research suggests that the ratio of the ultrasound-measured diameter of the inferior vena cava to the aorta correlates with the level of dehydration in children. This study was designed to externally validate this and to access the accuracy of the ultrasound measured inspiratory IVC collapse and physician gestalt to predict significant dehydration in children in the emergency department.

Methods: We prospectively enrolled a non-consecutive cohort of children ≤18 years old.

External validation and comparison of three pediatric clinical dehydration scales.

Objective: To prospectively validate three popular clinical dehydration scales and overall physician gestalt in children with vomiting or diarrhea relative to the criterion standard of percent weight change with rehydration.

Methods: We prospectively enrolled a non-consecutive cohort of children ≤ 18 years of age with an acute episode of diarrhea or vomiting. Patient weight, clinical scale variables and physician clinical impression, or gestalt, were recorded before and after fluid resuscitation in the emergency department and upon hospital discharge.

Closing the loop: best practices for cross-setting communication at ED discharge.

Purpose: This study aimed to develop emergency department best practice guidelines for improved communication during patient care transitions.

Basic Procedures: To our knowledge, there are no specific guidelines for communication at the point of transition from the emergency department to the community. In Rhode Island, we used a multistage collaborative quality improvement process to define best practices for emergency department care transitions.

A comparison of ultrasound-guided three-in-one femoral nerve block versus parenteral opioids alone for analgesia in emergency department patients with hip fractures: a randomized controlled trial.

Objectives: The primary objective was to compare the efficacy of ultrasound (US)-guided three-in-one femoral nerve blocks to standard treatment with parenteral opioids for pain control in elderly patients with hip fractures in the emergency department (ED).

Methods: A randomized controlled trial was conducted at a large urban academic ED over an 18-month period. A convenience sample of older adults (age ≥ 55 years) with confirmed hip fractures and moderate to severe pain (numeric rating score ≥ 5) were randomized to one of two treatment arms: US-guided three-in-one femoral nerve block plus morphine (FNB group) or standard care, consisting of placebo (sham injection) plus morphine (SC group).

Point-of-care ultrasound facilitates diagnosing a posterior shoulder dislocation.

Background: Posterior shoulder dislocation is an uncommon disruption of the glenohumeral joint. Risk factors include seizure, electric shock, and underlying instabilities of the shoulder joint.

Case Report: A 27-year-old man with a history of recurrent posterior shoulder dislocation presented to the Emergency Department with sudden shoulder pain and reduced range of motion about the shoulder after abducting and internally rotating his arm.

Identification of splenic infarction by emergency department ultrasound.

Background: Splenic rupture or infarction can occur secondary to acute infectious mononucleosis. Patients with abdominal pain and known or suspected infectious mononucleosis mandate evaluation for these complications, which can have significant morbidity or mortality.

Case Report: An 18-year old man presented to the emergency department (ED) with a 2-day history of left upper quadrant abdominal pain.

Ultrasound assessment of optic disc edema in patients with headache.

Point-of-care ocular ultrasonography is emerging as a powerful tool to evaluate emergency department (ED) patients at risk for ophthalmologic and intracranial pathology.We present cases of 3 patients in whom optic disc swelling was identified using ocular ultrasound. Causes for optic disc swelling in our patients included idiopathic intracranial hypertension, secondary syphilis, and malignant hypertension with associated hypertensive retinopathy.

ED point-of-care ultrasound in the diagnosis of ankle fractures in children.

In pediatric ankle injury, radiography is the current standard used to differentiate fracture from ligamentous injury; however, the associated cost, increased time, and radiation exposure pose a significant downside to this imaging modality. Point-of-care ultrasound may be an attractive alternative in this setting, as illustrated by this patient case. A 14-year-old boy presented to the emergency department with a left ankle inversion injury sustained while playing soccer.

Bedside ultrasonography detects significant femoral vessel overlap: implications for central venous cannulation.

Objective: Our goal was to gain a better understanding of the femoral vessel anatomy as it relates to central venous cannulation. The primary objective of this study was to use bedside ultrasonography to determine the amount of exposed femoral vein at three sites corresponding to surface anatomy of the landmark-based procedure.

Methods: This cross-sectional study enrolled a random sample of 180 adult patients presenting to a large urban academic emergency department.

An initial description of a sonographic sign that verifies intrathoracic chest tube placement.

Purpose: An initial description of a sonographic finding predictive of intrathoracic chest tube placement.

Methods: This was a prospective observational study using unembalmed cadaveric models. Chest tubes were randomly placed intra- and extrathoracically and evaluated using ultrasound.

Ultrasonographically guided insertion of a 15-cm catheter into the deep brachial or basilic vein in patients with difficult intravenous access.

Study Objective: Standard length (3 to 5 cm) intravenous catheters in the deep brachial or basilic vein tend to dislodge prematurely. We assess the safety and longevity of a 15-cm catheter inserted in these veins by a novel ultrasonographically guided technique.

Methods: This is a prospective cohort study conducted in an urban teaching emergency department (ED).

Feasibility of forearm ultrasonography-guided nerve blocks of the radial, ulnar, and median nerves for hand procedures in the emergency department.

Study Objective: We determine the feasibility of forearm ultrasonography-guided nerve blocks of the radial, ulnar, and median nerves, performed by emergency physicians, to provide procedural anesthesia of the hand in the emergency department (ED).

Methods: This was a prospective study involving a convenience sample of 11 patients presenting to an adult ED with hand pathology requiring a procedural intervention. Adults 18 years and older who presented to the ED during the 3-month study period were eligible.