Monthly Archives: September 2010

ACEP 2010- Ultrasound Management Course

USMGMTFaculty 500x333 ACEP 2010 Ultrasound Management Course The ACEP Ultrasound Section hosted its annual Ultrasound Management Course on Monday September 27. This year’s course was organized by director Troy Foster and co-directors Rajesh Geria and Bret Nelson. Special thanks goes out to Vivek Tayal for his mentoring, support and guidance! In addition, Marilyn Bromley and Julie Williams were instrumental in putting the course together.

Over 125 participants registered for this full-day course which served as a whirlwind introduction to the operational aspects of emergency ultrasound. New this year were two breakout sessions, where participants engaged in round-table discussions with national leaders. This is also the first year that we were able to provide AMA PRA category 1 CME to all those registered.

Faculty for the course (listed below) hailed from across the United States and brought enormous expertise to bear in their lectures and small group sessions. We look forward to their continued involvement as the course expands. Planning has already begun for the next Ultrasound Management Course to be held at ACEP in San Fransisco 2011!

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ACEP 2010- Ultrasound for pediatric appendicitis

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NelsonBentleyACEP2010 500x333 ACEP 2010 Ultrasound for pediatric appendicitis On September 28 Dr. Suzanne Bentley presented the abstract:

Ultrasound evaluation for appendicitis in children: Can we safely reduce CT scan utilization?

Bentley S, Nelson BP, Zahn L

at ACEP in Las Vegas. Data on using ultrasound as a first-line diagnostic modality (instead of CT scan) were discussed, with implications for diagnostic accuracy, radiation exposure, and length of stay. This was abstract #001, which carries no more prestige than #998 but we will be proud anyway.

A great deal of attention has recently focused on radiation exposure risks, and many organizations have allied to reduce necessary imaging. The Image Gently Alliance for example boasts dozens of member organizations and has done a great deal to educate providers about the risks of ionizing radiation in imaging. A brief article on the study was published by Reuters Health:

For pediatric appendicitis, ultrasound cuts radiation, saves time over CAT scans (subscription only)

Emergency Medicine has advocated the use of ultrasound for quite some time. As point-of-care ultrasound as well as radiology department ultrasound gain ground we hope to make informed diagnostic decisions while minimizing risks.

Lutheran Medical Center Course

Lutheran09212010 500x357 Lutheran Medical Center Course The Mount Sinai Division of Emergency Ultrasound was proud to visit Lutheran Medical Center today for a critical care ultrasound workshop. Many thanks to Dr. Bonnie Simmons, Chair of Emergency Medicine and Dr. Gloria Tsan, Director of Medical Student and Resident Education for inviting us and hosting the course.

The course was well-attended by faculty and residents representing Emergency Medicine, Critical Care, Surgery, Cardiology, and other departments. Multi-specialty courses are a fantastic opportunity to share knowledge and common ground among colleagues, and it is a pleasure to work with a group with diverse interests and talents.

Focusing on high-yield topics for acute care, we discussed on algorithms for Rapid Ultrasound in Shock/Hypotension (RUSH) as well as ultrasound for venous access. We look forward to future collaborations!

Top 3 Articles: Pelvic US

Miscarriage in progress from Sinai EM Ultrasound on Vimeo.

Pelvic ultrasound is one of our core US applications. It has been incorporated within many emergency departments and it is a bread and butter skill for the EP. So, how do we fare in our performance?

This early study showed that ED ultrasound was very similar to radiology department findings (or final outcome, or both) in 96% of the study cohort. Also, when ED ultrasound accurately identified IUPs, ectopic pregnancies were effectively ruled out with a NPV of 100%.

1. Durham, B., Lane, B., Burbridge, L., & Balasubramaniam, S. (1997). Pelvic ultrasound performed by emergency physicians for the detection of ectopic pregnancy in complicated first-trimester pregnancies. Annals of Emergency Medicine, 29(3), 338-47.

Also, why do we do it in the first place, and not send all the cases to radiology for ultrasound? The answer lies in the reduction of both ED length of stay as well as cost. Any means to reduce ED overcrowding and decrease spending are welcome!

2. Shih, C. H. (1997). Effect of emergency physician-performed pelvic sonography on length of stay in the emergency department. Annals of Emergency Medicine, 29(3), 348-51; discussion 352.

Lastly, when ectopic pregnancy is suspected, remember to perform a FAST exam as a positive finding (free fluid in Morison’s pouch) can predict the need for operative intervention.

3. Moore C, Todd WM, O’Brien E, Lin H. Free fluid in Morison’s pouch on bedside ultrasound predicts need for operative intervention in suspected ectopic pregnancy. Acad Emerg Med. 2007;14:755-758.