Elaine Hua Situ-LaCasse

Interests

Research

-Point-of-care ultrasound-Resident education-Medical student education-Resuscitation-Emergency medicine

Teaching

Teaching medical students, residents, fellows, and faculty how to perform emergency ultrasound exams and ultrasound-guided procedures.

Courses

Scholarly Contributions

Chapters

• Adhikari, S. R., & Situ-LaCasse, E. (2020). Soft tissue infections. In Emergency Ultrasound.(pp 523-534). McGraw-Hill Publishers.
• Acuna, J., & Situ-LaCasse, E. (2019). Principles of Ultrasound Guidance. In The Ultimate Guide to Point-of-Care Ultrasound-Guided Procedures. Springer Nature.
• Situ-LaCasse, E., & Arif Tiwari, H. (2019). Ultrasound-Guided Percutaneous Drainage Procedures. In The Ultimate Guide to Point-of-Care Ultrasound-Guided Procedures. Springer Nature.
• Situ-LaCasse, E. (2018). Upper Airway Assessment and Pathology. In iBook: Practical Guide to Critical Ultrasound.
• Situ-LaCasse, E. (2017). Ugh! Another repeat visit for back pain?! Keep epidural abscess on the differential!. In Avoiding Common Errors in the Emergency Department. 2nd Ed.(pp 406-407). Wolter Kluwers.
• Situ-LaCasse, E., & Acuna, J. (2019). Principles of Ultrasound Guidance. In The Ultimate Guide to Point-of-Care Ultrasound-Guided Procedures. Springer Nature.

Journals/Publications

• Acuna, J. G., Situ-LaCasse, E. H., Yarnish, A., McNinch, N., & Adhikari, S. R. (2023). Does Size Matter? A Prospective Study on the Feasibility of Using a Handheld Ultrasound Device in Place of a Cart-based System in the Evaluation of Trauma Patients. Journal of Emergency Medicine.
• Acuña, J., Situ-LaCasse, E., Yarnish, A. A., Amini, R., McNinch, N. L., & Adhikari, S. (2022). The Status of Women in Emergency Ultrasound Fellowships: A Potential Light for the Future of Gender Inclusion in Academic Medicine. Cureus, 14(9), e28701.
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  The objective of this study is to investigate gender differences in the percentage of men and women who have completed an Emergency Ultrasound (EUS) fellowship over a four-year period. Secondary objectives of this study include evaluation of the career paths and accomplishments of women who have recently completed an EUS fellowship. We will also be assessing program characteristics as reported by the program directors.
• Situ-LaCasse, E., Dehon, E., Zachrison, K., Peltzer-Jones, J., Tabatabai, R., Clair, E., Puskarich, M., Ondeyka, A., Dixon-Gordon, K., Walter, L., & Fix, M. (2022). This Article Corrects: “Sources of Distress and Coping Strategies Among Emergency Physicians During COVID-19”. Western Journal of Emergency Medicine, 23(2), 291-291. doi:10.5811/westjem.2022.2.56588
• Acuna, J., Yarnish, A., Situ-LaCasse, E., Amini, R., & Adhikari, S. (2021). The Use of Point-of-Care Ultrasound for Arthrocentesis Among Emergency Medicine Residents. Open access emergency medicine : OAEM, 13, 161-167.
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  The objective of this study is to determine if EM resident physicians are able to successfully utilize POCUS to perform an arthrocentesis in the ED. This is a retrospective review of ED patients who received an ultrasound-guided or ultrasound-assisted arthrocentesis performed in the ED over a 6-year period by an EM resident physician.
• Dehon, E., Zachrison, K. S., Peltzer-Jones, J., Tabatabai, R. R., Clair, E., Puskarich, M. A., Ondeyka, A., Dixon-Gordon, K., Walter, L. A., Situ-LaCasse, E. H., & Fix, M. L. (2021). Sources of Distress and Coping Strategies Among Emergency Physicians During COVID-19. The western journal of emergency medicine, 22(6), 1240-1252.
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  The coronavirus disease 2019 (COVID-19) pandemic has been shown to increase levels of psychological distress among healthcare workers. Little is known, however, about specific positive and negative individual and organizational factors that affect the mental health of emergency physicians (EP) during COVID-19. Our objective was to assess these factors in a broad geographic sample of EPs in the United States.
• Hahn, M., Ray, J., Hall, M., Coe, I., Situ-LaCasse, E., & Waterbrook, A. L. (2020). Ultrasound in Trauma and Other Acute Conditions in Sports, Part I. Current Sports Medicine Reports.
• Ray, J., Gende, A., Hall, M., Coe, I., Situ-LaCasse, E., & Waterbrook, A. L. (2020). Ultrasound in Trauma and Other Acute Conditions in Sports, Part II. Current Sports Medicine Reports.
• Situ-LaCasse, E., Acuna, J., Huynh, D., Amini, R., Irving, S., Samsel, K., Patanwala, A. E., Biffar, D. E., & Adhikari, S. R. (2020). Can ultrasound novices develop image acquisition skills after reviewing online ultrasound modules?. BMC Medical Education.
• Situ-lacasse, E., Ramdin, C., Gottlieb, M., & Alerhand, S. (2021). National Survey of Point-of-Care Ultrasound Scholarly Tracks in Emergency Medicine Residency Programs.. The western journal of emergency medicine, 22(5), 1095-1101. doi:10.5811/westjem.2021.5.52118
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  Residency scholarly tracks are educational programs, designed to help trainees develop an area of expertise. Although the breadth of residency point-of-care ultrasound (POCUS) education has developed considerably in recent years, there is no literature to date describing scholarly tracks specifically in POCUS. In this study we sought to determine the prevalence, characteristics, and outcomes of POCUS scholarly tracks in emergency medicine (EM)..This was a cross-sectional survey of EM residency programs accredited by the Accreditation Council for Graduate Medical Education. Surveys were distributed between March-August 2020 using a listserv followed by targeted emails to residency and ultrasound leadership. We summarized data using descriptive statistics, and performed logistic regression to identify factors associated with a POCUS scholarly track..Of 267 residency programs 199 (74.5%) completed the survey. Fifty-seven (28.6%) had a POCUS scholarly track as of the 2019-2020 academic year. Scholarly tracks in POCUS were more common in university-based/academic sites and larger residency programs. Of the 57 programs with POCUS scholarly tracks, 48 (84.2%) required residents to present at least one POCUS lecture, 45 (78.9%) required residents to serve as instructor at a hands-on workshop, and 42 (73.7%) required residents to participate in quality assurance of departmental POCUS scans. Only 28 (49.1%) tracks had a structured curriculum, and 26 (45.6%) required POCUS research. In total, 300 EM residents completed a POCUS scholarly track over the past three academic years, with a median of 4 (2-9) per program. Seventy-five (25.0%) proceeded to a clinical ultrasound fellowship after residency graduation, with a median of 1 (interquartile range 0-2) per program. A total of 139 POCUS-specific abstracts (median 2 [0-3]) and 80 peer-reviewed manuscripts (median 1 [0-2]) were published by scholarly track residents over the past three years..This survey study describes the current prevalence, characteristics, and outcomes of POCUS scholarly tracks across EM residency programs. The results may inform the decisions of residency programs to create these tracks.
• Stolz, L., Situ-LaCasse, E., Acuña, J., Thompson, M., Hawbaker, N., Valenzuela, J., Stolz, U., & Adhikari, S. (2021). What is the ideal approach for emergent pericardiocentesis using point-of-care ultrasound guidance?. World journal of emergency medicine, 12(3), 169-173.
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  Traditionally performed using a subxiphoid approach, the increasing use of point-of-care ultrasound in the emergency department has made other approaches (parasternal and apical) for pericardiocentesis viable. The aim of this study is to identify the ideal approach for emergency-physician-performed ultrasound-guided pericardiocentesis as determined by ultrasound image quality, distance from surface to pericardial fluid, and likely obstructions or complications.
• Tucker, R., Peterson, W., Mink, J., Taylor, L., Leetch, S., Nagdev, A., Leo, M., Liu, R., Stolz, L., Kessler, R., Boulger, C., Situ-LaCasse, E., Avila, J., & Huang, R. (2020). Defining an Ultrasound-guided Regional Anesthesia Curriculum for Emergency Medicine. AEM Education and Training.
• Adhikari, S., Situ-LaCasse, E., Acuña, J., Irving, S., Weaver, C., Samsel, K., Biffar, D. E., Motlagh, M., & Sakles, J. (2020). Integration of Pre-intubation Ultrasound into Airway Management Course: A Novel Training Program. Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine, 24(3), 179-183.
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  To determine the feasibility of integrating pre-intubation ultrasound into airway course and assess emergency medicine (EM) residents' confidence and comfort level in using ultrasound for pre-intubation hemodynamic stabilization and identifying cricothyroid membrane after the training session.
• Amini, R., Camacho, L. D., Valenzuela, J., Ringleberg, J. K., Patanwala, A. E., Stearns, J., Situ-LaCasse, E. H., Acuña, J., & Adhikari, S. (2020). Cadaver Models in Residency Training for Uncommonly Encountered Ultrasound-Guided Procedures. Journal of medical education and curricular development, 6, 2382120519885638.
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  Arthrocentesis of the ankle and elbow and brachial plexus nerve blocks are infrequently performed procedures; however, clinicians in specialties such as emergency medicine are required to be proficient in these procedures in the event of emergent or urgent necessity.
• Amini, R., Camacho, L., Acuña, J., Situ-La Casse, E. H., & Adhikari, S. (2020). Point of Care Ultrasound in Pyogenic Tenosynovitis: A Case Report. Bulletin of emergency and trauma, 8(1), 41-46.
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  Pyogenic tenosynovitis is caused by hematogenous spread of infection or trauma with direct inoculation of a tendon sheath. Symptoms and clinical examination findings associated with pyogenic tenosynovitis may be confused with superficial soft tissue infections, however management plans between pyogenic tenosynovitis and superficial soft tissue infection vary significantly. In patients with pyogenic tenosynovitis, operative intervention and subsequent irrigation and debridement offer a definitive therapy. Bedside ultrasound helps clinicians inspect the involved tendon sheath and may help assisting diagnosis of pyogenic tenosynovitis. In this case report, we described three cases, where point of care ultrasound was used to assist the diagnosis of pyogenic tenosynovitis, to accelerate consultation, and to expedite operative intervention.
• Cohen, S., Ford, L., Situ-LaCasse, E., & Tolby, N. (2020). Infective Endocarditis Causing Acute Myocardial Infarction. Cureus.
• Demirjian, J., & Situ-LaCasse, E. (2020). Urinary Retention in a Patient with an Artificial Urinary Sphincter: A Case Report of a Rare Cause of Urinary Retention. Cureus.
• Panebianco, N., Liu, R., Alerhand, S., Au, A., Bailitz, J., Chiem, A., Damewood, S., Friedman, L., Gottlieb, M., Lema, P., Lewiss, R., Lin, J., Lin, M., Liu, E. L., Magee, M., Nelson, M., Sajed, D., Situ-LaCasse, E., & Stolz, L. (2020). Joint Recommendations and Resources for Clinical Ultrasound Education Amidst the COVID-19 Era. AEM Education and Training.
• Acuna, J., Adhikari, S. R., & Situ-LaCasse, E. (2019). Evaluation of Gender Differences in Ultrasound Milestone Assessments during Emergency Medicine Residency Training: A Multicenter Study. AEM Education and Training.
• Acuña, J., Situ-LaCasse, E. H., Patanwala, A. E., Stolz, L. A., Amini, R., Friedman, L., & Adhikari, S. (2019). Identification of gender differences in ultrasound milestone assessments during emergency medicine residency training: a pilot study. Advances in medical education and practice, 10, 141-145.
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  Prior literature suggests that incongruities between male and female resident's procedural competency may be explained by gender bias during the evaluation process. There are no known studies investigating gender differences in the assessment of ultrasound-based procedural skills among emergency medicine (EM) residents. The purpose of this study was to evaluate for gender differences in ultrasound milestone assessments among EM residents. This is a retrospective study including EM residents. Milestone assessment data were collected from a total of 3 Accreditation Council for Graduate Medical Education (ACGME) EM residency programs representing a 3-year period The outcome measures included mean milestone levels, milestone levels at baseline and graduation and differences in milestone achievement between female and male EM residents. An unpaired Student's -test was used to compare milestone scores between female and male residents. A total of 456 ultrasound milestone evaluations were collected from 91 EM residents (34 females [37%] and 57 males [63%]). No significant differences were noted in the overall mean milestone level between females (2.3±0.6) and males (2.2±0.6) (=0.387). There were no significant differences noted in the ultrasound milestone level between females (0.8±0.6) and males (0.7±0.7) at baseline (=0.754). Although it did not reach statistical significance (=0.197), the increase in the mean ultrasound milestone level from baseline to graduation was greater in males (3.4±0.7) compared to females (3.1±0.7). Overall, there were no statistically significant differences in the mean ultrasound milestone levels between females and males. The rate of ultrasound milestone level achievement during EM residency training at our institution had a slight tendency to be higher for males than females in the observed residency programs; however, this also did not reach statistical significance. Possible gender bias while evaluating ultrasound milestone levels needs to be further studied on a larger scale.
• Situ-LaCasse, E. H., Amini, R., Bain, V., Acuña, J., Samsel, K., Weaver, C., Valenzuela, J., Pratt, L., Patanwala, A. E., & Adhikari, S. (2019). Performance of Ultrasound-guided Peripheral Nerve Blocks by Medical Students After One-day Training Session. Cureus, 11(1), e3911.
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  Introduction  Ultrasound-guided peripheral nerve blocks (USGPNB) are performed by various specialists and are excellent, non-addicting pain control techniques. Alternative pain management approaches are needed to combat opiate abuse. Medical students should be aware of alternative pain management therapies before they begin clinical practice. Objective  Our objective was to determine if medical students can identify peripheral nerves under ultrasound and perform a USGPNB after a one-day hands-on training session. Methods  This was a cross-sectional study at an academic medical center. The study participants were third-year medical students with minimal prior ultrasound experience. Students were given an introductory lecture highlighting the opiate epidemic and benefits of USGPNB prior to the workshop. The one-day hands-on educational workshop consisted of learning basic sonographic anatomy, indications for USGPNB, and practicing needle guidance under ultrasound guidance. After the educational workshop, students' procedural competency was assessed by ultrasound-trained emergency medicine clinicians. Results  A total of 94 participants were included in this study. The average pre-test score was 68.4% (95% confidence interval [CI]; 65.4% to 71.4%). After the one-day educational workshop, the post-test score was 92.8% (95% CI; 90.8% to 94.8%). The average hands-on evaluation score was 84.4% (95% CI; 81.6% to 87.3%). All students agreed that this educational session is a good start to learning about USGPNB, and they felt comfortable identifying the peripheral nerves using ultrasound. On a confidence scale of one (low) through 10 (high), 83% (95% CI; 75.9% to 90.15%) rated their confidence as ≥6. All except one student either agreed that this educational session helped them understand how USGPNB could be integrated into acute pain management. The majority (84% [95% CI; 77% to 91%]) agreed that the session will change how they manage patients' acute pain in their future medical practice. Conclusion  Medical students can learn the sonographic anatomy of peripheral nerves and techniques of USGPNB after a one-day educational session.
• Situ-LaCasse, E., Adhikari, S. R., Amini, R., & Acuna, J. (2019). Identification of Gender Differences in Ultrasound Milestone Assessments during Emergency Medicine Residency Training: A Pilot Study. Advances in Medical Education and Practice.
• Situ-LaCasse, E., Guirguis, H., Friedman, L., Patanwala, A. E., & Adhikari, S. R. (2019). Can Emergency Physicians Perform Extended Compression Ultrasound for the Diagnosis of Lower Extremity Deep Vein Thrombosis?. World Journal of Emergency Medicine.
• Situ-LaCasse, E., Guirguis, H., Friedman, L., Patanwala, A. E., Cohen, S. E., & Adhikari, S. (2019). Can emergency physicians perform extended compression ultrasound for the diagnosis of lower extremity deep vein thrombosis?. World journal of emergency medicine, 10(4), 205-209.
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  Current point-of-care ultrasound protocols in the evaluation of lower extremity deep vein thrombosis (DVT) can miss isolated femoral vein clots. Extended compression ultrasound (ECUS) includes evaluation of the femoral vein from the femoral vein/deep femoral vein bifurcation to the adductor canal. Our objective is to determine if emergency physicians (EPs) can learn ECUS for lower extremity DVT evaluation after a focused training session.
• Situ-LaCasse, E., Situ-LaCasse, E., Adhikari, S. R., Adhikari, S. R., Acuna, J., & Acuna, J. (2019). Evaluation of Gender Differences in Ultrasound Milestone Assessments during Emergency Medicine Residency Training: A Multicenter Study. AEM Education and Training.
• Acuna, J., Situ-LaCasse, E., Jamplis, R. P., Amini, R., & Adhikari, S. (2018). Point-of-care Ultrasound Evaluation of Tibial Avulsion Fractures. Cureus, 10(5), e2677.
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  It can be difficult to diagnose a tibial avulsion fracture based on physical examination alone as findings are often non-specific. Emergency physicians will usually opt for radiography as their initial imaging modality, which has several disadvantages in evaluating tibial avulsion fractures. The objective of this case series is to describe the utility of point-of-care ultrasound (POCUS) in the evaluation of tibial avulsion injuries. A 15-year-old male presented to the emergency department (ED) after sustaining a left knee injury while playing soccer. The clinician had a high suspicion for patellar tendon involvement. A POCUS exam revealed a cortical irregularity and interruption of the left proximal tibia. The patellar tendon was found attached to an avulsed bony portion. Findings were consistent with a tibial tuberosity avulsion fracture. The patient was admitted and scheduled for surgery the following day. Our second case is a 31-year-old male who presented to the ED with a complaint of left knee pain after a 10-foot fall from a ladder. A POCUS exam revealed a bony avulsion over the anterior tibia that was not noted on the initial radiography read by radiology. His patellar tendon showed no evidence of rupture. This led to prompt consultation with orthopedics who evaluated the patient in the ED. Radiographs were reviewed again and it appeared that there was a missed anterior tibial spine fracture. The patient was placed in a knee immobilizer and discharged with instructions to follow up with orthopedics for outpatient surgery. The use of POCUS in the evaluation of these patients led to prompt diagnosis of tibial avulsion injuries, which led to early consultation and appropriate patient management. POCUS allows for expedited diagnosis and appropriate management of patients with tibial avulsion injuries.
• Acuña, J., Situ-LaCasse, E., & Mosier, J. (2018). A 33-Year-Old Woman With Progressive Dyspnea and Fatigue. Chest, 154(3), e65-e67.
• Amini, R., Baker, N., Situ-LaCasse, E. H., Acuña, J., Nuño, T., Stolz, U., & Adhikari, S. (2018). Can emergency physicians accurately distinguish retinal detachment from posterior vitreous detachment?: A response. The American journal of emergency medicine, 36(8), 1499-1500.
• Baker, N., Amini, R., Situ-LaCasse, E. H., Acuña, J., Nuño, T., Stolz, U., & Adhikari, S. (2018). Can emergency physicians accurately distinguish retinal detachment from posterior vitreous detachment with point-of-care ocular ultrasound?. The American journal of emergency medicine.
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  There is significant overlap between the symptoms of patients presenting with retinal detachment (RD) and posterior vitreous detachment (PVD). Urgency to obtain consultation and treatment are dependent on the ability to accurately distinguish these two conditions. The objective of this study was to determine the ability of emergency physicians to differentiate RDs from PVDs using point-of-care (POC) ocular ultrasound.
• Fisher, J., Viscusi, R., Ratesic, A., Johnstone, C., Kelley, R., Tegethoff, A. M., Bates, J., Situ-Lacasse, E. H., Adamas-Rappaport, W. J., & Amini, R. (2018). Clinical skills temporal degradation assessment in undergraduate medical education. Journal of advances in medical education & professionalism, 6(1), 1-5.
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  Medical students' ability to learn clinical procedures and competently apply these skills is an essential component of medical education. Complex skills with limited opportunity for practice have been shown to degrade without continued refresher training. To our knowledge there is no evidence that objectively evaluates temporal degradation of clinical skills in undergraduate medical education. The purpose of this study was to evaluate temporal retention of clinical skills among third year medical students.
• Friedman, L., Situ-LaCasse, E., Acuna, J., Amini, R., Irving, S. C., Stolz, L. A., Sterling, R., Jung, C., Sanders, A. B., & Adhikari, S. (2018). Point-of-care Head and Neck Sonography for Clinical Problem-solving: Impact of One-day Training Sessions on Medical Student Education. Cureus, 10(12), e3740.
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  Introduction The curriculum for medical student education is continuously evolving to emphasize knowledge acquisition with critical problem-solving skills. Medical schools have started to implement curricula to teach point-of-care ultrasound skills. To our knowledge, the expansion into head and neck sonography for medical student education is novel and has never been studied. Our objective was to determine the feasibility of implementing point-of-care head and neck sonography and critical problem-solving instruction for medical student education. Methods This was a cross-sectional study enrolling third-year medical students with minimal prior ultrasound experience. A one-day educational curriculum focusing on the use of head and neck ultrasound for clinical problem-solving was integrated into one of the week-long intersessions. The components of point-of-care ultrasound workshop included asynchronous learning, one-hour didactic lecture, followed by a pre-test assessment, then a one-day hands-on workshop, and finally a post-test assessment administered at the end of the training session. Results A total of 123 subjects participated in this study. Ninety-one percent completed the questionnaire prior to the workshop and 83% completed the post-test questionnaire. The level of comfort with using an ultrasound system significantly increased from 31% to 92%. Additionally, the comfort level in interpreting ultrasound images also significantly increased from 21% to 84%. Eighty-nine percent (95% CI, 86%-97%) had an interest in learning ultrasound and would enroll in an optional ultrasound curriculum if given the opportunity. Knowledge of specific ultrasound applications also increased from 60% (after asynchronous learning and lectures) to 95% (after additional hands-on sonographic training). Conclusion At our institution, we successfully integrated point-of-care head and neck sonography and critical problem-solving instruction for medical student education.
• Situ-LaCasse, E., Grieger, R. W., Crabbe, S., Waterbrook, A. L., Friedman, L., & Adhikari, S. (2018). Utility of point-of-care musculoskeletal ultrasound in the evaluation of emergency department musculoskeletal pathology. World journal of emergency medicine, 9(4), 262-266.
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  To evaluate the utilization of point-of-care ultrasound (POCUS) for the assessment of emergency department (ED) patients with musculoskeletal symptoms and the impact of musculoskeletal POCUS on medical decision-making and patient management in the ED.
• Stolz, L. A., Adhikari, S. R., Fan, H., Amini, R., Stea, N., Situ-LaCasse, E., Fiorello, A. B., Acuna, J., Friedman, L., Irving, S., Irving, S., Friedman, L., Acua, J., Fiorello, A. B., Situ-LaCasse, E., Stea, N., Fan, H., Amini, R., Stolz, L. A., & Adhikari, S. R. (2018). Multimodular Ultrasound Orientation: Residents’ Confidence and Skill in Performing Point-of-care Ultrasound. Cureus, 10(11). doi:10.7759/cureus.3597
• Stolz, L. A., Amini, R., Situ-LaCasse, E., Acuña, J., Irving, S. C., Friedman, L., Fiorello, A. B., Stea, N., Fan, H., & Adhikari, S. (2018). Multimodular Ultrasound Orientation: Residents' Confidence and Skill in Performing Point-of-care Ultrasound. Cureus, 10(11), e3597.
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  Introduction The objectives of this study were to determine if a multimodular introductory ultrasound course improved emergency medicine intern confidence in performing a point-of-care ultrasound and if our educational objectives could be met with our chosen structure. Methods This is a prospective, observational study evaluating three consecutive incoming emergency medicine residency classes from three residency programs. A one-day introductory ultrasound course was delivered. The course consisted of 1) flipped classroom didactics, 2) in-person, case-based interactive teaching sessions, and 3) check-listed, goal-driven, hands-on instruction. Results Over three years, 73 residents participated in this study. There was no significant difference in performance on the written test (p = 0.54) or the skills assessment (p = 0.16) between years. Performance on the written pre-test was not a predictor of performance on the skills test (R= 0.028; p = 0.19). Prior to training, residents were most confident in performing a focused assessment with sonography for trauma examination (median confidence 5.5 (interquartile range (IQR): 3 - 7) on a 10-point Likert scale where 1 represents low confidence and 10 represents high confidence). They reported the lowest confidence in performing a cardiac ultrasound (3 (IQR: 2 - 6)). Following training, residents reported increased confidence with all applications (p < 0.001). Eighty-five percent (confidence interval (CI): 73, 92) of residents agreed that the online ultrasound lectures effectively teach point-of-care ultrasound applications and 98% (CI: 88, 100) agreed that case-based interactive sessions helped them understand how ultrasound changes the management of acutely ill patients. Conclusions A written test of knowledge regarding the use of point-of-care ultrasound does not correlate with procedural skills at the start of residency, suggesting that teaching and evaluation of both types of skills are necessary. Following a multimodular introductory ultrasound course, residents showed increased confidence in performing the seven basic ultrasound applications. Residents reported that an asynchronous curriculum and case-based interactive sessions met the learning objectives and effectively taught point-of-care ultrasound applications.
• Situ-LaCasse, E., Theodoro, D., Fields, J. M., Kang, T., Liu, R., Bailitz, J., Tayal, V., Blaivas, M., & Adhikari, S. (2017). Re: Downstream Imaging Utilization After Emergency Department Ultrasound Interpreted by Radiologists Versus Nonradiologists: A Medicare Claims-Based Study. Journal of the American College of Radiology : JACR.
• Stolz, L. A., Amini, R., Situ-LaCasse, E. H., Shareef, F., Reed, H. A., & Adhikari, S. (2017). Cervical Funneling: Potential Pitfall of Point-of-Care Pelvic Ultrasound. Cureus, 9(9), e1649.
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  Though point-of-care ultrasound applications continue to expand, there are findings that are not within the scope of emergency ultrasound. It is important for emergency physicians to be aware of incidental findings that can be identified on comprehensive ultrasounds performed by other imaging departments in order to fully understand the limitations of bedside ultrasound. In this case, a gravid patient presented to the emergency department with pelvic cramping and vaginal bleeding. Point-of-care transabdominal pelvic ultrasound examination was performed and demonstrated cervical funneling. In the appropriate patient, cervical insufficiency due to cervical funneling may be an indication for cerclage in a pregnant patient.
• Stolz, L., Valenzuela, J., Situ-LaCasse, E., Stolz, U., Hawbaker, N., Thompson, M., & Adhikari, S. (2017). Clinical and historical features of emergency department patients with pericardial effusions. World journal of emergency medicine, 8(1), 29-33.
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  Diagnosing pericardial effusion is critical for optimal patient care. Typically, clinicians use physical examination findings and historical features suggesting pericardial effusion to determine which patients require echocardiography. The diagnostic characteristics of these tools are not well described. The objective of this study is to determine the prevalence of historical features and sensitivity of clinical signs to inform clinicians when to proceed with echocardiogram.
• Acuna, J., Adhikari, S. R., & Situ-LaCasse, E. (2018). Evaluation of Gender Differences in Ultrasound Milestone Assessments during Emergency Medicine Residency Training: A Multicenter Study. AEM Education and Training.
• LaCasse, C. J., Janikashvili, N., Larmonier, C. B., Alizadeh, D., Hanke, N., Kartchner, J., Situ, E., Centuori, S., Har-Noy, M., Bonnotte, B., Katsanis, E., & Larmonier, N. (2011). Th-1 lymphocytes induce dendritic cell tumor killing activity by an IFN-γ-dependent mechanism. Journal of immunology (Baltimore, Md. : 1950), 187(12), 6310-7.
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  Dendritic cells (DCs) encompass a heterogeneous population of cells capable of orchestrating innate and adaptive immune responses. The ability of DCs to act as professional APCs has been the foundation for the development and use of these cells as vaccines in cancer immunotherapy. DCs are also endowed with the nonconventional property of directly killing tumor cells. The current study investigates the regulation of murine DC cytotoxic function by T lymphocytes. We provide evidence that CD4(+) Th-1, but not Th-2, Th-17 cells, or regulatory T cells, are capable of inducing DC cytotoxic function. IFN-γ was identified as the major factor responsible for Th-1-induced DC tumoricidal activity. Tumor cell killing mediated by Th-1-activated killer DCs was dependent on inducible NO synthase expression and NO production. Importantly, Th-1-activated killer DCs were capable of presenting the acquired Ags from the killed tumor cells to T lymphocytes in vitro or in vivo. These observations offer new possibilities for the application of killer DCs in cancer immunotherapy.
• Cantrell, J., Larmonier, C., Janikashvili, N., Bustamante, S., Fraszczak, J., Herrell, A., Lundeen, T., J LaCasse, C., Situ, E., Larmonier, N., & Katsanis, E. (2010). Signaling pathways induced by a tumor-derived vaccine in antigen presenting cells. Immunobiology, 215(7), 535-44.
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  We have previously reported on the anti-tumoral potential of a chaperone-rich cell lysate (CRCL) vaccine. Immunization with CRCL generated from tumors elicits specific T and NK cell-dependent immune responses leading to protective immunity in numerous mouse tumor models. CRCL provides both a source of tumor antigens and danger signals leading to dendritic cell activation. In humans, tumor-derived CRCL induces dendritic cell activation and CRCL-loaded dendritic cells promote the generation of cytotoxic T lymphocytes in vitro. The current study was designed to identify the signaling events and modifications triggered by CRCL in antigen presenting cells. Our results indicate that tumor-derived CRCL not only promotes the activation of dendritic cells, but also significantly fosters the function of macrophages that thus appear as major targets of this vaccine. Activation of both cell types is associated with the induction of the MAP kinase pathway, the phosphorylation of STAT1, STAT5 and AKT and with transcription factor NF-kappaB activation in vitro and in vivo. These results thus provide important insights into the mechanisms by which CRCL-based vaccines exert their adjuvant effects on antigen presenting cells.
• Larmonier, N., Cantrell, J., Lacasse, C., Li, G., Janikashvili, N., Situ, E., Sepassi, M., Andreansky, S., & Katsanis, E. (2008). Chaperone-rich tumor cell lysate-mediated activation of antigen-presenting cells resists regulatory T cell suppression. Journal of leukocyte biology, 83(4), 1049-59.
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  CD4(+)CD25(+) regulatory T lymphocytes (Tregs) critically contribute to the mechanisms of cancer-induced tolerance. These cells suppress anti-tumoral CD8(+) and CD4(+) T lymphocytes and can also restrain the function of APCs. We have previously documented the immunostimulatory effects of a chaperone-rich cell lysate (CRCL) anti-cancer vaccine. Tumor-derived CRCL induces tumor immunity in vivo, partly by promoting dendritic cell (DC) and macrophage activation. In the current study, we evaluated the effects of CD4(+)CD25(+)forkhead box P3(+) Tregs isolated from mice bearing 12B1 bcr-abl(+) leukemia on DC and macrophages that had been activated by 12B1-derived CRCL. CRCL-activated DC and macrophages resisted Treg suppression, as the production of proinflammatory cytokines, the activation of transcription factor NF-kappaB, and their immunostimulatory potential was unaffected by Tregs. Our results thus highlight CRCL as a powerful adjuvant endowed with the capacity to overcome tumor-induced Treg-inhibitory effects on APCs.
• Larmonier, N., Janikashvili, N., LaCasse, C. J., Larmonier, C. B., Cantrell, J., Situ, E., Lundeen, T., Bonnotte, B., & Katsanis, E. (2008). Imatinib mesylate inhibits CD4+ CD25+ regulatory T cell activity and enhances active immunotherapy against BCR-ABL- tumors. Journal of immunology (Baltimore, Md. : 1950), 181(10), 6955-63.
  More info

  Imatinib mesylate (Gleevec, STI571), a selective inhibitor of a restricted number of tyrosine kinases, has been effectively used for the treatment of Philadelphia chromosome-positive leukemias and gastrointestinal stromal tumors. Imatinib may also directly influence immune cells. Suppressive as well as stimulating effects of this drug on CD4(+) and CD8(+) T lymphocytes or dendritic cells have been reported. In the current study, we have investigated the influence of imatinib mesylate on CD4(+)CD25(+)FoxP3(+) regulatory T cells (Treg), a critical population of lymphocytes that contributes to peripheral tolerance. Used at concentrations achieved clinically, imatinib impaired Treg immunosuppressive function and FoxP3 expression but not production of IL-10 and TGF-beta in vitro. Imatinib significantly reduced the activation of the transcription factors STAT3 and STAT5 in Treg. Analysis of Treg TCR-induced signaling cascade indicated that imatinib inhibited phosphorylation of ZAP70 and LAT. Substantiating these observations, imatinib treatment of mice decreased Treg frequency and impaired their immunosuppressive function in vivo. Furthermore, imatinib mesylate significantly enhanced antitumor immune responses to dendritic cell-based immunization against an imatinib-resistant BCR-ABL negative lymphoma. The clinical applications of imatinib mesylate might thus be expanded with its use as a potent immunomodulatory agent targeting Treg in cancer immunotherapy.

Presentations

• Situ-LaCasse, E., Brzycki, R., Dandashi, J., Raslan, W., Arif, M. S., French, J., Garcia, J., Lee, E., Wallace, N., Demirjian, J., Lisowksi, M., Pratt, L., Cheng, V., & Adhikari, S. R. (2021). Point-of-Care Cardiac Ultrasound Findings in Emergency Department Patients Who Present with Syncope. Society for Academic Emergency Medicine Annual Meeting 2022.
• Situ-LaCasse, E., Diaz-Hanson, J., Cheng, V., Chea, I., & Adhikari, S. R. (2021). Baseline Point-of-Care Ultrasound Knowledge and Confidence of Emergency Medicine Interns: A Four-Year Study. Society for Academic Emergency Medicine Annual Meeting 2022.
• Acuna, J., Situ-LaCasse, E., & Adhikari, S. R. (2019, May). Assessment of Gender Differences in Ultrasound Milestone Evaluations in Emergency Medicine Residency Training. Society of Academic Emergency Medicine Annual Meeting. Las Vegas, NV: Society of Academic Emergency Medicine.
• Adhikari, S. R., Nuno, T., & Halasa, R. (2019, May). Comparison of thoracic ultrasound and chest X-ray in patients with traumatic pneumothorax and received tube thoracostomy. Society of Academic Emergency Medicine Regional Meeting. Napa, CA: Society of Academic Emergency Medicine.
• Huber, K., Situ-LaCasse, E., & Sanders, A. B. (2019, October). Medical Ethics Curriculum Integration: Use of Mixed Teaching Methods in Third Year Medical Student Ethics Sessions. American Society for Bioethics and Humanities Annual Meeting. Pittsburgh, Pennsylvania.
• Situ-LaCasse, E. (2019, March). Comparison of Common Bile Duct Measurement by Point-of-Care Ultrasound to Radiology-Performed Ultrasound. Western Regional Society for Academic Emergency Medicine. Napa Valley, California.
• Situ-LaCasse, E. (2019, March). Historical, Clinical, and Laboratory Features of Emergency Department Patients with Choledocholithiasis. Western Regional Society for Academic Emergency Medicine. Napa Valley, California.
• Situ-LaCasse, E. (2019, March). Medical Student Perception of Cutting-Edge Ultrasound Technology During a Gamified Education Session. Western Regional Society for Academic Emergency Medicine. Napa Valley, California.
• Situ-LaCasse, E. (2019, May). Historical, Clinical, and Laboratory Features of Emergency Department Patients with Choledocholithiasis. Society of Academic Emergency Medicine Annual Meeting. Las Vegas, NV: Society of Academic Emergency Medicine.
• Situ-LaCasse, E. (2019, October). Comparison of Common Bile Duct Measurement by Point-of-Care Ultrasound to Radiology-Performed Ultrasound. Academy of Emergency Physicians National Conference. Denver, CO.
• Adhikari, S. R., Acuna, J., Friedman, L., Patanwala, A. E., Amini, R., Situ-LaCasse, E., Stolz, L., Stolz, L., Situ-LaCasse, E., Amini, R., Friedman, L., Patanwala, A. E., Acuna, J., & Adhikari, S. R. (2018, February). Evaluation of Gender Differences in Ultrasound Milestone Assessments During Emergency Medicine Residency Training. Western Society of Academic Emergency Medicine Annual Meeting. Albuquerque, New Mexico.
• Adhikari, S. R., Friedman, L., Amini, R., Stolz, L., Situ-LaCasse, E., Patanwala, A. E., & Acuna, J. (2018, May). Evaluation of Gender Differences in Ultrasound Milestone Assessments During Emergency Medicine Residency Training. Society of Academic Emergency Medicine Annual Meeting. Indianapolis, IN.
• Lupez, K., Raper, J., Cox, C. A., Nomura, J. T., Davison, J., Ockerse, P., Esener, D. E., Fields, J. M., Situ-LaCasse, E., Adhikari, S. R., Ferre, R., Boyd, J., Queen, R., Leech, S. J., Tochiki, P., & Runyon, M. (2018, May). Baseline Predictors of Pulmonary Embolism Quality of Life Outcomes at One Month. Society of Academic Emergency Medicine Annual Meeting. Indianapolis, IN: Society of Academic Emergency Medicine.
• Lupez, K., Raper, J., Cox, C. A., Runyon, M., Weekes, A. J., Nomura, J. T., Leech, S. J., Davison, J., Queen, R., Ockerse, P., Esener, D. E., Fields, J. M., Situ-LaCasse, E., Adhikari, S. R., Ferre, R., & Boyd, J. (2018, March). Goal Directed Echo and Cardiac Biomarkers in Predicting 5-Day Clinical Deterioration from Pulmonary Embolism. American Institute of Ultrasound in Medicine Annual Meeting. New York, NY: American Institute of Ultrasound in Medicine.
• Situ-LaCasse, E., Amini, R., Bain, V., Patanwala, A. E., Samsel, K., Acuna, J., Biffar, D., Weaver, C., Valenzuela, J., Pratt, L., & Adhikari, S. R. (2018, February). Can Medical Students Perform Ultrasound-Guided Peripheral Nerve Blocks After One-Day Training Session?. Western Society of Academic Emergency Medicine Annual Meeting. Albuquerque, New Mexico.
• Situ-LaCasse, E., Guirguis, H., Patanwala, A. E., & Adhikari, S. R. (2018, February). Can Emergency Physicians Perform Extended Compression Ultrasound for the Diagnosis of Lower Extremity Deep Vein Thrombosis?. Western Society of Academic Emergency Medicine Annual Meeting. Albuquerque, New Mexico.
• Situ-LaCasse, E., Guirguis, H., Patanwala, A. E., & Adhikari, S. R. (2018, May). Can Emergency Physicians Perform Extended Compression Ultrasound for the Diagnosis of Lower Extremity Deep Vein Thrombosis?. Society of Academic Emergency Medicine Annual Meeting. Indianapolis, IN: Society of Academic Emergency Medicine.
• Situ-LaCasse, E., Huynh, D., Acuna, J., Patanwala, A. E., Diffar, D., Irving, S., Samsel, K., & Adhikari, S. R. (2018, March). Can Ultrasound Naïve First-Year Medical Students Develop Hands-On Skills in Image Acquisition After Reviewing Online Ultrasound Modules?. American Institute of Ultrasound in Medicine Annual Meeting. New York, New York.
• Stolz, L. A., Situ-LaCasse, E., Acuna, J., Irving, S., Amini, R., Friedman, L., Fiorello, A. B., Stea, N., Fan, H., & Adhikari, S. R. (2018, May). Multimodular Ultrasound Orientation: Residents’ Confidence and Skill in Performing Point-of-care Ultrasound. Society of Academic Emergency Medicine Annual Meeting. Indianapolis, IN: Society of Academic Emergency Medicine.
• Fisher, J., Viscusi, R. K., Ratesic, A., Johnsone, C., Kelley, R., Bates, J., Situ-LaCasse, E., Adamas-Rappaport, W., & Amini, R. (2017, February). Clinical Skills Temporal Degradation Assessment in Undergraduate Medical Education. Western Group on Educational Affairs. Salt Lake City, Utah.
• Fisher, J., Viscusi, R. K., Ratesic, A., Johnsone, C., Kelley, R., Bates, J., Situ-LaCasse, E., Adamas-Rappaport, W., & Amini, R. (2017, March). Clinical Skills Temporal Degradation Assessment in Undergraduate Medical Education. American Institute of Ultrasound in Medicine Annual Meeting. Orlando, Florida.
• Stolz, L., Valenzuela, J., Situ-LaCasse, E., Stolz, U., Hawbaker, N., Thompson, M., & Adhikari, S. R. (2016, April). Clinical and Historical Features of Emergency Department Patients with Pericardial Effusions. Arizona Emergency Medicine Research Resident Forum. Tucson, Arizona.
• Situ-LaCasse, E., Vander Werf, B., Habib, N., Rice, A., Smith, N., Huebner, K., & Panchal, A. R. (2011, June). Effects of advertising and venue choice on attendance at public compression only CPR instruction. Society for Academic Emergency Medicine 2011 Annual Meeting. Boston, Massachusetts.
• Situ-LaCasse, E., Katsanis, E., & Larmonier, N. (2010, January). Influence of Imatinib Mesylate on bone marrow-derived dendritic cells. American Federation for Medical Research and Participating Societies: Western Regional Meeting. Carmel, California.
• LaCasse, C., Janikashvili, N., Cantrell, J., Larmonier, C., Situ, E., Li, G., Larmonier, N., & Katsanis, E. (2008, March). Suppression of CD4+CD25+ regulatory T cells by imatinib mesylate. Third Annual Frontiers in Immunobiology and Immunopathogenesis Symposium 2008. Oro Valley, Arizona.

Poster Presentations

• Amini, R., Situ-LaCasse, E. H., Bradshaw, H. R., Stea, N., Medina, T., Williams, C., Berkman, M. R., Ng, V., Min Simpkins, A. A., Plitt, J., Tolby, N., & Keim, S. M. (2023). Emergency Medicine Advising Program 2.0: An Innovative Approach to Medical Student Advising. Association of American Medical Colleges Learn Serve Lead. Seattle, Washington.
• Situ-LaCasse, E. H., Lee, E., Haidar, D., Brzycki, R., Mott, B., & Adhikari, S. (2023). Point-of-Care Ultrasound Evaluation of Peritonsillar Abscesses in the Emergency Department. SAEM Annual Meeting 2023.
• Shirazi, F., Situ-LaCasse, E., Acuna, J., & Adhikari, S. R. (2020, October/Fall). Point-of-care Ultrasound in the Evaluation of Rattlesnake Envenomation. ACEP Research forum.
• Huber, K., Situ-LaCasse, E., & Sanders, A. B. (2019, April). Medical Ethics Curriculum Integration: Use of Mixed Teaching Methods in Third Year Medical Student Ethics Sessions. University of Arizona College of Medicine Medical Education Research Day. Tucson, AZ.
• Situ-LaCasse, E., & Adhikari, S. R. (2019, May). Emergency Medicine Residents’ Perception of Virtual Reality Ultrasound Systems. Society of Academic Emergency Medicine Annual Meeting. Las Vegas, NV: Society of Academic Emergency Medicine.
• Situ-LaCasse, E., Sandoval, L., Sandoval, M., & Adhikari, S. R. (2018, March). Baseline Point-of-Care Ultrasound Knowledge and Confidence of First-Year Emergency Medicine Residents. American Institute of Ultrasound in Medicine Annual Meeting. New York, New York.
• Acuna, J., Irving, S., Situ-LaCasse, E., & Adhikari, S. R. (2017, March). Point-of-Care Ultrasound Identification of the Yolk Stalk Sign in a Case of Failed First Trimester Pregnancy. American Institute of Ultrasound in Medicine Annual Convention. Orlando, FL.
• Adhikari, S. R., Situ-LaCasse, E., Acuna, J., Friedman, L., Tay, E., Tsung, J., & Blaivas, M. (2017, October). Accuracy of point-of-care ultrasound for the diagnosis of scrotal pathology in the emergency department. American College of Emergency Medicine National Meeting. District of Columbia.
• Friedman, L., Situ-LaCasse, E., Acuna, J., Irving, S., & Adhikari, S. R. (2017, March). Point-of-Care Ultrasound Diagnosis of Imperforate Hymen in Pediatric Abdominal Pain. American Institute of Ultrasound in Medicine Annual Meeting. Orlando, Florida.
• Situ-LaCasse, E., Acuna, J., Irving, S., & Adhikari, S. R. (2017, March). Point-of-care ultrasound in the diagnosis of subglottic stenosis and epiglottitis: The tale of two airways. American Institute of Ultrasound in Medicine Annual Meeting. Orlando, Florida.
• Situ-LaCasse, E., Grieger, R., & Adhikari, S. R. (2017, March). Utility of Point-of-care Musculoskeletal Ultrasound in The Evaluation of Emergency Department Musculoskeletal Pathology. American Institute of Ultrasound in Medicine Annual Meeting. Orlando, Florida.
• Situ-LaCasse, E., Grieger, R., Lakshmanan, R., Friedman, L., & Adhikari, S. R. (2017, April). Utility of Point-of-care Musculoskeletal Ultrasound in The Evaluation of Emergency Department Musculoskeletal Pathology. Western Society of Academic Emergency Medicine Annual Meeting. Palo Alto, California.
• LaCasse, C., Janikashvili, N., Cantrell, J., Larmonier, C., Situ, E., Li, G., Larmonier, N., & Katsanis, E. (2008, March). Evaluation of Tumor Necrosis Factor-Related Apoptosis Inducing Ligand (TRAIL) effects of human CD4+CD25+ regulatory T cells. Third Annual Frontiers in Immunobiology and Immunopathogenesis Symposium 2008. Tucson, Arizona.
• Situ, E., Merino, D., Janikashvili, N., Katsanis, E., & Larmonier, N. (2008, March). Evaluation of Tumor Necrosis Factor-Related Apoptosis Inducing Ligand (TRAIL) effects of human CD4+CD25+ regulatory T cells. 2008 Arizona Health Sciences Center Frontiers in Biomedical Research Poster Forum. Tucson, Arizona.

Creative Productions

• Situ-LaCasse, E. (2020. Approach to Elderly Abdominal Pain. AZEMcast PodcastAZEMcast Podcast.
• Situ-LaCasse, E. (2020. Point-of-Care Ultrasound in Emergency Medicine. National Foundation of Emergency Medicine's Paradigm Shift PodcastNational Foundation of Emergency Medicine.

Other Teaching Materials

• Situ-LaCasse, E., & Adhikari, S. R. (2018. SonoGuide: Ocular Emergencies. American College of Emergency Physicians.

Others

• Situ-LaCasse, E., & Adhikari, S. R. (2017, August). Special Contribution: Response to "Who should read point-of-care ED ultrasound exams?" as written by EL Ridley in Auntminnie.com. ACEP Emergency Ultrasound Section Newsletter.
• Situ-LaCasse, E., & Ng, V. (2016, March). GI Toxins. Pepid Emergency Medicine Suite.
• Situ-LaCasse, E., & Ng, V. (2016, March). Scalp Lacerations. Pepid Emergency Medicine Suite.