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Point-of-care ultrasound has become a useful clinical adjunct, especially in emergency medicine, because it is noninvasive, repeatable, and nonradiating. In cases of pulled elbow also known as nursemaid's elbow or radial head subluxation, diagnosis is usually performed clinically. However, there is the potential for a failed reduction or misdiagnosis. We introduce a potentially useful diagnostic finding for pulled elbow ("Hook sign") using point-of-care ultrasound in the emergency department.

Objective Living in high-rise buildings may cause delays in reaching a hospital after an out-of-hospital cardiac arrest. This study aimed to compare neurological outcomes in people who had had an out-of-hospital cardiac arrest, according to their floor of residence. Methods We conducted a retrospective study of 1541 patients aged ≥20 years who had out-of-hospital cardiac arrest between 1 October 2015 and 30 June 2018, using data from a central registry. We compared the outcomes of patients living on the first (ground) or second floor and those living on the third floor or above, using multiple logistic regression. Results Those living on higher floors were more likely to have been at home (88.1% vs. 58.0%); to have had bystander cardiopulmonary resuscitation (57.9% vs. 45.2%); and experienced a significantly longer emergency medical service response time [median interquartile range (IQR): 7 min (6–10 min) vs. 7 min (5–9 min), P = 0.001] and on-scene time [median (IQR): 16 min (11–23 min) vs. 12 min (8–19 min), P < 0.001]. The strongest predictors of a good neurological outcome were younger age [odds ratio (OR): 0.96, 95% confidence interval (CI): 0.94–0.97], being on a lower floor at the time of the cardiac arrest (OR: 1.82, 95% CI: 1.09–3.12) and having a shockable rhythm (OR: 21.97, 95% CI: 12.81–39.47). Conclusion People living on higher floors have poorer outcomes after an out-of-hospital cardiac arrest. Further studies are required to assess factors causing a delay in the emergency medical service response time, and placement of automated external defibrillators in high-rise buildings.

Our study suggests that point-of-care sonography should not replace Radiology-performed scans. The required amount of training for EPs to be competent in this examination needs further investigation. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 44:360-367, 2016.

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