Bubble Time – A New, Simple Way to Detect RV Dysfunction
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By agitating and injecting a saline flush into an IV catheter, right ventricular (RV) dysfunction was identified when bubbles were cleared from the RV at a time of ≥ 40 seconds with high sensitivity. It was ruled out as well with good specificity, with a bubble time < 40 seconds.
Source
Right Ventricular "Bubble Time" to Identify Patients With Right Ventricular Dysfunction. Ann Emerg Med. 2024 Aug;84(2):182-194. doi: 10.1016/j.annemergmed.2024.02.005. Epub 2024 Apr 10. PMID: 38597847.
Radiate Positivity – ACEP Policy on Advanced Imaging in Pediatrics
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Advanced imaging, including ultrasound, MRI, and CT, is an important tool for diagnosing children in the emergency department. This policy statement provides guidance to help clinicians optimize the use of these diagnostic tools.
Source
Optimizing Advanced Imaging of the Pediatric Patient in the Emergency Department: Policy Statement. Ann Emerg Med. 2024 Aug;84(2):e13-e23. doi: 10.1016/j.annemergmed.2024.03.023. PMID: 39032991.
Even a Blind Squirrel…Estimating Gestational Age with AI
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AI-enabled ultrasound devices are able to accurately estimate gestational age (GA) between 14 and 27 weeks when employed by novice users. This is particularly of importance in resource poor settings.
Ultrasound + Pediatric Appendicitis Risk Calculator = Rule Out?
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This was a single center retrospective study at a tertiary pediatric ED of patients with suspected pediatric appendicitis. The authors found that combining a low pediatric Appendicitis Risk Calculator (pARC) result with a nondiagnostic ultrasound results in a high negative predictive value for appendicitis.
Source
Identification of children with a nondiagnostic ultrasound at a low appendicitis risk using a pediatric Appendicitis Risk Calculator. Acad Emerg Med. Published online July 21, 2024.
Lipliner Sign and False Positive FAST – Is Ultrasound Too Smart?
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Post-processing techniques completed by ultrasound machines to improve spatial resolution has gotten so advanced that it now can fool us into thinking a FAST exam is positive.
Source
The Lipliner Sign: Potential Cause of a False Positive FAST Examination. Journal of Emergency Medicine, June 28, 2024; https://doi.org/10.1016/j.jemermed.2024.06.013
PROFUNDUS – POCUS-Plus for Aortic Syndromes
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Using the aortic dissection detection (ADD) risk score in addition to point-of-care ultrasound (POCUS) and D-dimer, providers can increase their diagnostic accuracy and ensure that the appropriate patients are receiving advanced imaging to make the diagnosis of acute aortic syndrome (AAS).
Source
Diagnosis of acute aortic syndromes with ultrasound and d-dimer: the PROFUNDUS study. Eur J Intern Med. 2024 Jun 12:S0953-6205(24)00234-6. doi: 10.1016/j.ejim.2024.05.029. Epub ahead of print. PMID: 38871565.
Can We Rule Out Pediatric Appendicitis If Appendix Not Seen on Ultrasound?
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In pediatric patients who have an Alvarado score 6 and below, the absence of free fluid or periappendiceal fat inflammation, when the appendix was not visualized on ultrasound, had a negative predictive value of 99.4% for appendicitis.
Source
Predictive values of indirect ultrasound signs for low risk of acute appendicitis in paediatric patients without visualisation of the appendix on ultrasound. Emerg Med J. 2024 May 10:emermed-2023-213466. doi: 10.1136/emermed-2023-213466. Online ahead of print. PMID: 38729752
POCUS for Pediatric Chest Tube – Is Fifth ICS Too Low?
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Reliance on landmark guidance for chest tube placement may pose significant safety issues in pediatric patients.
Source
Ultrasound Investigation of the Fifth Intercostal Space Landmark for Chest Tube Thoracostomy Site Selection in Pediatric Patients. Pediatr Emerg Care. 2024 Apr 23. doi: 10.1097/PEC.0000000000003207. Epub ahead of print. PMID: 38713844.
What’s the Best Target in the Neck for US Guided Central Access
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This was a network meta-analysis of 13 randomized controlled trials comparing 5 different central venous catheterization (CVC) approaches. The supraclavicular subclavian (SupraSCV) demonstrated superior first-attempt success, while artery puncture was similar for all five locations.
Source
Ultrasound-guided central venous catheterization around the neck: Systematic review and network meta-analysis. Am J Emerg Med. 2024;78:206-214.
Best POCUS Papers Made Easy? Count Me In!
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This expert panel from Canada has compiled a list of what they deem to be the most influential POCUS papers with regard to cardiac arrest as well as evaluation of shock. Whether you want to further educate yourself or guide your residents to learn more on the subject, this primer is a great place to start.
Source
POCUS literature primer: key papers on POCUS in cardiac arrest and shock. CJEM. 2023 Nov 23. doi: 10.1007/s43678-023-00611-1. Epub ahead of print.