EMUS Journal Club Dec 11, 2013

Are residents with limited US training able to reliably perform EM compression DVT Scans? This weeks journal article looks at one prospective study by Jang et al.

Jang, T. Resident-performed Compression Ultrasonography for

the Detection of Proximal Deep Vein Thrombosis: Fast

and Accurate. Acad Emerg Med. Mar 2004;11:319-322.

Journal Club, November 6 2013

Here is this month's article for EMUS journal club:

Bedside ultrasound and the assessment of renal
colic: a review

Peregrine James Dalziel, Vicki Elizabeth Noble

Emerg Med J (2012). doi:10.1136/emermed-2012-201375

This article is freely available online.

Journal club will be at 9:15 am at the Civic

EMUS Ottawa Journal Club - October 9, 2013

This week we explore the use of Ultrasound for the diagnosis of pediatric elbow fractures.  Will it stand up to Xray as a useful modality in this setting? Ribiner and the crew may hold the answer...

Accuracy of Point-of-Care Ultrasonography for Diagnosis of Elbow Fractures in Children. Annals of Emergency Medicine. 2013;61(1):9-17.

EMUS Ottawa Journal Club - Sept 18, 2013

Bowel has often been called one of the enemies of Ultrasound. The gas, fluid, and stool filled tube often "gets in the way" of seeing more "important" structures like the Aorta, Kidneys, and Gallbladder. If we take a step back and appreciate bowel ultrasound for what it can tell us about the condition of a patient, we may come to realize that there is much this enemy has to offer. This week we examine the ultrasound findings of a common emergency medicine presentation: diverticulitis.

Mazzei et al. Sigmoid Diverticulitis - US Findings. Critical Ultrasound Journal 2013, 5(Suppl 1):S5

http://www.ncbi.nlm.nih.gov/pubmed/23902791

Is it in the uterus?

A patient presents with sudden onset abdominal pain.  The week before, she had been seen at a private clinic to obtain a therapeutic abortion.  An ultrasound was performed there.  The patient reports that the physician told her the pregnancy was within the uterus, but that the procedure could not be performed due to her uterine anatomy.  (?was she told she had a bicornuate uterus - jw).

She was awaiting an appointment with a gynecologist at a teaching hospital on the day of presentation.

Examination revealed mild abdominal tenderness.

PoCUS images of the pelvis:

Is this pregnancy in the uterus?  The second video makes it even more clear.

Note also the free fluid in the pelvis.  On further scanning, significant free fluid was noted in the right upper quadrant also.

These images are challenging because it is somewhat difficult to determine if the pregnancy is in the uterus.  The tissue surrounding the pregnancy looks very much like uterine tissue.  However, if you look clearly you can see the bladder screen right, and the uterus with an endometrial reaction within.  Then, outside the uterus you see the pregnancy, definitely ectopic.  Another video:

The wise emergency physician remembers the following:

1) A patient with first trimester pain or bleeding has an ectopic until proved otherwise
2) One should always identify the bladder and clearly determine the outline of the uterus, not be transfixed by the pregnancy
3) One must be sure the pregnancy is inside the uterus