2017 LLSA notes from #ACEP17 twitter

During ACEP 2017 Scientific Assembly there is popular presentation reviewing the readings from the LLSA for the year.  These are the tweets that I put out from the talk and are my way of taking notes for myself from a presentation.  Posted here for your use and reference.

 

TWEETS from #ACEP17 LLSA readings reviews

2017 LLSA review with Lovata at #ACEP17 https://t.co/dOTCNOLga5

ACEP clincial policy on aortic dissection for 1st #LLSA #ACEP17

Are there clincial decision rules for low risk pts for aortic dissection? NO #LLSA #ACEP17

Is D Dimer adequate to ID low risk aortic dissection? NO #LLSA #ACEP17

Is CTA equivalent to MRI or TEE for dx of aortic dissection? YES. #LLSA #ACEP17 level B

Can transthoracic echo rule out aortic dissection? NO #LLSA #ACEP17

When we decrease SBP and HR for aortic dissection is morbidity and mortality reduced? Not great evidence level C #LLSA #ACEP17

Angioedema up next #LLSA #ACEP17 rapid firing

Types are Histamine with and without anaphylaxis, ACE inhib and hereditary angioedema #LLSA #ACEP17

Most widely available agent for hereditary angioedema is FFP (not beat but most available) #LLSA #ACEP17

Upper airway angioedema; lower too? Direct visualization to assess. #LLSA #ACEP17

CCB overdose with literature review article. Inherent limitations in Tox literature due to ethics #LLSA #ACEP17

Tx: go decontam, calcium, glucagon, lipids etc. But high dose insulin is best studied #LLSA #ACEP17

Delirium tremendous and treatment: withdrawal starts at 8, peak at 72 and duration average 5-7d #LLSA #ACEP17

CIWA evaluation for DTs help target treatment and prevent getting behind on tx #LLSA #ACEP17

Predicting DTs HR > 100 is a risk for DTs others too but may be important… #LLSA #ACEP17

Benzo to are key to DT tx, choice of agent less important that benzo being given #LLSA #ACEP17

Human trafficking definition by the UN #LLSA #ACEP17 @UN https://t.co/qS7Zyo4lUd

Many human trafficking victims will interact with healthcare providers at some point. #LLSA #ACEP17

Provides an opportunity. Key is separate trafficker and victim to get Hx and information #LLSA #ACEP17

Infection prevention next topic for #LLSA #ACEP17

Prevention of person to person and care associated infections #LLSA #ACEP17

C diff requires soap and water. Spores not tx with Alcohol hand gels. #LLSA #ACEP17

Airborne precaution for zoster and droplet for meningococcus #LLSA #ACEP17 https://t.co/mTjye0sLz3

Lyme disease erythema migrants: to with with dozy if not pregnant. #LLSA #ACEP17

Prophylaxis for Lyme if Rick? Need 72 h of tick adherent to infect, prophylaxis not routine #LLSA #ACEP17

#ultrasoundfirst approach for kidney stones dx has lower radiation exposure #LLSA #ACEP17

Palliative and hospice care not synonymous. #LLSA #ACEP17

Hospice includes prognosis < 6 mos. appropriate to start discussion in ED if appropriate #LLSA #ACEP17

Chemical exposures in the ED varied types of events, agents and volumes #LLSA #ACEP17

Cholinergic remember SLUDGE target respiratory issues with atropine #LLSA #ACEP17 https://t.co/zZxl86rZXF

Hydrocarbons with tachycardia txbwith beta blockade #LLSA #ACEP17 https://t.co/DXClpxaHBJ

For trauma airway remember etomidate should be dosed on IBW consider half dose for shock pts #LLSA #ACEP17 https://t.co/pEy5YnArQu

VTE treatment review article from JAMA. #LLSA #ACEP17

#LLSA #ACEP17 https://t.co/jjALnyc2ce

Provoked VTE 3 mos to, unprovoked prolonged tx, mult unprovoked life long #LLSA #ACEP17

Isolated calf DVT: consider serial US for propagation evaluation rather than anticoagulation #LLSA #ACEP17 https://t.co/yeYq5WnPd5

If need anticoagulation and renal dysfunction start with heparin #LLSA #ACEP17 https://t.co/hQQJ4t8abq

Introduction to Renal Ultrasound

An introductory lecture for renal ultrasound.  Renal Point of Care Ultrasound focuses on the diagnosis and grading of hydronephrosis. This is the indirect way of diagnosing nephrolithiasis in transit through the ureter rather than direct visualization of the stone, such as with CT imaging.  Data has shown that the use of ultrasound to diagnose the hydronephrosis in the appropriate clinical setting performs similar to CT with regard to diagnosis and outcomes.

 

The Ski-LIft: a technique to help with ultrasound guided access

This is a repost of an older post from the old version of the blog.  The video is the original and a little older quality.  I plan to eventually redo the video with some additions; but for the time being here is the video for reference and education.

 

My colleagues and I published an article in Academic Emergency Medicine, the journal for the Society for Academic Emergency Medicine, about something we termed the Ski Lift.  This is a method to help assist in viewing the needle during in-plane guidance for realtime ultrasound guidance for vascular access.

A brief description is presented here with a video, the full article can be found at:

Academic Emergency Medicine Vol 17 Issue 7 Page e83-e84, July 2010.

  1. Obtain a sagittal view of the target vessel
  2. Stabilize the transducer and brace your hand.  Then rock the probe to elevate the proximal section.
  3. Place the needle in the center of the probe (usually at the case seam) and under the probe footprint.
  4. Stop rocking the probe so the entire surface is again contacting the skin, the needle tip should be immediately visible.
  5. Advance the needle to the target vessel

Introduction to Ultrasound Physics for Point of Care Users

Video of basic ultrasound physics for the point of care users who is starting to learn ultrasound.  Targeted at new and early users including residents.  This is a more expanded version of the primer video that was a bare bones discussions.  This cover the majority of topics that would be needed to start the resident education for meeting ACEP guidelines at graduation and the EM-RRC Milestones.

SonoSite Turbo Hard Reboot Instructions

This is a short video demonstration with instructions of how to perform a hard reboot on your SonoSite Turbo system should it freeze and be non-perational.

Most times when the system, touchpad, or keyboard freezes you can hold down the power button until it powers down for a soft reboot.  If this fails you have to move onto the hard reboot.

This should also work for your other clamshells systems (MicroMaxx, Titan, and Edge).  However, the S series is set up a little differently.  The Exporte has a whole different setup for reboots.

US Guided Central Venous Catheter Kit Walk Through

This is a video from operator point of view of the placement of an ultrasound guided IJ central venous catheter.  The video uses a head mounted camera so there is a bit of movement so warning if you get motion illness early.

Yes I know, the bedside table had to be elevated for the camera angle and images so the edge of the kit wrapping relative to the drape is not ideal for sterile technique.

The video uses a Cook Spectrum antibiotic impregnated catheter with a Biopatch, chlorhexidine impregnated bandage.  Central line kits and contents will vary based upon manufacturer and customization.

Video provided for educational and informational purposes only.

I do not currently receive any funding or support from Cook or Biopatch.