CJEM Articles: ultrasonography
Displaying 1-10 of 17 results
Ali Pourmand, Hamid Shokoohi, Keith Boniface, M. Reza Taheri
Spontaneous rectus sheath hematoma is an uncommon condition that can mimic other conditions associated with an acute abdomen. We report the case of a patient with a spontaneous rectus sheath hematoma due to a ruptured inferior epigastric artery pseudoaneurysm who presented with hypotension and severe abdominal pain and was diagnosed using emergency department point-of-care ultrasonography. Point-of-care ultrasonography has been increasingly used in the evaluation of emergency department patients with acute abdomen and hypotension to expedite the diagnosis and management of aortic aneurysm and intraperitoneal bleeding. Resuscitation and urgent surgical and interventional radiology consultations resulted in the successful embolization of a branch of the inferior epigastric artery and a good outcome.
James H. Moak, John S. Rajkumar, William A. Woods
To determine whether novices can distinguish between properly and improperly placed guidewires in a vascular access model after only minimal training.
This was a prospective study involving trainees with no previous training in sonographic guidewire visualization. A vascular access model was created with guidewires positioned inside or adjacent to simulated veins. Subjects were taught to scan each wire to determine its location. Afterward, participants scanned a test model of five vein-wire pairs and recorded their answers as “inside,” “outside,” or “unsure.” The test characteristics of sonographic guidewire localization were determined using actual wire location as the criterion standard.
Forty trainees (21 emergency medicine residents, 19 medical students) participated, and each examined five simulated veins. There were 156 true positives (intravascular wire correctly identified), 38 true negatives (extravascular wire correctly identified), 2 false negatives, 2 false positives, and 2 cases in which the participant marked “not sure,” which were reclassified as false negatives. Test characteristics were sensitivity 97.5% (95% CI 93.3–99.2) and specificity 95.0% (95% CI 81.8–99.1). The overall accuracy was 97.0%.
Sonographic guidewire visualization, a step recommended for ensuring proper vessel cannulation during central venous access, can be accomplished by novices with a high degree of accuracy.
Nicholas M. Desy, Willis B. Grad
One of the most common acute injuries seen in the emergency department is the hip fracture. This injury is usually diagnosed by plain radiographs, however these fractures are sometimes not obviously apparent. Occult hip fractures present a pitfall for emergency department physicians. We present a case of a patient who sustained bilateral occult hip fractures. We review the epidemiology of the condition, examine what diagnostic studies are available that may help the physician avoid missing the occult hip fracture and what the literature tells us about the utility of each of these modalities. The prognosis of the occult hip fracture along with options for treatment is also discussed.
Bedside emergency department ultrasonography availability and use for blunt abdominal trauma in Canadian pediatric centresJanuary 2012 14 1Christine Meyers, Joe Nemeth, Robin Cardamore
To quantify the current availability and use of bedside emergency department ultrasonography (EDUS) for blunt trauma at Canadian pediatric centres and to identify any perceived barriers to the use of bedside EDUS in such centres.
An electronic survey was sent to 162 pediatric emergency physicians and 12 site directors from the 12 pediatric emergency departments across Canada.
Ninety-two percent (11 of 12) of centres completed the survey. The individual physician response rate was 65% (106 of 162), with 100% of site directors responding. Ultrasound machines were available in 45% (5 of 11) of centres. Forty-two percent (32 of 77) of emergency physicians working in equipped pediatric centres used bedside EDUS to evaluate blunt abdominal trauma (BAT). In the subgroup of staff who also worked at adults sites, the frequency of ultrasonography use for the evaluation of pediatric BAT was 75%. In the 55% (6 of 11) of centres without ultrasonography, 88% of staff intend to incorporate its use in the future and 81% indicated that they believed the incorporation of ultrasonography would have a positive impact on patient care. The main perceived barriers to the use of ultrasonography in the evaluation of BAT were a lack of training (41%) and a lack of equipment (26%).
Bedside EDUS is currently used in almost half of pediatric trauma centres, a frequency that is significantly lower than adult centres. Physicians in pediatric centres who use ultrasonography report that it has a high utility, and a great majority of physicians at pediatric centres without EDUS plan to incorporate it in the future. The main reported barriers to its use are a lack of training and a lack of equipment availability.
Amy Cheng, Carolyn Kelly-Smith, Geoff Sanz, Jonathan Theoret, Kevin Nemethy, Shannon O’Donnell
Bedside ultrasonography detects significant femoral vessel overlap: implications for central venous cannulationJuly 2011 13 4Fenwick Gardiner, Francesca L. Beaudoin, James Lincoln, Jamieson Cohn, Otto Liebmann, Roland C. Merchant
Objective: Our goal was to gain a better understanding of the femoral vessel anatomy as it relates to central venous cannulation. The primary objective of this study was to use bedside ultrasonography to determine the amount of exposed femoral vein at three sites corresponding to surface anatomy of the landmark-based procedure.
Methods: This cross-sectional study enrolled a random sample of 180 adult patients presenting to a large urban academic emergency department. Subjects underwent standardized ultrasonography to identify and measure the depth and diameter of the femoral vessels and amount of exposed femoral vein at the level of the inguinal ligament (0 cm) 2 cm and 4 cm below. Repeated measures analysis of variance was used to determine significant relationships between vessel measurements and distance from the inguinal ligament.
Results: The median age was 44.5 (range 19–90) years; 101 patients were male. The mean (± SD) percentage of exposed vein at the inguinal ligament was 83% (± 21). This decreased significantly (p < 0.01) with increasing distance from the inguinal ligament: 65% (± 25) at 2 cm and 56% (± 30) at 4 cm. At every distance away from the inguinal ligament, there were some subjects with no vein exposed.
Conclusion: This study demonstrates significant overlap of the femoral vessels at sites where landmark-based femoral vein cannulation is often attempted. Our results suggest that ultrasound guidance would be beneficial as femoral vein cannulation may be difficult or impossible in certain individuals owing to anatomic variations.
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.
Brooks Laselle, Jason D. Heiner, Katisha Baldwin
Alexandre Anawati, I. Ching Yeung, Marc-Andre Roy, Ray Wiss, Ron Robins, Steven J. Socransky
Objective: Determination of jugular venous pressure (JVP) by physical examination (E-JVP) is unreliable. Measurement of JVP with ultrasonography (U-JVP) is easy to perform, but the normal range is unknown. The objective of this study was to determine the normal range for U-JVP.
Methods: We conducted a prospective anatomic study on a con venience sample of emergency department (ED) patients over 35 years of age. We excluded patients who had findings on history or physical examination suggesting an alteration of JVP. With the head of the bed at 45°, we determined the point at which the diameter of the internal jugular vein (IJV) began to decrease on ultrasonography (“the taper”). Research assistants used 2 tech niques to measure U-JVP in all participants: by measuring the vertical height (in centimetres) of the taper above the sternal angle, and adding 5 cm; and by recording the quadrant in the IJV’s path from the clavicle to the angle of the jaw in which the taper was located. To determine interrater reliability, separate examiners measured the U-JVP of 15 participants.
Results: We successfully determined the U-JVP of all 77 participants (38 male and 39 female). The mean U-JVP was 6.35 (95% confidence interval 6.11–6.59) cm. In 76 participants (98.7%), the taper was located in the first quadrant. Determination of interrater reliability found κ values of 1.00 and 0.87 for techniques 1 and 2, respectively.
Conclusion: The normal U-JVP is 6.35 cm, a value that is slightly lower than the published normal E-JVP. Interrater reliability for U-JVP is excellent. The top of the IJV column is located less than 25% of the distance from the clavicle to the angle of the jaw in the majority of healthy adults. Our findings suggest that U-JVP provides the potential to reincorporate reliable JVP measurement into clinical assessment in the ED. However, further research in this area is warranted.
The utility of renal ultrasonography in the diagnosis of renal colic in emergency department patientsMay 2010 12 3Justin W. Yan, Karl D. Theakston, Marcia L. Edmonds, Robert J. Sedran, Shelley L. McLeod
Objective: Computed tomography (CT) is an imaging modality used to detect renal stones. However, there is concern about the lifetime cumulative radiation exposure attributed to CT. Ultrasonography (US) has been used to diagnose urolithiasis, thereby avoiding radiation exposure. The objective of this study was to determine the ability of US to identify renal colic patients with a low risk of requiring urologic intervention within 90 days of their initial emergency department (ED) visit.
Methods: We completed a retrospective medical record review for all adult patients who underwent ED-ordered renal US for suspected urolithiasis over a 1-year period. Independent, double data extraction was performed for all imaging reports and US results were categorized as “normal,” “suggestive of ureterolithiasis,” “ureteric stone seen” or “disease unrelated to urolithiasis.” Charts were reviewed to determine how many patients underwent subsequent CT and urologic intervention.
Results: Of the 817 renal US procedures ordered for suspected urolithiasis during the study period, the results of 352 (43.2%) were classified as normal, and only 2 (0.6%) of these patients required urologic intervention. The results of 177 (21.7%) renal US procedures were suggestive of ureterolithiasis. Of these, 12 (6.8%) patients required urologic intervention. Of the 241 (29.5%) patients who had a ureteric stone seen on US, 15 (6.2%) required urologic intervention. The rate of urologic intervention was significantly lower in those with normal results on US (p < 0.001) than in those with abnormal results on US.
Conclusion: A normal result on renal US predicts a low likelihood for urologic intervention within 90 days for adult ED patients with suspected urolithiasis.