Christopher Raio

• MD, MBA
• Northwell Health

Objective: Our objective was to determine whether organized or disorganized cardiac activity is associated with increased survival in patients who present in pulseless electrical activity (PEA) treated with either 1) standard advanced cardiac life support (ACLS) medications or 2) other interventions. Methods: This was a secondary analysis of a p...

Ultrasound (US) has become an integral modality in emergency care in the United States during the last two decades. Since the last update of these guidelines in 2008, US use has expanded throughout clinical medicine and established itself as a standard in the clinical evaluation of the emergency patient. There is a wide breadth of recognized emerge...

Reply to: Resuscitation. 2017 May;114:e5. doi: 10.1016/j.resuscitation.2016.11.028. Epub 2017 Feb 8.

Background: Point-of-care ultrasound has been suggested to improve outcomes from advanced cardiac life support (ACLS), but no large studies have explored how it should be incorporated into ACLS. Our aim was to determine whether cardiac activity on ultrasound during ACLS is associated with improved survival. Methods: We conducted a non-randomized...

In 2012 the Accreditation Council for Graduate Medical Education (ACGME) and the American Board of Emergency Medicine (ABEM) released the Emergency Medicine (EM) Milestones. The Patient Care 12 (PC12) subcompetency delineates staged and progressive accomplishment in emergency ultrasound (EUS). While valuable as an initial framework for ultrasound r...

Objectives: To assess the self-reported frequency of use of ultrasound guidance for central venous catheterization by emergency medicine (EM) residents, describe residents' perceptions regarding the use of ultrasound guidance, and identify barriers to the use of ultrasound guidance. Methods: A longitudinal cross-sectional study was conducted at...

Abstract OBJECTIVES: Resuscitation often requires rapid vascular access via central venous catheters. Chest radiography is the reference standard to confirm central venous catheter placement and exclude complications. However, radiographs are often untimely. The purpose of this study was to determine whether dynamic sonographic visualization of a s...

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...

Point-of-care ultrasound provides a safe, rapid, effective, and accurate tool for evaluating congenital groin masses in infants. We present a 4-week-old infant who presented to the emergency department with bilateral inguinal masses. Point-of-care ultrasonography discovered bilateral hernias with an ovary herniated through a patent processus vagina...

The American Institute of Ultrasound in Medicine (AIUM) is a multidisciplinary association dedicated to advancing the safe and effective use of ultrasound in medicine through professional and public education, research, development of guidelines, and accreditation. To promote this mission, the AIUM is pleased to publish, in conjunction with the Ame...

A 17 year-old man presented to the emergency department with signs and symptoms of a peritonsillar abscess. His trismus was so pronounced that it was too difficult to drain the abscess under dynamic ultrasound guidance. It was suggested that localization of the abscess with ultrasound be used concurrently with video laryngoscopy. The ultrasound was...

Objectives: Recent years have seen a rapid proliferation of emergency ultrasound (EUS) programs in the United States. To date, there is no evidence supporting that EUS fellowships enhance residents' ultrasound (US) educational experiences. The purpose of this study was to determine the impact of EUS fellowships on emergency medicine (EM) residents...

In children presenting to the emergency room with right lower quadrant pain, ultrasound is the preferred initial modality. In our patient, a 6-year-old male with a sudden onset of severe right lower quadrant pain, the differential is broad, including appendicitis and intussusception. In order to narrow our differential and secure the diagnosis, our...

Resuscitations in the emergency department often require rapid access with central venous catheters (CVC). Chest x-ray is the gold standard to confirm proper placement of the CVC and exclude pneumothorax after placement. However, radiographs are often untimely and expose patients to ionizing radiation. Studies have shown that visualization of the s...

Lower abdominal pain in females of reproductive age continues to be a diagnostic dilemma for the emergency physician (EP). Point-of-care ultrasound (US) allows for rapid, accurate, and safe evaluation of abdominal and pelvic pain in both the pregnant and non-pregnant patient. We present 3 cases of females presenting with right lower quadrant and ad...

Resuscitation often requires rapid vascular access via central venous catheters. Chest radiography is the reference standard to confirm central venous catheter placement and exclude complications. However, radiographs are often untimely. The purpose of this study was to determine whether dynamic sonographic visualization of a saline flush in the ri...

Transvaginal imaging of the right adnexa demonstrating a non-compressing, enlarged appendix with an appendicolith (hyperechoic with posterior shadow)

Background: Focused, proximal compression ultrasound (FPCUS) is a commonly used point-of-care study in the Emergency Department (ED). Pelvic vein deep venous thrombosis (DVT) is a rare presentation, and Emergency Physicians need to be aware of the limitations and pitfalls of FPCUS. Objective: A case of external iliac vein DVT diagnosed in the ED...

Background: Long-bone fractures represent one of the most commonly sustained injuries following trauma and account for nearly 4% of emergency department visits in the United States each year. These fractures are associated with a significant risk of bleeding and neurovascular compromise. Delays in their identification and treatment can lead to los...

Sialolithiasis is a relatively common diagnosis, with an uncertain etiology, that must be considered in patients presenting with a neck mass. Traditionally, invasive sialography was used to detect salivary stones. Currently, computed tomography has been the test of choice. Ultrasound presents an alternative, rapid, and safe imaging modality for the...

Although rare, cervical ectopic pregnancy (EP) represents a potentially lethal variation of a common first-trimester disease entity. We report a case of low abdominal pain and vaginal bleeding diagnosed as a cervical EP by point-of-care ultrasound. Familiarity with cervical EP and its sonographic appearance is essential for emergency physicians bec...

Urachal abnormalities are a rare cause of lower abdominal pain. They are often initially mistaken for more common causes of lower abdominal pain, and the diagnosis is usually made during evaluation for one of these more common conditions. We report a case of a painful periumbilical mass ultimately diagnosed as an infected urachal cyst. Although the...

Introduction Physical examination and laboratory testing lack sufficient accuracy to distinguish cholecystitis from cholelithiasis. As a result, imaging studies are often required to safely disposition patients presenting with right upper quadrant or epigastric pain. Ultrasound is the initial test of choice in the majority of these cases, and gener...

Myocarditis is an uncommon diagnosis that must be considered in young patients with acute myocardial dysfunction. Several infectious agents have been noted as causes of acute myocarditis; however, most cases are idiopathic in nature. This diagnosis may go unrecognized initially in patients presenting with atypical symptoms. We report a rare case of...

Over the past decade, emergency medicine ultrasound (US) fellowships have proliferated, yet there are no published data describing employment trends among fellowship graduates. This study sought to assess factors motivating emergency physicians to pursue an US fellowship and to characterize their employment and job satisfaction after graduation. An...

This is a case report of an eccentrically located intrauterine pregnancy initially diagnosed as an interstitial ectopic pregnancy. Although interstitial ectopic pregnancy represents a well-known pitfall in first-trimester sonography, the common error is to misidentify the ectopic pregnancy as intrauterine, not the reverse. Such an error is potentia...

The diagnosis of cholecystitis or biliary tract disease in children and adolescents is an uncommon occurrence in the emergency department and other acute care settings. Misdiagnosis and delays in diagnosing children with cholecystitis or biliary tract disease of up to months and years have been reported in the literature. We discuss the technique a...

The localization and removal of a superficial foreign body is a common challenge that emergency physicians encounter. The use of ultrasonography to detect superficial foreign bodies has been well documented, but with varying success. This case report demonstrates the use of a finder needle, placed under ultrasound-guidance, to assist in the localiz...

Over the past 25 years, research performed by emergency physicians (EPs) demonstrates that bedside ultrasound (US) can improve the care of emergency department (ED) patients. At the request of the Council of Emergency Medicine Residency Directors (CORD), leaders in the field of emergency medicine (EM) US met to delineate in consensus fashion the mo...

Emergency ultrasound has seen its clinical use expand greatlysince its original application in emergency medicine decadesago.1-5The use of emergency ultrasound is now widespread atboth community and academic hospitals of all sizes and also bymedical personnel in out-of-hospital scenarios.6-8Focusedemergency ultrasound is utilized to diagnose acute...

The standard evaluation of patients with right upper quadrant (RUQ) abdominal pain consists of a history and physical examination, laboratory analysis, and radiological investigation. Given the increasing availability of bedside ultrasound in the Emergency Department (ED), a growing proportion of Emergency Physicians are now performing their own ul...

Hypertrophic pyloric stenosis (HPS) is an acute abdominal emergency in infants that often presents to Emergency Departments. The clinical diagnosis of HPS relies on palpation of an olive-sized mass in the right upper quadrant of an infant with a history of projectile vomiting. However, studies have shown that clinicians cannot detect the olive in 1...

The internal jugular vein (IJV) is an optimal location for obtaining central venous access due to its superficial location. However, there are many potential pitfalls of using the landmark technique, including aberrant anatomy of the IJV, proximity to the carotid artery and cupola of the lung, body habitus, and prior neck surgery. Our case study de...

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. Me...

Study objectives: Emergency physicians may make clinical decisions according to kidney stone size. There have been many published studies reporting increased medical complications relating to kidney stone size. However, there is scant literature describing the relationship of kidney stone size with degree of hydronephrosis on focused emergency depa...

Study objectives: Obtaining vascular access in a critically ill child can be an imposing task. Intraosseous line placement can be an extremely valuable procedure in managing a pediatric emergency. We seek to determine whether emergency physicians could accurately confirm intraosseous needle placement using ultrasonography. Methods: We performed a p...