- Emergency Medicine
- Point of Care Ultrasound
- Patient and Family Centered Medicine
Clinical Associate Professor, Emergency Medicine
Boards, Advisory Committees, Professional Organizations
Member, Founding Patient and Family Advisory Council (2015 - Present)
Member, Cancer Center Patient and Family Advisory Council (2014 - Present)
Associate Editor, Visual Journal of Emergency Medicine (2014 - Present)
Reviewer, Western Journal of Emergency Medicine (2013 - Present)
Residency: Drexel University Emergency Medicine Residency (2012) PA
Medical Education: Rutgers Robert Wood Johnson Medical School (2009) NJ
Board Certification: American Board of Emergency Medicine, Emergency Medicine (2013)
- Interstitial Pulmonary Edema Assessed by Lung Ultrasound on Ascent to High Altitude and Slight Association with Acute Mountain Sickness: A Prospective Observational Study HIGH ALTITUDE MEDICINE & BIOLOGY 2019
Interstitial Pulmonary Edema Assessed by Lung Ultrasound on Ascent to High Altitude and Slight Association with Acute Mountain Sickness: A Prospective Observational Study.
High altitude medicine & biology
Alsup, Carl, Grant S. Lipman, David Pomeranz, Rwo-Wen Huang, Patrick Burns, Nicholas Juul, Caleb Phillips, Carrie Jurkiewicz, Mary Cheffers, Christina Evans, Anirudh Saraswathula, Peter Baumeister, Lucinda Lai, Jessica Rainey, and Viveta Lobo. Interstitial pulmonary edema assessed by lung ultrasound on ascent to high altitude and slight association with acute mountain sickness: A prospective observational study. High Alt Med Biol. 00:000-000, 2019. Background: Acute mountain sickness (AMS) is a common disease that may have a pulmonary component, as suggested by interstitial pulmonary edema quantified by the B-line score (BLS) on ultrasound (US). This subclinical pulmonary edema has been shown to increase with ascent to high altitude and AMS severity, but has not been prospectively associated with AMS incidence in a large prospective study. Materials and Methods: This prospective observational study was part of a randomized controlled trial enrolling healthy adults over four weekends ascending White Mountain, California. Subjects were assessed by lung US and the Lake Louise Questionnaire at 4110 ft (1240 m), upon ascent to 12,500 ft (3810 m), and the next morning at 12,500 ft (3810 m). Results: Three hundred five USs in total were completed on 103 participants, with 73% total incidence of AMS. The mean (±standard deviation) BLS increased from baseline (1.15 ± 1.80) to high altitude (2.56 ± 2.86), a difference of 1.37 (±2.48) (p = 0.04). Overall BLS was found, on average, to be higher among those diagnosed with AMS than without (2.97 vs. 2.0, p = 0.04, 95% confidence interval [CI] -∞ to -0.04). The change in BLS (ΔBLS) from low altitude baseline was significantly associated with AMS (0.88 vs. 1.72, r2 = 0.023, 95% CI -∞ to -0.01, p = 0.048). Conclusions: Interstitial subclinical pulmonary edema by lung US was found to have a small but significant association with AMS.
View details for PubMedID 31045443
Point-of-care Ultrasonography for Detecting the Etiology of Unexplained Acute Respiratory and Chest Complaints in the Emergency Department: A Prospective Analysis.
2018; 10 (8): e3218
Introduction Point-of-care ultrasound (POCUS) is increasingly used as a diagnostic tool in emergency departments. As the number and type of POCUS protocols expand, there is a need to validate their efficacy in comparison with current diagnostic standards. This study compares POCUS to chest radiography in patients with undifferentiated respiratory or chest complaints. Methods A prospective convenience sample of 59 adult patients were enrolled from those presenting with unexplained acute respiratory or chest complaints (and having orders for chest radiography) to a single emergency department in an academic tertiary-care hospital. After a brief educational session, a medical student, blinded to chest radiograph results, performed and interpreted images from the modified Rapid Assessment of Dyspnea in Ultrasound (RADiUS) protocol. The images were reviewed by a blinded ultrasound fellowship-trained emergency physician and compared to chest radiography upon chart review. The primary "gold standard" endpoint diagnosis was the diagnosis at discharge. A secondary analysis was performed using the chest computed tomography (CT) diagnosis as the endpoint diagnosis in the subset of patients with chest CTs. Results When using diagnosis at discharge as the endpoint diagnosis, the modified RADiUS protocol had a higher sensitivity (79% vs. 67%) and lower specificity (71% vs. 83%) than chest radiography. When using chest CT diagnosis as the endpoint diagnosis (in the subset of patients with chest CTs), the modified RADiUS protocol had a higher sensitivity (76% vs. 65%) and lower specificity (71% vs. 100%) than chest radiography. The medical student performed and interpreted the 59 POCUS scans with 92% accuracy. Conclusion The sensitivity and specificity of POCUS using the modified RADiUS protocol was not significantly different than chest radiography. In addition, a medical student was able to perform the protocol and interpret scans with a high level of accuracy. POCUS has potential value for diagnosing the etiology of undifferentiated acute respiratory and chest complaints in adult patients presenting to the emergency department, but larger clinical validation studies are required.
View details for PubMedID 30405993
Isolated Renal Laceration on Point-of-care Ultrasound.
2018; 10 (1): e2113
We report a renal laceration identified on a point-of-care ultrasound (POCUS) performed in the emergency department on a 58-year-old female presenting after blunt trauma. Emergency workup demonstrated a right flank abrasion with tenderness to palpation, hematuria, and decreasing hematocrit. A Focused Assessment with Sonography in Trauma (FAST) exam, performed as part of the intake trauma protocol, identified positive intraperitoneal fluid in the right upper quadrant. A computed tomography (CT) scan established a diagnosis of isolated right renal hematoma arising from a Grade IV laceration, with no collecting duct involvement. This report reviews the sonographic distinction between a renal hematoma and a positive FAST exam, and emphasizes the vital role ultrasound plays in the evaluation of the trauma patient.
View details for PubMedID 29581925
B-line detection using amplitude modulation-frequency modulation (AM-FM) features
SPIE MEDICAL IMAGING
View details for DOI 10.1117/12.2285224
The Sound Games: Introducing Gamification into Stanford's Orientation on Emergency Ultrasound.
2017; 9 (9): e1699
Point-of-care ultrasound is a critical component of graduate medical training in emergency medicine. Innovation in ultrasound teaching methods is greatly needed to keep up with a changing medical landscape. A field-wide trend promoting simulation and technology-enhanced learning is underway in an effort to improve patient care, as well as patient safety. In an effort to both motivate students and increase their skill retention, training methods are shifting towards a friendly competition model and are gaining popularity nationwide.In line with this emerging trend, Stanford incorporated the Sound Games - an educational ultrasound event with a distinctly competitive thread - within its existing two-day point-of-care ultrasound orientation course for emergency medicine interns. In this study, we demonstrate successful implementation of the orientation program, significant learning gains in participants, and overall student satisfaction with the course.
View details for PubMedID 29159006
Point-of-Care Ultrasound in Austere Environments A Complete Review of Its Utilization, Pitfalls, and Technique for Common Applications in Austere Settings
EMERGENCY MEDICINE CLINICS OF NORTH AMERICA
2017; 35 (2): 409-?
With the advent of portable ultrasound machines, point-of-care ultrasound (POCUS) has proven to be adaptable to a myriad of environments, including remote and austere settings, where other imaging modalities cannot be carried. Austere environments continue to pose special challenges to ultrasound equipment, but advances in equipment design and environment-specific care allow for its successful use. This article describes the technique and illustrates pathology of common POCUS applications in austere environments. A brief description of common POCUS-guided procedures used in austere environments is also provided.
View details for DOI 10.1016/j.emc.2016.12.007
View details for PubMedID 28411935
Caudal Edge of the Liver in the Right Upper Quadrant (RUQ) View Is the Most Sensitive Area for Free Fluid on the FAST Exam.
The western journal of emergency medicine
2017; 18 (2): 270-280
The focused assessment with sonography in trauma (FAST) exam is a critical diagnostic test for intraperitoneal free fluid (FF). Current teaching is that fluid accumulates first in Morison's pouch. The goal of this study was to evaluate the "sub-quadrants" of traditional FAST views to determine the most sensitive areas for FF accumulation.We analyzed a retrospective cohort of all adult trauma patients who had a recorded FAST exam by emergency physicians at a Level I trauma center from January 2012 - June 2013. Ultrasound fellowship-trained faculty with three emergency medicine residents reviewed all FAST exams. We excluded studies if they were incomplete, of poor image quality, or with incorrect medical record information. Positive studies were assessed for FF localization, comparing the traditional abdominal views and on a sub-quadrant basis: right upper quadrant (RUQ)1 - hepato-diaphragmatic; RUQ2 - Morison's pouch; RUQ3 - caudal liver edge and superior paracolic gutter; left upper quadrant (LUQ)1 - splenic-diaphragmatic; LUQ2 - spleno-renal; LUQ3 - around inferior pole of kidney; suprapubic area (SP)1 - bilateral to bladder; SP2 - posterior to bladder; SP3 - posterior to uterus (females). FAST results were confirmed by chart review of computed tomography results or operative findings.Of the included 1,008 scans, 48 (4.8%) were positive. The RUQ was the most positive view with 32/48 (66.7%) positive. In the RUQ sub-quadrant analysis, the most positive view was the RUQ3 with 30/32 (93.8%) positive.The RUQ is most sensitive for FF assessment, with the superior paracolic gutter area around the caudal liver edge (RUQ3) being the most positive sub-quadrant within the RUQ.
View details for DOI 10.5811/westjem.2016.11.30435
View details for PubMedID 28210364
Integration of Ultrasound in Undergraduate Medical Education at the California Medical Schools: A Discussion of Common Challenges and Strategies From the UMeCali Experience.
Journal of ultrasound in medicine
2016; 35 (2): 221-233
Since the first medical student ultrasound electives became available more than a decade ago, ultrasound in undergraduate medical education has gained increasing popularity. More than a dozen medical schools have fully integrated ultrasound education in their curricula, with several dozen more institutions planning to follow suit. Starting in June 2012, a working group of emergency ultrasound faculty at the California medical schools began to meet to discuss barriers as well as innovative approaches to implementing ultrasound education in undergraduate medical education. It became clear that an ongoing collaborative could be formed to discuss barriers, exchange ideas, and lend support for this initiative. The group, termed Ultrasound in Medical Education, California (UMeCali), was formed with 2 main goals: to exchange ideas and resources in facilitating ultrasound education and to develop a white paper to discuss our experiences. Five common themes integral to successful ultrasound education in undergraduate medical education are discussed in this article: (1) initiating an ultrasound education program; (2) the role of medical student involvement; (3) integration of ultrasound in the preclinical years; (4) developing longitudinal ultrasound education; and (5) addressing competency.
View details for DOI 10.7863/ultra.15.05006
View details for PubMedID 26764278
Thymic Tumor Extension into the Heart, a Rare Finding Found by Point-of-Care Ultrasound.
2016; 8 (8)
We report a cardiac mass detected by point-of-care ultrasound performed within the emergency department on a 65-year-old male with thymic cancer who presented with chronic cough and fever. Results from the initial emergency workup, which included blood tests, urinalysis, and a computerized tomography with angiography scan with venous phasing of the chest, did not result in a definitive diagnosis. A point-of-care echocardiogram was performed to evaluate for possible infective endocarditis, but alternatively identified a large mass in the right atria and ventricle. The mass was later confirmed to be metastatic tumor from the patient's known thymic cancer. This case emphasizes the vital role ultrasound can play in the acute care setting.
View details for DOI 10.7759/cureus.724
View details for PubMedID 27625910
View details for PubMedCentralID PMC5010378
CRITICAL CARE CLINICS
2014; 30 (1): 47-?
Focused cardiac echocardiography has become a critical diagnostic tool for the emergency physician and critical care physician caring for patients in shock and following trauma to the chest, and those presenting with chest pain and shortness of breath,. Cardiac echocardiography allows for immediate diagnosis of pericardial effusions and cardiac tamponade, evaluation of cardiac contractility and volume status, and detection of right ventricular strain possibly seen with a significant pulmonary embolus. This article addresses how to perform cardiac echocardiography using the standard windows, how to interpret a focused goal-directed examination, and how to apply this information clinically at the bedside.
View details for DOI 10.1016/j.ccc.2013.08.003
View details for PubMedID 24295841
CRITICAL CARE CLINICS
2014; 30 (1): 93-?
Thoracic ultrasonography (US) has proved to be a valuable tool in the evaluation of the patient with shortness of breath, chest pain, hypoxia, or after chest trauma. Its sensitivity and specificity for detecting disease is higher than that of a chest radiograph, and it can expedite the diagnosis for many emergent conditions. This article describes the technique of each thoracic US application, illustrating both normal and abnormal findings, as well as discussing the literature. Bedside thoracic US has defined imaging benefits in a wide range of thoracic disease, and US guidance has been shown to facilitate thoracic and airway procedures.
View details for DOI 10.1016/j.ccc.2013.08.002
View details for PubMedID 24295842