Performance and interpretation of focused right upper quadrant ultrasound by emergency physicians.

The objectives of this study were to determine the accuracy of Emergency Physicians (EP) performing focused right upper quadrant (RUQ) ultrasound, to quantify how sonographic experience affects accuracy for gallbladder pathology, and to establish the time needed to complete a focused RUQ ultrasound. A convenience sample of patients with suspected gallbladder disease received a focused RUQ ultrasound by an EP. Sonographic findings, number of previous RUQ ultrasounds performed, and time for examination completion were recorded. Each patient then had a formal RUQ ultrasound by a sonographer blinded to the focused RUQ ultrasound results. Focused RUQ and formal ultrasound findings were compared, with the exception of the sonographic Murphy sign, which was compared to pathology reports. One hundred nine patients were enrolled. Fifty-one had gallstones. Forty-nine were detected by EPs, yielding a sensitivity of 96% [95% confidence interval (CI).87-.99]. Of the 58 patients without gallstones, 51 were correctly diagnosed by EPs (specificity = 88%, 95% CI.77-.95). The sonographic Murphy sign was present during 54 emergency examinations, but in only 24 formal studies. When compared to pathology reports, the emergency sonographic Murphy sign had a sensitivity of 75% compared to the formal ultrasound sensitivity of 45% for acute cholecystitis. EPs were less accurate for other sonographic findings, and level of experience had little effect on sensitivity or specificity for detecting gallstones. Eighty-three percent of emergency studies were completed in less than 10 min. Gallstones are accurately detected by EPs in a timely fashion. Additionally, compared to the radiologist's interpretation, the EP-detected sonographic Murphy sign was more sensitive for diagnosing acute cholecystitis.

Incidental findings during emergency sonographic examinations: a case series.

The teaching of ultrasonography is rapidly being incorporated into emergency medicine (EM) training programs and clinical practice. Most literature focuses on appropriate indications for the performance of emergency ultrasonography, and most EM-related courses and programs limit their teaching to standard focused indications. Generally this will suffice; however, occasionally, incidental findings, which are beyond the realm of what is taught in these programs, have influenced patient care. In this paper we discuss 7 cases in which incidental findings were discovered during an emergency sonographic examination. In each case the findings changed the patient's disposition, diagnosis and, potentially, outcome.

Formation of charge-transfer complexes from neutral bis(porphyrin) sandwiches.

Lanthanide(III) bis(porphyrin) sandwich complexes of octaethyltetraazaporphyrin (OETAP) were synthesized and characterized by UV-vis, IR, and NMR spectroscopies. Cyclic voltammetry results indicate that these neutral sandwich complexes are very easily reduced. Charge-transfer reactions were performed in solution with Ln-(OETAP)2 sandwiches and zirconium(IV) bis(porphyrin) sandwiches. The lanthanide sandwiches partially oxidize the zirconium sandwiches in solution, and a solvent dependence of the charge-transfer reaction was observed. The solid-state properties of these charge-transfer materials were also studied. Magnetic susceptibility results suggest weak intermolecular interactions between the sandwiches. The conductivities of the charge-transfer species are greatly improved relative to those of the insulating undoped sandwiches, but the conductivities are in the lower semiconducting region. The low conductivity values are thought to be due to poor intermolecular overlap.

Penetrating neck trauma.

Penetrating neck trauma can pose significant diagnostic and therapeutic challenges for emergency physicians. Factors contributing to these problems are complex anatomy, proximity of vital structures, and potential for rapid deterioration of airway, vascular, or neurologic injuries. Other contributing factors are the lack of consensus in the literature regarding appropriate evaluation and management of penetrating neck injuries, and insufficient resources or experienced personnel at some institutions. This review focuses on the key components of the history and physical examinations that allow for an assessment of the severity and type of structures involved. In addition, current methods of airway management, as well as ways to manage penetrating neck trauma efficiently and cost effectively, are discussed.

Intranasal midazolam in patients with status epilepticus.

The patient in status epilepticus presents many challenges to the emergency physician. IV access is frequently difficult to achieve, and prolonged attempts at access can jeopardize the patient and endanger the caregiver. We present two cases in which the administration of intranasal midazolam appeared to successfully terminate status epilepticus. No adverse effects were noted. Studies are needed to clarify the safety, optimal dosing, and clinical utility of this treatment modality.

Effects of Ascorbic Acid on Display Life of Ground Beef.

Fresh ground beef containing 20 and 25% fat was either treated with 0.01, 0.05 or 0.10% crystalline ascorbic acid or remained as non-treated controls. Samples were displayed in polyvinyl chloride (PVC) film for up to 10 d (24 h/d) at 2 to 3°C under 1076 lux G. E. Natural light. Measures of display life included visual color scores, reflectance measurements, sensory panel scores, thiobarbituric acid (TBA) values and microbial standard plate counts (SPC). At days 1, 3 and 5 of display, average and worst point visual color scores were judged brighter for all ascorbic acid treatments compared to controls. Lower metmyoglobin percentages, higher %R630nm/%R580nm and higher CIE a* readings at days 3, 5 and 10 for the ascorbic acid-treated product supported visual color results. Higher fat (25%) and higher ascorbic acid levels (0.05 and 0.10%) gave brighter visual color responses at 5 d of display than the 20% fat product and that containing 0.01% ascorbic acid. More intense sensory panel beef flavor was associated with the 0.05 and 0.10% ascorbic acid treatments. More off-flavor was found in the higher fat product (25%). TBA values were not different for fat level comparisons, but were lower for the 0.05 and 0.10% ascorbic acid treatments. At day 5 of display, SPC were not affected by ascorbic acid treatment. The 25% fat product had lower SPC at day 5.