Aortas, Rectums, and BPPV
Hey Team,
Few things from last night.
1. Ultrasound for aortic dissection.
Don't forget to reach for that US probe.
A somewhat recently published protocol, the SPEED protocol, uses a PSLA view and abdominal aorta scan (diaphragm to iliac bifurcation) to look for three findings: intimal flap, pericardial effusion, or AOFT >35 mm. In this study, across 1,314 exams with 44 confirmed dissections, it had a 93.2% sensitivity overall (100% for Type A, 87% for Type B) and a 99.7% NPV.
Now, this study did not include the suprasternal notch view or color doppler. But this could be a helpful adjunct.
Here's a quick video demonstrating the suprasternal notch view
UMEM Pearls (my fellow pearl-ers) discussed this view wayyy back in 2014.
2. Perirectal and Perianal Abscesses
Remember, perianal or superficial perirectal abscesses can be drained in the ED. However, ischiorectal, intersphincteric, supralevator, and postanal or horseshoe abscesses require drainage in the operating room.
Sometimes it can be challenging to distinguish the different types of abscesses on visual inspection alone. Digital Rectal Exam is key here.
In the right context, CT imaging is indicated in patients who are unable to tolerate a digital rectal examination due to pain or exhibit induration or tenderness above the anal verge.
Take a deeper dive on EMRAPs Corependium for a focused review of this subject.
3. BPPV Review Article
For those dizzy enthusiasts, check out this recent JAMA Review on BPPV.
References:
Gibbons RC, Smith D, Feig R, Mulflur M, Costantino TG. The sonographic protocol for the emergent evaluation of aortic dissections (SPEED protocol): A multicenter, prospective, observational study. Acad Emerg Med. 2024 Feb;31(2):112-118. doi: 10.1111/acem.14839. Epub 2023 Dec 19. PMID: 38010071.
