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 [+]
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. [+]
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. [+]
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the last 15 years, fewer Emergency Medicine (EM) residents are applying for PEM fellowships than Pediatric residents, unpublished data suggesting that Pediatric candidates now outnumber EM candidates 20 to 1.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 [+]
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 [+]
Sulfamethoxazole-Trimethoprim for Skin and Soft Tissue Infections: 1 or 2 Tablets BID?
The 2014 Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections (SSTI) recommend sulfamethoxazole-trimethoprim (SMX-TMP) for purulent infections where methicillin-resistant S. aureus (MRSA) is a likely pathogen. 1 But, what dose of SMX-TMP should we be prescribing? Both the SSTI and MRSA guidelines say 1-2 double strength tablets twice a day. 1,2 So, which is it, 1 tablet or 2? [+]
Ultrasound For The Win: 22M with Scrotal 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 real clinical cases where bedside ultrasound changed management or aided in diagnoses. In this case, a 22-year-old man presents with acute scrotal pain. [+]
PV Card: Focused Echocardiography Ultrasound
So many great information can be gleaned from a focused echocardiogram in Emergency Department patients. What views are you obtaining? What is the importance of the e-point septal separation (EPSS) and how to measure this? Drs. Jimmy Fair, Mike Mallon, and Mike Stone provide a terrific step-by-step image-based guide to these questions that you can use at the bedside as a refresher. PV Card: Focused Echocardiography Ultrasound Adapted from [1, 2] References Randazzo M, Snoey E, Levitt M, Binder K. Accuracy of emergency physician assessment of left ventricular ejection fraction and central venous pressure using echocardiography. Acad Emerg Med. [+]
Trick of the Trade: L5 medial hamstring reflex
Traditionally in medical school, it is taught that lower extremity deep tendon reflexes for L4 and S1 nerve root levels can be elicited by tapping on the patella and Achilles tendons. It was just taught that L5 didn’t have a reflex to check. Knowing if an L5 radiculopathy existed would be especially helpful when assessing a patient for a potential lumbar disc herniation where a careful lower extremity neurologic exam is important. It turns out one can actually check for a L5 reflex. [+]
Sepsis in Older Adults: The Presentation May Be Subtle
60% of patients in the United States who develop severe sepsis are older adults (age 65 and over) [1], and the mortality of severe sepsis increases steadily with age to nearly 40% in those over 85 [2]. There are many factors that make older adults more susceptible to sepsis, and that can also make sepsis more difficult to detect. Here are some tips to help explain why this is, and how you can identify it sooner. [+]
Director of Growth, Strategic Alliance Initiative, Center for Innovation and Digital Health
Massachusetts General Hospital;
Chief Scientific Officer, Conductscience.com
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