ABSTRACT
In this article we seek to evaluate the diagnostic accuracy of emergency physicians performing emergency ultrasonography in the setting of an emergency medicine training program. A prospective observational study was performed at an inner city Level I trauma center with an emergency medicine residency training program. From July 1994 to December 1996 a convenience sample of ultrasound exams was recorded. The diagnostic quality ("acceptable or technically limited") was determined by a board-certified cardiologist or radiologist with fellowship training in ultrasonography. The emergency department interpretations were then compared to those of the blinded cardiologist or radiologist. Four hundred and fifty-six ultrasound examinations were videotaped and entered into the study; 408 (89%) of the studies performed were determined to be "acceptable." The diagnostic accuracy (sensitivity, specificity, positive and negative predictive values) of these studies were as follows: cardiac, to rule out effusion (n = 67; 0.83, 0.98, 0.88, 0.98); transabdominal, to rule out abdominal aortic aneurysms (AAA), cholelithiasis, or free peritoneal fluid (n = 263; 0.91, 0.89, 0.88, 0.92); renal, to rule out hydronephrosis (n = 45; 0.94, 0.96, 0.94, 0.96); pelvic, to rule in intrauterine pregnancy (n = 33; 1.0, 0.90, 0.96, 1.0). The 48 "technically limited studies" included: 39 transabdominal (33 gallbladder, 1 abdominal aortic aneurysm, 5 free peritoneal fluid), 6 cardiac, 2 renal, and 1 pelvic ultrasound. This study suggests that emergency physicians with a minimal amount of training display acceptable technical skill and interpretive acumen in their approach to emergency ultrasonography.
Subject(s)
Clinical Competence/standards , Emergency Medicine/education , Emergency Treatment/standards , Medical Staff, Hospital/education , Ultrasonography/standards , Education, Medical, Continuing , Education, Medical, Graduate , Emergency Treatment/instrumentation , Emergency Treatment/methods , Humans , Internship and Residency , Patient Selection , Point-of-Care Systems/standards , Program Evaluation , Prospective Studies , Reproducibility of Results , Sensitivity and Specificity , Single-Blind Method , Trauma Centers , Ultrasonography/instrumentation , Ultrasonography/methods , Videotape RecordingABSTRACT
This report describes the case of a young woman who presented to an emergency department with severe abdominal pain and shock. The patient was found to have pericardial tamponade due to a massive pericardial effusion. On further evaluation, the etiology of this effusion was considered to be secondary to hypothyroidism with concominant acute viral pericarditis leading to a fulminant tamponade. The presentation, differential diagnosis, and management of pericardial effusion and tamponade secondary to hypothyroidism and viral pericarditis are discussed. The diagnosis of hypothyroidism in conjunction with acute viral pericarditis should be considered in patients presenting with unexplained pericardial effusion and tamponade.
Subject(s)
Cardiac Tamponade/diagnosis , Emergencies , Herpesviridae Infections/diagnosis , Herpesvirus 4, Human , Hypothyroidism/diagnosis , Pericardial Effusion/diagnosis , Pericarditis/diagnosis , Adult , Female , Humans , Hypothyroidism/complicationsSubject(s)
Abdomen, Acute/etiology , Ileal Diseases/complications , Intestinal Obstruction/complications , Vomiting/etiology , Abdominal Pain/etiology , Child , Diagnosis, Differential , Emergencies , Female , Hernia/complications , Hernia/diagnosis , Humans , Ileal Diseases/diagnosis , Intestinal Obstruction/diagnosis , Mesentery/abnormalitiesABSTRACT
Hypoglycemia must be considered in any patient with an acute change of mental status or in a patient who shows a focal neurological deficit. Treatment with high IV glucose concentrations can save the patient from grave irreversible neurological sequelae and death.
