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The Art of Syringe Labeling in the ED

MedicationSyringeDrawThe ‘look-alike, sound-alike’ nature of many drug appearances and names is problematic. In high-stress environments such as the Emergency Department (ED), potential disasters can arise if “drug swap” or other medication errors occur. Drug swap is the accidental injection of the wrong drug.1 The anesthesiology literature contains several published reports presenting various ideas on how to properly label syringes used in the operating room to reduce medication errors. Techniques include color-coding the labels,2 labeling of the plunger,3 double-labeling,4,5 and specific placement of the labels on the syringe.6

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By |2019-02-19T18:49:33-08:00Mar 16, 2015|Expert Peer Reviewed (Clinical), Tox & Medications|
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PV Card: Focused Deep Vein Thrombosis (DVT) Ultrasound

ultrasound dvtDeep vein thrombosis (DVT) is always a consideration when patients with asymmetric lower extremity swelling. Why is one leg. Two-point focused DVT ultrasonography of the femoral and popliteal veins can be incredibly useful in the Emergency Department when trying to narrow the differential diagnosis. Drs. Margaret Greenwood-Ericksen, Joshua Rempell, and Mike Stone provide a clear, image-based clinical reference tool on this ultrasound technique.

 

PV Card: Focused DVT Ultrasound Assessment


Adapted from [1, 2]

References

  1. Kline J, O’Malley P, Tayal V, Snead G, Mitchell A. Emergency clinician-performed compression ultrasonography for deep venous thrombosis of the lower extremity. Ann Emerg Med. 2008;52(4):437-445. [PubMed]
  2. Bernardi E, Camporese G, Büller H, et al. Serial 2-point ultrasonography plus D-dimer vs whole-leg color-coded Doppler ultrasonography for diagnosing suspected symptomatic deep vein thrombosis: a randomized controlled trial. JAMA. 2008;300(14):1653-1659. [PubMed]
By |2021-10-05T12:54:30-07:00Mar 11, 2015|ALiEM Cards, Cardiovascular, Ultrasound|
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Diagnose on Sight: Lower extremity numbness and pain

GSW leg XRCase: An 18 year old male presents after a single gunshot wound to his left calf. He complains of pressure-like pain near the wound and sensory numbness below his left knee. On examination, the left leg is tense. He has no dorsalis pedis pulse. Based on the history, exam, and findings in the image, which of the following is true regarding this diagnosis?

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By |2016-12-22T18:49:50-08:00Mar 9, 2015|Diagnose on Sight, Orthopedic, Trauma|
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PV Card: Focused 1st Trimester Pregnancy Transvaginal Ultrasound

Intrauterine pregnancy ultrasound first trimester transvaginal endocavitaryEarly 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


Adapted from [1, 2]

 

References

  1. 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]
  2. 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 |2021-10-05T12:59:40-07:00Mar 4, 2015|ALiEM Cards, Ob/Gyn, Ultrasound|
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Ultrasound for Verification of Endotracheal Tube Location

ETT Lubricate endotracheal intubation confirmationIn 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 |2021-01-05T13:56:52-08:00Mar 2, 2015|Critical Care/ Resus, Expert Peer Reviewed (Clinical), Ultrasound|
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PV Card: Focused 1st Trimester Pregnancy Transabdominal Ultrasound

Intrauterine pregnancy first trimester ultrasound transaabdominal

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

  1. 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]
  2. 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 |2021-10-05T13:01:43-07:00Feb 25, 2015|ALiEM Cards, Ob/Gyn, Ultrasound|
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