Clinician-performed Beside Ultrasound for the Diagnosis of Traumatic Pneumothorax.

Introduction: Prior studies have reported conflicting results regarding the utility of ultrasound in the diagnosis of traumatic pneumothorax (PTX) because they have used sonologists with extensive experience. This study evaluates the characteristics of ultrasound for PTX for a large cohort of trauma and emergency physicians.

Methods: This was a prospective, observational study on a convenience sample of patients presenting to a trauma center who had a thoracic ultrasound (TUS) evaluation for PTX performed after the Focused Assessment with Sonography for Trauma exam.

Evidence-based diagnostics: adult septic arthritis.

Background: Acutely swollen or painful joints are common complaints in the emergency department (ED). Septic arthritis in adults is a challenging diagnosis, but prompt differentiation of a bacterial etiology is crucial to minimize morbidity and mortality.

Objectives: The objective was to perform a systematic review describing the diagnostic characteristics of history, physical examination, and bedside laboratory tests for nongonococcal septic arthritis.

Untreated hypertension and the emergency department: a chance to intervene?

Objectives: Untreated hypertension (HTN) is a major public health problem. Screening for untreated HTN in the emergency department (ED) may lead to appropriate treatment of more patients. The authors investigated the accuracy of identifying HTN in the ED, the proportion of ED patients with untreated HTN, patient characteristics predicting untreated HTN, and provider documentation of untreated HTN.

Intensivist bedside ultrasound (INBU) for volume assessment in the intensive care unit: a pilot study.

Background: Estimation of volume status in the high-acuity surgical population can be challenging. The use of intensivist bedside ultrasound (INBU) to rapidly assess volume status in the surgical intensive care unit (SICU) was hypothesized to be feasible and as accurate as invasive measures.

Methods: Clinician sonographers (CSs) were trained to perform basic cardiac ultrasound and sonographic assessment of the inferior vena cava (IVC).

Directed bedside transthoracic echocardiography: preferred cardiac window for left ventricular ejection fraction estimation in critically ill patients.

Background: Bedside transthoracic echocardiography (TTE) performed by emergency physicians (EPs) is valuable in the rapid assessment and treatment of critically ill patients. We sought to determine the preferred cardiac window for left ventricular ejection fraction (LVEF) estimation by EP sonographers in a critically ill patient population.

Methods: Prospective investigator-blinded study of focused bedside TTE in a convenience sample of surgical intensive care patients.

Emergency department operational changes in response to pay-for-performance and antibiotic timing in pneumonia.

Background: The percentage of adult patients admitted with pneumonia who receive antibiotics within four hours of hospital arrival is publicly reported as a quality and pay-for-performance measure by the Department of Health and Human Services and is called PN-5b.

Objectives: To determine attitudes among physician leaders at emergency medicine training programs toward using PN-5b as a quality measure for pay for performance, and to determine what operational changes academic emergency departments (EDs) have made to ensure early antibiotic administration for patients with pneumonia.

Methods: The authors administered an online questionnaire to 129 chairpersons and medical directors of 135 academic ED training programs in the United States on attitudes toward performance measurement in pneumonia and changes that academic EDs have made in response to PN-5b; one response was sought from each institution.

Stylet bend angles and tracheal tube passage using a straight-to-cuff shape.

Objectives: Malleable stylets improve maneuverability and control during tube insertion, but after passage through the vocal cords the stiffened tracheal tube may impinge on the tracheal rings, preventing passage. The goal of this study was to assess insertion difficulty with styletted tubes of different bend angles.

Methods: Tube passage was assessed with four different bend angles (25 degrees, 35 degrees, 45 degrees, and 60 degrees) using straight-to-cuff-shaped tubes.

Predictive values of triage temperature and pulse for antibiotic administration and hospital admission in elderly patients with potential infection.

To determine how well triage temperature and pulse abnormalities in elderly patients with potential infections predict antibiotic administration and hospital admission. Data from the National Hospital Ambulatory Care Survey (2001-2002), a sample of US emergency departments, were used. Patients (>or=65 years) with a reason for visit suggesting potential infection were included.

Laryngeal view during laryngoscopy: a randomized trial comparing cricoid pressure, backward-upward-rightward pressure, and bimanual laryngoscopy.

Study Objective: External cricoid and thyroid cartilage manipulations are commonly taught to facilitate laryngeal view during intubation. We compare the laryngeal views during laryngoscopy with 4 manipulations (no manipulation, cricoid pressure, backward-upward-rightward pressure [BURP], and bimanual laryngoscopy) to determine the method that optimizes laryngeal view.

Methods: This was a randomized intervention study involving emergency physicians participating in airway training courses from December 2003 to November 2004.

Limitations of difficult airway prediction in patients intubated in the emergency department.

Study Objective: Physiognomic assessment of difficult laryngoscopy before rapid sequence intubation has been advocated for all emergency department (ED) intubations. The study objectives were to evaluate whether Mallampati scores, thyromental distance, and neck mobility could have been assessed in non-cardiac arrest ED-intubated patients and determine whether such tests would have been feasible in our rapid sequence intubation-associated laryngoscopy failures.

Methods: We retrospectively reviewed 37 months of ED intubations using prospectively collected data from electronic medical records, critical care flow sheets, and a trauma registry.

A modified approach to supraclavicular subclavian vein catheter placement: the pocket approach.

Background: Central venous access is often necessary for the administration of fluids, blood products, and medications. Several approaches to supraclavicular subclavian venous access have been described. This study examines the effectiveness of central venous catheter placement utilizing an alternative set of anatomic landmarks for supraclavicular subclavian vein access.

Preevent vaccination against smallpox: a survey of pediatric emergency health care providers.

Background: In January 2003, smallpox vaccinations were offered to health care workers to create hospital-based teams prepared to care for patients with smallpox as part of national bioterrorism preparedness activities.

Methods: An anonymous survey of pediatric emergency health care workers was conducted in November and December 2002. Two mailings were sent to physicians, nurses and ancillary staff at five academic pediatric emergency departments in major US cities.

Factors influencing analgesic use for skatepark-related musculoskeletal injuries.

Objective: This study was designed to determine the proportion of patients with skatepark-related musculoskeletal injuries who were administered analgesics in the emergency department (ED) or at discharge, and to determine if differences in use of pain medication varied by injury type, anatomic location, or patient age.

Methods: This is a retrospective review of a cohort of consecutive patients with musculoskeletal injuries presenting to a large urban ED from a local skatepark over a 1-year period (1999-2000). Patients with non-musculoskeletal injuries were excluded.

Smallpox vaccination: a national survey of emergency health care providers.

Unlabelled: Concerns about bioterrorism have prompted a national voluntary smallpox (SP) vaccination program in the United States. Although emergency health care providers are among the first targeted for vaccination, little is known about how these providers view the risks and benefits of SP vaccination.

Objectives: To assess the willingness of emergency health care personnel to receive pre-event SP vaccination prior to the start of the national program.

Skatepark injuries and the influence of skatepark design: a one year consecutive case series.

Skateboarding and in-line skating are popular activities that attract millions of participants yearly and have spawned the development of skateparks (SPs). This study examined the types and distribution of injuries within a local commercial SP. Subjects were prospectively enrolled in a university Emergency Department (ED) after an injury at a local SP.