Introduction: New medical technology brings the potential of lawsuits related to the usage of that new technology. In recent years the use of point-of-care (POC) ultrasound has increased rapidly in the emergency department (ED). POC ultrasound creates potential legal risk to an emergency physician (EP) either using or not using this tool. The aim of this study was to quantify and characterize reported decisions in lawsuits related to EPs performing POC ultrasound.

Methods: We conducted a retrospective review of all United States reported state and federal cases in the Westlaw database. We assessed the full text of reported cases between January 2008 and December 2012. EPs with emergency ultrasound fellowship training reviewed the full text of each case. Cases were included if an EP was named, the patient encounter was in the emergency department, the interpretation or failure to perform an ultrasound was a central issue and the application was within the American College of Emergency Physician (ACEP) ultrasound core applications. In order to assess deferred risk, cases that involved ultrasound examinations that could have been performed by an EP but were deferred to radiology were included.

Results: We identified five cases. All reported decisions alleged a failure to perform an ultrasound study or a failure to perform it in a timely manner. All studies were within the scope of emergency medicine and were ACEP emergency ultrasound core applications. A majority of cases (n=4) resulted in a patient death. There were no reported cases of failure to interpret or misdiagnoses.

Conclusion: In a five-year period from January 2008 through December 2012, five malpractice cases involving EPs and ultrasound examinations that are ACEP core emergency ultrasound applications were documented in the Westlaw database. All cases were related to failure to perform an ultrasound study or failure to perform a study in a timely manner and none involved failure to interpret or misdiagnosis when using of POC ultrasound. [West J Emerg Med. 2015;16(1):–0.]

Introduction: Common carotid flow measurements may be clinically useful to determine volumeresponsiveness. The objective of this study was to assess the ability of emergency physicians (EP)to obtain sonographic images and measurements of the common carotid artery velocity time integral(VTi) for potential use in assessing volume responsiveness in the clinical setting.

Methods: In this prospective observational study, we showed a five-minute instructional videodemonstrating a technique to obtain common carotid ultrasound images and measure the commoncarotid VTi to emergency medicine (EM) residents. Participants were then asked to image thecommon carotid artery and obtain VTi measurements. Expert sonographers observed participantsimaging in real time and recorded their performance on nine performance measures. An expertsonographer graded image quality. Participants were timed and answered questions regarding easeof examination and their confidence in obtaining the images.

Results: A total of 30 EM residents participated in this study and each performed the examinationtwice. Average time required to complete one examination was 2.9 minutes (95% CI [2.4-3.4 min]). Participants successfully completed all performance measures greater than 75% of the time, with theexception of obtaining measurements during systole, which was completed in 65% of examinations.Median resident overall confidence in accurately performing carotid VTi measurements was 3 (on ascale of 1 [not confident] to 5 [confident]).

Conclusion: EM residents at our institution learned the technique for obtaining common carotidartery Doppler flow measurements after viewing a brief instructional video. When assessed atperforming this examination, they completed several performance measures with greater than 75%success. No differences were found between novice and experienced groups. [West J Emerg Med.2015;16(2):255–259.]