Emergency medicine clinics of North America
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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.
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Many invasive procedures are now safer and more efficient with the use of ultrasound guidance. As emergency physicians continue to develop skills in sonography, new applications of this technology will continue to impact the practice of emergency medicine.
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The true value of ultrasound in acute abdominal pain lies in its ability to detect gynecologic disorders and effectively rule out other causes of acute abdominal pain that require surgical repair. Although the emergent gynecologic indications discussed in this article are few in number, this does not suggest that the nonpregnant patient presenting to the ED with abdominal pain should not receive an ultrasound examination. On the contrary, the author believes that in a "perfect world," ultrasound should be the initial imaging study in most of these patients. ⋯ EPs should not be discouraged from developing expertise in this examination when a confirmatory study in radiology will be performed. Miles on the "ultrasound odometer" will not only sharpen sonographic skills but also will help the EP to better communicate with nonpregnant patients presenting with abdominal pain. There is a fairly specific barometer already in place to gauge one's gynecologic ultrasound skills: a seasoned EP sonographer never skips over the chart of a young woman with right lower quadrant pain.
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Emerg. Med. Clin. North Am. · Aug 2004
Emergency medicine ultrasound policies and reimbursement guidelines.
Every emergency medicine physician should be knowledgeable of current emergency medicine expert policy and recommendations regarding the use of ultrasound imaging technology in the emergency department. In the last 3 years, a number of publications have provided critical information on practice management and reimbursement issues relating to bedside ultrasound performed by emergency physicians. This article summarizes the salient points of these publications. Because of their potential impact and relevance to emergency medicine, specific policies issued from the general house of medicine that relate to ultrasound technology also are included.
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Many thousands of individuals are submersion victims each year in the United States. The majority of victims are young, previously healthy people. ⋯ Most submersion incidents should never take place. Emergency physicians can take the lead in public education and prevention.