Chair's Letter

Meghan Herbst, MD, FACEP
ACEP EUS Chair
Professor of Emergency Medicine
UConn School of Medicine

A colleague texted me last week to let me know a patient was sent to the emergency department by her nephrologist after he detected a pericardial effusion with tamponade using his handheld ultrasound device. Ironically, the patient had just previously been evaluated by a cardiologist for pleuritic chest pain and was sent home with a diagnosis of “costochondritis.”

This story underscores the value of ultrasound regardless of medical specialty. With access to ultrasound and knowledge on how to use it, anyone can make a difference, even save a life. In the hands of emergency physicians, these opportunities come by the minute. It is up to us to make the most of them, even when we don’t think it will help.

This newsletter has several articles that review common, often devastating, pathologies that can be nuanced in presentation but appreciated early and critically with ultrasound. This includes pericardial tamponade, which presents itself more commonly than it occupies the top of our differential. Drs. Boivin and Stenberg discuss the sonographic findings of pericardial tamponade, how to make the diagnosis accurately, and limitations to avoid, in a case-based review.

Drs. Bowling and Stenberg explain how to assess for critical aortic stenosis—something we may not consider as often as tamponade, but we probably should. And Drs. Cruz-Kan, Ismath, Singh, and Jelic discuss how to detect regional wall motion abnormalities among patients with occlusive myocardial infarction. All three of these articles include elegantly simple and effective infographics that cement the content covered.

For our Probing the Literature series, Dr. Mirsch summarizes Dr. Cozzi’s discussion of PoCUS findings for central retinal artery occlusion, and what is on the horizon for research in this area.

With advancing technology and new (smaller) products to choose from, Drs. Bull and Lobo summarize the latest and greatest handheld ultrasound technology available with pros and cons of each, and how to manage them in a healthcare system.

Drs. Koehler and Theyyunni break down all you need to know about disinfection, from the levels of disinfection, the categories of transducers used, the indications for sterile and nonsterile probe covers, and when to use sterile gel. They mention an FDA-approved high-level disinfection wipe (!) that is compatible with many transducers.

And finally, this newsletter has several articles geared for our pediatric emergency physicians. Drs. Kanjanauptom and Dessie take us on a sonographic anatomy tour of the infant spine. With clearly labeled images, they make it clear where the conus medullaris tapers and CSF is most accessible when performing an ultrasound-assisted lumbar puncture.

Drs. Chaudoin, Shah, Moake, and Lam update us with our pediatric subcommittee productivity (pocket cards are coming!), PEM pocus online collaboratives, and the 10^th anniversary of the P2 network.

Huge thanks to Dr. Oh and all of our contributors. If there are ultrasound topics you are passionate about or want to share with our section, please contribute to our newsletter.

Happy reading and happy scanning!
Meghan