Mount Sinai Emergency Medicine Ultrasound

Congratulations to Sinai’s own Dr. Jim Tsung, who recently coauthored a major evidence-based consensus guideline on point-of-care lung ultrasound. The manuscript is the result of a multi-national effort by pioneering clinician-sonographers, and was just published in the journal Intensive Care Medicine:

International evidence-based recommendations for point-of-care lung ultrasound.

PMID: 22392031

On November 17, 2011 Dr. Braden Hexom presented research organized by Mount Sinai and conducted at JFK Hospital in Liberia. The project,

Evaluation of Novel Obstetrics Ultrasound Curriculum for Local Healthcare Providers in Liberia

Bentley S, Hexom B, Nelson BP

described a novel ultrasound curriculum developed in concert with providers in Liberia after a needs assessment and analysis of various use models of ultrasound deployment in the area.

It was determined that among the highest-yield applications of point-of-care ultrasound was pregnancy evaluation, especially during the third trimester. According to the United Nations Population Fund, Liberia’s rate of maternal mortality is among the highest in sub-Saharan Africa (994 per 100,000 live births). Increasingly international organizations such as WINFOCUS have lauded ultrasound as a means of empowering patients and providers in under-resourced areas and improving the quality of care delivered.

A great presentation by Alberta Spreafico (Outreach and International Development Program Coordinator at Henry Ford Health Systems) highlights this topic in an eloquent and inspiring fashion. See below for her TED talk!

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.

Bret Nelson and Mt. Sinai’s director of Disaster Preparedness and Prehospital Care, Kevin Chason, collaborated on this pilot study on use of Prehospital FAST and Aorta US which showed that paramedics can obtain and interpret these studies.

Visual Diagnosis Case from JEM.  Bret and Ted discuss a case of appendicitis confirmed with ultrasound after CT was not conclusive.