In this series, we cut to the chase and highlight our choice for the the top three articles on a given topic. Read on for the articles and brief discussion.
Three DVT articles that every emergency physician should know. What are they?
1) If there is any “must know” article for DVT or PE, this is it: commonly known as the Well’s Criteria, it provides a framework for the EP to approach any patient presenting with the the suspicion of DVT or PE. It is the ability to categorize patients into the different risk categories that we’re able to effectively use pre-test and post-test probability of a negative D-dimer to rule out the disease.
Wells PS, Anderson DR, Rodger M, et al. Evaluation of D-dimer in the diagnosis of suspected deep-vein thrombosis. N Engl J Med. 2003;349:1227.
2) With the introduction of bedside clinician performed ultrasound, EPs now have a tool to evaluate the proximal lower extremity veins themselves. While there is abundant literature suggesting the feasibility of an EP performed bedside ultrasound, this review article showed that properly trained EPs can accurately diagnose DVTs with a pooled overall sensitivity and specificity of 95% and 96% respectively. However, several limitations were highlighted with regards to the available literature – there is no standardization of the technique used, and the studies involved EPs already highly trained in ultrasound and so the results cannot be generalized to all EPs.
Burnside PR, Brown MD, Kline JA. Systematic review of emergency physician-performed ultrasonography for lower-extremity deep vein thrombosis.Â Acad Emerg Med. 2008;15:493-498.
3) This large RCT compares 2 point compression ultrasonography plus D-dimer with formal ultrasonography in symptomatic patients with suspected DVT. The rates of Â confirmed DVT at 3 months were similar in the 2 groups. This suggests that EPs canÂ manage symptomatic patients suspected of having DVT with just 2-point compression ultrasound and D-dimer.
Bernardi E, Camporese G, BÃ¼ller HR, 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;300:1653-1659.
Do you have other suggestions for studies? Comment below!
Visual Diagnosis Case from JEM.Â Bret and Ted discuss a case of appendicitis confirmed with ultrasound after CT was not conclusive.
X-Ray Stinks #1: Finger Injury
In this new series we will highlight cases where ultrasound proved more useful than x-ray.
A seven year old boy presented with distal phalanx pain, tenderness after a fall.
The following x-ray was performed:
What is your diagnosis? Can ultrasound help? How would you perform an ultrasound on such a superficial structure?
The following ultrasound of the distal finger was performed (probe marker towards fingertip):
What is your diagnosis now? Continue reading “XRS – 1”
Bret Nelson recently filmed a webinar on critical care ultrasound at Gulfcoast Ultrasound Institute in Florida. He discussed evaluation of the hypotensive patient, incorporating Scott Weingart’s RUSH exam as well as other literature on acute assessment of the heart, IVC, FAST exam, and pleura.
Information on the webinar is available at Gulfcoast.
References for a variety of hypotension evaluations are included below, as well as a few screenshots from the webinar!
- UHP protocol
- Trinity Protocol
- RCT of ultrasound in hypotension
- FATE: Focused Assessed Transthoracic Echocardiography
- FEER: Focused Echocardiographic Evaluation in Resuscitation
- CA– USE: Cardiac Arrest Ultrasound Exam
- RUSH: Rapid Ultrasound in Shock and Hypotension
- ACES: Abdominal and Cardiac Evaluation with Sonography in Shock
- RUSH: Rapid Ultrasound in Shock
Continue reading “Gulfcoast ultrasound”
The Emergency and Critical Care community will no doubt benefit from this new journal.Â The Critical Ultrasound Journal is the official publication of the international ultrasound group WINFOCUS (world interactive network focused on criticalÂ ultrasound) .Â It is new this year, but they are already into their third issue.Â Â Â Headed by Mike Blaivas, the pediatric and neonatology section is edited by none other than our own Jim Tsung.
As of right now, all content if avaiable in full text.Â Subscribe via email or RSS.
We are pleased to present our annual critical care ultrasound pre-conference course at the Clinical Decision Making in Emergency Medicine symposium in Ponte Vedra, Florida on June 23. Each year this intensive, hands on course features ultrasound faculty from across the country working in small groups with live models and plenty of hands-on scanning time.
Highlights of the four-hour course include:
- Cardiac ultrasound
- Thoracic ultrasound
- Ultrasound for venous access
- Assessment of the hypotensive patient
Faculty for this year’s course include:
- Bret Nelson, MD, RDMS (course director)
- Phillip Andrus, MD
- Petra Duran, MD
- Daniel Duque, MD, RDMS
- Joe Wood, MD, JD, RDMS