CJEM Articles: Ultrasound

Displaying 1-5 of 5 results

  • 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.

  • Diagnostic accuracy and clinical utility of emergency department targeted ultrasonography in the evaluation of first-trimester pelvic pain and bleeding: a systematic review
    July 2009 11 4
    Andrew McRae, Heather Murray, Marcia Edmonds

    Objective: Emergency department targeted ultrasonography (EDTU) offers the possibility of rapid exclusion of ectopic pregnancy in patients with first-trimester pelvic pain or bleeding. We sought to systematically review the evidence describing the diagnostic accuracy and clinical utility of EDTU in the first trimester of pregnancy, and to generate a pooled estimate of the sensitivity and specificity of EDTU for the detection of intrauterine pregnancy (IUP).

    Methods: The literature search, abstract review and study selection were performed using predefined criteria. We abstracted the sensitivity and specificity of EDTU for IUP from included studies, and evaluated and summarized the evidence assessing the effect of EDTU use on time to diagnosis, time to treatment of ectopic pregnancy, emergency department (ED) length of stay and health care costs.

    Results: The specificity of EDTU for IUP in most studies exceeds 98%. The sensitivity in most studies exceeds 90%. Pooled estimates were not calculated because of statistical heterogeneity between studies. Published evidence indicates that EDTU use reduces the frequency of missed ectopic pregnancies, decreases time to surgery for ectopic pregnancy, shortens the length of stay for patients with normal pregnancies and may be more cost-effective than diagnostic strategies requiring formal ultrasonography.

    Conclusion: EDTU is highly specific for the identification of IUP. Patients who have an IUP identified with EDTU may be safely discharged from the ED with outpatient follow-up. The specificity of EDTU for IUP, along with the potential improvements in patient care that EDTU affords, justifies its adoption as routine ED care in evaluating first-trimester pain or bleeding.

  • Ultrasound-guided central venous access: a homemade phantom for simulation
    September 2007 9 5
    Jeffrey P. Faragher, John L. Kendall
  • Identification and correction of guide wire malposition during internal jugular cannulation with ultrasound
    March 2007 9 2
    Michael B. Stone

    Real-time ultrasound guidance for central venous catheterization increases success and reduces procedural complications. I describe a case in which guide wire resistance was encountered and real-time ultrasound visualization of the guide wire facilitated correction of guide wire malposition. No additional passes of the introducer needle were necessary and the chances of inadvertent carotid artery puncture or pneumothorax were therefore reduced. The technique described here may prove valuable when guide wire resistance is encountered while placing a central venous catheter.

  • Unusual case of acute onset abdominal pain: uses and limitations of medical imaging
    July 2003 5 4
    Eric Poulin, Glen Bandiera

    A 28-year-old male with atraumatic abdominal pain and transient hypotension was assessed using bedside emergency department (ED) ultrasonography and contrast enhanced helical computed tomography (CT). Both tests revealed free intraperitoneal fluid, but neither detected a splenic defect. The patient subsequently underwent splenectomy for a ruptured spleen. His serology for typical viral causes was negative. This article discusses spontaneous splenic rupture, the role of imaging in diagnosis, and the limitations of ED ultrasound and contrast enhanced helical CT.