Prospective, multicentre observational study of point-of-care ultrasound practice in emergency departments across Australia and New Zealand: The POCUS-ED Registry.

Objectives: The present study aimed to describe the characteristics, performance, accuracy and significance of point-of-care ultrasound (POCUS) use in the ED, by utilising an expanded version of the ACEM-mandated special skills placement (SSP) logbook, to develop a novel clinical quality registry.

Methods: A prospective, observational study was performed across EDs in Australia and New Zealand over a 12-month period. Trainees undertaking ACEM-approved ultrasound (US) SSPs recorded all US scan interpretations and follow-up imaging reports in an online database.

The case for an ultrasound mandate.

Emergency Medicine pioneered the use of ultrasound at the bedside. All of the Colleges of Emergency Medicine in the Anglo-American system have incorporated Emergency Ultrasound into their training curriculum, and all but ACEM have made training and proficiency mandatory. Emergency Ultrasound has not taken hold in Australasia the way it has in other parts of the world.

Three patients with signs of acute flail mitral leaflet seen on emergency department echo: a critical constellation within the focused cardiac exam.

Acute flail mitral leaflet is a time-sensitive, reversible cause of cardiogenic shock. Transthoracic echocardiography (echo) is increasingly becoming a vital tool for non-cardiologist physicians who treat patients with undifferentiated chest pain and dyspnoea. The sonographic abnormalities seen in acute flail mitral leaflet are within the boundaries of a focused echo.

Derivation and validation of a clinical prediction rule for uncomplicated ureteral stone--the STONE score: retrospective and prospective observational cohort studies.

Objective: To derive and validate an objective clinical prediction rule for the presence of uncomplicated ureteral stones in patients eligible for computed tomography (CT). We hypothesized that patients with a high probability of ureteral stones would have a low probability of acutely important alternative findings.

Design: Retrospective observational derivation cohort; prospective observational validation cohort.

ED echo of reverse Tako-tsubo cardiomyopathy: a rare and misleading finding.

Tako-tsubo transient cardiomyopathy (TCM) is a syndrome of specific myocardial wall motion abnormalities that appear in response to extreme physiological or emotional stress. The patients have normal coronary arteries and usually present as new-onset heart failure or acute coronary syndrome. We report on a 48-year-old woman with post-community cardiac arrest presenting as an acute myocardial infarction.

Subdural empyema complicating sinusitis.

Acute sinusitis is a common childhood illness most often involving the ethmoid and maxillary sinuses. Diagnosis is usually based on a history of an upper respiratory tract infection lasting longer than 7 days with a prominent nasal component. Treatment involves 10-14 days of antibiotics.

An unusual cause of dyspnea.

Dyspnea is an alarming symptom for both the patient and the emergency physician. There are many causes of dyspnea, some of which are life-threatening, especially in the elderly patient. In addition to the usual cardiac and pulmonary causes such as congestive heart failure, asthma exacerbation, COPD, pneumonia, and pulmonary embolism, there are less common causes of dyspnea, which if not diagnosed and managed expeditiously may have dire consequences for both the patient and physician.

Two teenagers with syncope.

We report the cases of 2 teenagers with syncope and headaches who were subsequently found, on head computed tomography examinations, to have central nervous system etiologies (arteriovenous malformation and arachnoid cyst) of their syncope. These cases highlight the importance of a focused history and physical examination when evaluating patients who present with syncope.

Type IV renal tubular acidosis presenting as dyspnea in two older patients taking angiotensin-converting enzyme inhibitors.

The evaluation of dyspnea most often leads to a cardiac or pulmonary diagnosis. In the elderly, however, the cause is commonly multifactorial. The emergency physician should always consider noncardiopulmonary etiologies when treating such patients.