Emergency medicine clinics of North America
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Emerg. Med. Clin. North Am. · Feb 1992
ReviewLegal issues in emergency radiology. Practical strategies to reduce risk.
Various joint commission and individual state standards affect emergency radiology practice and have legal implications. The ACEP has entered the burgeoning field of practice guidelines; fortunately, their practice guideline preparation system is arguably the most thorough in medicine at this time. This is of great importance to emergency physicians, because practice guidelines are not without their own potential legal, educational, and compliance problems. ⋯ The use of CQI strategies may prove helpful in improving practice patterns. Communication between emergency physician and radiologists is critical. Good communication requires the development of good rapport and should pay dividends in improved patient care.
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The use of ultrasonography in emergency medicine is an area of rapid growth and controversy. This article reviews the current and future applications of emergency ultrasonography with particular emphasis on the role of bedside scanning by the emergency practitioner. Abdominal, pelvic, and cardiac ultrasonographic applications are reviewed, as are the uses of ultrasonography as an adjunct to the performance of procedures in the Emergency Department.
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US is the imaging modality of choice in many situations encountered in the Emergency Department. It is particularly useful in evaluating renal colic, pain or vaginal bleeding in the pregnant patient, and pelvic pain in the nonpregnant woman; and in diagnosing gallbladder disease, appendicitis, proximal lower extremity DVT, and pericardial effusion. The information presented in each section, including sonographic findings and the role of US, should be helpful in choosing the most appropriate test in the evaluation process.
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Emergency physicians need an understanding of the utility of echocardiography in the Emergency Department. With the recent emphasis of emergency department use of portable ultrasonography, emergency physicians will have the opportunity to gain proficiency in using echocardiography to diagnose certain conditions. Echocardiography may aid in the diagnosis of acute MI, pericardial effusion and tamponade, acute valvular dysfunction, acute aortic dissection, and post-traumatic cardiac disorders. An understanding of the potential limitations of echocardiography, combined with experience in its techniques, will ultimately help the emergency physician with its use in daily patient care.