Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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As emergency physicians (EPs) and other noncardiologists incorporate bedside ultrasound (US) and bedside echocardiography (echo) into their practice, confusion has resulted from the differing imaging conventions used by cardiac and general imaging. The author discusses the origin of these differences, current cardiac imaging conventions, and controversies in emergency medicine (EM) regarding adoption of imaging conventions. Also discussed in detail are specific echo windows and experience with different approaches. While there is no perfect solution to merging the differing conventions, it is important that those performing and teaching bedside US and echo have a thorough understanding of the issues involved, and adopt a consistent approach.
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The Centers for Disease Control and Prevention (CDC) recommends routine human immunodeficiency virus (HIV) screening of emergency department (ED) patients aged 13 to 64 years. The study objectives were to determine the accessibility of rapid HIV testing in academic EDs, to identify factors that influence an ED's adoption of testing, and to describe current HIV testing practices. ⋯ Most academic EDs now offer rapid HIV testing (57%), but few use it in situations other than occupational exposure. Less than half of academic EDs expect to implement CDC guidelines regarding routine screening within the next few years. The authors identified facility characteristics (e.g., counseling, ability to refer) that may influence adoption of rapid HIV testing.
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Measurements of the optic nerve sheath diameter (ONSD) using bedside ultrasound (US) have been shown to correlate with clinical and radiologic signs and symptoms of increased intracranial pressure (ICP). ⋯ Using an ROC curve the authors systematically confirmed the commonly used threshold of ONSD > 5 mm to detect ICP > 20 cm H2O. This study directly correlates ventriculostomy measurements of ICP with US ONSD measurements and provides further support for the use of ONSD measurements as a noninvasive test for elevated ICP.