Pearl 10/31

Dx: Jones fracture Ankle and foot paint are common presenting complaints to the emergency department.  It is important to be able to tell the difference between a Jones fracture displayed above and a Pseudo-jones fracture.  Both of these fractures involve the base of the 5th metatarsal. A Jones fracture goes through the diaphysis of theRead more

Pearl 10/30

Dx: Subarachnoid hemorrhage Risk factors include hypertension, smoking, polycystic kidney disease, family history, and connective tissue disorders. Subarachnoid hemorrhages are related to ruptured arteriovenous malformations, bleeding disorders, cerebral aneurysms, trauma, use of blood thinners, and idiopathic causes. Symptoms include but are not limited to sudden onset severe headache, decreased level of consciousness, vomiting, seizure, visionRead more

Pearl 10/29

Safe wishes to everyone from TR A disaster  is defined as an inability to meet current needs due to some event either internal or external (ie. Natural disaster, terrorist, man-made) Disaster Preparedness and Response – follow these steps (courtesy of Titinalli) activate EOP set up command center assess hospital capacity, create surge establish communications provide suppliesRead more

Pearl 10/26

Treatment/Management of Acute Hemorrhagic Stroke (based on Sinai protocol) Labs: FS, electrolytes, CBC, coags, cardiac enzymes Radiology: CT head Maintain SBP between 160-180 and MAP <130 using labetalol, nicardipine, or clevidipine If Hypotensive maintain SBP >90 with fluids before starting vasopressors consider norepinephrine or phenylephrine infusions If intracranial HTN: analgesia and sedation, mannitol, hypertonice saline,Read more

Pearl 10/25

Ischemic stroke management (based on Sinai protocol) Labs: FS, electrolytes, CBC, coags, cardiac enzymes Radiology: CT head Indications for tPA: ischemic stroke, definite time of onset, NIHSS>1, no hemorrhage on head CT, onset of symptoms within 3 hours (4.5 hours in select patients) Contraindications to tPA: thrombolytics given prior to arrival, SBP > 185 orRead more

Gi Pearl

70 yo F presents with RUQ pain, fever, and AMS.  What is the diagnosis?Read more

Ultrasound First

We previously reported on AIUM’s Ultrasound First initiative back in March. Since then a number of helpful articles have been published in the Journal of Ultrasound in Medicine, each highlighting the utility of ultrasound as the primary imaging modality. Thus far, topics include: Sonography in Postmenopausal Bleeding – Steven R. Goldstein, MD Think Ultrasound WhenRead more

Intubation devices

Many new developments in ultrasound were demonstrated at the ACEP conference in Denver this week. Since airway management rivals ultrasound as my academic interest, I’d like to focus for a moment on an intubating device I saw demonstrated at an ultrasound vendor booth.  I’ve seen lots of organs on my ultrasound screen- hearts, gallbladders, eyeballs, prostates. I’ve even seen airway structures, but notRead more

Ultrasound Awareness Month

As a part of Ultrasound Awareness Month we’d like to let providers of all levels know about membership opportunities with national and international organizations. They offer an enormous amount of information for providers at all levels; from the first time Sonographer to the Ultrasound Director and offer forums and support for all your Ultrasound-related endeavors.Read more

Propofol Infusion Syndrome

Propofol is widely used in critically ill ED patients.  Although rare, propofol infusion syndrome (PRIS) has been reported/described, and is something to keep in mind when administering this drug.  What are the clinical features and risk factors for PRIS?  What is the earliest sign of cardiac instability?Read more