Emergency Medicine Advanced Ultrasound Service: A new paradigm.

OBJECTIVE: Point-of-care ultrasound (POCUS) is now ubiquitous in emergency medicine. Increased accessibility does not, however, ensure expertise in its use. We present a unique model of an Emergency Medicine Advanced Ultrasound Service (EMAUS). In our model specialist emergency physicians with advanced ultrasound (US) qualifications (emergency sonologists), provide images and reports for the entire department. The service is considered an extension of the traditional radiology model. It is consultative, diagnostic and procedural, and includes full US examinations as well as POCUS examinations. METHODS: A 4-month prospective descriptive observational study was conducted at a tertiary hospital during which data was recorded about emergency medicine US use and its outcomes. RESULTS: A total of 1336 US scans were recorded. Emergency sonologists conducted the majority of examinations, 69.8%. Half the consultative USs demonstrated positive findings. Follow-up computed tomography (CT) was recommended in 8.8% of consultative US studies and 12.4% of POCUS studies. Concerning incidental findings requiring further investigation (usually CT/magnetic resonance imaging) were infrequent at 1.6%. CONCLUSION: Globally POCUS has proliferated with varying expertise and data to support its use. The EMAUS provides a trusted and accountable service with the advantages of simultaneously integrating consultative US into the clinical context by an emergency physician. A diverse range of indications, scan types and pathology was recorded over the period demonstrating the utility of combining the roles of senior clinician, sonographer and radiologist and the benefits of advanced training and credentialing.

Predictors of False-Negative Focused Assessment With Sonography for Trauma Examination in Pediatric Blunt Abdominal Trauma.

OBJECTIVES: This study investigated associations between patient and injury characteristics and false-negative (FN) focused assessment with sonography for trauma (FAST) in pediatric blunt abdominal trauma (BAT). We also evaluated the effects of FN FAST on in-hospital mortality and length of stay (LOS) variables. METHODS: This retrospective cohort studied children younger than 18 years between January 1, 2002, and December 31, 2013, with BAT, documented FAST, and pathologic fluid on computed tomography, surgery, or autopsy. Multivariable and bivariate analyses were used to assess associations between FN FAST and patient injury characteristics, mortality, and hospital LOS. RESULTS: A total of 141 pediatric BAT patients with pathologic free fluid were included. There were no patient or injury characteristics, which conferred increased odds of an FN FAST. Splenic and bladder injury were negatively associated with FN FAST odds ratio of 0.4 (95% confidence interval [CI], 0.2-0.8) and 0.1 (95% CI, 0-0.8). Abbreviated Injury Scale score of 4 or greater to the abdomen and extremity was negatively associated with FN FAST odds ratio of 0.1 (95% CI, 0-0.3) and 0.3 (95% CI, 0.1-0.9). There was no association between FN FAST and mortality. Patients with an FN FAST had increased hospital LOS after controlling for sex, age, and Injury Severity Score. CONCLUSIONS: Clinicians need to be cautious applying a single initial FAST to patients with minor abdominal trauma or with suspected injuries to organs other than the spleen or bladder. Formalized studies to develop risk stratification tools could allow clinicians to integrate FAST into the pediatric patient population in the safest manner possible.

Impact of hydrotherapy on skin blood flow: How much is due to moisture and how much is due to heat?

Hydrotherapy and whirlpool are used to increase skin blood flow and warm tissue. However, recent evidence seems to show that part of the increase in skin blood flow is not due to the warmth itself but due to the moisture content of the heat. Therefore, two series of experiments were accomplished on 10 subjects with an average age of 24.2 +/- 9.7 years and free of diabetes and cardiovascular disease. Subjects sat in a 37 degrees C hydrotherapy pool under two conditions: one in which a thin membrane protecting their skin from moisture while their arm was submerged in water and the second where their arm was allowed to be exposed to the water for 15 minutes. During this period of time, skin and body temperature were measured as well as skin blood flow by a Laser Doppler Imager. The results of the experiments showed that the vapor barrier blocked any change in skin moisture content during submersion in water, and while skin temperature was the same as during exposure to the water, the blood flow with the arm exposed to water increased from 101.1 +/- 10.4 flux to 224.9 +/- 18.2 flux, whereas blood flow increased to only 118.7 +/- 11.4 flux if the moisture of the water was blocked. Thus, a substantial portion of the increase in skin blood flow associated with warm water therapy is probably associated with moisturizing of the skin rather than the heat itself.