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Am Fam Physician 2020 03;101(5):275-285

Naval Hospital Jacksonville, Jacksonville, FL, USA.

Point-of-care ultrasonography (POCUS) is performed by a physician at the bedside and is standard practice in obstetric, emergency, and musculoskeletal medicine. When compared with formal sonography, POCUS is equivalent in screening for abdominal aortic aneurysm and as accurate in diagnosing deep venous thrombosis. POCUS has high accuracy for diagnosing pneumonia and detecting acute decompensated heart failure but is less accurate than computed tomography for identifying pulmonary embolism. Read More

Cureus 2019 Oct 24;11(10):e5989. Epub 2019 Oct 24.

Emergency Medicine, University of the Witwatersrand, Johannesburg, ZAF.

Patients who present to the emergency department (ED) with aortic emergencies can be some of the highest acuity patients that we manage. Ultrasonography performed at the bedside is traditionally considered to be a screening test that is especially useful in the unstable patient. Computed tomography (CT) with angiography is the imaging modality of choice to confirm the diagnosis and plan the management of abdominal aortic aneurysm (AAA), as an ultrasound is generally thought not to provide the clinician with sufficient anatomical information. Read More

AANA J 2018 Oct;86(5):379-382

is a urologist at Great River Medical Center.

A 79-year-old ASA class 3 patient scheduled for outpatient testing secondary to prostate cancer, was found to have a previously unknown 10-cm abdominal aortic aneurysm (AAA) causing acute renal insufficiency and hydronephrosis, requiring prompt surgical intervention. The patient was instructed to return to the hospital for further evaluation of the AAA and emergent ureteral stent placement. During the preanesthetic examination, the patient revealed he had eaten a small amount of food before returning to the hospital, placing him at increased risk of pulmonary aspiration. Read More

BMC Surg 2018 Nov 16;18(1):100. Epub 2018 Nov 16.

Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.

Background: Thoracic endovascular aortic repair (TEVAR) is the therapeutic choice for type B aortic dissection. One of the most unfavored complications of this procedure is hemorrhage, which has a low incidence but high mortality. Renal hemorrhage (RH) after endovascular aortic repair has been rarely reported. Read More

Rev Assoc Med Bras (1992) 2018 May;64(5):474-480

Faculty of Medicine of the Barbacena, Barbacena/MG, Brasil.

Point-of-care ultrasonography, which is performed at the bedside by physicians who are not specialists in imaging, has become possible thanks to recent technological advances that have allowed for a device with greater portability while maintaining image quality. The increasing use of point-of-care ultrasonography in different specialties has made it possible to expand physical examinations, make timely decisions about the patients and allows the performance of safer medical procedures. In this review, three cases from our experience are presented that highlight the use of point-of-care ultrasonography by clinicians. Read More

Ann Vasc Surg 2018 Oct 17;52:15-21. Epub 2018 May 17.

Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada; Division of Vascular and Endovascular Surgery, The Ottawa Hospital, Ottawa, ON, Canada.

Background: The use of point-of-care ultrasound (POCUS) has become increasingly prevalent in medical practice as a non-invasive tool for focused bedside diagnosis. Consequently, some medical schools have begun implementing POCUS training as a standard in their medical school curriculum. The feasability and value of introducing POCUS training at the medical student level to screen for abdominal aortic aneurysms (AAA) should be explored. Read More

Singapore Med J 2017 12;58(12):690-694

Department of Diagnostic Radiology, Changi General Hospital, Singapore.

A 77-year-old man presented with acute-onset severe chest pain radiating to the back and elevated blood pressure. Multiphasic computed tomography of the aorta revealed an intimal tear in the descending thoracic aorta which extended both retrograde to the aortic root and antegrade to the infra-renal abdominal aorta. The initial impression, that the images showed a Stanford type B aortic dissection, was because the portion of the false lumen that extended beyond the aortic arch remained unopacified even on delayed phases, making it challenging to assess the extent of the dissection flap. Read More

Am J Emerg Med 2017 Dec 26;35(12):1984.e3-1984.e7. Epub 2017 Aug 26.

Department of Radiology, George Washington University Medical Center, United States.

Objective: To assess the impact of an ultrasound hypotension protocol in identifying life-threatening diagnoses that were missed in the initial evaluation of patients with hypotension and shock.

Methods: A subset of cases from a previously published prospective study of hypotensive patients who presented at the Emergency Department in a single, academic tertiary care hospital is described. An ultrasound-trained emergency physician performed an ultrasound on each patient using a standardized hypotension protocol. Read More

J Neuroimaging 2017 03 22;27(2):237-242. Epub 2016 Aug 22.

Department of Surgery, Vascular and Endovascular Surgery, University of Regensburg, Franz-Josef-Strauss Allee 11, 93053, Regensburg, Germany.

Background And Purpose: Quantification of changes in optic nerve sheath diameter (ONSD) using ocular sonography (OS) constitutes an elegant technique for estimating intracranial and intraspinal pressure. Aortic aneurysm repair (AAR) is associated with a reasonable risk of increased spinal fluid pressure, which is largely dependent on the extent of aneurysm repair (supra- vs. infrarenal). Read More

BMC Emerg Med 2015 Dec 11;15:36. Epub 2015 Dec 11.

Department of Family and Emergency Medicine, Université Laval, Quebec City, QC, Canada.

Background: Point-of-care ultrasound (POCUS) can be used to provide rapid answers to specific and potentially life-threatening clinical questions, and to improve the safety of procedures. The rate of POCUS access and use in Canada is unclear. The objective of this study was to examine access to POCUS and potential barriers/facilitators to its use among rural physicians in Quebec. Read More

JAAPA 2015 Nov;28(11):54-5

Clare Scott practices emergency medicine at Johns Hopkins Hospital in Baltimore, Md. The author has disclosed no potential conflicts of interest, financial or otherwise.

Int J Cardiovasc Imaging 2016 Jan 24;32(1):35-48. Epub 2015 Jul 24.

Division of Angiology, Department of Internal Medicine, University Hospital Basel, Basel, Switzerland.

Contrast-enhanced ultrasound (CEUS) is increasingly being used to evaluate patients with known or suspected atherosclerosis. The administration of a microbubble contrast agent in conjunction with ultrasound results in an improved image quality and provides information that cannot be assessed with standard B-mode ultrasound. CEUS is a high-resolution, noninvasive imaging modality, which is safe and may benefit patients with coronary, carotid, or aortic atherosclerosis. Read More

Clin Imaging 2015 May-Jun;39(3):476-9. Epub 2015 Jan 20.

Emergency Department, Iran University of Medical Sciences (IUMS).

Objective: Abdominal pain is a common complaint in the emergency department and accurate diagnosis of its etiology may affect the patient's outcome.

Method: Patients with abdominal pain underwent ultrasound study first by trained emergency physicians and then by radiologists blinded to emergency physician's results.

Result: Emergency physician who performed bedside ultrasound had 78% diagnostic accuracy. Read More

Br J Hosp Med (Lond) 2014 Oct;75(10):594-5

Acute Medical Registrar in the Department of Acute Medicine, Bristol Royal Infirmary, Bristol BS2 8HW.

Praxis (Bern 1994) 2014 Jun;103(12):697-703

Chirurgische Klinik, Spitalnetz Bern, Tiefenau.

Ultrasound is an easy to learn and highly efficient diagnostic tool to complete the clinical examination and improve bedside decision-making. In the trauma room, surgeons are often required to make a quick decision as to whether or not a patient needs an emergency intervention or whether further diagnostics are required. For this reason, education of surgeons in performing focused emergency ultrasound is pivotal. Read More

J Emerg Med 2013 Dec 6;45(6):894-6. Epub 2013 Aug 6.

Department of Emergency Medicine, University of Colorado School of Medicine, Denver, Colorado.

Background: A timely diagnosis of aortic dissection is associated with lower mortality. The use of emergent bedside ultrasound has been described to diagnose aortic dissection. However, there is limited literature regarding the use of bedside ultrasound to identify superior mesenteric artery dissection, a known high-risk feature of aortic dissection. Read More

Acad Emerg Med 2013 Feb;20(2):128-38

Department of Emergency Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA.

Background: The use of ultrasound (US) to diagnose an abdominal aortic aneurysm (AAA) has been well studied in the radiology literature, but has yet to be rigorously reviewed in the emergency medicine arena.

Objectives: This was a systematic review of the literature for the operating characteristics of emergency department (ED) ultrasonography for AAA.

Methods: The authors searched PubMed and EMBASE databases for trials from 1965 through November 2011 using a search strategy derived from the following PICO formulation: Patients-patients (18+ years) suspected of AAA. Read More

J Emerg Med 2012 Dec 14;43(6):1055-8. Epub 2012 Aug 14.

ASL N°2 Savonese, SC Medicina e Chirurgia d'Accettazione e d'Urgenza-OBI, Ospedale San Paolo, Savona, Italia.

Background: Bedside ultrasonography performed by the Emergency Physician is a safe procedure for evaluating patients with trauma, hypotension, chest or abdominal pain, and dyspnea of unknown origin.

Objectives: To present a case with apparent concordance between the patient's history, symptoms, signs, and ultrasound imaging, that lead to diagnostic error.

Case Report: A 74-year-old man was admitted to the hospital due to epigastric pain, radiating to the back. Read More

Am J Emerg Med 2012 Nov 12;30(9):2084.e1-5. Epub 2012 Jan 12.

Department of Emergency Medicine, University of Ottawa, Ottawa, Canada.

Aortic dissection (AD) is one of the most challenging diagnoses in emergency medicine. This is due, in part, to its variable presentation, ranging from abrupt tearing chest pain in a hemodynamically unstable patient to back pain in a stable patient, as well as its high mortality rates. (1) With the expanding role of ultrasound (U/S) performed by emergency physicians, it is possible to make the diagnosis of AD at the bedside before any other imaging modality has been accessed. Read More

Emerg Med Pract 2011 Mar;13(3):1-27; quiz 27-8

Kaiser Permanente, CA, USA.

Paramedics bring into the ED an elderly man who is complaining of right-sided chest and abdominal pain. Earlier this morning, a friend had arrived at the patient's home and found him on the floor at the bottom of the stairs. The patient is in pain, somewhat altered, and unable to provide further details about what happened. Read More

Eur Heart J Cardiovasc Imaging 2012 Jul 29;13(7):574-8. Epub 2011 Nov 29.

Cardiology Department, AP-HP, Bichat Hospital, 46 rue Henri Huchard, 75018 Paris, France.

Aims: Patients with acute myocardial infarction (AMI) represent a high-risk population in which screening for abdominal aortic aneurysm (AAA) is recommended but only occasionally performed. Transthoracic echocardiography (TTE) may offer the unique opportunity to evaluate the cardiac function and to screen for AAA during the same examination. We aimed to evaluate the feasibility of AAA screening at bedside using a portable cardiac ultrasound (US) echo machine and to determine the prevalence of AAA in population with AMI. Read More

Echocardiography 2012 Mar 8;29(3):285-90. Epub 2011 Nov 8.

Echocardiography Department, University of Bordeaux, Pessac, France.

Background: Ultraminiaturization of echographic systems extraordinarily provides the image "within" the clinical examination. Abdominal aorta aneurysm (AAA) diagnosis based on conventional evaluation with a dedicated operator and ultrasound machine is still controversial due to the lack of evidence of the proposed management and guidelines' cost-effectiveness. We hypothesized that less expensive ultraportable devices could identify AAA with the same level of accuracy as conventional approaches. Read More

Eur J Echocardiogr 2011 Sep 2;12(9):665-70. Epub 2011 Aug 2.

Levanger Hospital, Nord-Trøndelag Health Trust, Levanger, Norway.

Aims: To study the reliability and feasibility of point-of-care pocket-sized echocardiography (POCKET) at the bedside in patients admitted to a medical department at a non-university hospital.

Methods And Results: One hundred and eight patients were randomized to bedside POCKET examination shortly after admission and later high-end echocardiography (HIGH) in the echo-lab. The POCKET examinations were done by cardiologists on their ward rounds. Read More

Emerg Med J 2011 Jun 2;28(6):472-6. Epub 2010 Aug 2.

Department of Emergency Medicine, Johns Hopkins University, Johns Hopkins Bayview Medical Center, B-Building, Baltimore, MD 21224, USA.

Background: The aims of this study were to examine the association between emergency department (ED) providers' experience with bedside ultrasound after achieving credentialing for abdominal aortic aneurysm (AAA) sonography, and their successful visualisation rate of the abdominal aorta among consecutive patients who presented asymptomatically but with risk factors for AAA.

Methods: Study coordinators enrolled asymptomatic men > 50 years presenting to a single ED with AAA risk factors. One of 20 AAA credentialed ED sonographers screened each subject for AAA. Read More

Acad Emerg Med 2009 Aug 22;16(8):809-10. Epub 2009 Jun 22.

Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY, USA.

Abdom Imaging 2010 Jun 25;35(3):376-80. Epub 2009 Mar 25.

Department of Radiology, University Hospital of Geneva, Switzerland.

Aortocaval fistula (ACF) is a rare, life threatening complication of abdominal aortic aneurysms. Time to diagnosis is crucial as preoperative diagnosis and early surgical intervention significantly improve the outcome. The clinical spectrum being varied, the challenge of prompt and reliable diagnosis rests on emergency radiology. Read More

Clin Hemorheol Microcirc 2009 ;41(3):151-68

Department of Clinical Radiology, Klinikum Grosshadern, University of Munich, Munich, Germany.

Endoleaks following endovascular aneurysm repair (EVAR) are common and present a diagnostic challenge in the follow-up after EVAR. Contrast-enhanced ultrasound (CEUS) with low mechanical index (low MI) is a promising new method for the diagnosis and follow-up of endoleaks. CEUS with SonoVue allows a more rapid and noninvasive diagnosis, especially in critical patients owing to its bedside availability. Read More

Clin Hemorheol Microcirc 2008 ;40(4):267-79

Interdisciplinary Ultrasound Center, Department of Clinical Radiology, University of Munich, Grosshadern Campus, Munich, Germany.

Purpose: The purpose of this study was to compare color coded duplex sonography (CCDS), contrast-enhanced ultrasound (CEUS) and multislice computed tomography (MS-CT) angiography in pathological aortic lesions.

Material And Methods: 36 patients with a mean age of 71 years (range 51-87 yrs) with known or suspected treated and untreated aortic lesions detected by CTA were included in this prospective study. Standardized MS-CTA using a 16 or 64 row scanner (Somatom Sensation 16 or 64, Siemens Medical Systems, Forchheim, Germany) served as reference standard. Read More

J Emerg Med 2010 May 26;38(4):490-3. Epub 2008 Nov 26.

Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.

Background: An aortic dissection is a life-threatening process that must be diagnosed and treated expeditiously. Imaging modalities used for diagnosis in the emergency department include computed tomography, magnetic resonance imaging, and trans-esophageal echocardiography. There are significant limitations to these studies, including patient contraindications (intravenous contrast dye allergies, renal insufficiency, metal-containing implants, hemodynamic instability) and the length of time required for study completion and interpretation by a radiologist or cardiologist. Read More

Am J Emerg Med 2008 Oct;26(8):883-7

Department of Surgery, Section of Emergency Medicine, Yale University School of Medicine, New Haven, CT 06519, USA.

Objective: Abdominal aortic aneurysm (AAA) is a deadly but often clinically silent disease. Patients at increased risk are elderly men with risk factors for vascular disease who may not have adequate screening through primary care. We sought to examine the prevalence and feasibility of screening for AAA in at-risk patients presenting for unrelated complaints using emergency physician-performed bedside ultrasound. Read More

Med Arh 2008 ;62(3):165-8

Katedra urgentne medicine, Medicinski fakultet Univerziteta u Tuzli.

Ultrasound (US) has been recognized as a powerful tool for use in the diagnosis and evaluation of many diseases in clinical practice. The possibility of immediate bedside US examinations in the evaluation of specific emergent complaints makes it an ideal tool for the emergency specialist. Correct diagnosis of potential life-threatening emergencies such as hematoperitoneum following blunt trauma, abdominal emergencies, ectopic pregnancy, pericardial tamponade, and aortic aneurysms with US evaluation can be easily made. Read More

Pediatrics 2008 May;121(5):e1404-12

Division of Emergency Medicine, Children's Hospital Boston, 300 Longwood Ave, Boston, MA 02115, USA.

Bedside emergency ultrasound has been used by emergency physicians for >20 years for a variety of conditions. In adult centers, emergency ultrasound is routinely used in the management of victims of blunt abdominal trauma, in patients with abdominal aortic aneurysm and biliary disease, and in women with first-trimester pregnancy complications. Although its use has grown dramatically in the last decade in adult emergency departments, only recently has this tool been embraced by pediatric emergency physicians. Read More

J Ultrasound Med 2007 Nov;26(11):1611-6

Department of Radiology, Grenoble University Hospital, Grenoble, France.

Objective: The TER system is a robot-based tele-echography system allowing remote ultrasound examination. The specialist moves a mock-up of the ultrasound probe at the master site, and the robot reproduces the movements of the real probe, which sends back ultrasound images and force feedback. This tool could be used to perform ultrasound examinations in small health care centers or from isolated sites. Read More

Am J Emerg Med 2007 Sep;25(7):838-41

Department of Emergency Medicine, MetroHealth Medical Center, Cleveland, OH 44109, USA.

Bedside ultrasound examinations performed by emergency physicians are goal-directed studies meant to answer specific questions. These studies are frequently performed in critically ill patients with undifferentiated abdominal pain who are suspected of having intra-abdominal hemorrhage or a ruptured abdominal aortic aneurysm. Patients presenting with a perforated hollow viscus may have a similar clinical presentation. Read More

CJEM 2004 Mar;6(2):112-5

Emergency Department, Hawkesbury General Hospital, Hawkesbury, Ontario, Canada.

Ultrasonography is a useful tool for the immediate evaluation of patients with suspected ruptured ectopic pregnancy, abdominal aortic aneurysm, traumatic intra-abdominal hemorrhage or cardiac tamponade. The 1999 Canadian Association of Emergency Physicians position statement states that bedside emergency department ultrasonography should be available 24 hours per day. This case study illustrates how emergency physicians properly trained in emergency bedside ultrasonography can use this tool effectively to dramatically impact patient care. Read More

Eur Radiol 2007 Nov 12;17(11):2991-3000. Epub 2007 Jan 12.

Department of Clinical Radiology, University of Munich-Grosshadern, Munich, Germany.

Aortic abnormalities are commonly encountered and may represent a diagnostic challenge in patients with acute or chronic clinical symptoms. Contrast-enhanced ultrasound (CEUS) with low mechanical index (low MI) is a new promising method in the diagnosis and follow-up of pathological aortic lesions. CEUS with SonoVue allows a more rapid and noninvasive diagnosis, especially in critical patients because of its bedside availability. Read More

Cardiovasc Intervent Radiol 2007 May-Jun;30(3):480-4

Department of Clinical Radiology, University of Munich-Grosshadern Campus, Munich, Germany.

An aorto-caval fistula is a rare complication of a symptomatic or ruptured infrarenal aortic aneurysm having a frequency of 3-6%. Patients typically present with clinical signs of diffuse abdominal pain associated with increasing venous congestion and tachycardia, rapid cardiopulmonary decompensation with acute dyspnea, and an audible machinerylike bruit. Perioperative mortality is high, ranging from 20% to 60%. Read More

Emerg Med J 2006 Oct;23(10):803-4

Grand Rapids Medical Education and Research, Michigan, USA.

A short-cut review was carried out to establish whether emergency department ultrasound scanning had clinical utility for the diagnosis of abdominal aortic aneurysm (AAA). A total of 73 papers were found using the reported searches, of which 4 presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are tabulated. Read More

J Emerg Med 2005 Nov;29(4):461-5

Department of Emergency Medicine, Medical College of Georgia, Augusta, Georgia 30912-4007, USA.

Patients presenting with hypotension may be evaluated with a FAST (Focused Abdominal Sonography for Trauma) examination as recent literature has suggested its utility in the unstable patient. Those who are found to have intraperitoneal fluid on the FAST examination may have solid organ injury from unknown trauma, ruptured abdominal aortic aneurysm (AAA), hemorrhaging ovarian cyst, ruptured ectopic pregnancy, or other disease process responsible for intra-periteal blood. However, because ultrasound does not assist in fluid identification, it is possible that the fluid present is not blood, but ascites. Read More

Emerg Med Clin North Am 2005 Nov;23(4):1179-94

Division of Emergency Medicine, University of Maryland School of Medicine, Baltimore, 21201, USA.

Bedside sonography has become an important tool in the emergency physician's diagnostic armamentarium. Sonography is useful in the evaluation of a number of conditions, including cholecystitis, abdominal aortic aneurysm, and ectopic pregnancy. Applied to the heart, sonography aids in the assessment of pericardial tamponade, electromechanical dissection, pulmonary embolus, and other cardiorespiratory emergencies. Read More

AJR Am J Roentgenol 2005 Feb;184(2):423-7

Department of Radiology, S. Maria delle Grazie Hospital, Via Domitiani, Pozzuoli 80078, Italy.

Objective: We describe the contrast-specific sonography features of ruptured abdominal aortic aneurysm, and we hypothesize that this technique would be useful for emergency imaging of patients with suspected aneurysm rupture.

Conclusion: We used contrast-specific sonography to assess eight patients with ruptured abdominal aortic aneurysm. Five of these cases were correlated with CT findings. Read More

J Emerg Med 2004 Feb;26(2):193-6

Department of Emergency Medicine, Medical College of Georgia, Augusta, Georgia 30912-4007, USA.

Bedside ultrasound is the diagnostic method of choice for unstable patients with suspected abdominal aortic aneurysm. Its ability to provide rapid and accurate diagnosis is critical in an emergency setting. Previous studies have documented the ability of Emergency Physicians to accurately diagnose abdominal aortic aneurysms, thus potentially saving lives. Read More

Acad Emerg Med 2004 Jan;11(1):103-5

Department of Emergency Medicine, Medical College of Georgia, Augusta, GA 30912-4007, USA.

Objectives: To determine how often emergency physicians (EPs) scanning the abdominal aorta (AA) of nonfasted emergency department (ED) patients are able to visualize the entire AA.

Methods: The authors performed a retrospective study of patients receiving ultrasound (US) by EPs to rule out abdominal aortic aneurysm (AAA) at a suburban Level I ED. For patients being evaluated for possible AAA, EPs evaluated the entire length of the AA with US in short axis, making standard proximal, middle, and distal measurements. Read More

Am J Emerg Med 2003 Mar;21(2):133-5

St. Lukes Hospital, Bethlehem, PA 18015, USA.

Although more than 5% of the geriatric male population is thought to have an abdominal aortic aneurysm, no study has evaluated the ability of ED physician sonographers to screen for this condition. The purpose of this study was to evaluate whether a screening program to sonographically identify abdominal aortic aneurysms would result in increased identification of this potentially lethal disease. This prospective clinical study used a convenience sample and was performed in a community teaching hospital ED. Read More

J Emerg Med 2002 Feb;22(2):171-4

Department of Emergency Medicine, Health Sciences Centre, Winnipeg, Manitoba, Canada.

Acute aortic dissection is an emergency that may not only cause significant morbidity but often results in death. A timely diagnosis can prove difficult in the event of an atypical presentation. Classically, aortic dissection presents as sudden, severe chest, back, or abdominal pain that is characterized as ripping or tearing in nature. Read More

J Emerg Med 2001 Aug;21(2):141-4

Department of Emergency Medicine, Medical College of Pennsylvania/Hahnemann University, Philadelphia, Pennsylvania 19129, USA.

We report a case of a patient who presented to the Emergency Department with pulseless electrical activity. A rapid diagnosis of ruptured abdominal aortic aneurysm was made by Emergency Medicine bedside ultrasonography. On arrival, the patient was without palpable pulses and bradycardic. Read More

Ann Emerg Med 2000 Sep;36(3):219-23

Departments of Emergency Medicine, and Radiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.

Study Objective: This study was conducted to determine whether emergency physicians with relatively limited training and experience can accurately identify the presence or absence of abdominal aortic aneurysms (AAAs) by performing bedside ultrasound scanning, and to assess the potential impact of ultrasound scanning on clinical management.

Methods: Patients in whom AAAs were suspected, including those patients older than 50 years presenting with abdominal/back pain of unclear origin or presumed renal colic, were eligible for study entry. Consenting adults had ultrasound scanning by an emergency physician who was not responsible for their primary care. Read More

Acad Emerg Med 1999 Jun;6(6):661-4

Bellflower Kaiser, CA, USA.