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Nti BK, Benzoni N, Starr R, Hays M, Vish D, End B, Russell F. Serial Trauma Abdominal Ultrasound in Children (STAUNCH): A Pilot Study. Pediatr Emerg Care 2024:00006565-990000000-00430. [PMID: 38587011 DOI: 10.1097/pec.0000000000003208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
BACKGROUND Ultrasound has established utility within pediatric emergency medicine and has an added benefit of avoiding excessive radiation exposure. The serial focused assessment with sonography in trauma (sFAST) examination is a potential alternative to improve pediatric trauma evaluation. We sought to evaluate the accuracy of sFAST in pediatric patients with blunt abdominal trauma. METHODS We performed a multicenter, retrospective observational study of electronic medical records, trauma registry data, and image archiving records of previous sFAST examinations. Examinations from pediatric patients (18 years or younger) who presented to an emergency department with blunt abdominal trauma were eligible for inclusion as long as the period between the first and second FAST was at least 30 minutes but no more than 24 hours. Demographic data and patient and outcomes were collected. RESULTS Data collected from 3 institutions found a total of 38 sFAST performed between July 2017 and September 2021 on eligible patients. Of these, there were 6 (15.4%) FAST examinations that were positive after an initial negative or indeterminate interpretation. The overall sensitivity and specificity of sFAST were 66.7% (95% confidence interval 22.3-95.7%) and 93.8% (79.2-99.3%), respectively. CONCLUSIONS This pilot study found that sFAST can enhance blunt trauma evaluation and improve sensitivity and diagnostic accuracy. More data are needed to determine how sFAST can be utilized in pediatric patients with blunt abdominal trauma.
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Affiliation(s)
- Benjamin K Nti
- From the Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Nicole Benzoni
- Franciscan Critical Care Medicine at St. Michael, Silverdale, WA
| | - Rebecca Starr
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY
| | - Matthew Hays
- Department of Biostatistics and Health Science Data, Indiana University School of Medicine, Indianapolis, IN
| | - Dylan Vish
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY
| | - Bradley End
- Department of Emergency Medicine, West Virginia University, Morgantown, WV
| | - Frances Russell
- From the Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN
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2
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Overton N, Baruffi F, Neidhardt J, End B. Man with urethral foreign body sensation. J Am Coll Emerg Physicians Open 2023; 4:e13033. [PMID: 37662442 PMCID: PMC10469027 DOI: 10.1002/emp2.13033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 08/15/2023] [Indexed: 09/05/2023] Open
Affiliation(s)
- Nicholas Overton
- Department of Emergency Medicine1 Medical Center DrWest Virginia UniversityMorgantownWest VirginiaUSA
| | - Francesca Baruffi
- Department of Emergency Medicine1 Medical Center DrWest Virginia UniversityMorgantownWest VirginiaUSA
| | - Jessica Neidhardt
- Department of Emergency Medicine1 Medical Center DrWest Virginia UniversityMorgantownWest VirginiaUSA
| | - Bradley End
- Department of Emergency Medicine1 Medical Center DrWest Virginia UniversityMorgantownWest VirginiaUSA
- Department of Medical EducationWest Virginia University School of Medicine1 Medical Center DrWest Virginia University School of MedicineWest VirginiaMorgantownUSA
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3
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Craven P, End B, Griffin P. Emergency Department Point-of-care Ultrasound Identification of Suspected Lemierre's Syndrome: A Case Report. Clin Pract Cases Emerg Med 2023; 7:172-174. [PMID: 37595317 PMCID: PMC10438937 DOI: 10.5811/cpcem.1245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 06/05/2023] [Accepted: 06/05/2023] [Indexed: 08/20/2023] Open
Abstract
INTRODUCTION Lemierre's syndrome is septic thrombophlebitis of the internal jugular vein, most commonly associated with head and neck infections. While central catheters are associated with venous thromboembolism and catheter-associated bacterial infections, cases of Lemierre's syndrome caused by central catheters are extraordinarily rare. CASE REPORT We detail a case of Lemierre's syndrome resulting from a peripherally inserted central catheter in a pregnant female patient. Diagnosis of this rare and potentially life-threatening disease process was expedited using point-of-care ultrasound. CONCLUSION Diagnosis of rare but potentially life- or limb-threatening pathologies is paramount to the successful practice of emergency medicine. Identifying these rare disease processes requires a high index of suspicion and a work-up strategy that includes consideration of medical history in combination with lab and imaging findings to determine appropriate interventions.
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Affiliation(s)
- Paul Craven
- West Virginia University, Department of Emergency Medicine, Morgantown, West Virginia
| | - Bradley End
- West Virginia University, Department of Emergency Medicine, Morgantown, West Virginia
| | - Peter Griffin
- West Virginia University, Department of Emergency Medicine, Morgantown, West Virginia
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4
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Platt E, Neidhardt JM, End B, Cundiff C, Fang W, Kum V, Tucker H, Quedado JM. Safety and Efficacy of Low-Dose Versus High-Dose Parenteral Ketorolac for Acute Pain Relief in Patients 65 Years and Older in the Emergency Department. Cureus 2023; 15:e40333. [PMID: 37456458 PMCID: PMC10338378 DOI: 10.7759/cureus.40333] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2023] [Indexed: 07/18/2023] Open
Abstract
Background There is limited data surrounding acute pain management in elderly ED patients. Ketorolac is a potent non-steroidal anti-inflammatory drug (NSAID) with dose/duration-dependent side effects. There is evidence that an analgesic ceiling effect exists for parenteral ketorolac doses greater than 10 milligrams (mg); however, this has not been studied in patients 65 years and older. Methods This was a retrospective chart review of ED patients 65 years and older who received at least one dose of parenteral ketorolac. Patients were separated into two cohorts based on the ketorolac dose received: 15 mg IV or 30 mg intramuscular (IM) and 30 mg IV or 60 mg IM. The primary objective was to evaluate the analgesic efficacy of parenteral ketorolac doses measured as needing rescue analgesia from 30 minutes to 2 hours after ketorolac administration. Secondary objectives included changes in pain scores and the occurrence of adverse drug events commonly associated with ketorolac. Results Two-hundred and sixty patients received ketorolac doses of 15 mg IV or 30 mg IM, and 52 received 30 mg IV or 60 mg IM. The primary outcome occurred in seven of 52 patients who received ketorolac 30 mg IV or 60 mg IM and 17 of 260 patients who received ketorolac 15 mg IV or 30 mg IM (13.5% vs. 6.5%, p=0094; OR: 2.22, 95% CI: 0.87-5.67). The average change in pain scores were 2.9 (±3.1) and 2.8 (±2.9) for patients who received doses 30 mg IV or 60 mg IM compared to doses 15 mg IV or 30 mg IM, respectively (p=0.154). The occurrence of adverse events was low in both groups. Conclusion Parenteral ketorolac doses of 15 mg IV or 30 mg IM did not demonstrate a greater need for rescue analgesia compared to doses of 30 mg IV or 60 mg IM.
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Affiliation(s)
- Emma Platt
- Pharmacy, West Virginia University, Morgantown, USA
| | - Jessica M Neidhardt
- Emergency Medicine and Medical Education and Simulation, West Virginia University, Morgantown, USA
| | - Bradley End
- Emergency Medicine and Medical Education, West Virginia University, Morgantown, USA
| | - Courtney Cundiff
- Emergency Medicine and Medical Education and Simulation, West Virginia University, Morgantown, USA
| | - Wei Fang
- Statistics, West Virginia University, Morgantown, USA
| | - Vivian Kum
- Pharmacy, NewYork-Presbyterian Hospital, New York, USA
| | - Heather Tucker
- Emergency Medicine, West Virginia University, Morgantown, USA
| | - Jeffrey M Quedado
- Pharmacology and Therapeutics, West Virginia University, Morgantown, USA
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5
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Kirbos C, Pagenhardt J, Minardi J, End B. Point-of-Care Ultrasound Diagnosis of Ventricular Septal Rupture Post Myocardial Infarction: A Case Report. J Emerg Med 2022; 63:777-780. [PMID: 36369118 DOI: 10.1016/j.jemermed.2022.09.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/16/2022] [Accepted: 09/04/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Ventricular septal rupture (VSR) is a rare but life-threatening complication of ST-elevation myocardial infarction. Point-of-care ultrasound (POCUS) is a rapid, noninvasive imaging modality that is easily accessible and highly effective in diagnosing VSR in the emergency department (ED) setting. CASE REPORT A 73-year-old man with a history of type II diabetes mellitus and hypertension presented with complaints of intermittent chest pain for 48 h that had since become constant, associated with diaphoresis and shortness of breath. Physical examination was notable for shock and a new, grade V/VI systolic murmur. An electrocardiogram showed evidence of an inferior ST-elevation myocardial infarction (MI) with associated Q waves. POCUS revealed a large ventricular septal rupture with new ventricular septal defect and associated left-to-right shunting. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: POCUS in the ED setting is an effective and rapid tool for elucidating the etiology of various shock states. Emergency physicians should be aware of this particular case, as POCUS may help identify MI-related complications, including post-myocardial infarction VSR, that may necessitate surgical intervention as opposed to coronary reperfusion procedures.
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Affiliation(s)
- Catherine Kirbos
- Department of Emergency Medicine, West Virginia University, Morgantown, West Virginia
| | - Justine Pagenhardt
- Department of Emergency Medicine, West Virginia University, Morgantown, West Virginia
| | - Joseph Minardi
- Department of Emergency Medicine, West Virginia University, Morgantown, West Virginia; Department of Medical Education, West Virginia University, Morgantown, West Virginia
| | - Bradley End
- Department of Emergency Medicine, West Virginia University, Morgantown, West Virginia; Department of Medical Education, West Virginia University, Morgantown, West Virginia
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End B, Prats MI, Minardi J, Sharon M, Bahner DP, Boulger CT. Language of transducer manipulation 2.0: continuing to codify terms for effective teaching. Ultrasound J 2021; 13:44. [PMID: 34709487 PMCID: PMC8555041 DOI: 10.1186/s13089-021-00245-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 10/07/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Accurate communication is an integral component of ultrasound education. In light of the recent global pandemic, this has become even more crucial as many have moved to virtual education out of necessity. Several studies and publications have sought to establish common terminology for cardinal ultrasound probe motions. To date, no studies have been performed to determine which of these terms have been adopted by the ultrasound community at large. METHODS A survey was developed which asked respondents to describe videos of six common probe motions in addition to providing basic demographic and training data. The survey was disseminated electronically across various academic listservs and open access resources. RESULTS Data were collected over a 6-week period and yielded 418 unique responses. Responses demonstrated significant variation in terminology related to all 6 cardinal probe motions. While some degree of difference in response can be accounted for by discipline of training, inter-group variation still exists in terminology to describe common probe motions. Of the survey respondents, 57.5% felt that inconsistent probe motion terminology made teaching ultrasound more difficult. CONCLUSIONS The results demonstrate that despite efforts to codify probe motions, variation still exists between ultrasound practitioners and educators in the description of cardinal probe motions. This lack of consensus can contribute to challenges in both virtual and in-person ultrasound education.
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Affiliation(s)
- Bradley End
- Department of Emergency Medicine, Robert C. Byrd Health Sciences Center, West Virginia University, 1 Medical Center Drive, PO Box 9149, Morgantown, WV, 26506, USA. .,West Virginia University School of Medicine, 64 Medical Center Drive, P.O. Box 9100, Morgantown, WV, 26506-9600, USA.
| | - Michael I Prats
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, 750 Prior Hall, 376 W 10th Ave, Columbus, OH, 43210, USA
| | - Joseph Minardi
- Department of Emergency Medicine, Robert C. Byrd Health Sciences Center, West Virginia University, 1 Medical Center Drive, PO Box 9149, Morgantown, WV, 26506, USA.,West Virginia University School of Medicine, 64 Medical Center Drive, P.O. Box 9100, Morgantown, WV, 26506-9600, USA
| | - Melinda Sharon
- Department of Emergency Medicine, Robert C. Byrd Health Sciences Center, West Virginia University, 1 Medical Center Drive, PO Box 9149, Morgantown, WV, 26506, USA
| | - David P Bahner
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, 750 Prior Hall, 376 W 10th Ave, Columbus, OH, 43210, USA
| | - Creagh T Boulger
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, 750 Prior Hall, 376 W 10th Ave, Columbus, OH, 43210, USA
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7
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Beam G, Check R, Denne N, Minardi J, End B. Point-of-Care Ultrasound Findings in a Case of Orbital Cellulitis: A Case Report. J Emerg Med 2021; 61:157-160. [PMID: 33972132 DOI: 10.1016/j.jemermed.2021.03.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 03/18/2021] [Accepted: 03/27/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Ophthalmologic complaints are common in the emergency department. The utility of point-of-care ultrasound (POCUS) as an accessible, noninvasive modality to evaluate ocular pathology is of great value-particularly in settings where resources are limited or where ophthalmologic consultation may not be readily available. CASE REPORT A 21-year-old woman presented to the emergency department with periorbital edema, erythema, and drainage that was worsening despite topical and oral antimicrobial therapy. Mild proptosis was present on examination. POCUS was performed to investigate her symptoms further. A modified ocular ultrasound revealed prominence and edema of the retro-orbital soft tissue with echogenic fat, consistent with the diagnosis of orbital cellulitis. These findings were corroborated with computed tomography imaging. Why Should an Emergency Physician Be Aware of This?: Few reports describe the utility of POCUS in evaluating patients for orbital cellulitis. This case emphasizes the value of POCUS in assessing patients presenting to the emergency department with ocular complaints and demonstrates ultrasound-specific findings that may lead the clinician toward the diagnosis of orbital cellulitis. © 2021 Elsevier Inc.
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Affiliation(s)
- Gabrielle Beam
- West Virginia University School of Medicine, BS Morgantown, West Virginia
| | - Ryan Check
- Department of Emergency Medicine, University of West Virginia, Morgantown, West Virginia
| | - Nick Denne
- Department of Emergency Medicine, University of West Virginia, Morgantown, West Virginia
| | - Joseph Minardi
- Department of Emergency Medicine, University of West Virginia, Morgantown, West Virginia
| | - Bradley End
- Department of Emergency Medicine, University of West Virginia, Morgantown, West Virginia
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Shavor C, Pagenhardt J, Sun Y, Kraft C, End B, Minardi J. Ureteral Stone Mimics Appendicitis: A Point-of-care Ultrasound Case Report. Clin Pract Cases Emerg Med 2020; 4:555-558. [PMID: 33217271 PMCID: PMC7676809 DOI: 10.5811/cpcem.2020.7.48155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 07/24/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction Abdominal pain is a common complaint in the emergency department. Point-of-care ultrasound (POCUS) is a rapid modality to evaluate for the etiology. Case Report A teenage male presented with symptoms concerning for appendicitis. POCUS revealed a non-peristalsing, non-compressible, tubular structure containing an echogenic stone. This was determined to be a ureteral stone within a dilated ureter, not appendicitis. Conclusion We propose a syndromic sonographic approach to right lower quadrant pain (RLQ) that includes the gallbladder, right kidney, bladder, and right adnexa, in addition to RLQ landmarks. This case emphasizes the value of such an approach to avoid diagnostic error.
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Affiliation(s)
- Cindy Shavor
- West Virginia University School of Medicine, Department of Emergency Medicine, Morgantown, West Virginia
| | - Justine Pagenhardt
- West Virginia University School of Medicine, Department of Emergency Medicine, Morgantown, West Virginia
| | - YuanYuan Sun
- West Virginia University School of Medicine, Department of Emergency Medicine, Morgantown, West Virginia
| | - Clara Kraft
- West Virginia University School of Medicine, Department of Emergency Medicine, Morgantown, West Virginia
| | - Bradley End
- West Virginia University School of Medicine, Department of Emergency Medicine, Morgantown, West Virginia.,West Virginia University School of Medicine, Department of Medical Education, Morgantown, West Virginia
| | - Joseph Minardi
- West Virginia University School of Medicine, Department of Emergency Medicine, Morgantown, West Virginia.,West Virginia University School of Medicine, Department of Medical Education, Morgantown, West Virginia
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Grimmett S, End B, Quedado K, Kraft C, Minardi J. The Value of Sonography Education Faculty in an Academic Emergency Ultrasound Program. Journal of Diagnostic Medical Sonography 2020. [DOI: 10.1177/8756479320925400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Within the West Virginia University (WVU) Department of Emergency Medicine (DEM), education related to point-of-care ultrasound (POCUS) has been under the jurisdiction of the POCUS director in the emergency department. To facilitate sonography education and extend the capabilities of the POCUS director, a dedicated sonography education faculty member (SEFM) was hired. A SEFM is an experienced sonographer who brings technical knowledge, experience, and pedagogical skills. In addition, the SEFM is able to assist with administrative and operational aspects of a POCUS program, including image archival, disinfection protocols, and quality guidelines. From the sonographer’s prospective, the position has been challenging and fulfilling, and there remain countless opportunities for growth. From the POCUS director’s perspective, the SEFM has been instrumental in strengthening the residency program and other educational offerings.
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Affiliation(s)
- Stacy Grimmett
- Department of Emergency Medicine, School of Medicine, West Virginia University, Morgantown, WV, USA
| | - Bradley End
- Department of Emergency Medicine, School of Medicine, West Virginia University, Morgantown, WV, USA
| | - Kimberly Quedado
- Department of Emergency Medicine, School of Medicine, West Virginia University, Morgantown, WV, USA
| | - Clara Kraft
- Department of Emergency Medicine, School of Medicine, West Virginia University, Morgantown, WV, USA
| | - Joseph Minardi
- Department of Emergency Medicine, School of Medicine, West Virginia University, Morgantown, WV, USA
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Rempfer E, Basinger H, Stawovy L, End B, Shockcor W, Minardi J. MitraClip-Associated Endocarditis: Emergency Department Diagnosis With Point of Care Ultrasound. J Emerg Med 2020; 58:942-946. [PMID: 32247658 DOI: 10.1016/j.jemermed.2020.02.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 01/15/2020] [Accepted: 02/16/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Management of mitral valve regurgitation in patients with multiple comorbidities is complicated because of poor surgical candidacy. Less invasive techniques for these patients include the MitraClip device, an endovascular repair option used to reduce mitral valve regurgitation symptoms. However, complications include leaflet damage, stenosis, and infectious endocarditis. CASE REPORT Four years after MitraClip placement, an 80-year-old man presented to the emergency department with progressive dyspnea. He was diagnosed with MitraClip-associated infectious endocarditis by the emergency physician using point-of-care ultrasound. There are 6 reported cases of infective endocarditis in patients with MitraClip devices, with this being the first case identified using point-of-care ultrasound. This is also the first reported case of MitraClip-associated Corynebacterium endocarditis. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: The use of the MitraClip device and its echocardiographic appearance is not widely described in the published emergency medicine literature. Knowledge of this device, its appearance, and the potential complications is essential for emergency physicians caring for these patients. Rapid diagnosis may lead to earlier initiation of treatment and optimal disposition for these complex patients.
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Affiliation(s)
- Elizabeth Rempfer
- West Virginia University School of Medicine, Morgantown, West Virginia
| | - Hayden Basinger
- West Virginia University School of Medicine, Morgantown, West Virginia
| | - Lauren Stawovy
- Department of Internal Medicine, West Virginia University, Morgantown, West Virginia
| | - Bradley End
- Department of Emergency Medicine, West Virginia University, Morgantown, West Virginia
| | - William Shockcor
- Department of Internal Medicine, West Virginia University, Morgantown, West Virginia
| | - Joseph Minardi
- Department of Emergency Medicine, West Virginia University, Morgantown, West Virginia
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Affiliation(s)
- Melinda Sharon
- Department of Emergency Medicine, West Virginia University School of Medicine, Morgantown, WV
| | - Brandon Wilson
- Department of Emergency Medicine, West Virginia University School of Medicine, Morgantown, WV
| | - Bradley End
- Department of Emergency Medicine, West Virginia University School of Medicine, Morgantown, WV
| | - Clara Kraft
- Department of Emergency Medicine, West Virginia University School of Medicine, Morgantown, WV
| | - Joseph Minardi
- Department of Emergency Medicine, West Virginia University School of Medicine, Morgantown, WV
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12
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Sharon MJ, End B, Findley S, Kraft C, Minardi JJ. Definitive Diagnosis before Leaving the Room: POCUS for Pediatric Intussusception. J Emerg Med 2019; 57:247-248. [PMID: 31060849 DOI: 10.1016/j.jemermed.2019.03.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 03/27/2019] [Indexed: 06/09/2023]
Affiliation(s)
- Melinda J Sharon
- Department of Emergency Medicine, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Bradley End
- Department of Emergency Medicine, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Scott Findley
- Department of Emergency Medicine, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Clara Kraft
- Department of Emergency Medicine, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Joseph J Minardi
- Department of Emergency Medicine, West Virginia University School of Medicine, Morgantown, West Virginia
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