Emergency medicine clinics of North America
-
The evidence that supports the general application of US guidance for venous access in the ED has reached a critical mass. The increasing familiarity of emergency physicians with US and the recent focus on patient safety and clinical outcomes has intensified attention on the capacity for US to improve patient care in the ED. ⋯ Varying levels of evidence support the use of US guidance over the traditional landmark approach for venous access in adult and pediatric populations and for central and peripheral veins. Many different techniques may be applied, depending on the clinical situation and equipment available.
-
Ultrasound represents the cornerstone of the emergent evaluation of pregnancy-related complaints. Knowledge of the potential and the limitations of this imaging modality, regardless of who performs it, is important for physicians who evaluate and manage these patients and their unborn children in the ED.
-
The use of echocardiography in the ED is well established and continues to gain widespread use in the evaluation of critically ill patients. In certain circumstances such as chest trauma, pericardial effusion, and cardiac arrest,EPs can perform and interpret echocardiographic examinations reliably. ⋯ Academic- and community-based EPs should seek to incorporate further the use of echocardiography in their respective clinical practices, with special attention given to training and quality assurance. As EPs continue to improve their skills in cardiac ultrasound, their ability to diagnose a wider spectrum of cardiac diseases undoubtedly will grow proportionally.
-
Bedside US has an established role in the evaluation of chest trauma patients. Transthoracic echocardiography and TEE can be used to obtain critical information at the bedside for many emergent conditions, including the immediate detection of hemopericardium and acute aortic injury. ⋯ These diagnostic techniques can improve patient outcome and are within the scope of practice of emergency physicians and trauma surgeons. Physicians caring for trauma patients should be familiar with these techniques.
-
Acute scrotal pain makes up approximately 0.5% of all complaints presenting to an emergency department. Some of the most com-mon diagnoses for this complaint are testicular torsion and epididymitis. ⋯ A key component of the testicular examination is use of power and spectral Doppler ultrasonography. Examination of the acute scrotum should not be undertaken unless Doppler capability is available because the evaluation of blood flow is such an important part of diagnosis of testicular torsion, orchitis, epididymitis,trauma, and hemorrhage into a mass.