Prospective, multicentre observational study of point-of-care ultrasound practice in emergency departments across Australia and New Zealand: The POCUS-ED Registry.

OBJECTIVES: The present study aimed to describe the characteristics, performance, accuracy and significance of point-of-care ultrasound (POCUS) use in the ED, by utilising an expanded version of the ACEM-mandated special skills placement (SSP) logbook, to develop a novel clinical quality registry. METHODS: A prospective, observational study was performed across EDs in Australia and New Zealand over a 12-month period. Trainees undertaking ACEM-approved ultrasound (US) SSPs recorded all US scan interpretations and follow-up imaging reports in an online database. RESULTS: In total, 2647 USs were recorded by 26 special skills trainees across 10 EDs in Australia or New Zealand; of these 2356 scans (89%) were clinically indicated. Overall, 2493 scans (94%) were used for diagnostic assessment, of which 1147 (43%) had abnormal findings. Basic echocardiography, extended Focused Assessment with Sonography in Trauma and right upper quadrant scans were the most commonly used modalities. There were 134 US-guided procedures logged in the registry. Approximately 36% of scans were reported to alter the original provisional diagnosis, whereas in another 37% of cases, POCUS was thought to confirm the original clinical suspicion. The majority of scans (76.5%) entered into the registry were physically reviewed by the SSP supervisor. CONCLUSIONS: This multicentred registry provides a detailed description of the current utilisation of POCUS within special skills US placements across EDs in Australia and New Zealand. This data should inform clinical leaders in emergency US to improve both POCUS education and governance around this important tool.

Bedside ultrasound in the emergency department for reduction and radial manipulation of distal radial fractures.

OBJECTIVE: Distal radial fracture reduction is a common procedure in the ED. Previous studies have suggested that ultrasound (US)-guided reduction improves outcomes for patients who undergo manipulation and reduction of distal radial fractures in the ED. We aimed to investigate this with the first randomised controlled trial looking at US-guided distal radial fracture reduction. Our primary objective was to compare rates of operative intervention between the study groups. Rate of re-manipulation was compared as a secondary outcome. METHODS: ED patients were prospectively randomised to either standard landmark guided or US-guided closed reduction of distal radial fractures. The closed reductions were performed by senior emergency clinicians and the USs were performed by emergency physicians experienced in point-of-care US. Following reduction patients were managed equally and referred to the local orthopaedic service who were blinded to whether US was used to assist manipulation or not. This service decided on the need for re-manipulation or operative intervention. RESULTS: One hundred patients were enrolled and randomised equally into each cohort. We found no statistically significant difference between the control and intervention groups of our study. In the control group, 46% of patients underwent operative fixation, compared to 48% in the US-guided group (P = 0.36). Our secondary intervention of re-manipulation in the ED or theatre following the initial reduction showed no statistically significant difference between the groups (P = 1.0). CONCLUSION: US-guided reduction of dorsally displaced, distal radius fractures in the ED setting, did not improve measured clinical outcomes.

Rocket launcher: A novel reduction technique for posterior hip dislocations and review of current literature.

OBJECTIVE: We provide a review of literature on reduction techniques for posterior hip dislocations and present our experience with a novel technique for the reduction of acute posterior hip dislocations in the ED, 'the rocket launcher' technique. METHODS: We present our results with six patients with prosthetic posterior hip dislocation treated in our rural ED. We recorded patient demographics. The technique involves placing the patient's knee over the shoulder, and holding the lower leg like a 'Rocket Launcher' allow the physician's shoulder to work as a fulcrum, in an ergonomically friendly manner for the reducer. We used Fisher's t-test for cohort analysis between reduction techniques. RESULTS: Of our patients, the mean age was 74 years (range 66 to 85 years). We had a 83% success rate. The one patient who the 'rocket launcher' failed in, was a hemi-arthroplasty patient who also failed all other closed techniques and needed open reduction. When compared with Allis (62% success rate), Whistler (60% success rate) and Captain Morgan (92% success rate) techniques, there was no statistically significant difference in the successfulness of the reduction techniques. There were no neurovascular or periprosthetic complications. CONCLUSION: We have described a reduction technique for posterior hip dislocations. Placing the patient's knee over the shoulder, and holding the lower leg like a 'Rocket Launcher' allow the physician's shoulder to work as a fulcrum, thus mechanically and ergonomically superior to standard techniques.