M. Bollinger

A Randomized Controlled Trial of Ultrasound-Assisted Lumbar Puncture

Evidence showing the systematic utility of ultrasound imaging during lumbar puncture (LP) in the emergency department is lacking. Our hypothesis was that ultrasound‐assisted LP would increase the success rate and ease of performing LP with a greater benefit in obese patients.

Female authorship in emergency medicine parallels women practicing academic emergency medicine.

BACKGROUND Studies have shown that women in emergency medicine (EM) lag behind their male counterparts in academic productivity. OBJECTIVES We compared the proportion of female attending physicians from EM academic programs to the proportion of female first or second authors of original scientific manuscripts and case reports from four major EM journals in a single year. METHODS We used a retrospective cross-sectional design. Original scientific manuscripts and case reports from four major EM journals published in 2005: Academic Emergency Medicine, Annals of Emergency Medicine, American Journal of Emergency Medicine, and Journal of Emergency Medicine were reviewed to determine genders of first and second authors. The proportion of female first or second authorship was then compared to the proportion of female EM attending physicians from 134 academic EM programs in the United States. Data were analyzed using Pearsons chi-squared and Clopper-Pearson binomial confidence intervals as appropriate. A p-value of ≤ 0.05 was considered significant. RESULTS The percentage of female faculty; 940/3571 (26.32%, 95% confidence interval [CI] 24.9-27.8%) vs. the percentage of female first or second authorship 289/1123 (25.73%, 95% CI 23.3-28.4%) was not statistically significant (p = 0.562). There was no difference in the proportion of male and female authors with multiple manuscripts (p = 0.889). CONCLUSIONS As measured by first and second authorship, there was no discrepancy between the proportion of female EM faculty and the proportion of female authorship in EM literature from 2005.

Emergency medicine resident performed bedside ultrasonography of the gallbladder in non-fasted healthy volunteers.

BACKGROUND Gallbladder ultrasonography is a commonly performed test in the emergency department. It is unknown whether a non-fasting state alters the visualization of the gallbladder by emergency medicine (EM) residents. OBJECTIVES We conducted this study to determine whether EM residents are able to visualize the gallbladder in volunteers who have recently consumed a fatty meal. METHODS This study used a prospective, single-blinded, randomized controlled design. Initial scans were performed on fasting volunteers. A fatty meal was then consumed. Thirty minutes after eating, a different resident, who was unaware of whether the volunteer had eaten or fasted, performed a second scan. To control for operator bias, 10% of subjects remained fasting between scans. Students paired-samples t-test, Pearsons chi-squared, and McNemar test were determined as appropriate. RESULTS A total of 92 scans from 46 volunteers were analyzed. EM residents were able to visualize the gallbladder in all 40 pre-prandial scans (100%) and all 40 post-prandial scans (100%). Gallbladder area as measured in the longitudinal axis decreased 20% from a mean baseline of 11.58 +/- 4.86 cm(2) (95% confidence interval [CI] 11.17-12.98) to 9.2 +/- 5.04 cm(2) (95% CI 7.74-10.66, p = 0.0009) after food intake. Total time to scan for the fasting volunteers (110.2 s, 95% CI 84.34-136) did not change significantly from non-fasting volunteers (129.7 s, 95% CI 110.29-149.01, p = 0.153). CONCLUSIONS EM residents are able to visualize the gallbladder in non-fasted healthy volunteers.