Mount Sinai Emergency Medicine Ultrasound

Many of our lectures reference the same pantheon of literature on ultrasound in the acutely hypotensive patient. For ease of reference here they are, with appropriate links to the original publications:

• UHP protocol
  • Rose JS et al,  Am J Emerg Med 2001 (PMID: 11447518)
• Trinity Protocol
  • Bahner D,  JDMS 2002
• RCT of ultrasound in hypotension
  • Jones AE et al, Crit Care Med 2004 (PMID: 15286547)
• FATE:Focused Assessed Transthoracic Echocardiography
  • Jensen et al, Eur J Anaesthesiol 2004 (PMID: 15595582)
• FEER:Focused Echocardiographic Evaluation in Resuscitation
  • Breitkreutz et al, Crit Care Med 2007 (PMID: 17446774)
• CAUSE:Cardiac Arrest Ultrasound Exam
  • Hernandez et al, Resuscitation 2008 (PMID: 17822831)
• RUSH: Rapid Ultrasound in Shock and Hypotension
  • Weingart et al, emcrit.org 2008, EMedHome 2009
• ACES:Abdominal and Cardiac Evaluation with Sonography in Shock
  • Atkinson et al, Emerg Med J 2009 (PMID: 19164614)
• RUSH: Rapid Ultrasound in Shock
  • Perera P et al, Emerg Med Clin N Am 2010 (PMID: 19945597)

Sinai’s own Dr. Lana Friedman, Pediatric Emergency Medicine Fellow, was just named one of three recipients of the prestigious SPR Fellow Clinical Research Award. Her abstract entitled, “Accuracy of Point-of-Care Ultrasound (PoCUS) by Novice Pediatric Emergency Sonologists in the Diagnosis of Skull Fractures,” was selected from a very competitive pool of submissions. She will present the abstract at the PAS meeting in Denver in April.
Congratulations to Dr. Friedman and her research advisor, Dr. Jim Tsung!

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.

The ultrasound division is proud to welcome two research scholars: Dr. Hong Chuen Toh and Dr. Shiang-Hu Ang.

Dr Hong Chuen Toh is an Associate Consultant from the Department of Emergency Medicine, Alexandra Hospital, Singapore. He obtained his bachelor degree in medicine and surgery M.B.B.S (Singapore) in 2000 and post graduate degree in Accident and Emergency Medicine MRCSEd (A&E) in 2007. He’s a member of the Royal College of Surgeons of Edinburgh, and his main sub-clinical interest is in emergency ultrasound. He has organized many WINFOCUS courses at his home hospital.
Dr. Shiang-Hu Ang (also known as Ash) is from Singapore’s Changi General Hospital Department of Emergency Medicine. He has been tasked to set up an emergency ultrasound service for his department. His interests include emergency ultrasound as well as emergency critical care, and his research interests lie in the ever expanding field of emergency soft-tissue ultrasound. He also manages the website of the Society for Emergency Medicine in Singapore- please check it out!

www.semsonline.org