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The primary study objective was to evaluate insertion success rates. Secondary objectives included patient satisfaction, procedure time, complication rates, completion of therapy and dwell time of the novel AccuCath 2.25″ Blood Control (BC) Catheter System (FDA approved) placed in difficult-access patients. This was a single-arm feasibility trial evaluating the AccuCath 2.25″ BC Catheter System in a convenience sample of DIVA patients defined as at least two failed initial attempts or a history of difficult access plus the inability to directly visualize or palpate a target vein. All enrolled patients were 18 years of age or older. A total of 120 patients were enrolled. These patients had an average of 3.7 and median of 3 prior attempts at vascular access prior to AccuCath placement. Successful access was gained in 100% of the patients, 77% on the first attempt and all within three attempts; 88.5% of patients completed therapy, with the remaining 12.5% experiencing minor complications that required discontinuation of the catheter. The average patient satisfaction score on a 5-point Likert scale was highly positive at 4.6. Preliminary results show that the AccuCath 2.25″ BC Catheter System has excellent success rates in gaining vascular access in an extremely difficult patient population. The device did not lead to any significant complications. Patients were also very satisfied with the procedure.

Background Ultrasound is of proven accuracy in the diagnosis of pneumothorax. In certain locations, pre-hospital providers are adopting its use for the management of critically ill patients. Objectives To determine the sensitivity and specificity of emergency medical service (EMS) providers in identifying pneumothorax on ultrasound examinations. Methods This was an educational study evaluating 33 EMS providers. Each subject went through a brief didactic session covering the use of ultrasound in diagnosis of pneumothorax. They were then given an examination consisting of 20 individual ultrasound real-time video cases depicting either a pneumothorax or normal lung sliding. Sensitivities and specificities with 95% confidence intervals (95% CIs) were calculated for recognition of pneumothorax. Results The 33 study participants were able to identify pneumothorax with a sensitivity of 82% (95% CI 77-86%), specificity of 94% (95% CI 90-96%), positive predictive value of 93% (95% CI 89-95%), and negative predictive value of 84% (95% CI 80-87%). Conclusions Emergency medical service providers were able to identify pneumothorax at a relatively high rate. Real-time scanning by the study subjects might lead to even better results.

The double-line sign (DLS) is a wedge-shaped hypoechoic area in Morison's pouch bounded on both sides by echogenic lines. It represents a false-positive finding for free intraperitoneal fluid when performing focused assessment with sonography in trauma examinations. The purpose of this study was to determine the prevalence of DLS. Secondarily, the study will further investigate the relationship between the presence of a DLS and body mass index (BMI). This was a prospective study that enrolled patients over a 7-month period. Inclusion criteria were patients ≥ 18 years of age presenting to the Emergency Department (ED) requiring a FAST examination as part of the patient's standard medical care. Each examination was performed by one of six experienced ultrasonographers. Presence or absence of the DLS was established in real time and gender, height, weight, and BMI were recorded for each patient. The overall prevalence rate of DLS and the corresponding 95 % confidence interval were calculated, as well as the prevalence rates broken down by BMI characterized as underweight, normal weight, overweight, and obese; and age category (18-29, 30-64, and 65+). The Chi-square test and a Fisher's exact test for BMI category were used to compare the prevalence rates of positive DLS among the different demographic groups. 100 patients were enrolled in the study; the overall prevalence was 27 %. There was no statistical significance among the different demographic groups or BMI. The DLS is a prevalent finding. We believe this sign has become more apparent due to improved imaging technology and resolution.

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