Should UK emergency physicians undertake diagnostic ultrasound examinations?

From the published evidence there is no doubt that emergency physicians in America can undertake focused ultrasound examinations and that, by extrapolation, this would also be the case for UK emergency physicians. If this skill is to become part of the diagnostic armamentarium of the emergency physician, however, it needs to be demonstrated to be cost effective compared with the alternatives already available to the hospital. Trials to test for this benefit should adopt a hospital and not an emergency department perspective if the results are to influence health policy and specialty training.     

Should UK emergency physicians undertake diagnostic ultrasound examinations?

From the published evidence there is no doubt that emergency physicians in America can undertake focused ultrasound examinations and that, by extrapolation, this would also be the case for UK emergency physicians. If this skill is to become part of the diagnostic armamentarium of the emergency physician, however, it needs to be demonstrated to be cost effective compared with the alternatives already available to the hospital. Trials to test for this benefit should adopt a hospital and not an emergency department perspective if the results are to influence health policy and specialty training.     

Can emergency physicians perform extended compression ultrasound for the diagnosis of lower extremity deep vein thrombosis?

BACKGROUND: Current point-of-care ultrasound protocols in the evaluation of lower extremity deep vein thrombosis (DVT) can miss isolated femoral vein clots. Extended compression ultrasound (ECUS) includes evaluation of the femoral vein from the femoral vein/deep femoral vein bifurcation to the adductor canal. Our objective is to determine if emergency physicians (EPs) can learn ECUS for lower extremity DVT evaluation after a focused training session.METHODS: Prospective study at an urban academic center. Participants with varied ultrasound experience received instruction in ECUS prior to evaluation. Two live models with varied levels of difficult sonographic anatomy were intentionally chosen for the evaluation. Each participant scanned both models. Pre- and post-study surveys were completed.RESULTS: A total of 96 ultrasound examinations were performed by 48 participants (11 attendings and 37 residents). Participants’ assessment scores averaged 95.8% (95% CI 93.3%-98.3%) on the easier anatomy live model and averaged 92.3% (95% CI 88.4%-96.2%) on the difficult anatomy model. There were no statistically significant differences between attendings and residents. On the model with easier anatomy, all but 1 participant identified and compressed the proximal femoral vein successfully, and all participants identified and compressed the mid and distal femoral vein. With the difficult anatomy, 97.9% (95% CI 93.8%-102%) identified and compressed the proximal femoral vein, whereas 93.8% (95% CI 86.9%-100.6%) identified and compressed the mid femoral vein, and 91.7% (95% CI 83.9%-99.5%) identified and compressed the distal femoral vein.CONCLUSION: EPs at our institution were able to perform ECUS with good reproducibility after a focused training session.     

How comfortable are emergency physicians with pediatric patients?

We sought to understand how emergency physicians perceive the adequacy of their training in pediatrics. A survey was distributed to emergency physicians regarding residency training, clinical experience, importance of Core Content curricular areas, and the adequacy of their training. The results demonstrated that 84.0% of respondents felt well, completely, or adequately prepared with pediatric cardiopulmonary arrests compared to 96.4% who felt prepared for adult arrests. Trauma resuscitations and care of acutely ill patients revealed differences in preparedness for children versus adults [81.5% vs. 90.1%, respectively (p < 0.001) and 92.2% vs. 97.1%, respectively (p < 0.001)]. Pediatric arrest was the most often cited clinical situation giving trouble to first year attendings (24%) and infants were second (22%). Pediatric disorders were cited as the fourth most important area in training. Certain residency characteristics were associated with an increased sense of preparedness. These results may interest Emergency Medicine educators in planning pediatric curricula and experiences for residents.     

Can emergency medicine residents detect acute deep venous thrombosis with a limited,two-site ultrasound examination?

The purpose of this prospective clinical study was to determine the ability of Emergency Medicine (EM) residents to accurately detect acute deep venous thrombosis (aDVT) after training in a limited, two-site examination. Six residents received a 90-min session consisting of a lecture and a hands-on component. Each resident then performed the examination on symptomatic extremities referred to the vascular laboratory of a community teaching hospital. The examination was limited to the femoral and popliteal sites and was considered normal when the vein completely compressed. A formal examination was completed by the vascular technician (who was blinded to the resident's results) within 30 min of the resident examination. Of the 121 symptomatic extremities, vascular technicians detected nine cases of aDVT in the target area (7% prevalence); resident examinations revealed eight of these (sensitivity 89%). EM residents can perform a limited duplex examination with considerable but not perfect accuracy after receiving very limited instruction.     

Towards evidence-based emergency medicine: best BETs from the Manchester Royal Infirmary. Can inflammatory markers distinguish streptococcal from viral tonsillitis?

A short-cut review was performed to evaluate whether inflammatory markers such as C reactive protein (CRP), erythrocyte sedimentation rate (ESR), white cell count (WCC) and procalcitonin (PCT) are able to discriminate between streptococcal and viral tonsillitis, enabling a reduction in the overuse of antibiotics. Eight studies with a total of 1031 participants were found. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. The clinical bottom line is that WCC, CRP and PCT levels are higher in patients with streptococcal tonsillitis compared to patients with tonsillitis or pharyngitis without group A streptococcus isolated from a throat swab. Which of these markers has the best test performance characteristics requires further study.     

Can ultrasound help to manage patients with scrotal trauma?

Traumatic injuries to the scrotum are uncommon but, when they do occur, frequently lead to serious complications. Early complications include testicular infarction, necrosis and abscess formation; in the longer-term trauma may result in testicular atrophy and subfertility. Early surgical intervention in patients with testicular rupture can significantly improve the clinical outcome and reduce the need for delayed orchidectomy. However, clinical examination of the scrotum following trauma is difficult and frequently inaccurate; this may result in incorrect triage of patients for surgical exploration. Scrotal ultrasound can reliably assess scrotal injuries and diagnose testicular rupture with a high level of accuracy. Additionally, ultrasound can provide important information regarding testicular perfusion, which can further inform decisions on surgical management. This article reviews the sonographic findings that may be encountered in patients with scrotal trauma, with an emphasis on blunt trauma. It describes the pivotal role that ultrasound can play in the accurate triage of these patients to surgical or conservative management.     

Can different physicians providing urgent and non-urgent treatment improve patient flow in emergency department?

Background

Emergency Department (ED) overcrowding is a worldwide problem, and it might be caused by prolonged patient stay in the ED. This study tried to analyze if different practice models influence patient flow in the ED.