Friday, January 8, 2010

ED Physicians Ultrasound Test Available

The American College of Emergency Physicians (ACEP) has published an on-line self test for emergency physicians to take when they are ready to document that they are proficient in the use of ultrasound in the practice of emergency medicine. This is the first test that I know of to address the issue of self credentialing. I took a few modules of the test myself (I passed) and found the test to be challenging, though I have been practicing ultrasound for many years as a Sonographer. The modules are of the multiple choice form with embedded videos that one may click on for clarification. One should read the question carefully before answering as the question itself can be confusing. I found at least two wrong answers listed as the correct response. For example: a patient is NOT routinely placed in the PRONE position to image the gall bladder. I am sure these issues will be ironed out. I do believe this is a great first step in beginning a standardized pathway for ED physicians to obtain self credentialing at the institutions where they are employed. Currently, there is no charge for taking the test, and results can be printed out. Here is the link:
Thanks Dr Morale

Tuesday, January 5, 2010

Pneumothorax by U/S?

Recently,methods have been published outlining a technique for identifying moderate to sever pneumothorax using high frequency ultrasound. This technique is time saving and rather simple to perform at bedside and has been embraced by many ED Physicians in the trauma department. It involves looking for the presence or absence of a sliding lung using intercostal technique. Below is a link to one paper discussing this exciting new application of diagnostic ultrasound. Happy New Year.

Article Title: Sonographic Detection of Pneumothorax by Radiology Residents as Part of Extended Focused Assessment With Sonography for Trauma
Authors: Olga R. Brook, MD, Nira Beck-Razi, MD, Subhi Abadi, MD, Janna Filatov, MD, Anat Ilivitzki, MD, Diana Litmanovich, MD and Diana Gaitini, MD
A recently published article in the Journal of Ultrasound in Medicine assessed the accuracy of sonographic pneumothorax detection by radiology residents as a part of extended focused assessment with sonography for trauma (eFAST).

A sonographic search for pneumothoraces was performed as part of a standard FAST examination by the on-call resident. Each lung field was scanned at the second to fourth anterior intercostal spaces and the sixth to eighth midaxillary line intercostal spaces. A normal pleural interface was identified by the presence of parietal-over-visceral pleural sliding –“lung sliding sign”. Absence of lung sliding and comet tail was presumed to be indicative of a pneumothorax.

The sonographic diagnosis was correlated with supine chest radiography and chest CT. A total of 169 patients were included in the study. Chest CT was considered the reference standard examination. CT chest identified 43 pneumothoraces (13%): 34 small and 9 moderate.

On chest radiography, 7 pneumothoraces (16%) were identified. Extended FAST identified 23 pneumothoraces (53%). Compared with CT, eFAST had sensitivity of 47%, specificity of 99%, a positive predictive value of 87%, and a negative predictive value of 93%.

All of the moderate pneumothoraces were identified by eFAST. Twenty small pneumothoraces missed by eFAST did not require chest tube placement during the hospitalization period.

The authors concluded that the eFAST exam for detection of pneumothoces is an accurate and efficient tool for detection of clinically significant pneumothoraces. However, small to moderate pneumothaces may be missed.

To read full abstract go to:

Thank You Sonoworld for the link