European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Emergency ultrasonography is a frequently used imaging tool in the bedside diagnosis of the acute abdomen. Classic indications include imaging for acute abdominal aneurysm, acute cholecystitis, hydronephrosis, and free intra-abdominal fluid in patients with trauma or suspected vascular or ectopic pregnancy rupture. Point-of-care sonographic imaging often emphasizes the diagnostic utility of fluid and edema, both as a significant finding and as a desirable adjunct for improved imaging. ⋯ These studies advocate that sonographic findings of abnormal air can be straightforward and can become crucial for increasing the diagnostic yield of bedside ultrasound of the acute abdomen. They suggest that practitioners should familiarize themselves with the findings and techniques to gain the experience required to make the diagnosis with confidence. This article will discuss four groups of abnormal air patterns found in the abdomen and the retroperitoneum and the respective scanning techniques, with a focus on the use of ultrasound for diagnosing pneumoperitoneum and a suggested scanning approach in the emergency setting.
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Comparative Study
Accuracy of prehospital diagnoses by emergency physicians: comparison with discharge diagnosis.
A correct prehospital diagnosis of emergency patients is crucial as it determines initial treatment, admitting specialty, and subsequent treatment. We evaluated the diagnostic accuracy of emergency physicians. ⋯ Medical history, physical examination, ECG, and blood glucose enabled a correct diagnosis in most cases, but some were impossible to resolve without further technical and laboratory investigations. Only a few were definitively incorrect. A detailed medical history is essential. Neurological disorders can present with misleading symptoms and when the diagnosis is not clear it is better to assume the worst case.
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Chest pain is one of the most frequent reasons for presentation to the Emergency Department. The possible causes of chest pain are numerous and diverse, but importantly, several conditions, such as acute coronary syndrome, pulmonary embolism and aortic dissection, require urgent management and, in some cases, may be life-threatening. ⋯ We review the current indications for urgent echocardiography in this article, with reference to international management guidelines where available, when managing patients with suspected acute coronary syndrome, acute pulmonary embolism, acute aortic dissection, acute pericarditis and trauma. We also discuss the differences between comprehensive and FOcussed Cardiac UltraSound (FOCUS) echocardiography studies, along with the associated quality control and medicolegal implications.
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To introduce an external landmark for optimizing probe placement during Focused Assessment with Sonography for Trauma (FAST) exam. ⋯ The HS line is an external landmark that may optimize probe placement and facilitates teaching and performance of FAST examination.
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To evaluate the utility of urine dipstick test (UDT) for detecting rhabdomyolysis and acute kidney injury (AKI) due to crush injury. ⋯ UDT can be considered as an early screening tool for the detection and triage of patients at risk of developing AKI because of traumatic rhabdomyolysis after mass disasters.