NYC RESUSCITATIVE US ROUNDS – JUNE 9

NY RESUS US - JUNE 9OPTIMIZING YOUR ULTRASOUND PRESENTATION

Edward Tufte – statistician and pioneer in the field of data visualization. Worth a look.

Garr Reynolds’ book Presentation Zen is required reading for the presentation enthusiast.

Nancy Duarte is a professional writer speaker and her design firm has prepared countless TED talks including Al Gore’s inconvenient truth. Tons of resources on her site.

The Teaching Course is an expensive introduction to cutting edge medical education – developed by Rob Rogers and Salim Rezaie. Scott Weingart has posted his lecture on presentation preparation mastery to vimeo.

The United States Military Academy offers this incredible pdf of a presentation on dynamic planning for counter insurgency in Afghanistan.

Ben Smith’s ultrasound of the week website hosts his clip deidentifier app, m-modify and a PMID citation generator. Not to mention highly educational weekly ultrasound cases.

iSKySoft offers an excellent commercial video and media conversion software.

Propanolol for stage fright: Effect of beta blockade and beta stimulation on stage fright. Brantigan CO, Brantigan TA, Joseph N. Am J Med. 1982 Jan;72(1):88-94. PMID: 6120650

CARDIAC STANDSTILL

Blyth meta-analysis that purported to lyse the dogma of standstill being associated with 100% mortality.

Bedside focused echocardiography as predictor of survival in cardiac arrest patients: a systematic review. Blyth L, Atkinson P, Gadd K, Lang E. Acad Emerg Med. 2012 Oct;19(10):1119-26. doi: 10.1111/j.1553-2712.2012.01456.x. Epub 2012 Oct 5. Review. Erratum in: Acad Emerg Med. 2015 Jul;22(7):892. PMID: 23039118

Tomruk paper from a group in Turkey that achieved ROSC in 55 patients with standstill. 45% of those with standstill were successfully resuscitated. No mention of survival to discharge, long term outcome, etc.

Assessment of cardiac ultrasonography in predicting outcome in adult cardiac arrest. Tomruk O, Erdur B, Cetin G, Ergin A, Avcil M, Kapci M. J Int Med Res. 2012;40(2):804-9. PMID: 22613446

Bocka definition of echocardiac cardiac activity: Electromechanical dissociation in human beings: an echocardiographic evaluation. Bocka JJ, Overton DT, Hauser A. Ann Emerg Med. 1988 May;17(5):450-2. PMID: 3364823

Turning Technologies remote polling system

The R Project for statistical computing. https://www.r-project.org/

Krippendorff, K. (2011). Computing Krippendorff’s Alpha-Reliability. Retrieved from http://repository.upenn.edu/asc_papers/43

Hayes A, Krippendorff K. Answering the Call for a Standard Reliability Measure for Coding Data. Communication Methods and Measures. 2007;1(1):77-89.

Reason Study: ppt from CAEP presentation

Ultrasound podcast on REASON study.

 

SMALL BOWEL OBSTRUCTION

Unluer et al compared bedside ultrasound and radiology ultrasound to clinical course and surgical findings.  174 patients. Bedside and radiology ultrasound were found to have similar test characteristics and both exceeded plain film radiography.

Ultrasonography by emergency medicine and radiology residents for the diagnosis of small bowel obstruction. Unlüer EE, Yava?i O, Ero?lu O, Yilmaz C, Akarca FK. Eur J Emerg Med. 2010 Oct;17(5):260-4. doi: 10.1097/MEJ.0b013e328336c736. PMID: 20216422

Jang et al found that bedside ultrasound outperformed plain films using ct as gold standard in 76 patients.

Bedside ultrasonography for the detection of small bowel obstruction in the emergency department. Jang TB, Schindler D, Kaji AH. Emerg Med J. 2011 Aug;28(8):676-8. doi: 10.1136/emj.2010.095729. Epub 2010 Aug 22. PMID: 20732861

 

DIVERTICULITIS

This radiology study meta-analysis of 630 ultrasound patients and 684 ct patients found US test characteristics to be non-inferior to CT.

Graded compression ultrasonography and computed tomography in acute colonic diverticulitis: meta-analysis of test accuracy. Laméris W, van Randen A, Bipat S, Bossuyt PM, Boermeester MA, Stoker J. Eur Radiol. 2008 Nov;18(11):2498-511. PMID: 18523784


APPENDICITIS

Fox compared bedside ultrasound in 126 patients to either path report for those that underwent appendectomy or telephone follow up if they didn’t. They achieved excellent  specificity 90% – but mediocre sensitivity – only 65%. This is one way we use very commonly use ultrasound, though – as a rule in only modality.

Prospective evaluation of emergency physician performed bedside ultrasound to detect acute appendicitis. Fox JC, Solley M, Anderson CL, Zlidenny A, Lahham S, Maasumi K. Eur J Emerg Med. 2008 Apr;15(2):80-5. doi: 10.1097/MEJ.0b013e328270361a. PMID: 18446069

Jim Tsung’s 2014 study found 100% sensitivity with a strict technique – their protocol required the appendix to be fully visualized from tip to cecum in long view and then transversely throughout the same course. This resulted in a higher number of equivocal studies, but no false negative laparotomies.  Having no false negative laparotomies builds real trust with your pediatric surgeons.

The effect of point-of-care ultrasonography on emergency department length of stay and computed tomography utilization in children with suspected appendicitis. Elikashvili I, Tay ET, Tsung JW. Acad Emerg Med. 2014 Feb;21(2):163-70. doi: 10.1111/acem.12319. PMID: 24673672

 

CHOLECYSTITIS

Summers and Fox found test characteristics in BUS noninferior to RUS.

A prospective evaluation of emergency department bedside ultrasonography for the detection of acute cholecystitis. Summers SM, Scruggs W, Menchine MD, Lahham S, Anderson C, Amr O, Lotfipour S, Cusick SS, Fox JC. Ann Emerg Med. 2010 Aug;56(2):114-22. doi: 10.1016/j.annemergmed.2010.01.014. PMID: 20138397

Villar’s and Fox’s study – looked at data from a prior study comparing gallstones along vs. stones + secondary signs for the diagnosis of cholecystitis with Radiology ultrasound or pathology report as the gold standard. They found that absence of gallstones ruled out cholecystitsi with a sensitivity of 100%..

Studies like these make my life so easy.

The Absence of Gallstones on Point-of-Care Ultrasound Rules Out Acute Cholecystitis. Villar J, Summers SM, Menchine MD, Fox JC, Wang R. J Emerg Med. 2015 Oct;49(4):475-80. doi: 10.1016/j.jemermed.2015.04.037. Epub 2015 Jul 7. PMID: 26162764

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