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To determine the utility of emergency physician-performed point-of-care biliary ultrasound in the evaluation of emergency department (ED) patients with isolated acute non-traumatic epigastric pain. This was a multi-center prospective observational study of adult patients presenting to the ED with isolated acute non-traumatic epigastric pain. Patients with abdominal tenderness at any site other than the epigastric region, or with a history of gall stones, cholecystectomy, gastrointestinal bleeding, chronic abdominal pain, trauma, or altered mental status were excluded. Emergency physician investigators performed point-of-care biliary ultrasound after clinical assessment. Demographic information, history, physical examination findings, laboratory results, additional diagnostic tests, and disposition data were collected. A total of 51 patients (39 women, 12 men) were enrolled. The mean age of the patients was 36.4 years ± 13.6 (SD). All subjects had isolated epigastric tenderness. Gallstones were found in 20/51 (39%, 95% CI 26-52%) on point-of-care biliary ultrasound. Of the 20 patients who had gallstones, eight had sonographic signs of chloecystitis. The treating emergency physicians' initial evaluation did not plan to include an ultrasound in 17/20 patients with gallstones. 19/20 patients were initially given a GI cocktail by the treating emergency physicians. Point-of-care biliary ultrasound detected gall stones in more than one-third of ED patients with isolated acute non-traumatic epigastric pain. All patients presenting to the ED with non-traumatic epigastric pain should be evaluated for biliary disease with an ultrasound imaging study. Bedside ultrasound can avoid misdiagnosis and expedite management in these patients.

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IntroductionEmergency physician-performed compression ultrasonography focuses primarily on the evaluation of the proximal veins of the lower extremity in patients with suspected deep venous thrombosis (DVT). A detailed sonographic evaluation of lower extremity is not performed. The objective of this study was to determine the prevalence of non-thrombotic findings on comprehensive lower extremity venous duplex ultrasound (US) examinations performed on emergency department (ED) patients.MethodsWe performed a retrospective six-year review of an academic ED’s records of adult patients who underwent a comprehensive lower extremity duplex venous US examination for the evaluation of DVT. The entire US report was thoroughly reviewed for non-thrombotic findings.ResultsWe detected non-thrombotic findings in 263 (11%, 95% CI [9.5–11.9%]) patients. Among the non-thrombotic findings, venous valvular incompetence (81, 30%) was the most frequent, followed by cyst/mass (41, 15%), lymphadenopathy (33, 12%), phlebitis (12, 4.5%), hematoma (8, 3%), cellulitis (1, 0.3%) and other (6, 2.2%).ConclusionIn our study, we detected a variety of non-thrombotic abnormalities on comprehensive lower extremity venous duplex US examinations performed on ED patients. Some of these abnormalities could be clinically significant and potentially be detected with point-of-care lower extremity US examinations if the symptomatic region is evaluated. In addition to assessment of the proximal veins for DVT, we recommend sonographic evaluation of the symptomatic area in the lower extremity when performing point-of-care ultrasound examinations to identify non-thrombotic abnormalities that may require immediate intervention or close follow up.

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vials of Fab and 19.1(9.3) vials of F(ab') 2 (ratio: 0.55; 95% CI 0.45 -0.65).Conclusion: Regardless of the antivenom used, most rattlesnake patients in the NASBR receive multiple antivenom doses. This analysis does not distinguish doses given for initial control (either antivenom), scheduled maintenance (Fab), or to treat recurrent venom effects (either antivenom), and do not account for pre-treatment severity.

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first anti-emetic used, route of administration (IV, PO, or IM), and need for subsequent dosing of an antiemetic up to 3 doses was recorded.Results: Charts reviewed totaled 3340; first line medications were: 1,802 (59.99%) patients received ondansetron, 609 (20.27%) received prochlorperazine, 502 (61.71%) received metoclopramide, 91 (3.03%) patients received haloperidol and 0 received promethazine. 78% of the ondansetron group, 96% of the prochlorperazine group, 81.6% of the metoclopramide group, and 53% of the haloperidol group did not need a second dose of anti-emetics. Of the percentage of patients who required a second dose; if ondansetron was given, 78% of patients did not need a third dose of anti-emetics, if prochlorperazine was administered, it was 93%, metoclopramide 69%, and haloperidol 89%.Conclusion: Ondansetron was not superior to prochlorperazine for first-line use for N&V. Patients receiving prochlorperazine and not ondansetron, were least likely to need a second dose of antiemetics. Ondansetron was not superior to haloperidol as a second line antiemetic. Patients receiving haloperidol as a second antiemetic were least likely to need a third dose of antiemetics. Further studies should adjudicate the need for repeat antiemetic dosing when the antiemetic chosen is matched to the apparent cause and mechanism of N&V.