ACR Appropriateness Criteria head trauma--child.

Head trauma is a frequent indication for cranial imaging in children. CT is considered the first line of study for suspected intracranial injury because of its wide availability and rapid detection of acute hemorrhage. However, the majority of childhood head injuries occur without neurologic complications, and particular consideration should be given to the greater risks of ionizing radiation in young patients in the decision to use CT for those with mild head trauma.

Ultrasound-guidance can reduce adverse events during femoral central venous cannulation.

Background: Ultrasound-guidance for internal jugular central venous cannulation (CVC) has become the recommended best practice and has been shown to improve placement success and reduce complications. There is a dearth of studies that evaluate emergency point-of-care ultrasound guidance of femoral CVC.

Objective: Our aim was to determine if point-of-care ultrasound guidance for femoral CVC decreases adverse events and increases the likelihood of successful placement when compared with the landmark technique.

Applications of justification and optimization in medical imaging: examples of clinical guidance for computed tomography use in emergency medicine.

Availability, reliability, and technical improvements have led to continued expansion of computed tomography (CT) imaging. During a CT scan, there is substantially more exposure to ionizing radiation than with conventional radiography. This has led to questions and critical conclusions about whether the continuous growth of CT scans should be subjected to review and potentially restraints or, at a minimum, closer investigation.

Assessment of Medicare's imaging efficiency measure for emergency department patients with atraumatic headache.

Study Objective: Computed tomography (CT) use has increased rapidly, raising concerns about radiation exposure and cost. The Centers for Medicare & Medicaid Services (CMS) developed an imaging efficiency measure (Outpatient Measure 15 [OP-15]) to evaluate the use of brain CT in the emergency department (ED) for atraumatic headache. We aim to determine the reliability, validity, and accuracy of OP-15.

Summary of workshop on CT in emergency medicine: ensuring appropriate use.

This paper addresses the increasing use of CT in medical radiologic imaging, with a focus on applications in emergency medicine. The rapidly increasing use of CT in medical imaging over the past 3 decades has been a major subject in many recent publications, including a discussion of concerns about patient radiation doses, unnecessary CT examinations, and the costs of CT examinations. One area of these concerns has been the use of CT examinations for triage, selection of treatment options, and release of patients from emergency medical settings.

Prospective durability testing of a vascular access phantom.

Introduction: We assessed the acoustic transmission, image quality, and vessel integrity of the Blue Phantom™ 2 Vessel Original Ultrasound Training Model with repeated use.

Methods: The study consisted of two phases. During the first phase, a portion of the Blue Phantom™ rubber matrix (without a simulated vessel) was placed over a two-tiered echogenic structure and was repeatedly punctured with a hollow bore 18-gauge needle in a 1 cm(2) area.

Unilateral papilledema: a case of optic neuritis diagnosed with bedside ocular sonography.

Optic neuritis is a demyelinating inflammatory condition that causes acute loss of vision, especially color vision, and eye pain. Magnetic resonance imaging and fundoscopy have traditionally aided the diagnosis of what largely remains a clinical diagnosis. We report a case of optic neuritis diagnosed in the emergency department with the aid of bedside ocular sonography.

Resident training in emergency ultrasound: consensus recommendations from the 2008 Council of Emergency Medicine Residency Directors Conference.

Over the past 25 years, research performed by emergency physicians (EPs) demonstrates that bedside ultrasound (US) can improve the care of emergency department (ED) patients. At the request of the Council of Emergency Medicine Residency Directors (CORD), leaders in the field of emergency medicine (EM) US met to delineate in consensus fashion the model "US curriculum" for EM residency training programs. The goal of this article is to provide a framework for providing US education to EM residents.

The double-line sign: a false positive finding on the Focused Assessment with Sonography for Trauma (FAST) examination.

Background: Emergency physicians commonly perform Focused Assessment with Sonography for Trauma (FAST) examinations to evaluate for free intraperitoneal fluid. Many ultrasound findings can be misinterpreted as free fluid, resulting in false-positive FAST examinations.

Objectives: To describe a previously unreported ultrasound finding that can be misinterpreted as free intraperitoneal fluid.

Transcranial ultrasound in clinical sonothrombolysis (TUCSON) trial.

Objective: Microspheres (microS) reach intracranial occlusions and transmit energy momentum from an ultrasound wave to residual flow to promote recanalization. We report a randomized multicenter phase II trial of microS dose escalation with systemic thrombolysis.

Methods: Stroke patients receiving 0.

Safety and dose-escalation study design of Transcranial Ultrasound in Clinical SONolysis for acute ischemic stroke: the TUCSON Trial.

Rationale Transcranial Doppler (TCD) monitoring during intravenous tissue plasminogen activator (i.v.-tPA) infusion increases recanalization rates in acute ischemic stroke.

Emergency medicine resident performed bedside ultrasonography of the gallbladder in non-fasted healthy volunteers.

Background: Gallbladder ultrasonography is a commonly performed test in the emergency department. It is unknown whether a non-fasting state alters the visualization of the gallbladder by emergency medicine (EM) residents.

Objectives: We conducted this study to determine whether EM residents are able to visualize the gallbladder in volunteers who have recently consumed a fatty meal.

Does the simple triage and rapid treatment method appropriately triage patients based on trauma injury severity score?

Objectives: To correlate the simple triage and rapid treatment (START) colors to trauma injury severity scores (ISS).

Design: Six volunteer healthcare providers unfamiliar with START were trained to triage. Each chart was designated a START color by a volunteer healthcare provider and the "expert" trainer.

Ultrasound diagnosis of penile fracture.

Background: Rupture of the corpus cavernosum, penile fracture, is an uncommon occurrence. Diagnosis is straightforward when classical historical and physical examination findings are present. However, atypical presentations can make the diagnosis difficult.

Cross sectional survey of ultrasound use for central venous catheter insertion among resident physicians.

Background: Use of ultrasound guidance for Central Venous Catheter insertion has been associated with decreased complications and increased success rates. Previous reports show low rates of use among physicians.

Objectives: Evaluation of the frequency of Ultrasound Guidance use for Central Venous Catheter insertion among residents at a teaching institution.

A pilot randomized clinical safety study of sonothrombolysis augmentation with ultrasound-activated perflutren-lipid microspheres for acute ischemic stroke.

Background And Purpose: Ultrasound transiently expands perflutren-lipid microspheres (muS), transmitting energy momentum to surrounding fluids. We report a pilot safety/feasibility study of ultrasound-activated muS with systemic tissue plasminogen activator (tPA).

Methods: Stroke subjects treated within 3 hours had abnormal Thrombolysis in Brain Ischemia (TIBI) residual flow grades 0 to 3 before tPA on transcranial Doppler (TCD).

Ultrasound diagnosis of quadriceps tendon rupture.

Quadriceps tendon ruptures are an uncommon knee injury. The diagnosis is often complicated by a limited examination secondary to edema and pain, the insensitivity of radiographs, and the unavailability of non-emergent magnetic resonance imaging. A delay in diagnosis and treatment has been shown to cause significant morbidity.