PV Card: Focused 1st Trimester Pregnancy Transvaginal Ultrasound

Early 1st trimester pregnancies can be challenging to risk stratify when patient present with bleeding or pain. The pregnancy may be still too early for transabdominal ultrasonography, which was covered in last week’s PV card. The same authors, Drs. Matt Lipton, Mike Mallon, and Mike Stone provide a great bedside clinical reference tool on performing the focused transvaginal ultrasound in pregnancy.

PV: Focused 1st Trimester Pregnancy Transvaginal Ultrasound

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Adapted from [1, 2]

References

Tayal V, Cohen H, Norton H. Outcome of patients with an indeterminate emergency department first-trimester pelvic ultrasound to rule out ectopic pregnancy. Acad Emerg Med. 2004;11(9):912-917. [PubMed]
Wang R, Reynolds T, West H, et al. Use of a β-hCG discriminatory zone with bedside pelvic ultrasonography. Ann Emerg Med. 2011;58(1):12-20. [PubMed]

By Scott Kobner|2021-10-05T12:59:40-07:00Mar 4, 2015|ALiEM Cards, Ob/Gyn, Ultrasound|

Ultrasound for Verification of Endotracheal Tube Location

In patients undergoing emergent tracheal intubation, there is currently no universally accepted gold-standard test to confirm the location of the endotracheal tube (ETT).¹ End-tidal carbon dioxide (CO2) detection is the best of the tests that are routinely utilized to confirm ETT placement, however, it has been shown to have an error rate as high as 1/10 for proper determination of ETT location in emergency intubations.² As a result, multiple modalities are necessary to confirm ETT location, which can delay mechanical ventilation and other treatments. The lack of a single, reliable test to confirm ETT placement can potentially lead to confusion regarding the location of the tube. This confusion can result in both unrecognized esophageal intubations (“false positive”), as well as successful tracheal intubations that are subsequently removed (“false negative”), subjecting the patient to further unnecessary attempts at airway management. Both scenarios can lead to disastrous consequences.

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By Mark Favot, MD|2021-01-05T13:56:52-08:00Mar 2, 2015|Critical Care/ Resus, Expert Peer Reviewed (Clinical), Ultrasound|

PV Card: Focused 1st Trimester Pregnancy Transabdominal Ultrasound

Although history, physical, and lab tests are obtained for patients with first trimester vaginal bleeding and abdominal pain, none compare to the utility of bedside ultrasonography. Today’s PV card reviews the transabdominal approach to the focused pregnancy ultrasound and was written by Drs. Matt Lipton, Mike Mallon, and Mike Stone.

PV Card: Focused 1st Trimester Pregnancy Transabdominal Ultrasound

Adapted from [1, 2]

References

Tayal V, Cohen H, Norton H. Outcome of patients with an indeterminate emergency department first-trimester pelvic ultrasound to rule out ectopic pregnancy. Acad Emerg Med. 2004;11(9):912-917. [PubMed]
Wang R, Reynolds T, West H, et al. Use of a β-hCG discriminatory zone with bedside pelvic ultrasonography. Ann Emerg Med. 2011;58(1):12-20. [PubMed]

By Scott Kobner|2021-10-05T13:01:43-07:00Feb 25, 2015|ALiEM Cards, Ob/Gyn, Ultrasound|

Ultrasound For The Win: 46F with Right Abdominal and Flank Pain #US4TW

Welcome to another ultrasound-based case, part of the “Ultrasound For The Win!” (#US4TW) Case Series. In this peer-reviewed case series, we focus on a real clinical case where bedside ultrasound changed the management or aided in the diagnosis. In this case, a 46-year-old woman presents with acute right-sided abdominal and flank pain.

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By Jeffrey Shih, MD, RDMS|2021-03-10T10:02:08-08:00Feb 24, 2015|Expert Peer Reviewed (Clinical), Genitourinary, Ultrasound, Ultrasound for the Win|

Trick of the Trade: Needle-vein alignment in ultrasound guided peripheral IV

Placing a peripheral IV under ultrasound guidance is often much more challenging than it outwardly appears, especially for novice users. One of the more difficult aspects is in making sure that the target vessel is perfectly in the middle of the screen and then guessing where that corresponds to the middle of the ultrasound probe.

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By Jeff Wiswell, MD|2016-10-26T17:04:32-07:00Feb 23, 2015|Tricks of the Trade, Ultrasound|

Should you do a Pediatric Emergency Medicine fellowship?

Each year hundreds of residents apply to Pediatric Emergency Medicine (PEM) fellowships. There are multiple reasons that an EM resident might want to undertake a PEM fellowship, but over the last 15 years, fewer Emergency Medicine (EM) residents are applying for PEM fellowships than Pediatric residents, unpublished data suggesting that Pediatric candidates now outnumber EM candidates 20 to 1.

Recently, a group of PEM Fellowship Program Directors formed the “EM-to-PEM task force” of like-minded individuals desiring to promote PEM fellowships to EM residents. A PEM fellowship is an excellent career move for a resident who has a passion for the emergency care and advocacy of children. In this post, we will discuss and review benefits of EM residents undergoing a PEM fellowship.

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By James O’Neill, MD|2016-10-26T17:04:32-07:00Feb 20, 2015|Medical Education, Pediatrics|

Malignancy-Associated Hypercalcemia: Which Bisphosphonate is Best?

Malignancy-associated hypercalcemia (MAH) is the most common metabolic derangement encountered in the oncologic population in the ED. It can occur in up to 30% of cancer patients at some point during the disease.^1–3 Clinical manifestations include mental status changes (which may progress to coma) and renal impairment.³ These patients may be classified based on both type and severity. Therapies for managing MAH emergently should focus on correcting the underlying mechanism, as outlined below with their respective causes:³

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By Meghan Groth, PharmD, BCPS|2016-12-19T12:59:11-08:00Feb 19, 2015|Endocrine-Metabolic, Expert Peer Reviewed (Clinical), Tox & Medications|

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