BACKGROUND:The current standard for confi rmation of correct supra-diaphragmatic central venous catheter (CVC) placement is with plain fi lm chest radiography (CXR). We hypothesized that a simple point-of-care ultrasound (POCUS) protocol could effectively confi rm placement and reduce time to confi rmation. METHODS:We prospectively enrolled a convenience sample of patients in the emergency department and intensive care unit who required CVC placement. Correct positioning was considered if turbulent flow was visualized in the right atrium on sub-xiphoid, parasternal or apical cardiac ultrasound after injecting 5 cc of sterile, non-agitated, normal saline through the CVC. RESULTS:Seventy-eight patients were enrolled. POCUS had a sensitivity of 86.8% (95%CI 77.1%-93.5%) and specifi city of 100% (95%CI 15.8%-100.0%) for identifying correct central venous catheter placement. Median POCUS and CXR completion were 16 minutes (IQR 10-29) and 32 minutes (IQR 19-45), respectively. CONCLUSION:Ultrasound may be an effective tool to confirm central venous catheter placement in instances where there is a delay in obtaining a confi rmatory CXR.

No abstract

Plasmablastic lymphoma (PBL) is a rare type of non-Hodgkin lymphoma frequently found in the context of immunosuppression and infection with human immunodeficiency virus (HIV) and/or Epstein-Barr virus (EBV). A 33-year-old immunocompetent male presented with recurrent episodes of epistaxis and a growing intranasal mass. Excisional biopsy of the mass revealed an immunohistochemical profile diagnostic of PBL. Upon completion of chemoradiation, he underwent a transnasal endoscopic mucosal flap tissue rearrangement to restore patency for both functional and surveillance purposes. There was no endoscopic evidence of residual or recurrent disease. However, 8 months later, he was found to have a relapse involving the skin. The nasal cavity is one of the most common sites affected by PBL. Involvement of the nasal cavity may present with symptoms of persistent epistaxis accompanied by an enlarging mass. A plasmablastic immunophenotype in combination with HIV or EBV positivity can aid diagnosis.

BCC, Basal cell carcinoma; BSC, basosquamous cell carcinoma; DFSP, dermatofibrosarcoma protuberans; DVT, deep vein thrombosis; EMPD, extramammary Paget disease; Gyn, gynecology; Gyn onc, gynecology oncology; n/a, not applicable; OBGYN, obstetrics and gynecology; Postop, postoperative; SCC, squamous cell carcinoma; VC, verrucous carcinoma. *Defect size was only reported in 2 cases. y In 3 of 107 cases, recurrence was not reported, and these were not included in the calculation of recurrence rate.

No abstract

No abstract

BACKGROUND: Point-of-care ultrasound (POCUS) has become increasingly integrated into the practice of emergency medicine. A common application is the extended focused assessment with sonography in trauma (eFAST) exam. The American College of Emergency Physicians has guidelines regarding the scope of ultrasound in the emergency department and the appropriate documentation. The objective of this study was to conduct a review of performed, documented and billed eFAST ultrasounds on trauma activation patients.METHODS: This was a retrospective review of all trauma activation patients during a 10-month period at an academic level-one trauma center. A list comparing all trauma activations was crossreferenced with a list of all billed eFAST scans. Medical records were reviewed to determine whether an eFAST was indicated, performed, and appropriately documented. RESULTS:We found that 1,507 of 1,597 trauma patients had indications for eFAST, but 396 (27%) of these patients did not have a billed eFAST. Of these 396 patients, 87 (22%) had documentation in the provider note that an eFAST was performed but there was no separate procedure note. The remaining 309 (78%) did not have any documentation of the eFAST in the patient's chart although an eFAST was recorded and reviewed during ultrasound quality assurance.CONCLUSION: A significant proportion of trauma patients had eFAST exams performed but were not documented or billed. Lack of documentation was multifactorial. Emergency ultrasound programs require appropriate reimbursement to support training, credentialing, equipment, quality assurance, and device maintenance. Our study demonstrates a significant absence of adequate documentation leading to potential revenue loss for an emergency ultrasound program.

No abstract