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Introduction: Providers can evaluate patients who sustain trauma during outdoor activities by using the extended focused assessment with sonography for trauma (FAST) and the limited knee ultrasound. Remote tele-mentored ultrasound (RTMUS) can help minimally trained providers in the wilderness if they have difficulty obtaining a view or have questions about the interpretation of an image. The goal of our study was to determine the feasibility of using RTMUS to teach the FAST exam and knee ultrasound exam to ultrasound-naive medical students during a wilderness medicine outdoor activity., Methods: Medical students from two large academic institutions were randomized to receive either in-person or RTMUS education during a wilderness activity 1 d before completion of FAST and knee ultrasound exams. All students received limited ultrasound instruction before the event. The images obtained by the students were compared. Two ultrasound-trained emergency physicians evaluated the images for their ability to identify structures and support a diagnosis from the images. Simple descriptive statistics were performed., Results: There was a statistically significant difference between the RTMUS group and the in-person group. The images captured by the in-person group were more likely to identify structures and support a diagnosis than those captured by the RTMUS group., Conclusions: In this study, ultrasound-naive medical students who received in-person education on conducting the knee exam and FAST exam obtained higher-quality images than students who received RTMUS education. This study suggests that if RTMUS is used for medical purposes, increased ultrasound training may be needed prior to initiation of RTMUS.

Introduction: Ultrasound is used for peripheral intravenous (PIV) cannulation in patients with difficult landmark-guided IV access in the Emergency Department. Distal-to-proximal application of an Esmarch bandage on the target limb has been suggested as a method for increasing vein size and ease of cannulation., Methods: This study was a single-blinded crossover randomized controlled trial comparing basilic vein size under ultrasound with use of an Esmarch bandage in addition to standard IV tourniquet ("tourniquet + Esmarch") compared to use of a standard IV tourniquet alone. Participant discomfort with the tourniquet + Esmarch was also compared to that with standard IV tourniquet alone., Results: Twenty-two healthy volunteers were used to measure basilic vein size with and without the Esmarch bandage. There was no difference in basilic vein size between the two groups, with a mean diameter of 6.0 ± 1.5 mm in the tourniquet + Esmarch group and 6.0 ± 1.4 mm in the control group, p = 0.89. Discomfort score (from 0 to 10) was different between the groups, with a mean discomfort score of 2.1 in the tourniquet + Esmarch group and 1.1 in the standard IV tourniquet alone group (p < 0.001)., Conclusions: This study showed that the use of an Esmarch bandage does not increase basilic vein size in healthy volunteers but is associated with a mild increase in discomfort., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Bedside sonography has become an important tool in the emergency physician's diagnostic armamentarium. Sonography is useful in the evaluation of a number of conditions, including cholecystitis, abdominal aortic aneurysm, and ectopic pregnancy. Applied to the heart, sonography aids in the assessment of pericardial tamponade, electromechanical dissection, pulmonary embolus, and other cardiorespiratory emergencies. Echocardiography also has a role in differentiating patients with cardiac activity from those in ventricular standstill and in estimating central venous pressure. This article reviews these and other clinical applications and the physics of ultrasound, techniques for sonographic evaluation, and the practical aspects of emergency department use, such as strategic placement of the equipment for quick activation and storage of collected data.

Study Objectives: To compare the current state of emergency medicine residency ultrasound training with guidelines for that training from the Society for Academic Emergency Medicine (SAEM)., Methods: A brief questionnaire was sent to program directors from 119 emergency medicine residency programs in the United States. Responses were compared with the SAEM guidelines for clinical experience (150 total ultrasounds) and didactic experience (40 hours of didactic instruction)., Results: The overall response rate was 92%. Seventy-six (69%) of the programs own an ultrasound machine (ownership defined as 24-hour availability and complete discretion over use). Of these, 12 (16%) indicated that their average 1998 graduate had done at least 150 total ultrasound scans during residency, although none of the programs had average numbers that exceeded the minimum guidelines for all 4 procedure categories. Information on didactic curriculum was available from 74 ultrasound-owning programs: the duration was 0 to 20 hours in 49 (66%), 20 to 40 hours in 19 (26%), and 40 to 100 hours in 6 (8%). Only 1 program's average graduate met or exceeded the SAEM guidelines for both didactic and clinical training., Conclusion: Most emergency medicine residency programs own at least 1 ultrasound machine, with more than half of these obtaining their first machine within the past 3 years. Only 1 program currently meets SAEM training guidelines.

A 75-year-old man with severe chronic obstructive pulmonary disease and epistaxis experienced progressive respiratory failure after receiving an injection of meperidine and hydroxyzine in preparation for nasal packing. The patient and his family refused endotracheal intubation; despite aggressive medical care, he continued to deteriorate toward an expected fatal outcome. An i.v. infusion of doxapram hydrochloride at 2 mg/min rapidly reversed his downhill course and hypercarbic coma. This case illustrates the potential usefulness of doxapram in the emergency setting. The mechanism of action, indications, dosing methods, and potential side effects of this agent are discussed.

The neurologic complications of cocaine toxicity are responsible for a major portion of the morbidity and mortality associated with cocaine. Most of the complications appear to be related to the hyperadrenergic state induced by cocaine and may be treated symptomatically. Diazepam is the most effective drug for cocaine-induced seizures.