Stefan Posth

A framework for implementation, education, research and clinical use of ultrasound in emergency departments by the Danish Society for Emergency Medicine

The first Danish Society for Emergency Medicine (DASEM) recommendations for the use of clinical ultrasound in emergency departments has been made. The recommendations describes what DASEM believes as being current best practice for training, certification, maintenance of acquired competencies, quality assurance, collaboration and research in the field of clinical US used in an ED.

A 69-Year-Old Man With Dyspnea Following Lung Biopsy

A 69-year-old man with COPD and ischemic heart disease was admitted with dyspnea to the ED. Nine hours prior to the admission, the patient had been seen in an outpatient clinic where a CT scan-guided biopsy of an opacity in the right lung had been performed. Aft er the biopsy, the patient did not have any complaints. A control CT scan of the chest following the biopsy as well as a control chest radiograph 4 h aft er the biopsy had been performed did not have signs of pneumothorax or other complications. Th e patient was allowed to go home without any further observation.

Medical trigger teams for severely ill medical patients in the Emergency Department

Background Medical patients who arrive severely ill at the Emergency Department (ED) need to be diagnosed and treated immediately, as prognosis decreases rapidly with time spent before correct treatment is given for most of these patients. At Odense University Hospital, patients arriving at the ED with either a pulse rate >140, systolic blood pressure 35 or <8 or a saturation <80% are met by the medical trigger team. Patients with suspected apoplexy, STEMI or orthopedic multitrauma are met by other specialized teams.

Successful emergency splenectomy during cardiac arrest due to cytomegalovirus-induced atraumatic splenic rupture

A 27-year-old woman was admitted to the emergency department with fever and a petechial rash on suspicion of meningitis. Shortly after arriving she developed cardiac arrest. Blood work up showed severe lactate acidosis, anaemia and thrombocytopenia. A focused assessment with sonography in trauma scan showed free intraperitoneal fluid and an emergency laparotomy revealed massive bleeding from a ruptured spleen. The patient was successfully resuscitated. She proved to be infected with cytomegalovirus causing idiopathic thrombocytopenic purpura, splenomegaly and splenic rupture. She was treated for 14 days with ganciclovir and meropenem and discharged on recovery. Atraumatic splenic rupture caused by viral infection is a rare condition although well described. In the case of our patient, thrombocytopenia added to the severity of the splenic rupture. A multidisciplinary team approach was essential for the management and the eventual recovery of the patient.