BACKGROUND: Ultrasonography use is increasing in emergency departments, and ultrasound education is now recommended in resident training. Ultrasound phantoms are used in many institutions for training purposes. The purpose of this study is to describe an inexpensive and simple method to create ultrasound-imaging models for the purpose of education and practice using clear ballistic gel. METHODS: Clear ballistic gel is used to simulate tissue for firing practice and other military evaluations. RESULTS: The transparent and durable ultrasound phantom we produced was clear and contained four vessel lumens. The images obtained using the phantom were of high quality and compared well to normal sonographic anatomy. CONCLUSIONS: The clear ballistic brand gel is unique because it is inexpensive, does not dry out, does not decay, is odorless, and is reusable. The ultrasound images obtained using the phantom are realistic and useful for ultrasound education.

BACKGROUND: Diagnosing pericardial effusion is critical for optimal patient care. Typically, clinicians use physical examination findings and historical features suggesting pericardial effusion to determine which patients require echocardiography. The diagnostic characteristics of these tools are not well described. The objective of this study is to determine the prevalence of historical features and sensitivity of clinical signs to inform clinicians when to proceed with echocardiogram. METHODS: A retrospective review of point-of-care echocardiograms performed over a two and a half year period in two emergency departments were reviewed for the presence of a pericardial effusion. Patient charts were reviewed and abstracted for presenting symptoms, historical features and clinical findings. The prevalence of presenting symptoms and historical features and the sensitivity of classic physical examination findings associated with pericardial effusion and tamponade were determined. RESULTS: One hundred and fifty-three patients with pericardial effusion were identified. Of these patients, the most common presenting complaint was chest pain and shortness of breath. Patients had no historical features that would suggest pericardial effusion in 37.5% of cases. None of the patients with pericardial effusion or pericardial tamponade had all of the elements of Beck's triad. The sensitivity of Beck's triad was found to be 0 (0%–19.4%). The sensitivity for one finding of Beck's triad to diagnose pericardial tamponade was 50% (28.0%–72.0%). CONCLUSION: History and physical examination findings perform poorly as tests for the diagnosis of pericardial effusion or pericardial tamponade. Clinicians must liberally evaluate patients suspected of having a pericardial effusion with echocardiography.

BACKGROUND: To evaluate the utilization of point-of-care ultrasound (POCUS) for the assessment of emergency department (ED) patients with musculoskeletal symptoms and the impact of musculoskeletal POCUS on medical decision-making and patient management in the ED. METHODS: This was a retrospective review of ED patients presenting with musculoskeletal symptoms who received a POCUS over a 3.5-year period. An ED POCUS database was reviewed for musculoskeletal POCUS examinations used for medical decision-making. Electronic medical records were then reviewed for demographic characteristics, history, physical examination findings, ED course, additional imaging studies, and impact of musculoskeletal POCUS on patient management in ED. RESULTS: A total of 264 subjects (92 females, 172 males) and 292 musculoskeletal POCUS examinations were included in the final analysis. Most common symptomatic sites were knee (31.8％) and ankle (16.3％). Joint effusion was the most common finding on musculoskeletal POCUS, noted in 33.7％ of the patients, and subcutaneous edema/cobblestoning was found in 10.2％ of the patients. Muscle or tendon rupture was found in 2.3％ of the patients, and 1.9％ of the patients had joint dislocation. Bursitis or bursa fluid was found in 3.4％ of patients, and tendonitis/tendinopathy was found in 2.3％. Twenty percent of them were ultrasound-guided musculoskeletal procedures, and most of them (73.3％) were arthrocentesis. Of the included studies, all except three either changed or helped guide patient management as documented in the patients' medical records. CONCLUSION: Our study findings illustrate the utility of POCUS in the evaluation of a variety of musculoskeletal pathologies in the ED.

Inguinal hernias affect 5% of children and are usually defined as a protrusion of intestine or omentum through abdominal wall or inguinal canal defects.[1] Inguinal hernias may contain structures other than bowel and unique cases have been documented since the early 1900's.[2–10] Ultrasound has been demonstrated to differentiate superficial swellings and has been used by radiologists to evaluate inguinal masses for decades.[1–5,11–13] Although the use of radiology-performed ultrasound for the diagnosis of congeni tal inguinal hernias containing ovaries, uterus, and fallopian tubes has been documented; the use of point-of-care ultrasound for the evaluation of the acute inguinal mass prior to reduction has not been demonstrated. Accurate identification by the emergency physician of the herniated structures may lead to earlier diagnosis, faster consultation, improve patient management, and superior patient outcomes.