The Well-Tempered Sonographer

PROFUNDUS or Just SUPERFICIALIS? Dissecting Acute Aortic Syndromes

Have you ever had a patient's aortic intima and media peel off each other like the plastic casing from a cheap laptop and wish had more tools than just shipping them off to the CT scanner? Well, the D-dimer and the suprasternal aortic notch views may be a solution to your problems! * This week's show notes [https://docs.google.com/document/d/1hBzPhe6H_MzMtRguaDrTqkQ7mWuXrGif/edit?usp=sharing&ouid=116165082000802517383&rtpof=true&sd=true] * Aortic Dissection Detection Risk Score (ADD-RS) on MDCalc [https://www.mdcalc.com/calc/4060/aortic-dissection-detection-risk-score-add-rs] * POCUS 101 post on performing aortic ultrasound [https://www.pocus101.com/aorta-ultrasound-made-easy-step-by-step-guide/] * ADD-RS and D-dimer systematic review and meta-analysis by Ren et al in PLOS ONE [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11192411/] * PROFUNDUS paper by Morello et al in the European Journal of Internal Medicine [https://linkinghub.elsevier.com/retrieve/pii/S0953620524002346] * SPEED protocol by Gibbons et al in AEM [https://onlinelibrary.wiley.com/doi/abs/10.1111/acem.14839] * Analysis of the SPEED protocol in EMA [https://www.emrap.org/episode/ema2024march/abstract11sonog] and SGEM [https://thesgem.com/2024/03/sgem432-speed-give-me-what-i-need-to-diagnose-acute-aortic-dissections/] Your questions and comments are welcome at welltemperedsonocast@gmail.com. The views expressed in this podcast are my own and do not necessarily reflect the views of the Department of Defense or U.S. Air Force. The theme music was adapted from the Prelude in C# major from J.S. Bach's Well-Tempered Clavier, volume II, as performed by Raymond Smullyan [https://imslp.org/wiki/Prelude_and_Fugue_in_C-sharp_major,_BWV_872_(Bach,_Johann_Sebastian)]. It was used under a CC BY-SA 4.0 license.

The Indication Just Says "CT Scanner Is Broken"

* This week's show notes [https://docs.google.com/document/d/19jRR-g4Z8wjxonCfa4uJuBh080RgLA8b/edit?usp=sharing&ouid=117254950967202159129&rtpof=true&sd=true] * Integrating Pre-test Probability and Point-of-Care Ultrasound (POCUS) in the Emergency Department (ED) Diagnosis of Small Bowel Obstruction (SBO) - PMC [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11026035/] - Paper #1 * Contrast‐enhanced point of care ultrasound for the evaluation of stable blunt abdominal trauma by the emergency physician: A prospective diagnostic study - PMC [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11031391/] - Paper #2 * Diagnostic Performance of Ultrasonography for Identification of Small Bowel Obstruction; a Systematic Review and Meta-analysis - PMC [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11077389/] - SR/MA on U/S performance on SBO evaluation * Likelihood ratios: Clinical application in day-to-day practice - PMC [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2683447/] - Review of likelihood ratios * Use of the D-dimer in detecting pulmonary embolism in the emergency department [https://linkinghub.elsevier.com/retrieve/pii/S0736467918300441] - D-dimer NLR * Is it time to re-think FAST? A systematic review and meta-analysis of Contrast-Enhanced Ultrasound (CEUS) and conventional ultrasound for initial assessment of abdominal trauma - PMC [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9881326/] - SR/MA of CEUS (general population) * Contrast-enhanced ultrasound in pediatric blunt abdominal trauma: a systematic review - PMC [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9402848/] - SR/MA of CEUS in pediatric population * How to perform Contrast-Enhanced Ultrasound (CEUS) - PMC [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5802984/] - Overview of CEUS procedure * Safety With Echocardiographic Contrast Agents [https://www.ahajournals.org/doi/10.1161/CIRCIMAGING.116.005459] - Echo contrast safety profile * Diagnostic accuracy of eFAST in the trauma patient: a systematic review and meta-analysis | Canadian Journal of Emergency Medicine | Cambridge Core [https://www.cambridge.org/core/product/identifier/S1481803519003816/type/journal_article] - SR/MA evaluating the E-FAST exam Your questions and comments are welcome at welltemperedsonocast@gmail.com. The views expressed in this podcast are my own and do not necessarily reflect the views of the Department of Defense or U.S. Air Force. The theme music was adapted from the Prelude in C# major from J.S. Bach's Well-Tempered Clavier, volume II, as performed by Raymond Smullyan [https://imslp.org/wiki/Prelude_and_Fugue_in_C-sharp_major,_BWV_872_(Bach,_Johann_Sebastian)]. It was used under a CC BY-SA 4.0 license.

Wells Score of 12.5

This week, we are embolizing information from my microphone straight into your ears, as I have a systematic review covering the accuracy of DVTs performed by EM providers and a trial looking at how well a new diagnostic measure called the RV bubble time does in looking for RV dysfunction. * This week's script/show notes [https://docs.google.com/document/d/1vnnsxMVDBT4SzPTCCwI2ZzGyfttKw3yezSeJoXtfYG8/edit?usp=sharing] * Paper 1: Hercz D, Mechanic OJ, Varella M, Fajardo F, Levine RL. Ultrasound Performed by Emergency Physicians for Deep Vein Thrombosis: A Systematic Review. West J Emerg Med. 2024 Mar;25(2):282-290. doi: 10.5811/westjem.18125. PMID: 38596931; PMCID: PMC11000565. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11000565/] * Paper 2: Cohen A, Li T, Bielawa N, Nello A, Gold A, Gorlin M, Nelson M, Carlin E, Rolston D. Right Ventricular "Bubble Time" to Identify Patients With Right Ventricular Dysfunction. Ann Emerg Med. 2024 Apr 10:S0196-0644(24)00095-7. doi: 10.1016/j.annemergmed.2024.02.005. Epub ahead of print. PMID: 38597847. [https://www.annemergmed.com/article/S0196-0644(24)00095-7/abstract] * A primer on performing DVT studies from POCUS 101 [https://www.pocus101.com/dvt-ultrasound-made-easy-step-by-step-guide/] * Dr. Sara Crager on Rescuing the Right Ventricle [https://www.icuedu.org/rvfailure] Your questions and comments are welcome at welltemperedsonocast@gmail.com. Content review for this episode was done by Dr. Titus Chu, ultrasound faculty in the Wright State University Emergency Medicine program. The views expressed in this podcast are my own and do not necessarily reflect the views of the Department of Defense or U.S. Air Force. The theme music was adapted from the Prelude in C# major from J.S. Bach's Well-Tempered Clavier, volume II, as performed by Raymond Smullyan [https://imslp.org/wiki/Prelude_and_Fugue_in_C-sharp_major,_BWV_872_(Bach,_Johann_Sebastian)]. It was used under a CC BY-SA 4.0 license.

GI Bleeds, VTI, and You

On this episode, we cover two papers on the use of ultrasound hemodynamic findings in clinically evaluating blood loss: one in suspected upper GI bleeding to risk stratify patients into transfusion candidates vs not at the bedside, and the other covering an emerging use of wearable ultrasound to relate carotid Doppler findings with cardiac output. * Show notes for paper 1 (Ayar et al) [https://docs.google.com/document/d/1TTpkfqa_SWuyQ7XLSwLpyhtoIejF1JU9/edit?usp=sharing&ouid=117254950967202159129&rtpof=true&sd=true] * Citation: Ayar MS, Baydın A, Ustaoglu M, Caliskan F, Erenler AK. Inferior vena cava collapsibility index and stroke volume as predictors of blood transfusion in upper gastrointestinal bleeding in the emergency department. J Gastroenterol Hepatol. 2024 Feb 9. doi: 10.1111/jgh.16500. Epub ahead of print. PMID: 38334062. * Show notes for paper 2 (Zhao et al) [https://docs.google.com/document/d/1j5WtmGbyERkKRUhp3JPT2dK4vhJQ_8Ej/edit?usp=sharing&ouid=117254950967202159129&rtpof=true&sd=true] * Citation: Zhao, X., Yuan, W., Wang, S. et al. Evaluation of hemorrhagic shock and fluid resuscitation in pigs using handless Doppler carotid artery ultrasound. Eur J Trauma Emerg Surg (2024). https://doi.org/10.1007/s00068-024-02481-3 [https://doi.org/10.1007/s00068-024-02481-3] Your questions and comments are welcome at welltemperedsonocast@gmail.com. Content review for this episode was done by Dr. Titus Chu, ultrasound faculty in the Wright State University Emergency Medicine program. The views expressed in this podcast are my own and do not necessarily reflect the views of the Department of Defense or U.S. Air Force. The theme music was adapted from the Prelude in C# major from J.S. Bach's Well-Tempered Clavier, volume II, as performed by Raymond Smullyan [https://imslp.org/wiki/Prelude_and_Fugue_in_C-sharp_major,_BWV_872_(Bach,_Johann_Sebastian)]. It was used under a CC BY-SA 4.0 license.