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Cardiac Arrest Ultrasound AIUM 2014

Screen Shot 2014 03 30 at 1.27.53 PM Cardiac Arrest Ultrasound AIUM 2014

As promised, references from today’s lecture.

Background

1. Arntfield RT, and Millington SJ. Point of care cardiac ultrasound applications in the emergency department and intensive care unit–a review. Curr Cardiol Rev. 2012, May;8(2): 98-108.
2. Bocka JJ, Overton DT, and Hauser A. Electromechanical dissociation in human beings: an echocardiographic evaluation. Ann Emerg Med. 1988, May;17(5):450-2.

3. Giraud R, Siegenthaler N, Schussler O, Kalangos A, Müller H, Bendjelid K, and Banfi C. The LUCAS 2 Chest Compression Device Is Not Always Efficient: An Echographic Confirmation. Ann Emerg Med. 2014, Feb 12;
4. Hollister N, Bond R, Donovan A, and Nicholls B. Saved by focused echo evaluation in resuscitation. Emerg Med J. 2011, Nov;28(11):986-9.

5. Niendorff DF, Rassias AJ, Palac R, Beach ML, Costa S, and Greenberg M. Rapid cardiac ultrasound of inpatients suffering PEA arrest performed by nonexpert sonographers. Resuscitation. 2005, Oct;67(1):81-7.
6. Rich S, Wix HL, and Shapiro EP. Clinical assessment of heart chamber size and valve motion during cardiopulmonary resuscitation by two-dimensional echocardiography. Am Heart J. 1981, Sep;102(3 Pt 1):368-73.

7. Werner A, Greene L, Janko L, and Cobb A. Visualization of cardiac valve motion in man during external chest compression using two-dimensional echocardiography. Implications regarding the mechanism of blood flow. Circulation. 1981, Jun 1;63(6):1417-1421.

Prognosis in Cardiac Arrest Ultrasound

1. Aichinger G, Zechner PM, Prause G, Sacherer F, Wildner G, Anderson CL, et al. Cardiac movement identified on prehospital echocardiography predicts outcome in cardiac arrest patients. Prehosp Emerg Care. 2012;16(2):251-5.
2. Breitkreutz R, Price S, Steiger HV, Seeger FH, Ilper H, Ackermann H, et al. Focused echocardiographic evaluation in life support and peri-resuscitation of emergency patients: a prospective trial. Resuscitation. 2010, Nov;81(11):1527-33.

3. Cohn B. Does the absence of cardiac activity on ultrasonography predict failed resuscitation in cardiac arrest? Ann Emerg Med. 2013, Aug;62(2):180-1.
4. Cureton EL, Yeung LY, Kwan RO, Miraflor EJ, Sadjadi J, Price DD, and Victorino GP. The heart of the matter: utility of ultrasound of cardiac activity during traumatic arrest. J Trauma Acute Care Surg. 2012, Jul;73(1):102-10.

5. Hayhurst C, Lebus C, Atkinson PR, Kendall R, Madan R, Talbot J, et al. An evaluation of echo in life support (ELS): is it feasible? What does it add? Emerg Med J. 2011, Feb;28(2):119-21.
6. Kudenchuk PJ, Cobb LA, Copass MK, Cummins RO, Doherty AM, Fahrenbruch CE, et al. Amiodarone for resuscitation after out-of-hospital cardiac arrest due to ventricular fibrillation. N Engl J Med. 1999, Sep 16;341(12):871-8.

7. Nelson BP, Patel VR, Norris MM, and Richardson BK. The utility of cardiac sonography and capnography in predicting outcome in cardiac arrest. International journal of emergency medicine. 2008;1(3):213-5.
8. Salen P, O’Connor R, Sierzenski P, Passarello B, Pancu D, Melanson S, et al. Can cardiac sonography and capnography be used independently and in combination to predict resuscitation outcomes? Academic emergency medicine : official journal of the Society for Academic Emergency Medicine. 2001;8(6):610-5.

9. Salen P, Melniker L, Chooljian C, Rose JS, Alteveer J, Reed J, and Heller M. Does the presence or absence of sonographically identified cardiac activity predict resuscitation outcomes of cardiac arrest patients? Am J Emerg Med. 2005, Jul;23(4):459-62.

10. Schuster KM, Lofthouse R, Moore C, Lui F, Kaplan LJ, and Davis KA. Pulseless electrical activity, focused abdominal sonography for trauma, and cardiac contractile activity as predictors of survival after trauma. J Trauma. 2009, Dec;67(6):1154-7.

11. Schuster KM, and Davis KA. Response to “Pulseless electrical activity focused abdominal sonography for trauma, and cardiac contractile activity as predictors of survival after trauma”. J Trauma. 2010, May;68(5):1270.

12. Tayal VS, and Kline JA. Emergency echocardiography to detect pericardial effusion in patients in PEA and near-PEA states. Resuscitation. 2003, Dec;59(3):315-318.
13. Tomruk O, Erdur B, Cetin G, Ergin A, Avcil M, and Kapci M. Assessment of Cardiac Ultrasonography in Predicting Outcome in Adult Cardiac Arrest. Journal of International Medical Research. 2012, Apr 1;40(2):804-809.

Algorithmic approach to Cardiac Arrest Ultrasound

1. Amaya SC, and Langsam A. Ultrasound detection of ventricular fibrillation disguised as asystole. Ann Emerg Med. 1999, Mar;33(3):344-6.

2. Blyth L, Atkinson P, Gadd K, and Lang E. Bedside focused echocardiography as predictor of survival in cardiac arrest patients: a systematic review. Acad Emerg Med. 2012, Oct;19(10): 1119-26.

3. Chardoli M, Heidari F, Rabiee H, Sharif-Alhoseini M, Shokoohi H, and Rahimi-Movaghar V. Echocardiography integrated ACLS protocol versus conventional cardiopulmonary resuscitation in patients with pulseless electrical activity cardiac arrest. Chin J Traumatol. 2012;15(5):284-7.

4. Hernandez C, Shuler K, Hannan H, Sonyika C, Likourezos A, and Marshall J. C.A.U.S.E.: Cardiac arrest ultra-sound exam–a better approach to managing patients in primary non- arrhythmogenic cardiac arrest. Resuscitation. 2008, Feb;76(2):198-206.

5. Horowitz R, Gossett JG, Bailitz J, Wax D, and Pierce MC. The FLUSH Study-Flush the Line and Ultrasound the Heart: Ultrasonographic Confirmation of Central Femoral Venous Line Placement. Ann Emerg Med. 2014, Jan 15;

6. Mallin M, Curtis K, Dawson M, Ockerse P, and Ahern M. Accuracy of ultrasound-guided marking of the cricothyroid membrane before simulated failed intubation. The American Journal of Emergency Medicine. 2014, Jan;32(1):61-63.

7. Nagdev A, and Mantuani D. A novel in-plane technique for ultrasound-guided pericardiocentesis. Am J Emerg Med. 2013, Sep;31(9):1424.e5-9.

8. Pfeiffer P, Rudolph SS, Børglum J, and Isbye DL. Temporal comparison of ultrasound vs. auscultation and capnography in verification of endotracheal tube placement. Acta Anaesthesiol Scand. 2011, Nov;55(10):1190-5.

9. Pfeiffer P, Bache S, Isbye DL, Rudolph SS, Rovsing L, and Børglum J. Verification of endotracheal intubation in obese patients – temporal comparison of ultrasound vs. auscultation and capnography. Acta Anaesthesiol Scand. 2012, May;56(5):571-6.
10. Weingart SW, Duque DD, and Nelson BN. The RUSH Exam – Rapid Ultrasound for Shock / Hypotension [Internet]. ACEP-EMED Home. 2009, Apr 3;[cited 2011, Jan 9] Available from: http:// www.webcitation.org/5vyzOaPYU

Future of Cardiac Arrest Ultrasound

1. Abbasi S, Farsi D, Zare MA, Hajimohammadi M, Rezai M, and Hafezimoghadam P. Direct ultrasound methods: a confirmatory technique for proper endotracheal intubation in the emergency department. Eur J Emerg Med. 2014, Jan 16;

2. Blaivas M. Transesophageal echocardiography during cardiopulmonary arrest in the emergency department. Resuscitation. 2008, Aug;78(2):135-40.

3. Copetti R. Clinical Integrated Ultrasound in Peri Cardiac Arrest and Cardiac Arrest. J Clinic Experiment Cardiol S. 2012;102.

4. Doepp Connolly F, Reitemeier J, Storm C, Hasper D, and Schreiber SJ. Duplex sonography of cerebral blood flow after cardiac arrest-A prospective observational study. Resuscitation. 2013, Dec 30;

5. Hogan TS. External cardiac compression may be harmful in some scenarios of pulseless electrical activity. Med Hypotheses. 2012, Oct;79(4):445-7.

6. van der Wouw PA, Koster RW, Delemarre BJ, de Vos R, Lampe-Schoenmaeckers AJ, and Lie KI. Diagnostic accuracy of transesophageal echocardiography during cardiopulmonary resuscitation. J Am Coll Cardiol. 1997, Sep;30(3):780-3.
7. Vieillard-Baron A, Slama M, Mayo P, Charron C, Amiel JB, Esterez C, et al. A pilot study on safety and clinical utility of a single-use 72-hour indwelling transesophageal echocardiography probe. Intensive Care Med. 2013, Apr;39(4):629-35.

 

 

Faculty group photo

SonoSweden 2014 course

At the end of January, Bret Nelson joined an incredible team of international a faculty for the largest SonoSweden course to date. Course director Christofer Muhr hosted this unique, intensive hands-on conference at the scenic Yasuragi hotel in Stockholm, Sweden. Over thirty faculty and one hundred participants took part in this three-day course.

Among the faculty were lung ultrasound pioneer Vicki Noble, Matt Dawson and Mike Mallin (creators of the Ultrasound Podscast) and others from around the globe.

Registration is not yet open for the 2015 course, but check out the SonoSweden website for a countdown timer- there were over 100 people on the waiting list for this year’s course!

Last days of the stethoscope?

GH TOC 500x381 Last days of the stethoscope?In the current issue of Global Heart (journal of the World Heart Foundation), several Mount Sinai authors have published articles on the use of point-of-care ultrasound. Phil Andrus wrote about focused cardiac ultrasound, Jennifer Huang co-authored a review of ultrasound use in IVC assessment, Daniel Lakoff described ultrasound incorporation into rapid response teams in inpatient wards, and Bret Nelson and Amy Sanghvi wrote a review of non-cardiologist use of cardiac ultrasound.

Bret Nelson and Global Heart Editor-in-Chief Jagat Narula wrote the editorial for the issue, which focused on improvements in ultrasound technology creating new opportunities and markets for ultrasound use. One theme of the editorial was whether ultrasound could replace the stethoscope, and as you may imagine the press has picked up on that thread!
CBS news visited Mount Sinai and interviewed Drs. Nelson and Narula.
And a number of media outlets have covered the story, including Popular Mechanics, the Huffington Post and others.
Mount Sinai has incorporated ultrasound into medical student education in Gross Anatomy since 2006, and last year began a curriculum in focused ultrasound as part of the physical examination course.

ACEP National Faculty Teaching Award

The American College of Emergency Physicians awarded its annual National Faculty Teaching award in Seattle this year during the Academic Affairs committee meeting.

Bret Nelson, Director of the Emergency Ultrasound Division at Mount Sinai, was one of four faculty honored nationally.

NFTA group 500x332 ACEP National Faculty Teaching Award

Left to right: Federico E. Vaca, MD, MPH; Vicken Y. Totten, MD, MS, FACEP; Bret P. Nelson, MD, RDMS, FACEP; Yashwant Chathampally, MD, MS

According to ACEP,

The American College of Emergency Physicians sponsors a national faculty teaching and junior faculty teaching award to honor outstanding educators in emergency medicine. These awards are designed to support emergency medicine faculty in their efforts to achieve academic advancement, as well as support the continued academic development of the specialty. The awards recognize superior teaching activities including didactic lectures, clinical instruction, the development of innovative educational programs, as well as the endorsement by faculty, residents, and students.

Second World Congress on Ultrasound in Medical Education

The University of South Carolina once again hosted the incredible World Congress on Ultrasound in Medical Education in Columbia. Dean Richard Hoppmann hosted over 100 faculty and hundreds of attendees, with dozens of countries represented.

img 9474 500x333 Second World Congress on Ultrasound in Medical Education

Mount Sinai emergency ultrasound director Bret Nelson gave a plenary talk on the use of ultrasound in remote environments, from the battlefield to the International Space Station.

BretPlenary 500x333 Second World Congress on Ultrasound in Medical Education

Pediatric emergency medicine ultrasound director Jim Tsung led a well-attended course on pediatric ultrasound, along with Ee Tay.

Jim Teaching Lung US 500x317 Second World Congress on Ultrasound in Medical EducationMount Sinai emergency ultrasound fellow Amy Sanghvi presented an abstract on a novel interdepartmental ultrasound education project. Obstetric and emergency medicine interns learned pelvic ultrasound through a combination of didactics, online tutorials, hands-on skill stations with live models and several types of simulators, then underwent an OSCE for competency assessment and completed an online interactive question bank.

Amy Sanghvi Abstract 500x438 Second World Congress on Ultrasound in Medical Education

There were far too many ultrasound visionaries to list them all here. Here we have Mike Mallin and Matt Dawson (of Ultrasound Podcast fame) and Vicki Noble (ultrasound director at MGH and thoracic ultrasound guru) making sure Bret’s seersucker was for real.

057 500x375 Second World Congress on Ultrasound in Medical Education

Check out the World Congress website for the final program, images and videos from the conference, and more!

Left to right: Kim Poh

2013 Ultrasound Fellow Graduation

We were proud to graduate three ultrasound fellows this year:

  • Kim Poh Chan, our international fellow who will return to Singapore and head up a new ultrasound program
  • Daniel Lakoff, who will co-direct the ultrasound program at Elmhurst Hospital, and
  • Ee Tay, our first pediatric emergency ultrasound fellow, who will remain at Sinai
ChanLakoffDuqueNelsonSanghviTayGraduationDiplomas 500x375 2013 Ultrasound Fellow Graduation

Left to right: Kim Poh Chan, Daniel Lakoff, Danny Duque, Bret Nelson, Amy Sanghvi, Ee Tay

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2013 Tri-State Ultrasound Fellow Conference

The first annual Tri-State Ultrasound Fellow Conference kicked off today at Lenox Hill Hospital in New York City. The first day of this two-day course focused on administrative issues in ultrasound, featuring nationally recognized speakers from all around the area.

Bret Nelson from the Icahn School of Medicine at Mount Sinai discussed faculty development, including:

  • Creating a niche
  • The educator portfolio
  • Making connections

Here are a few references from the talk:

 

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