Joseph R. Pare

Boston University | BU · Department of Emergency Medicine

Study objective: Ascending aortic dissection (AAD) is an uncommon, time-sensitive, and deadly diagnosis with a nonspecific presentation. Ascending aortic dissection is associated with aortic dilation, which can be determined by emergency physician focused cardiac ultrasound (EP FOCUS). We seek to determine if patients who receive EP FOCUS have red...

Objectives: Predictive analytics in emergency care has mostly been limited to the use of clinical decision rules (CDRs) in the form of simple heuristics and scoring systems. In the development of CDRs, limitations in analytic methods and concerns with usability have generally constrained models to a preselected small set of variables judged to be...

To determine characteristics of patients who develop compartment syndrome (CS) from IV infiltration requiring surgical intervention. A systematic review was conducted of available English literature from 1990 to date. Key terms were entered into a MEDLINE search in addition to searching grey literature and references of included manuscripts. Inclus...

Emergency physician (EP)-performed focused cardiac ultrasound (EP FOCUS) has been increasingly recognized as a crucial tool to help clinicians diagnose and treat potentially life-threatening conditions. The existing literature demonstrates a variety of EP FOCUS applications and protocols; however, EP FOCUS is not taught, practiced, or interpreted c...

Stroke should not solely be considered a disease of the elderly, and racial disparities are most evident among young adults. Acute stroke can present at any age and it is important to be familiar with the evaluation and treatment of stroke to provide timely care. The National Institute of Health Stroke Scale helps physicians objectively evaluate st...

Lung ultrasound (LUS) as a diagnostic tool is gaining support for its role in the diagnosis and management of COVID-19 and a number of other lung pathologies. B-lines are a predominant feature in COVID-19, however LUS requires a skilled clinician to interpret findings. To facilitate the interpretation, our main objective was to develop automated me...

Objectives Opioid use disorder (OUD) is a national epidemic, and Black and Hispanic patients are less likely to receive treatment when compared to white patients. In this study, race was used a proxy to assess potential effects of racism on the referral process for OUD treatment. Our primary aim was to examine whether Black or Hispanic patients exp...

Background Recent literature has suggested echocardiography (echo) may prolong pauses in chest compressions during cardiac arrest. Objectves We sought to determine the impact of the sonographic approach (subxiphoid [SX] vs. parasternal long [PSL]) on time to image completion, image quality, and visualization of cardiac anatomy during echo, as perf...

Medical ultrasound is one of the most commonly used diagnostic imaging modalities in the practice of medicine. It is portable, low-cost, and capable of real-time image acquisition and visualization. Unlike computed tomography or x-ray, there is no ionizing radiation exposure associated with ultrasound, thus making it a safe imaging choice. Ultrasou...

Introduction: The American College of Emergency Physicians (ACEP) recommends that Emergency Medicine physicians with advanced training can evaluate right ventricular (RV) pressures via point-of-care ultrasound (POCUS) by measuring a tricuspid regurgitant jet (TRJ). We were unable to find a published curriculum to deliver education for this at any...

Background Point-of-care ultrasound (POCUS) is useful in the evaluation of early pregnancy by confirming intrauterine pregnancy and recognizing hemorrhage from ectopic pregnancy. We sought to determine whether transabdominal POCUS by itself or in conjunction with consultative radiology ultrasound (RADUS), reduces Emergency Department (ED) treatment...

Ultrasound-guided peripheral venous access plays an important role in medical care. The prevalence of difficult venous access patients makes this skill important to the medical provider. In this chapter we will outline the relevant venous anatomy, ultrasound machine preparation and patient set-up, description of technical approaches, and considerat...

Introduction: Pulmonary hypertension, associated with high mortality in pediatric patients, is traditionally screened for by trained professionals by measuring a tricuspid regurgitant jet velocity (TRJV). Our objective was to test the feasibility of novice physician sonographers (NPS) to perform echocardiograms of adequate quality to exclude patho...

Introduction: Current recommendations for diagnostic imaging for moderately to severely ill patients with suspected coronavirus disease 2019 (COVID-19) include chest radiograph (CXR). Our primary objective was to determine whether lung ultrasound (LUS) B-lines, when excluding patients with alternative etiologies for B-lines, are more sensitive for...

Bladder scanners allow for quick determination of bladder volumes (BV) with minimal training. BV measured by a machine is generally accurate; however, circumstances exist in which falsely elevated BVs are reported. This case details a patient with a significant small bowel obstruction (SBO) due to superior mesenteric artery syndrome causing a false...

Objectives: Ultrasound guided peripheral intravenous catheters (USPIV) are frequently utilized in the Emergency Department (ED) and lead to reduced central venous catheter (CVC) placements. USPIVs, however, are reported to have high failure rates. Our primary objective was to determine the proportion of patients that required CVC after USPIV. Our...

Introduction Supporting an “ultrasound-first” approach to evaluating renal colic in the emergency department (ED) remains important for improving patient care and decreasing healthcare costs. Our primary objective was to compare emergency physician (EP) ultrasound to computed tomography (CT) detection of hydronephrosis severity in patients with sus...

Objectives: The primary objectives were to describe the diagnostic characteristics tricuspid annular plane systolic excursion (TAPSE) for pulmonary embolism (PE) and to optimize the measurement cutoff of TAPSE for the diagnosis of PE. Secondary objectives included assessment of interrater reliability and the quantitative visual estimation of TAPSE...

Objective: Monitoring of patient's intravascular volume status without invasive measures remains challenging and unreliable. Our objective was to determine if corrected flow time (FTc) measurement could detect preload reduction with administration of nitroglycerin (NTG) as a surrogate for volume loss. Methods: Post hoc FTc analysis was performed...

Computed tomography (CT) scanning is an essential diagnostic tool and has revolutionized care of patients in the acute care setting. However, there is widespread agreement that overutilization of CT, where benefits do not exceed possible costs or harms, is occurring. The goal was to seek consensus in identifying and prioritizing research questions...

Our primary aim was to evaluate the use of ultrasound (US) as an initial screening test for diagnosing appendicitis in young adult men. Secondary exploratory analyses included the effects of using US for initial screening in these patients, compared with the use of CT, on radiation exposure, length of stay (LOS), and cost of imaging. We retrospecti...

Pyomyositis is a rare disease in temperate climates. This case is a unique presentation of pyomyositis of the rectus abdominal muscle mimicking an acute abdominal process. Most reported cases of pyomyositis are of extremity infections with Staphylococcus aureus.This report presents a case of polymicrobial pyomyositis from Haemophylus parainfluenza...

Introduction. This chapter will cover the evaluation of the geriatric patient presenting to the emergency department (ED) with chest pain. Although potentially an indication of acute cardiac ischemia, there are a number of alternative etiologies for the elderly individual with chest pain that will be discussed. These include several pulmonary, vasc...

Acute vision loss is frightening to patients and may represent serious pathology that is irreversible if not intervened upon quickly. We present a case of a 36 year-old male with sudden onset of unilateral painless central visual disturbance described as flashes of light. His Emergency Department exam was normal, and an ophthalmologic consult found...

ACADEMIC EMERGENCY MEDICINE 2012; 19:e1–30 © 2012 by the Society for Academic Emergency Medicine The authors present a case of a 65-year-old male who presented four times to the emergency department (ED) with left-sided chest pain. On the first three visits, the patient was admitted with a different diagnosis related to his chest pain. On the final...

Colon cancer is the second leading cause of cancer death in the United States. Early detection and removal of precancerous lesions through screening colonoscopy prevents colon cancer progression. Previous studies have shown that primary care physician (PCP) referral is a significant motivator for completing screening colonoscopies. Despite PCP refe...