CJEM Articles: John L. Kendall

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  • Bacterial contamination and cleanliness of emergency department ultrasound probes
    November 2011 13 6
    Catherine Erickson, Geoffrey E. Sanz, John L. Kendall, Jonathan Theoret, Michael M. Liao

    Objectives: As ultrasonography is increasingly used in the emergency department (ED), ultrasound equipment has become a potential threat to infection control. Improperly cleaned ultrasound probes may serve as a vector for pathogens such as methicillin-resistant
    Staphylococcus aureus
    (MRSA). The primary objective of this study was to determine the prevalence of MRSA colonization on ultrasound probes used in a busy, urban ED. It was hypothesized that cultures of our ED ultrasound probes would yield a significant number of positive results for MRSA.
    Methods: In this observational study, 11 ED ultrasound probes were randomly sampled on 10 different occasions. Samples were taken using a RODAC plate method and were cultured for MRSA and methicillin-sensitive
    Staphylococcus aureus
    (MSSA). On half of the randomly assigned sampling occasions, a visual inspection of each ultrasound probe for general cleanliness was conducted and recorded. Data were stratified by ultrasound location in the ED and analyzed using the Fisher exact test, with
    p
    < 0.05 deemed to be statistically significant.
    Results: Of 110 samples, no isolates of MRSA were cultured. One probe yielded a positive culture for MSSA. Probes in the medicine, trauma, and pediatrics areas were found to be clean 65%, 33%, and 70% of the time, respectively. This variability in probe cleanliness by ED location was found to be statistically significant (
    p
    < 0.01).
    Conclusions: Contrary to our hypothesis, MRSA contamination of ultrasound probes was not found. This finding suggests that the spread of MRSA by ED ultrasound machines in a high-volume urban ED is unlikely. Further research at different centres with larger sample sizes is required before these results can be generalized.

  • The ‘‘guitar pick’’ sign: a novel sign of retrobulbar hemorrhage
    May 2011 13 3
    Catherine Erickson, David Matero, Geoffrey E. Sanz, John L. Kendall, Jonathan Theoret, Michael M. Liao, Todd Guth

    Retrobulbar hemorrhage is a rare complication of blunt ocular trauma. Without prompt intervention, permanent reduction in visual acuity can develop in as little as 90 minutes. We report a novel bedside ultrasound finding of conical deformation of the posterior ocular globe: the "guitar pick" sign. In our elderly patient, the ocular globe shape normalized post–lateral canthotomy and inferior cantholysis. Identifying this sonographic finding may add to the clinical examination when deciding whether to perform decompression.

  • Ultrasound-guided central venous access: a homemade phantom for simulation
    September 2007 9 5
    Jeffrey P. Faragher, John L. Kendall
  • Incidental findings during emergency sonographic examinations: a case series
    April 2001 3 2
    Diku Mandavia, John L. Kendall

    The teaching of ultrasonography is rapidly being incorporated into emergency medicine (EM) training programs and clinical practice. Most literature focuses on appropriate indications for the performance of emergency ultrasonography, and most EM-related courses and programs limit their teaching to standard focused indications. Generally this will suffice; however, occasionally, incidental findings, which are beyond the realm of what is taught in these programs, have influenced patient care. In this paper we discuss 7 cases in which incidental findings were discovered during an emergency sonographic examination. In each case the findings changed the patient's disposition, diagnosis and, potentially, outcome.