Longitudinal Ultrasound Education Track Curriculum Implemented Within an Emergency Medicine Residency Program.

Emergency Medicine residency programs offer ultrasound-focused curricula to address Accreditation Council for Graduate Medical Education (ACGME) milestones. Although some programs offer advanced clinical tracks in ultrasound, no standard curriculum exists. We sought to establish a well-defined ultrasound track curriculum to allow interested residents to develop advanced clinical skills and scholarship within this academic niche. The curriculum involves a greater number of clinical scans, ultrasound-focused scholarly and quality improvement projects, enhanced faculty-driven ultrasound focused didactics, and participation at a national ultrasound conference to receive certification. Successful ultrasound scholarly tracks can provide residents with the potential to obtain fellowships or competency beyond ACGME requirements.

The Midline Catheter: A Clinical Review.

BACKGROUND: Venous access in the emergency department (ED) is an often under-appreciated procedural skill given the frequency of its use. The patient's clinical status, ongoing need for laboratory investigation, and intravenous therapeutics guide the size, type, and placement of the catheter. The availability of trained personnel and dedicated teams using ultrasound-guided insertion techniques in technically difficult situations may also impact the selection. Appropriate device selection is warranted on initial patient contact to minimize risk and cost. OBJECTIVE: To compare venous access device indications and complications, highlighting the use of midline catheters as a potentially cost-effective and safe approach for venous access in the ED. DISCUSSION: Midline catheters (MC) offer a comparable rate of device-related bloodstream infection to standard peripheral intravenous catheters (PIV), but with a significantly lower rate than peripherally inserted central catheters (PICC) and central venous catheters (CVC) (PIV 0.2/1000, MC 0.5/1000, PICC 2.1-2.3/1000, CVC 2.4-2.7/1000 catheter days). The average dwell time of a MC is reported as 7.69-16.4 days, which far exceeds PIVs (2.9-4.1 days) and is comparable to PICCs (7.3-16.6 days). Cost of insertion of a MC has been cited as comparable to three PIVs, and their use has been associated with significant cost savings when placed to avoid prolonged central venous access with CVCs or in patients with difficult-to-access peripheral veins. Placement of a MC includes modified Seldinger and accelerated, or all-in-one, Seldinger techniques with or without ultrasound guidance, with a high rate of first-attempt success. CONCLUSION: The MC is a versatile venous access device with a low complication rate, long dwell time, and high rate of first-attempt placement. Its utilization in the ED in patients deemed to require prolonged hospitalization or to have difficult-to-access peripheral vasculature could reduce cost and risk to patients.

Acute management of auricular hematoma: a novel approach and retrospective review.

This retrospective case series is used to describe a refined technique for the aspiration and drainage of auricular hematoma that is simple, cost-effective, and allows for rapid recovery. Patients, all high school males participating in competitive wrestling, were enrolled voluntarily after risks and benefits were discussed, and consent was obtained. Criteria for enrollment included acute auricular hematoma of at least 2 cm in size with occurrence no greater than 3 weeks before presentation, and no overt signs of infection. Patients underwent alcohol cleansing followed by injection of 1% lidocaine, and hematoma aspiration with an 18-gauge catheter. The cannula was left within the hematoma cavity, and a compression dressing was applied. This method is an acceptable alternative to current methods of managing auricular hematoma. It is simple, cost-effective, and provides rapid recovery with a complication rate comparable to other procedures described.

Cranial Neuropathies and Neuromuscular Weakness: A Case of Mistaken Identity.

We describe a case of wound botulism initially thought to represent Miller-Fisher variant Guillain-Barré syndrome (MFS). Botulism classically presents with the so-called "four D's" (diplopia, dysarthria, dysphagia, dry mouth) with symmetric, descending weakness. MFS presents with a triad of limb-ataxia, areflexia, and ophthalmoplegia, with variable cranial nerve and extremity involvement. The distinction can be difficult but is important as early initiation of botulinum antitoxin is associated with improved patient outcomes in cases of botulism. Furthermore, it is important to recognize intravenous drug use as a risk factor in the development of botulism, especially given an increase in injection drug use.