Clinical Focus


  • Emergency Medicine

Academic Appointments


Administrative Appointments


  • Ultrasound Fellowship Co-Director, Stanford Emergency Department (2020 - Present)
  • Assistant Director of Ultrasound Research, Stanford Emergency Department Ultrasound Section (2018 - Present)

Professional Education


  • Fellowship: Brigham and Women's Hospital Harvard Medical School (2018) MA
  • MPH, Harvard T.H. Chan School of Public Health
  • Board Certification: American Board of Emergency Medicine, Emergency Medicine (2017)
  • Emergency Ultrasound Fellowship, Brigham and Women's Hospital
  • Residency: Mount Sinai Beth Israel-Icahn School of Medicine at Mt Sinai (2016) NY
  • Emergency Medicine Residency, Mount Sinai School of Medicine - Beth Israel
  • Medical Education: Columbia University College of Physicians and Surgeons (2013) NY
  • MD, Columbia College of Physicians and Surgeons

2022-23 Courses


All Publications


  • Beyond the Numbers: Assessing Competency in Point-of-Care Ultrasound. Annals of emergency medicine Gottlieb, M., Duanmu, Y. 2023

    View details for DOI 10.1016/j.annemergmed.2023.01.020

    View details for PubMedID 36805290

  • A consensus list of ultrasound competencies for graduating emergency medicine residents. AEM education and training Haidar, D. A., Peterson, W. J., Minges, P. G., Carnell, J., Nomura, J. T., Bailitz, J., Boyd, J. S., Leo, M. M., Liu, E. L., Duanmu, Y., Acuña, J., Kessler, R., Elegante, M. F., Nelson, M., Liu, R. B., Lewiss, R. E., Nagdev, A., Huang, R. D. 2022; 6 (6): e10817

    Abstract

    Emergency ultrasound (EUS) is a critical component of emergency medicine (EM) resident education. Currently, there is no consensus list of competencies for EUS training, and graduating residents have varying levels of skill and comfort. The objective of this study was to define a widely accepted comprehensive list of EUS competencies for graduating EM residents through a modified Delphi method.We developed a list of EUS applications through a comprehensive literature search, the American College of Emergency Physicians list of core EUS benchmarks, and the Council of Emergency Medicine Residency-Academy of Emergency Ultrasound consensus document. We assembled a multi-institutional expert panel including 15 faculty members from diverse practice environments and geographical regions. The panel voted on the list of competencies through two rounds of a modified Delphi process using a modified Likert scale (1 = not at all important, 5 = very important) to determine levels of agreement for each application-with revisions occurring between the two rounds. High agreement for consensus was set at >80%.Fifteen of 15 panelists completed the first-round survey (100%) that included 359 topics related to EUS. After the first round, 195 applications achieved high agreement, four applications achieved medium agreement, and 164 applications achieved low agreement. After the discussion, we removed three questions and added 13 questions. Fifteen of 15 panelists completed the second round of the survey (100%) with 209 of the 369 applications achieving consensus.Our final list represents expert opinion on EUS competencies for graduating EM residents. We hope to use this consensus list to implement a more consistent EUS curriculum for graduating EM residents and to standardize EUS training across EM residency programs.

    View details for DOI 10.1002/aet2.10817

    View details for PubMedID 36425790

    View details for PubMedCentralID PMC9677397

  • Evolving Paralysis after Motor Vehicle Collision. Clinical practice and cases in emergency medicine Prendergast, N., Duanmu, Y. 2022; 6 (3): 254-255

    Abstract

    CASE PRESENTATION: An 85-year-old male who had been prescribed prasugrel presented to the emergency department (ED) after a motor vehicle collision and developed progressive neurological deficits. Computed tomography imaging demonstrated epidural thickening from the second through seventh cervical vertebrae, and magnetic resonance imaging was notable for a cervicothoracic epidural hematoma. The patient underwent emergent decompression with a favorable outcome.DISCUSSION: Cases of traumatic spinal epidural hematomas are rarely seen in the ED. These are part of a small subset of operative neurological emergencies that benefit from urgent surgical intervention.

    View details for DOI 10.5811/cpcem2022.3.51179

    View details for PubMedID 36049194

  • Less is more: Recommendations for achieving best practices in antibiotic use for acute upper respiratory infections JOURNAL OF THE AMERICAN COLLEGE OF EMERGENCY PHYSICIANS OPEN Sills, J., Boccio, E., Govindarajan, P., Duanmu, Y. 2022; 3 (3)

    View details for DOI 10.1002/emp2.12767

    View details for Web of Science ID 000812693400001

  • A Distance-Learning Approach to Point-of-Care Ultrasound Training (ADAPT): A Multi-Institutional Educational Response During the COVID-19 Pandemic. Academic medicine : journal of the Association of American Medical Colleges Nix, K., Liu, E. L., Oh, L., Duanmu, Y., Fong, T., Ashenburg, N., Liu, R. B. 2021

    Abstract

    PROBLEM: The COVID-19 pandemic significantly disrupted point-of-care ultrasound (POCUS) education. Medical schools and residency programs placed restrictions on bedside teaching and clinical scanning as part of risk mitigation. In response, POCUS faculty nationwide from 15 institutions collaborated on an alternative model of ultrasound education, A Distance-learning Approach to POCUS Training (ADAPT).APPROACH: ADAPT was repeated monthly from April 1 through June 30, 2020. It accommodated 70 learners, who included 1- to 4-week rotators and asynchronous learners. The curriculum included assigned pre-work and learning objectives covering 20 core POCUS topics. A rotating group of 30 faculty and fellows delivered daily virtual teaching sessions that included gamification to increase learner engagement and hands-on instruction through teleguidance. After participation, faculty and learners completed anonymous surveys.OUTCOMES: Educators reported a significant decrease in preparatory time (6.2 vs. 3.1 hours per week, P < .001) dedicated to ultrasound education after implementing ADAPT. The majority of 29 learners who completed surveys felt "somewhat confident" or "very confident" in their ability to acquire (n = 25, 86.2%) and interpret (n = 27, 93.1%) ultrasound images after the intervention; the majority of 22 educators completing surveys rated the program "somewhat effective" or "very effective" at contributing to learner's ability to acquire (n = 13, 59.1%) and interpret (n = 20, 90.9%) images. Most learners (n = 28, 96.6%) and all educators (n = 22, 100%) were "satisfied" or "very satisfied" with ADAPT as a whole, and the large majority of educators were "very likely" (n = 18, 81.8%) to recommend continued use of this program.NEXT STEPS: A virtual curriculum that pools the efforts of multiple institutions nationwide was implemented rapidly and effectively while satisfying educational expectations of both learners and faculty. This collaborative framework can be replicated and may be generalizable to other educational objectives.

    View details for DOI 10.1097/ACM.0000000000004399

    View details for PubMedID 34524135

  • Point-of-Care Ultrasound Predicts Clinical Outcomes in Patients With COVID-19. Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine Kumar, A., Weng, I., Graglia, S., Lew, T., Gandhi, K., Lalani, F., Chia, D., Duanmu, Y., Jensen, T., Lobo, V., Nahn, J., Iverson, N., Rosenthal, M., Gordon, A. J., Kugler, J. 2021

    Abstract

    OBJECTIVES: Point-of-care ultrasound (POCUS) detects the pulmonary manifestations of COVID-19 and may predict patient outcomes.METHODS: We conducted a prospective cohort study at four hospitals from March 2020 to January 2021 to evaluate lung POCUS and clinical outcomes of COVID-19. Inclusion criteria included adult patients hospitalized for COVID-19 who received lung POCUS with a 12-zone protocol. Each image was interpreted by two reviewers blinded to clinical outcomes. Our primary outcome was the need for intensive care unit (ICU) admission versus no ICU admission. Secondary outcomes included intubation and supplemental oxygen usage.RESULTS: N=160 patients were included. Among critically ill patients, B-lines (94 vs 76%; P<.01) and consolidations (70 vs 46%; P<.01) were more common. For scans collected within 24hours of admission (N=101 patients), early B-lines (odds ratio [OR] 4.41 [95% confidence interval, CI: 1.71-14.30]; P<.01) or consolidations (OR 2.49 [95% CI: 1.35-4.86]; P<.01) were predictive of ICU admission. Early consolidations were associated with oxygen usage after discharge (OR 2.16 [95% CI: 1.01-4.70]; P=.047). Patients with a normal scan within 24hours of admission were less likely to require ICU admission (OR 0.28 [95% CI: 0.09-0.75]; P<.01) or supplemental oxygen (OR 0.26 [95% CI: 0.11-0.61]; P<.01). Ultrasound findings did not dynamically change over a 28-day scanning window after symptom onset.CONCLUSIONS: Lung POCUS findings detected within 24hours of admission may provide expedient risk stratification for important COVID-19 clinical outcomes, including future ICU admission or need for supplemental oxygen. Conversely, a normal scan within 24hours of admission appears protective. POCUS findings appeared stable over a 28-day scanning window, suggesting that these findings, regardless of their timing, may have clinical implications.

    View details for DOI 10.1002/jum.15818

    View details for PubMedID 34468039

  • Development of a Three-Dimensionally Printed Ultrasound-Guided Peripheral Intravenous Catheter Phantom. Cureus Tan, T. X., Wu, Y. Y., Riley, I., Duanmu, Y., Rylowicz, S., Shimada, K. 2021; 13 (8): e17139

    Abstract

    Introduction Ultrasound-guided peripheral intravenous catheter (US-PIVC) placement is an effective technique to establish PIV access when the traditional approach fails. Many training programs utilize commercial or homemade phantoms for procedural training. However, commercial products tend to be expensive and lack realism, while homemade blocks tend to be single-use and degrade easily. Thanks to the increasing availability of three-dimensional (3D) printers in academic settings, we sought to design and develop a reusable 3D-printed US-PIVC phantom and to evaluate its utility in terms of time needed to achieve IV placement and perceived realism compared to a commercial model among a group of emergency medicine (EM) physicians. Methods The upper extremity vascular phantom was constructed using 3D printing and casting techniques. A convenience sampling of EM physicians was timed by placing a US-PIVC in the 3D-printed and commercial models. Participants were also surveyed to assess their impression of the realism of the models. The primary outcome was the time required for US-PIVC placement in the 3D-printed model compared to the commercial model. Secondary outcomes were the assessment of differences in perceived realism and total cost between the two models. Results Twenty-one EM physicians completed the study. There were no significant differences in the mean time (seconds) for US-PIVC placement in the 3D-printed model (31, SD: 21) compared to the commercial model (30, SD: 18), p=0.77. Mean realism score trended higher for the 3D-printed model (3.6, SD: 0.9) compared to the commercial model (3.1, SD: 1.0), p=0.10. The total cost for the 3D-printed model was $120, with the interchangeable replacement part costing $21, which was much cheaper compared to the commercial phantom, which cost $549. Conclusion We developed a 3D-printed reusable US-PIVC phantom, and it proved to be more economical without sacrificing the realism and time required for US-PIVC placement when compared to a commercial phantom.

    View details for DOI 10.7759/cureus.17139

    View details for PubMedID 34532175

    View details for PubMedCentralID PMC8435066

  • Utilization of Point-of-care Echocardiography in Cardiac Arrest: A Cross-sectional Pilot Study. The western journal of emergency medicine Wolfe, Y., Duanmu, Y., Lobo, V., Kohn, M. A., Anderson, K. L. 2021; 22 (4): 803-809

    Abstract

    Point-of-care (POC) echocardiography (echo) is a useful adjunct in the management of cardiac arrest. However, the practice pattern of POC echo utilization during management of cardiac arrest cases among emergency physicians (EP) is unclear. In this pilot study we aimed to characterize the utilization of POC echo and the potential barriers to its use in the management of cardiac arrest among EPs.This was a cross-sectional survey of attending EPs who completed an electronic questionnaire composed of demographic variables (age, gender, year of residency graduation, practice setting, and ultrasound training) and POC echo utilization questions. The first question queried participants regarding frequency of POC echo use during the management of cardiac arrest. Branching logic then presented participants with a series of subsequent questions regarding utilization and barriers to use based on their responses.A total of 155 EPs participated in the survey, with a median age of 39 years (interquartile range 31-67). Regarding POC echo utilization, participants responded that they always (66%), sometimes (30%), or never (4.5%) use POC echo during cardiac arrest cases. Among participants who never use POC echo, 86% reported a lack of training, competency, or credentialing as a barrier to use. Among participants who either never or sometimes use POC echo, the leading barrier to use (58%) reported was a need for improved competency. Utilization was not different among participants of different age groups (P = 0.229) or different residency graduation dates (P = 0.229). POC echo utilization was higher among participants who received ultrasound training during residency (P = 0.006) or had completed ultrasound fellowship training (P <0.001) but did not differ by gender (P = 0.232), or practice setting (0.231).Only a small minority of EPs never use point-of-care echocardiography during the management of cardiac arrest. Lack of training, competency, or credentialing is reported as the leading barrier to use among those who do not use POC echo during cardiac arrest cases. Participants who do not always use ultrasound are less likely to have received ultrasound training during residency.

    View details for DOI 10.5811/westjem.2021.4.50205

    View details for PubMedID 35354015

  • Using a Simulated Model and Mastery Learning Approach to Teach the Ultrasound-guided Serratus Anterior Plane Block to Emergency Medicine Residents: A Pilot Study. AEM education and training Rider, A. C., Miller, D. T., Ashenburg, N., Duanmu, Y., Lobo, V., Schertzer, K., Sebok-Syer, S. S. 2021; 5 (3): e10525

    Abstract

    Background: The serratus anterior plane block (SAPB) is a safe, single-injection alternative for pain control in patients with rib fractures. This pilot study aims to teach the ultrasound-guided SAPB to emergency medicine (EM) residents using a mastery learning approach.Methods: A 19-item checklist was created and mastery was determined to be 17 of 19 items correct. This pass score was established using a Mastery Angoff standard-setting exercise with a group of EM experts. Learners participated in baseline testing on a simulated model and performance was assessed by two raters. Learners then watched an instructional video and participated in an individualized teaching session. Learners underwent deliberate practice followed by posttesting until mastery was achieved. Score differences in baseline testing and posttesting were analyzed using a paired t-test. Pre- and posttesting surveys were also completed by participants.Results: Twenty-eight PGY-1 to -4 residents volunteered to participate in the study. The range of reported SAPBs seen previously was 0 to 5. The mean (±SD) number of items correct on the checklist for initial testing was 8.5 of 19 (±2.7), while the mean (±SD) final score was 18 of 19 (±0.6; p<0.001). All participants met mastery standards after the curriculum intervention. Median self-reported procedural confidence was 2 out of 5 on a 5-point Likert scale before the session and 5 out of 5 after the session (Z=-4.681, p<0.001).Conclusions: Using a mastery learning approach and simulated model, we were able to successfully train EM residents to perform the SAPB at a level of mastery and increase their overall confidence in executing this procedure.

    View details for DOI 10.1002/aet2.10525

    View details for PubMedID 34041432

  • A randomized controlled trial of simulation-based mastery learning to teach the extended focused assessment with sonography in trauma. AEM education and training Smith, S., Lobo, V., Anderson, K. L., Gisondi, M. A., Sebok-Syer, S. S., Duanmu, Y. 2021; 5 (3): e10606

    Abstract

    Background: Mastery learning has gained popularity for training residents in procedural skills due to its demonstrated superiority over traditional methods. However, no studies have compared the efficacy of traditional versus mastery learning methods in residency point-of-care ultrasound education. We hypothesized that mastery learning would improve residents' skills in performing the extended focused assessment with sonography in trauma (eFAST).Methods: All first-year emergency medicine (EM) resident physicians at a single university hospital underwent a crossover randomized controlled trial to receive mastery-learning eFAST training either at the beginning of the academic year or 6months into intern year. Participants were taught using a checklist validated by a panel of experts using Mastery Angoff methods and were given feedback on missed tasks until each trainee completed the eFAST with a minimum passing standard (MPS). Our primary outcome was technical proficiency between the two groups for eFAST examinations performed in the emergency department during the academic year.Results: Sixteen interns were enrolled; eight were randomized to each group. The group that received mastery training at the beginning of the year had mean clinical eFAST proficiency scores above the MPS in the first two quarters of the academic year, while the control group did not. Once the control group underwent eFAST mastery training at the midpoint of the year, both groups had mean proficiency scores above the MPS for the remainder of the year.Conclusion: Simulation-based mastery learning is an effective method of teaching the eFAST examination. This training during intern orientation conferred early proficiency in clinical performance of eFAST among EM residents. This difference in proficiency was no longer present after the control group received mastery learning education halfway through the academic year.

    View details for DOI 10.1002/aet2.10606

    View details for PubMedID 34141999

  • Utilization of Point-of-care Echocardiography in Cardiac Arrest: A Cross-sectional Pilot Study WESTERN JOURNAL OF EMERGENCY MEDICINE Wolfe, Y., Duanmu, Y., Lobo, V., Kohn, M. A., Anderson, K. L. 2021; 22 (4): 803-809
  • Lung Ultrasound Findings in Patients Hospitalized With COVID-19. Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine Kumar, A., Weng, Y., Duanmu, Y., Graglia, S., Lalani, F., Gandhi, K., Lobo, V., Jensen, T., Chung, S., Nahn, J., Kugler, J. 2021

    Abstract

    OBJECTIVES: Lung ultrasound (LUS) can accurately diagnose several pulmonary diseases, including pneumothorax, effusion, and pneumonia. LUS may be useful in the diagnosis and management of COVID-19.METHODS: This study was conducted at two United States hospitals from 3/21/2020 to 6/01/2020. Our inclusion criteria included hospitalized adults with COVID-19 (based on symptomatology and a confirmatory RT-PCR for SARS-CoV-2) who received a LUS. Providers used a 12-zone LUS scanning protocol. The images were interpreted by the researchers based on a pre-developed consensus document. Patients were stratified by clinical deterioration (defined as either ICU admission, invasive mechanical ventilation, or death within 28days from the initial symptom onset) and time from symptom onset to their scan.RESULTS: N = 22 patients (N = 36 scans) were included. Eleven (50%) patients experienced clinical deterioration. Among N = 36 scans, only 3 (8%) were classified as normal. The remaining scans demonstrated B-lines (89%), consolidations (56%), pleural thickening (47%), and pleural effusion (11%). Scans from patients with clinical deterioration demonstrated higher percentages of bilateral consolidations (50 versus 15%; P = .033), anterior consolidations (47 versus 11%; P = .047), lateral consolidations (71 versus 29%; P = .030), pleural thickening (69 versus 30%; P = .045), but not B-lines (100 versus 80%; P = .11). Abnormal findings had similar prevalences between scans collected 0-6days and 14-28days from symptom onset.DISCUSSION: Certain LUS findings may be common in hospitalized COVID-19 patients, especially for those that experience clinical deterioration. These findings may occur anytime throughout the first 28days of illness. Future efforts should investigate the predictive utility of these findings on clinical outcomes.

    View details for DOI 10.1002/jum.15683

    View details for PubMedID 33665872

  • Interobserver agreement of lung ultrasound findings of COVID-19. Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine Kumar, A., Weng, Y., Graglia, S., Chung, S., Duanmu, Y., Lalani, F., Gandhi, K., Lobo, V., Jensen, T., Nahn, J., Kugler, J. 2021

    Abstract

    BACKGROUND: Lung ultrasound (LUS) has received considerable interest in the clinical evaluation of patients with COVID-19. Previously described LUS manifestations for COVID-19 include B-lines, consolidations, and pleural thickening. The interrater reliability (IRR) of these findings for COVID-19 is unknown.METHODS: This study was conducted between March and June 2020. Nine physicians (hospitalists: n = 4; emergency medicine: n = 5) from 3 medical centers independently evaluated n = 20 LUS scans (n = 180 independent observations) collected from patients with COVID-19, diagnosed via RT-PCR. These studies were randomly selected from an image database consisting of COVID-19 patients evaluated in the emergency department with portable ultrasound devices. Physicians were blinded to any patient information or previous LUS interpretation. Kappa values (kappa) were used to calculate IRR.RESULTS: There was substantial IRR on the following items: normal LUS scan (kappa = 0.79 [95% CI: 0.72-0.87]), presence of B-lines (kappa = 0.79 [95% CI: 0.72-0.87]), ≥3 B-lines observed (kappa = 0.72 [95% CI: 0.64-0.79]). Moderate IRR was observed for the presence of any consolidation (kappa = 0.57 [95% CI: 0.50-0.64]), subpleural consolidation (kappa = 0.49 [95% CI: 0.42-0.56]), and presence of effusion (kappa = 0.49 [95% CI: 0.41-0.56]). Fair IRR was observed for pleural thickening (kappa = 0.23 [95% CI: 0.15-0.30]).DISCUSSION: Many LUS manifestations for COVID-19 appear to have moderate to substantial IRR across providers from multiple specialties utilizing differing portable devices. The most reliable LUS findings with COVID-19 may include the presence/count of B-lines or determining if a scan is normal. Clinical protocols for LUS with COVID-19 may require additional observers for the confirmation of less reliable findings such as consolidations.

    View details for DOI 10.1002/jum.15620

    View details for PubMedID 33426734

  • Development and validation of a novel prediction score for cardiac tamponade in emergency department patients with pericardial effusion. European heart journal. Acute cardiovascular care Duanmu, Y., Choi, D. S., Tracy, S., Harris, O. M., Schleifer, J. I., Dadabhoy, F. Z., Wu, J. C., Platz, E. 2021; 10 (5): 542-549

    Abstract

    Determining which patients with pericardial effusion require urgent intervention can be challenging. We sought to develop a novel, simple risk prediction score for patients with pericardial effusion.Adult patients admitted through the emergency department (ED) with pericardial effusion were retrospectively evaluated. The overall cohort was divided into a derivation and validation cohort for the generation and validation of a novel risk score using logistic regression. The primary outcome was a pericardial drainage procedure or death attributed to cardiac tamponade within 24 h of ED arrival. Among 195 eligible patients, 102 (52%) experienced the primary outcome. Four variables were selected for the novel score: systolic blood pressure < 100 mmHg (1.5 points), effusion diameter [1-2 cm (0 points), 2-3 cm (1.5 points), >3 cm (2 points)], right ventricular diastolic collapse (2 points), and mitral inflow velocity variation > 25% (1 point). The need for pericardial drainage within 24 h was stratified as low (<2 points), intermediate (2-4 points), or high (≥4 points), which corresponded to risks of 8.1% [95% confidence interval (CI) 3.0-16.8%], 63.8% [95% CI 50.1-76.0%], and 93.7% [95% CI 84.5-98.2%]. The area under the curve of the simplified score was 0.94 for the derivation and 0.91 for the validation cohort.Among ED patients with pericardial effusion, a four-variable prediction score consisting of systolic blood pressure, effusion diameter, right ventricular collapse, and mitral inflow velocity variation can accurately predict the need for urgent pericardial drainage. Prospective validation of this novel score is warranted.

    View details for DOI 10.1093/ehjacc/zuaa023

    View details for PubMedID 33823539

  • Visual Estimation of Tricuspid Annular Plane Systolic Excursion by Emergency Medicine Clinicians. The western journal of emergency medicine Duanmu, Y., Goldsmith, A. J., Henwood, P. C., Platz, E., Hoyler, J. E., Kimberly, H. H. 2020; 21 (4): 1022–28

    Abstract

    INTRODUCTION: Tricuspid annular plane systolic excursion (TAPSE) is an established echocardiographic marker of right ventricular (RV) systolic function. The objective of this study was to evaluate whether emergency clinicians can visually estimate RV function using TAPSE in a set of video clips compared to a reference standard M-mode measurement.METHODS: Emergency clinicians were shown a five-minute educational video on TAPSE. Participants then viewed 20 apical four-chamber point-of-care ultrasound (POCUS) echocardiography clips and recorded their estimate of TAPSE distance in centimeters (cm), as well as whether TAPSE was normal (>1.9 cm), borderline (1.5-1.9 cm), or abnormal (<1.5 cm). We calculated sensitivity, specificity, and overall accuracy of visual TAPSE categorization using M-mode measurement as the criterion standard. Participants also reported their comfort with assessing TAPSE on a five-point Likert scale before and after participation in the study.RESULTS: Among 70 emergency clinicians, including 20 postgraduate year 1-4 residents, 22 attending physicians, and 28 physician assistants (PA), the pooled sensitivity and specificity for visual assessment of TAPSE was 88.6% (95% confidence interval, 85.4-91.7%) and 81.6% (95% CI, 78.2-84.4%), respectively. The sensitivity and specificity for the clips in which the measured TAPSE was <1.5 cm or >1.9 cm was 91.4% (95% CI, 88.4-94.3%) and 90.8% (95% CI, 87.7-93.9%), respectively. There was no significant difference in sensitivity (p = 0.27) or specificity (p = 0.55) between resident and attending physicians or between physicians and PAs (p = 0.17 and p = 0.81). Median self-reported comfort with TAPSE assessment increased from 1 (interquartile range [IQR] 1-2) to 3 (IQR 3-4) points after participation in the study.CONCLUSION: A wide range of emergency clinicians demonstrated fair accuracy for visual estimation of TAPSE on previously recorded POCUS echocardiography video clips. These findings should be considered hypothesis generating and warrant validation in larger, prospective studies.

    View details for DOI 10.5811/westjem.2020.5.46714

    View details for PubMedID 32726278

  • Characteristics of Emergency Department Patients With COVID-19 at a Single Site in Northern California: Clinical Observations and Public Health Implications. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine Duanmu, Y. n., Brown, I. P., Gibb, W. R., Singh, J. n., Matheson, L. W., Blomkalns, A. L., Govindarajan, P. n. 2020

    Abstract

    In December 2019, a novel coronavirus disease (COVID-19) emerged in Wuhan, China and spread globally, resulting in the first World Health Organization (WHO) classified pandemic in over a decade.1 As of April 2020, the United States (US) has the most confirmed COVID-19 cases worldwide, but public health interventions and testing availability have varied across the country. 2.

    View details for DOI 10.1111/acem.14003

    View details for PubMedID 32344458

  • Correlation of OSCE performance and point-of-care ultrasound scan numbers among a cohort of emergency medicine residents. The ultrasound journal Duanmu, Y., Henwood, P. C., Takhar, S. S., Chan, W., Rempell, J. S., Liteplo, A. S., Koskenoja, V., Noble, V. E., Kimberly, H. H. 2019; 11 (1): 3

    Abstract

    Point-of-care ultrasound (POCUS) is an important clinical tool for a growing number of medical specialties. The current American College of Emergency Physicians (ACEP) Ultrasound Guidelines recommend that trainees perform 150-300 ultrasound scans as part of POCUS training. We sought to assess the relationship between ultrasound scan numbers and performance on an ultrasound-focused observed structured clinical examination (OSCE).This was a cross-sectional cohort study in which the number of ultrasound scans residents had previously performed were obtained from a prospective database and compared with their total score on an ultrasound OSCE. Ultrasound fellowship trained emergency physicians administered a previously published OSCE that consisted of standardized questions testing image acquisition and interpretation, ultrasound machine mechanics, patient positioning, and troubleshooting. Residents were observed while performing core applications including aorta, biliary, cardiac, deep vein thrombosis, Focused Assessment with Sonography in Trauma (FAST), pelvic, and thoracic ultrasound imaging.Twenty-nine postgraduate year (PGY)-3 and PGY-4 emergency medicine (EM) residents participated in the OSCE. The median OSCE score was 354 [interquartile range (IQR) 343-361] out of a total possible score of 370. Trainees had previously performed a median of 341 [IQR 289-409] total scans. Residents with more than 300 ultrasound scans had a median OSCE score of 355 [IQR 351-360], which was slightly higher than the median OSCE score of 342 [IQR 326-361] in the group with less than 300 total scans (p = 0.04). Overall, a LOWESS curve demonstrated a positive association between scan numbers and OSCE scores with graphical review of the data suggesting a plateau effect.The results of this small single residency program study suggest a pattern of improvement in OSCE performance as scan numbers increased, with the appearance of a plateau effect around 300 scans. Further investigation of this correlation in diverse practice environments and within individual ultrasound modalities will be necessary to create generalizable recommendations for scan requirements as part of overall POCUS proficiency assessment.

    View details for DOI 10.1186/s13089-019-0118-7

    View details for PubMedID 31359167

  • Correlation of OSCE performance and point-of-care ultrasound scan numbers among a cohort of emergency medicine residents ULTRASOUND JOURNAL Duanmu, Y., Henwood, P. C., Takhar, S. S., Chan, W., Rempell, J. S., Liteplo, A. S., Koskenoja, V., Noble, V. E., Kimberly, H. H. 2019; 11
  • Accuracy of Resident-Performed Point-of-Care Lung Ultrasound Examinations Versus Chest Radiography in Pneumothorax Follow-up After Tube Thoracostomy in Rwanda. Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine Shumbusho, J. P., Duanmu, Y. n., Kim, S. H., Bassett, I. V., Boyer, E. W., Ruutiainen, A. T., Riviello, R. n., Ntirenganya, F. n., Henwood, P. C. 2019

    Abstract

    The aim of this study was to evaluate the accuracy and timeliness of resident-performed point-of-care lung ultrasound (LUS) examinations for the follow-up of pneumothorax (PTX) after tube thoracostomy.After brief training, Rwandan surgical residents blinded to chest radiography (CXR) performed and interpreted LUS examinations for PTX in participants undergoing CXR for PTX follow-up. Treating clinicians interpreted CXR for the presence of PTX for therapeutic decisions. Lung ultrasound was later reviewed by ultrasound experts, and CXR was reviewed by a radiologist. We defined expert LUS interpretation as the reference standard. The sensitivity and specificity of resident-performed LUS examinations for diagnosing PTX were calculated. We assessed agreement between trained resident versus expert LUS and clinician versus radiology CXR using the Cohen κ coefficient. We compared the time to results between LUS and CXR.Over an 8-month period, 51 participants were enrolled. Compared to expert LUS interpretation, the sensitivity and specificity (95% confidence intervals) of resident LUS were 100% (85%-100%) and 96% (82%-100%), respectively, whereas the sensitivity and specificity of clinician-interpreted CXR were 48% (27%-69%) and 100% (88%-100%). The agreement between resident and expert LUS was excellent (κ = 0.96), whereas the agreement between clinician and radiologist CXR was only moderate (κ = 0.60). The time to results was significantly longer for CXR than LUS (mean, 1335 versus 396 minutes; P = .0001).A resident-performed LUS examination was a quicker imaging modality with superior sensitivity compared to clinician-interpreted CXR for PTX follow-up after tube thoracostomy in this Rwandan study. Lung ultrasound can be a valuable imaging tool for PTX follow-up, especially in resource-limited settings.

    View details for DOI 10.1002/jum.15126

    View details for PubMedID 31490569