Richard Amini

Interests

Research

Evidence Based Medicine Assessment in Undergraduate Medical EducationOptic Nerve Sheath MeasurementsPoint of Care UltrasoundUltrasound Education in Undergraduate Medical EducationUltrasound Milestones Education and Assessment

Teaching

Evidence Based MedicinePatient EducationPoint of Care Ultrasound

Courses

Scholarly Contributions

Chapters

• Amini, R., & Javedani, P. P. (2020). Ultrasound-Guided Ear, Nose, and Throat Procedures. In The Ultimate Guide to Point-of-Care Ultrasound-Guided Procedures. Springer, Cham. doi:10.1007/978-3-030-28267-7_7
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  Head and neck procedures are often performed in the acute care settings. Historically, anatomical landmarks have guided physicians as they determine accurate location and approach when performing these procedures. Due to anatomical variations, landmark-guided techniques lead to considerable variability in both success and complication rates. In recent years, ultrasound is increasingly being used at the bedside by clinicians. Ultrasound can be extremely useful in identifying relevant anatomy and thus facilitating various head and neck procedures in the acute care settings. Furthermore, because the regions of the face and neck are relatively shallow, high-frequency and high-resolution ultrasound probes can be used to provide significant detail of the anatomy in question. The use of ultrasound guidance for procedures has been demonstrated to decrease complications and improve patient safety and satisfaction. A thorough understanding of the basic principles of ultrasound, sonographic anatomy, and manual dexterity skills is essential in the use of ultrasound for procedural guidance.

Journals/Publications

• Goldsmith, A. J., Brown, J., Duggan, N. M., Finkelberg, T., Jowkar, N., Stegeman, J., Riscinti, M., Nagdev, A., & Amini, R. (2024). Ultrasound-guided nerve blocks in emergency medicine practice: 2022 updates. The American journal of emergency medicine, 78, 112-119.
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  In the Emergency Department (ED), ultrasound-guided nerve blocks (UGNBs) have become a cornerstone of multimodal pain regimens. We investigated current national practices of UGNBs across academic medical center EDs, and how these trends have changed over time.
• 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.
• 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.
• Amini, R., Patanwala, A. E., Shokoohi, H., & Adhikari, S. (2021). Number Needed to Scan: Evidence-Based Point-of-Care Ultrasound (POCUS). Cureus, 13(8), e17278.
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  Interest and enthusiasm, regarding the use of point-of-care ultrasound (POCUS), continues to grow among clinicians in multiple medical specialties. Ultrasound machines technology has advanced to allow for smaller, even handheld machines. Integration of automated imaging technology has made these machines more user-friendly. However, one of the concerns with the widespread availability of POCUS is the overuse and misuse of this technology. In order to maximize the clinical impact of POCUS, this manuscript seeks to discuss a novel concept called the "Number needed to scan" (NNS). The NNS is an expression of the number of POCUS examinations needed to be performed to attain a benefit to the patient or to prevent an adverse outcome of a procedure. NNS serves a dual purpose: it can help clinicians understand the magnitude of clinical impact when they apply POCUS, and it can help clinicians explain this magnitude in layman terms to their patients. In this manuscript, we have focused our NNS calculations on landmark articles in three major categories: change in management; safety and accuracy; and catching a missed diagnosis. As clinicians seek to be good stewards of POCUS, NNS should be a concept used to consider which patients will be most likely to benefit from a clinician performed ultrasound.
• Situ-LaCasse, E., Acuña, J., Huynh, D., Amini, R., Irving, S., Samsel, K., Patanwala, A. E., Biffar, D. E., & Adhikari, S. (2021). Can ultrasound novices develop image acquisition skills after reviewing online ultrasound modules?. BMC medical education, 21(1), 175.
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  Point-of-care ultrasound is becoming a ubiquitous diagnostic tool, and there has been increasing interest to teach novice practitioners. One of the challenges is the scarcity of qualified instructors, and with COVID-19, another challenge is the difficulty with social distancing between learners and educators. The purpose of our study was to determine if ultrasound-naïve operators can learn ultrasound techniques and develop the psychomotor skills to acquire ultrasound images after reviewing SonoSim® online modules.
• Smith, K. W., Amini, R., Banerjee, M., & Clemens, C. J. (2021). The Feasibility of Blinding Residency Programs to USMLE Step 1 Scores During GME Application, Interview, and Match Processes. Journal of graduate medical education, 13(2), 276-280.
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  With the recent announcement that Step 1 score reporting will soon change to pass/fail, residency programs will need to reconsider their recruitment processes.
• Smith, K. W., Clemens, C. J., Banerjee, M., & Amini, R. (2021). The Feasibility of Blinding Residency Programs to USMLE Step 1 Scores During GME Application, Interview, and Match Processes. Journal of Graduate Medical Education. doi:10.4300/jgme-d-20-00653.1
• 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.
• Blaivas, M., Shokoohi, H., Duggan, N. M., Amini, R., Selame, L. A., Adhikari, S. R., Selame, L. A., Adhikari, S. R., Duggan, N. M., Amini, R., Shokoohi, H., & Blaivas, M. (2020). Point‐of‐care ultrasound stewardship. Journal of the American College of Emergency Physicians, ePub ahead of Print. doi:https://doi.org/10.1002/emp2.12279
• Shokoohi, H., Duggan, N. M., Adhikari, S., Selame, L. A., Amini, R., & Blaivas, M. (2020). Point-of-care ultrasound stewardship. Journal of the American College of Emergency Physicians open, 1(6), 1326-1331.
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  Rapid adoption and widespread use of point-of-care ultrasound (POCUS) has impacted diagnostic testing and clinical care across medical disciplines. The benefits of POCUS must be weighed against certain pitfalls, such as the risk of misdiagnosis and false assurance. Beyond technical error in image acquisition and interpretation, an important pitfall is reliance on POCUS results without considering pre-test patient characteristics or the diagnostic accuracy of POCUS in varying clinical contexts. In this article, we introduce the concept of POCUS stewardship that emphasizes critical evaluation of clinical indications prior to performing POCUS as well as the individual patient and test characteristics of POCUS when integrating results into clinical decisionmaking. Adherence to these principles can lead to optimized POCUS application and improved patient care.
• Valenzuela, J., Stilson, B., Patanwala, A. E., Amini, R., & Adhikari, S. (2020). Prevalence, documentation, and communication of incidental findings in focused assessment with sonography for trauma (FAST) examinations.. The American journal of emergency medicine, 38(7), 1414-1418. doi:10.1016/j.ajem.2019.11.040
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  As the focused assessment with sonography for trauma (FAST) examination becomes increasingly ubiquitous in the emergency department (ED), a parallel increase in incidental findings can also be expected. The purpose of this study was to determine the prevalence, documentation, and communication of incidental findings on emergency physician-performed FAST examinations..Retrospective review at two academic EDs. Adult trauma patients undergoing FAST examinations used for clinical decision-making at the bedside were identified from an ED ultrasound image archival system. Expert sonologists reviewed ultrasound images for incidental findings, as well as electronic medical records for demographic information, mechanism of injury, type of incidental findings, documentation of incidental findings, and communication of incidental findings to the patient..A total of 1,452 FAST examinations were reviewed. One hundred and thirty-seven patients with incidental findings were identified (9.4%); 7 patients had an additional incidental finding. Renal cysts were most common (49/144, 34.0%), followed by pelvic cysts in women (32/144, 22.2%). While 31/144 (21.5%) incidental findings were identified and documented in the ultrasound reports or medical records by ED providers, only 6/137 (4.4%) patients were noted to be informed of their incidental findings..Incidental findings were often encountered in FAST examinations, with cysts of the kidneys and pelvis being the most common findings. A vast majority of incidental findings were not documented or noted to be communicated to patients, which can be a barrier to follow-up care.
• Yarnish, A., Wilson, B., Stea, N., Situ-lacasse, E., Shirazi, M., Effron, Z., Bach, M., Amini, R., Adhikari, S., & Acuna, J. (2020). 353 Point-of-Care Ultrasound in the Evaluation of Rattlesnake Envenomation. Annals of Emergency Medicine, 76(4). doi:10.1016/j.annemergmed.2020.09.369
• 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.
• Amini, R., Situ-LaCasse, E. H., Acuña, J., Theodoro, D., Blaivas, M., Tayal, V., & Adhikari, S. (2019). Impact of Point-of-Care Ultrasound in Critically Ill Patients: Flawed Data and Wrong Conclusions. Critical care explorations, 1(9), e0042.
• Camacho, L. D., Stearns, J., & Amini, R. (2019). Management of Trazodone Overdose with Severe Hypotension. Case reports in emergency medicine, 2019, 2470592.
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  Trazodone is a medication that possesses antidepressant, anxiolytic, and hypnotic properties. Its mechanism of action includes blockade of serotonin type 2 receptors, weak inhibition of serotonin reuptake, blockade of histamine 1 receptors, and blockade of alpha-1-adrenergic receptors. We present a case of intentional ingestion of an estimated 2500 mg of trazodone leading to persistent hypotension, requiring aggressive fluid resuscitation, pressor support, and intensive care unit admission. Complications associated with trazodone overdoses are significant and clinicians should be aware of the associated symptoms and necessary management plans necessary for such ingestions.
• Rodriguez, C. E., Shah, R. J., Smith, C., Gay, C. J., Alvarado, J., Rappaport, D., Adamas-Rappaport, W. J., & Amini, R. (2019). Students Teaching Students: A Novel Solution for Teaching Procedures via Instruction on the Corpse. Journal of advances in medical education & professionalism, 7(2), 51-55.
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  Increased faculty and resident responsibilities have led to the decreased time available for teaching clinical skills to medical students. Numerous advances in education and simulation have attempted to obviate this problem; however, documented success is lacking. Our objective was to describe a novel fresh cadaver-based, student-driven procedural skills lab and to compare the educational effectiveness of student instructors to the senior instructor (SI).
• 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.
• Valenzuela, J., Stearns, J., Situ-lacasse, E. H., Ringleberg, J. K., Patanwala, A. E., Camacho, L. D., Amini, R., Adhikari, S., & Acuna, J. (2019). Cadaver Models in Residency Training for Uncommonly Encountered Ultrasound-Guided Procedures.. Journal of medical education and curricular development, 6, 2382120519885638. doi:10.1177/2382120519885638
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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..The objective of this study was to create, implement, and assess a fresh cadaver-based educational model to help resident physicians learn how to perform ultrasound-guided arthrocentesis of the ankle and elbow and ultrasound-guided regional nerve blocks..This was a single-center cross-sectional study conducted at an academic medical center. After a brief didactic session, 26 emergency medicine residents with varying levels of clinical and ultrasound experience rotated through 4 fresh cadaver-based stations. The objective of each station was to understand the sonographic anatomy and to perform ultrasound-guided arthrocentesis or regional nerve block with hands-on feedback from ultrasound fellows and faculty. Participants were subsequently asked to complete a questionnaire which evaluated participants' experience level, opinions, and procedural confidence regarding the 4 stations..A total of 26 residents participated in this study. All 26 residents agreed that the cadaver model (compared with clinical anatomy) was realistic regarding ultrasound quality of the joint space, ultrasound quality of the joint effusion, ultrasound quality of nerves, tissue density, needle guidance, and artifacts. Finally, there was a statistically significant difference between mean scores for pre-simulation and post-simulation session participant procedural confidence for all 4 procedures..This fresh cadaver-based ultrasound-guided educational model was an engaging and well-received opportunity for residents to gain proficiency and statistically significant confidence in procedures which are uncommonly performed in clinical settings.
• Valenzuela, J., Stilson, B., Patanwala, A., Amini, R., & Adhikari, S. (2019). Prevalence, documentation, and communication of incidental findings in focused assessment with sonography for trauma (FAST) examinations. The American journal of emergency medicine.
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  As the focused assessment with sonography for trauma (FAST) examination becomes increasingly ubiquitous in the emergency department (ED), a parallel increase in incidental findings can also be expected. The purpose of this study was to determine the prevalence, documentation, and communication of incidental findings on emergency physician-performed FAST examinations.
• 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.
• 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.
• Amini, R., Baker, N., Woolridge, D. P., Echeverria, A. B., Amini, A., & Adhikari, S. (2018). Emergency department diagnosis of an ovarian inguinal hernia in an 11-year-old female using point-of-care ultrasound. World journal of emergency medicine, 9(4), 291-293.
• Amini, R., Laughlin, B. S., Smith, K. W., Siwik, V. P., Adamas-Rappaport, W. J., & Fantry, G. T. (2018). "Flipped classroom" for academic and career advising: an innovative technique for medical student advising. Advances in medical education and practice, 371-376.
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  Career advising for medical students can be challenging for both the student and the adviser. Our objective was to design, implement, and evaluate a "flipped classroom" style advising session.
• 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.
• Paulino, L., Hamblin, D. J., Osondu, N., & Amini, R. (2018). Variants of Erythema Multiforme: A Case Report and Literature Review. Cureus, 10(10), e3459.
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  Erythema multiforme is an acute skin condition characterized by targetoid lesions and occurs most frequently in young adults, particularly males. There are two variants of this condition, one with mucosal involvement, termed erythema multiforme major, and one without mucosal involvement, known as erythema multiforme minor. Due to the similarities in clinical and histological findings, it was previously believed that erythema multiforme major was indistinguishable from Steven-Johnson syndrome (SJS). However, evidence suggests these are two distinct diseases with a different etiology. It is important for clinicians to readily identify the difference between erythema multiforme from SJS, as the prognosis and mortality rate vary significantly between the two disorders.
• Stolz, L. A., Amini, R., Situ-LaCasse, E., Acuna, J., Irving, S., Friedman, L., Fiorello, A. B., Stea, N., Fan, H., Adhikari, S. R., Stolz, L. A., Amini, R., Situ-LaCasse, E., Acuna, J., Irving, S., Friedman, L., Fiorello, A. B., Stea, N., Fan, H., & 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.
• Ahmad, F. A., White, A. J., Hiller, K. M., Amini, R., & Jeffe, D. B. (2017). An assessment of residents' and fellows' personal finance literacy: an unmet medical education need. International journal of medical education, 8, 192-204.
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  This study aimed to assess residents' and fellows' knowledge of finance principles that may affect their personal financial health.
• Amini, R., Patanwala, A. E., & Adhikari, S. (2017). The Risks and Benefits of Treating Isolated Calf Deep Vein Thrombosis: Terms To Discuss With Your Patient. JAMA surgery, 152(6), 605-606.
• Amini, R., Stolz, L., Patanwala, A., & Adhikari, S. (2017). Reply. Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine, 36(5), 1073-1074.
• Amini, R., Wang, J. B., Trueger, N. S., Hoyer, R., & Adhikari, S. (2017). Use of Social Media in Emergency Ultrasound Fellowship Programs. AEM education and training, 1(1), 27-33.
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  Social media has been gaining traction among learners and educators for its ability to stimulate discussion, increase participation, and promote knowledge sharing. Despite the growing research around the benefits of social media in education, there is little evidence on how it is being incorporated into emergency ultrasound (EUS) fellowships. This study aims to determine the preference and use of social media by engaging with program directors across EUS programs in the United States to assess the current landscape of and attitudes toward social media use.
• Amini, R., Wyman, M. T., Hernandez, N. C., Guisto, J. A., & Adhikari, S. (2017). Use of Emergency Ultrasound in Arizona Community Emergency Departments. Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine.
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  Despite the increased educational exposure to point-of-care ultrasound (US) at all levels of medical training, there are utilization gaps between academic and nonacademic emergency department (ED) settings. The purpose of this study was to assess the current practices and potential barriers to the use of point-of-care US in nonacademic EDs throughout the state of Arizona.
• Amukele, T. K., Hernandez, J., Snozek, C. L., Wyatt, R. G., Douglas, M., Amini, R., & Street, J. (2017). Drone Transport of Chemistry and Hematology Samples Over Long Distances. American journal of clinical pathology, 148(5), 427-435.
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  We addressed the stability of biological samples in prolonged drone flights by obtaining paired chemistry and hematology samples from 21 adult volunteers in a single phlebotomy event-84 samples total.
• Ashby, P. F., Alfafara, C., Amini, A., & Amini, R. (2017). Spontaneous Rupture of a Hepatic Adenoma: Diagnostic Nuances and the Necessity of Followup. Cureus, 9(12), e1975.
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  We present the case of a young female on oral contraceptives (OCs) who was diagnosed with focal nodular hyperplasia (FNH) and remained on oral contraceptives. Months later, the patient presented with acute abdominal pain and intratumoral hemorrhage in the liver. The patient was taken to the operating room (OR) and was diagnosed with a ruptured hepatic adenoma (HA). We review the key diagnostic features of FNH and HA, the different management guidelines including use of OCs, and potential surgical indications. HA compared to FNH has a significantly higher rate of sequelae despite being a benign lesion, thus providers must accurately distinguish between the two diagnoses to prevent potential morbidity and mortality.
• Baker, N., Amini, R., Situ-LaCasse, E. H., Acuña, J., Nuño, T., Stolz, U., & Adhikari, S. (2017). 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.
• Ellis, M. S., Nelson, J. T., Kartchner, J. Z., Yousef, K. A., Adamas-Rappaport, W. J., & Amini, R. (2017). Cadaver-based abscess model for medical training. Advances in medical education and practice, 8, 85-88.
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  Ultrasound imaging is a rapid and noninvasive tool ideal for the imaging of soft tissue infections and is associated with a change of clinician management plans in 50% of cases. We developed a realistic skin abscess diagnostic and therapeutic training model using fresh frozen cadavers and common, affordable materials. Details for construction of the model and suggested variations are presented. This cadaver-based abscess model produces high-quality sonographic images with internal echogenicity similar to a true clinical abscess, and is ideal for teaching sonographic diagnostic skills in addition to the technical skills of incision and drainage or needle aspiration.
• Higa, K., Irving, S., Cervantes, R. J., Pangilinan, J., Slykhouse, L. R., Woolridge, D. P., & Amini, R. (2017). The Case of an Obstructed Stone at the Distal Urethra. Cureus, 9(12), e1974.
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  This report highlights a presentation of urinary calculus impacted at the urethral meatus and bedside extraction after evaluation with point-of-care ultrasound (POCUS). Visualization of a stone at the urethral meatus prompted a point-of-care ultrasound of the penile shaft and glans. The ultrasound ruled out anatomic variations such as urethral diverticula and as a result bedside removal was expedited. The stone was successfully removed with traction and intraurethral lidocaine gel without urethral lesions or injury to the meatus. Bedside ultrasound is readily available in the emergency department and can be used to characterize urethral foreign bodies, evaluate urethral anatomy, and assess the likelihood of bedside removal.
• Khan, S. J., Desmarais, A. M., Joseph, B., & Amini, R. (2017). A Rare Case of Adult Onset Intussusception Complicated By Narcotic Dependence. Cureus, 9(1), e964.
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  This report describes a rare case of adult intussusception in a patient with a history of a Roux-en-Y gastric bypass procedure; complicated by a history of narcotic abuse, methadone dependence, and methamphetamine abuse. Adult patients who have undergone a Roux-en-Y gastric bypass procedure may be at an increased risk of developing intussusception, and clinicians involved in their care should be aware of this potential complication.
• Means, R., Cabrera, J., Moreno, X., & Amini, R. (2017). Remote South American Snakebite with Extensive Myonecrosis. Clinical practice and cases in emergency medicine, 1(1), 47-49.
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  This report describes a patient envenomated by a , common fer-de-lance viper, in the remote rainforest of eastern Ecuador and without access to definitive care for seven days. Antivenom was not administered; by the time of presentation to a hospital, he had suffered myonecrosis of his lower leg, which was treated with debridement and eventual skin graft. The ramifications of this long evacuation demonstrate the need for more accessible health services and educational outreach.
• Milligan, R., Houmes, S., Goldberg, L. C., Nagdev, A., & Amini, R. (2017). Ultrasound-guided forearm nerve blocks in managing hand and finger injuries. Internal and emergency medicine, 12(3), 381-385.
• Minckler, M. R., Conser, E., Figueroa, J. J., Scott, A. J., Gaither, J., & Amini, R. (2017). The Semantics of Priapism and the First Sign of Chronic Myeloid Leukemia. Case reports in emergency medicine, 2017, 2656203.
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  Priapism is defined as an erection that persists beyond four hours, lasting beyond or unrelated to sexual stimulation (Salonia et al., 2014). Because the risk of ischemic damage and impotence is high with priapism (35%), management guidelines are directed towards rapid treatment of this condition (Salonia et al., 2014). This report describes the rare case of an 18-year-old male who presented to the Emergency Department (ED) three times with recurrent and worsening episodes of sustained penile erections. On the patient's third visit, he presented with priapism of greater than six-hour duration that was found to be the result of chronic myeloid leukemia. Clinician awareness of the diagnostic semantics and differential diagnosis surrounding priapism is pivotal in its urgent management.
• Minckler, M. R., Fisher, J., Bowers, R., & Amini, R. (2017). Unusual etiology of gastrointestinal symptoms: the case of jojoba butter. Open access emergency medicine : OAEM, 9, 27-29.
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  Jojoba butter is cyanogenic and has gained attention among herbal supplement consumers due to claims that it may aid in weight loss. Jojoba butter is extracted from the seeds of jojoba shrubs found in the Sonoran Desert. The seeds have long been recognized as inedible, however clinical symptoms following ingestion are not well documented.
• Mohty, K. M., Cravens, M. G., Adamas-Rappaport, W. J., Amini-Shervin, B., Irving, S. C., Stea, N., Adhikari, S., & Amini, R. (2017). Cadaver-based Necrotizing Fasciitis Model for Medical Training. Cureus, 9(4), e1168.
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  Necrotizing fasciitis is a devastating infectious disease process that is characterized by extensive soft tissue necrosis along deep fascial planes, systemic toxicity, and high mortality. Ultrasound imaging is a rapid and non-invasive tool that can be used to help make the diagnosis of necrotizing fasciitis by identifying several distinctive sonographic findings. The purpose of this study is to describe the construction of a realistic diagnostic training model for necrotizing fasciitis using fresh frozen cadavers and common, affordable materials. Presently, fresh non-embalmed cadavers have been used at medical institutions for various educational sessions including cadaver-based ultrasound training sessions. Details for the preparation and construction of a necrotizing fasciitis cadaver model are presented here. This paper shows that the images obtained from the cadaver model closely imitate the ultrasound appearance of fluid and gas seen in actual clinical cases of necrotizing fasciitis. Therefore, it can be concluded that this cadaver-based model produces high-quality sonographic images that simulate those found in true cases of necrotizing fasciitis and is ideal for demonstrating the sonographic findings of necrotizing fasciitis.
• 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.
• Yee, A. M., Christensen, D. N., Waterbrook, A. L., & Amini, R. (2017). Parapharyngeal abscess with tracheal deviation. Internal and emergency medicine, 12(7), 1077-1078.
• Yee, A. M., Etebari, C. V., Adhikari, S., & Amini, R. (2017). Point of Care Ultrasound Diagnosis of a Massive Thoracoabdominal Aortic Aneurysm. Cureus, 9(8), e1611.
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  This report highlights an atypical presentation of extensive thoracoabdominal aortic aneurysm with intramural hematoma and transient paralysis of the lower extremities. Clinical suspicion for aortic pathology prompted a point of care ultrasound of the heart and aorta, which demonstrated a thoracic and abdominal aortic aneurysm with intraluminal pathology. Consultation and transfer to a tertiary care facility was based solely on the emergency physician's ultrasound. Subsequent computed tomography (CT) imaging confirmed the ultrasound findings and discovered a left common iliac artery thrombosis consistent with the patient's presentation. Point of care ultrasound can help clinicians diagnose aortic pathology and direct patient care efficiently and effectively.
• Yousef, K. A., Goshinska, A. J., Bailowitz, Z. P., & Amini, R. (2017). Cactus thorn detection using bedside ultrasound.. Internal and emergency medicine, 12(4), 545-546. doi:10.1007/s11739-016-1515-6
• Amini, R., Amini, A., Hollinger, P., Rhodes, S. M., & Schmier, C. (2016). Emergency department diagnosis of a concealed pleurocutaneous fistula in a 78-year-old man using point-of-care ultrasound. World journal of emergency medicine, 7(4), 307-309.
• Amini, R., Patricia Javedani, P., Amini, A., & Adhikari, S. (2016). Ultrasound-Guided Forearm Nerve Blocks: A Novel Application for Pain Control in Adult Patients with Digit Injuries. Case reports in emergency medicine, 2016, 2518596.
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  Phalanx fractures and interphalangeal joint dislocations commonly present to the emergency department. Although these orthopedic injuries are not complex, the four-point digital block used for anesthesia during the reduction can be painful. Additionally, cases requiring prolonged manipulation or consultation for adequate reduction may require repeat blockade. This case series reports four patients presenting after mechanical injuries resulting in phalanx fracture or interphalangeal joint dislocations. These patients received an ultrasound-guided peripheral nerve block of the forearm with successful subsequent reduction. To our knowledge, use of ultrasound-guided peripheral nerve blocks of the forearm for anesthesia in reduction of upper extremity digit injuries in adult patients in the emergency department setting has not been described before.
• Amini, R., Stolz, L. A., Breshears, E., Patanwala, A. E., Stea, N., Hawbaker, N., Thompson, M., Sanders, A. B., & Adhikari, S. (2016). Assessment of ultrasound-guided procedures in preclinical years. Internal and emergency medicine.
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  Medical graduates entering residency often lack confidence and competence in procedural skills. Implementation of ultrasound (US)-guided procedures into undergraduate medical education is a logical step to addressing medical student procedural competency. The objective of our study was to determine the impact of an US teaching workshop geared toward training medical students in how to perform three distinct US-guided procedures. Cross-sectional study at an urban academic medical center. Following a 1-h didactic session, a sample of 11 students out of 105 (10.5 %) were asked to perform three procedures each (total 33 procedures) to establish a baseline of procedural proficiency. Following a 1-h didactic session, students were asked to perform 33 procedures using needle guidance with ultrasound to establish a baseline of student proficiency. Also, a baseline survey regarding student opinions, self-assessment of skills, and US procedure knowledge was administered before and after the educational intervention. After the educational workshop, students' procedural competency was assessed by trained ultrasound clinicians. One-hundred-and-five third-year medical students participated in this study. The average score for the knowledge-based test improved from 46 % (SD 16 %) to 74 % (SD 14 %) (p 
• Amini, R., Stolz, L. A., Hernandez, N. C., Gaskin, K., Baker, N., Sanders, A. B., & Adhikari, S. (2016). Sonography and hypotension: a change to critical problem solving in undergraduate medical education. Advances in medical education and practice, 7, 7-13.
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  Multiple curricula have been designed to teach medical students the basics of ultrasound; however, few focus on critical problem-solving. The objective of this study is to determine whether a theme-based ultrasound teaching session, dedicated to the use of ultrasound in the management of the hypotensive patient, can impact medical students' ultrasound education and provide critical problem-solving exercises.
• Amini, R., Stolz, L. A., Javedani, P. P., Gaskin, K., Baker, N., Ng, V., & Adhikari, S. (2016). Point-of-care echocardiography in simulation-based education and assessment. Advances in medical education and practice, 7, 325-8.
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  Emergency medicine milestones released by the Accreditation Council for Graduate Medical Education require residents to demonstrate competency in bedside ultrasound (US). The acquisition of these skills necessitates a combination of exposure to clinical pathology, hands-on US training, and feedback.
• Amini, R., Stolz, L. A., Javedani, P. P., Gaskin, K., Baker, N., Ng, V., & Adhikari, S. R. (2016). Point-of-Care Echocardiography in Simulation Education and Assessment. Advances in Medical Education and Practice, 7, 325-8.
• Amini, R., Stolz, L. A., Kartchner, J. Z., Thompson, M., Stea, N., Hawbaker, N., Joshi, R., & Adhikari, S. (2016). Bedside echo for chest pain: an algorithm for education and assessment. Advances in medical education and practice, 7, 293-300.
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  Goal-directed ultrasound protocols have been developed to facilitate efficiency, throughput, and patient care. Hands-on instruction and training workshops have been shown to positively impact ultrasound training.
• Dandorf, S. J., Bradley, J. J., Gaither, J. B., & Amini, R. (2016). Edematous face. Internal and emergency medicine.
• Gordon, P. R., Keim, S. M., Hernandez, N. C., Gordon, P. R., & Amini, R. (2016). Using standardized patients to evaluate medical students' evidence-based medicine skills.. Journal of evidence-based medicine, 9(1), 38-42. doi:10.1111/jebm.12183
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  To analyze the effectiveness of an Evidence Based Medicine Objective Structured Clinical Examination (EBM OSCE) with standardized patients for end of third year medical students at our institution..This was a single-center prospective cross-sectional investigation. As part of the eight-station OSCE exam, the authors developed and implemented a new 25-minute EBM OSCE station with the goal of evaluating evidence based medicine skills necessary for daily clinical encounters. The OSCE case involved a highly educated patient with a history of recurrent debilitating migraines who has brought eight specific questions regarding the use of steroids for migraine headaches. Students were provided computer stations equipped to record a log of the searches performed..One hundred and four third-year medical students participated in this study. The average number of search tools used by the students was 4 (SD = 2). The 104 students performed a total of 896 searches. The two most commonly used websites were uptodate.com and google.com. Sixty-nine percent (95% CI, 60% to 78%) of students were able to find a meta-analysis regarding the use of dexamethasone for the prevention of rebound migraines. Fifty-two percent of students were able to explain that patients who took dexamethasone had a moderate RR (0.68 to 0.78) of having a recurrent migraine, and 71% of students were able to explain to the standardized patient that the NNT for dexamethasone was nine..The EBM OSCE was successfully integrated into the existing eight-station OSCE and was able to assess student EBM skills.
• Hoyer, R., Adhikari, S., & Amini, R. (2016). Ultrasound transducer disinfection in emergency medicine practice. Antimicrobial resistance and infection control, 5, 12.
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  External ultrasound transducer disinfection is common practice in medicine. Unfortunately, clinically significant organisms, such as methicillin-resistant Staphylococcus aureus (MRSA), Pseudomonas aeruginosa, and Klebsiella pneumonia spread throughout healthcare facilities via direct contact despite disinfection protocols. Ultrasound transducers and coupling gel provide potential vectors for pathogen transmission, especially in immunocompromised and high-risk patient populations. Our objective was to conduct a survey to investigate the variety of cleaning solutions or sanitary wipes used and evaluate current standard practice for transducer disinfection across emergency medicine training programs in the United States.
• Kay, R. D., Manoharan, A., Nematollahi, S., Nelson, J., Cummings, S. H., Rappaport, W. J., & Amini, R. (2016). A novel fresh cadaver model for education and assessment of joint aspiration. Journal of orthopaedics, 13(4), 419-24.
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  The objective of this study was to describe a novel cadaver model and to determine the utility of this model for teaching and assessing students in performing knee, elbow, and wrist arthrocentesis.
• Mhayamaguru, M., Bruno, E. H., Rhodes, S. M., & Amini, R. (2016). Large ovarian cyst with torsion. Internal and emergency medicine.
• Miller, R., Ho, H., Ng, V., Tran, M., Rappaport, D., Rappaport, W. J., Dandorf, S. J., Dunleavy, J., Viscusi, R., & Amini, R. (2016). Introducing a Fresh Cadaver Model for Ultrasound-guided Central Venous Access Training in Undergraduate Medical Education. The western journal of emergency medicine, 17(3), 362-6.
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  Over the past decade, medical students have witnessed a decline in the opportunities to perform technical skills during their clinical years. Ultrasound-guided central venous access (USG-CVA) is a critical procedure commonly performed by emergency medicine, anesthesia, and general surgery residents, often during their first month of residency. However, the acquisition of skills required to safely perform this procedure is often deficient upon graduation from medical school. To ameliorate this lack of technical proficiency, ultrasound simulation models have been introduced into undergraduate medical education to train venous access skills. Criticisms of simulation models are the innate lack of realistic tactile qualities, as well as the lack of anatomical variances when compared to living patients. The purpose of our investigation was to design and evaluate a life-like and reproducible training model for USG-CVA using a fresh cadaver.
• Rhodes, S. M., Bates, J., & Amini, R. (2016). Ultrasound Guided Femoral Nerve Blocks and the Management of Elder Patients with Hip Fractures. Journal of Hospital & Medical Management, 1(1). doi:10.4172/2471-9781.100004
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  Hip fractures in the elder population are not infrequent and often result in untreated pain or large quantities of opioid administration. Femoral nerve blocks (FNBs) offer a safe, effective method for improving pain control in the setting of hip fracture, which can be initiated in the emergency department (ED). The use of ultrasound has been shown to improve efficiency and accuracy of FNB with an added benefit of reducing the volume of local anesthetics utilized compared to landmark technique. Prior studies have shown that ultrasound training for FNB proficiency can be easily accomplished in the ED setting. There are relatively few known complications associated with FNBs and published studies on ultrasound-guided FNBs have reported zero complications. After reviewing the available literature, we believe the emergency physician is well suited to perform ultrasound guided FNBs; which will lead to improved pain control, decrease opioid requirements, and can potentially reduce medication-induced delirium in the elder population requiring lower extremity pain control.
• Stolz, L. A., Cappa, A. R., Minckler, M. R., Stolz, U., Wyatt, R. G., Binger, C. W., Amini, R., & Adhikari, S. (2016). Prospective evaluation of the learning curve for ultrasound-guided peripheral intravenous catheter placement. The journal of vascular access, 17(4), 366-70.
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  It is unclear how many ultrasound-guided peripheral intravenous catheters (USG PIVC) one must place to become proficient at the procedure. The objective of this study was to determine the learning curve associated with PIVC placement and determine how many attempts are required for non-physician learners to reach proficiency.
• Yousef, K. A., Goshinska, A. J., Bailowitz, Z. P., & Amini, R. (2016). Cactus thorn detection using bedside ultrasound. Internal and emergency medicine.
• Adhikari, S. R., Fan, H., Stea, N., Fiorello, A. B., Friedman, L., Irving, S., Acuna, J., Situ-LaCasse, E., Amini, R., & Stolz, L. A. (2018). Multimodular Ultrasound Orientation: Residents’ Confidence and Skill in Performing Point-of-care Ultrasound. Cureus, 10(11). doi:10.7759/cureus.3597
• Amini, R., & Guisto, J. A. (2016). Survey of Ultrasound Practice in Arizona Emergency Departments. Journal of Ultrasound in Medicine.
• Amini, R., Hernandez, N. C., Keim, S. M., & Gordon, P. R. (2015). Using standardized patients to evaluate medical students' evidence-based medicine skills. Journal of evidence-based medicine.
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  To analyze the effectiveness of an Evidence Based Medicine Objective Structured Clinical Examination (EBM OSCE) with standardized patients for end of third year medical students at our institution.
• Amini, R., Kartchner, J. Z., Nagdev, A., & Adhikari, S. (2016). Ultrasound-Guided Nerve Blocks in Emergency Medicine Practice. Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine.
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  The purpose of this study was to investigate the current practice of ultrasound (US)-guided regional anesthesia at academic emergency departments, including education, protocols, policies, and quality assessment.
• Amini, R., Kartchner, J. Z., Stolz, L. A., Biffar, D., Hamilton, A. J., & Adhikari, S. (2015). A novel and inexpensive ballistic gel phantom for ultrasound training. World journal of emergency medicine, 6(3), 225-8.
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  Ultrasonography use is increasing in emergency departments, and ultrasound education is now recommended in resident training. Ultrasound phantoms are used in many institutions for training purposes. The purpose of this study is to describe an inexpensive and simple method to create ultrasound-imaging models for the purpose of education and practice using clear ballistic gel.
• Amini, R., Panchal, A. R., Bahner, D., & Adhikari, S. (2015). Half-dose alteplase for sub-massive pulmonary embolism directed by emergency department point-of-care ultrasound. The western journal of emergency medicine, 16(1), 181-3.
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  This report describes a patient with sub-massive pulmonary embolism (PE) who was successfully treated with half-dose thrombolytics guided by the use of point-of-care (POC) ultrasound. In this case, POC ultrasound was the only possible imaging since computed tomography was contraindicated. POC ultrasound demonstrated a deep vein thrombosis and evidence of cardiac strain. In situations or locations where definitive imaging is unobtainable, POC ultrasound can help diagnose submassive PE and direct the use of half-dose tissue plasminogen activator.
• Amini, R., Stolz, L. A., Gross, A., O'Brien, K., Panchal, A. R., Reilly, K., Chan, L., Drummond, B. S., Sanders, A., & Adhikari, S. (2015). Theme-based teaching of point-of-care ultrasound in undergraduate medical education. Internal and emergency medicine, 10(5), 613-8.
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  A handful of medical schools have developed formal curricula to teach medical students point-of-care ultrasound; however, no ideal method has been proposed. The purpose of this study was to assess an innovative theme-based ultrasound educational model for undergraduate medical education. This was a single-center cross-sectional study conducted at an academic medical center. The study participants were 95 medical students with minimal or no ultrasound experience during their third year of training. The educational theme for the ultrasound session was "The evaluation of patients involved in motor vehicle collisions." This educational theme was carried out during all components of the 1-day event called SonoCamp: asynchronous learning, the didactic lecture, the skills stations, the team case challenge and the individual challenge stations. Assessment consisted of a questionnaire, team case challenge, and individual challenges. A total of 89 of 95 (94 %) students who participated in SonoCamp responded, and 92 % (87 of 95) completed the entire questionnaire before and after the completion of SonoCamp. Ninety-nine percent (95 % CI, 97-100 %) agreed that training at skill stations helped solidify understanding of point-of-care ultrasound. Ninety-two percent (95 % CI, 86-98 %) agreed that theme-based learning is an engaging learning style for point-of-care ultrasound. All students agreed that having a team exercise is an engaging way to learn point-of-care ultrasound; and of the 16 groups, the average score on the case-based questions was 82 % (SD + 28). The 1-day, theme-based ultrasound educational event was an engaging learning technique at our institution which lacks undergraduate medical education ultrasound curriculum.
• Amini, R., Stolz, L. A., Patanwala, A. E., & Adhikari, S. (2015). Coronal Axis Measurement of the Optic Nerve Sheath Diameter Using a Linear Transducer. Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine, 34(9), 1607-12.
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  The true optic nerve sheath diameter cutoff value for detecting elevated intracranial pressure is variable. The variability may stem from the technique used to acquire sonographic measurements of the optic nerve sheath diameter as well as sonographic artifacts inherent to the technique. The purpose of this study was to compare the traditional visual axis technique to an infraorbital coronal axis technique for assessing the optic nerve sheath diameter using a high-frequency linear array transducer.
• Bates, J. S., Rhodes, S. M., & Amini, R. (2015). Ultrasound Guided Femoral Nerve Blocks and the Management of Elder patients with Hip Fractures; ; Accepted November 2015.. Hospital and Medical Management.
• Hoyer, R., Means, R., Robertson, J., Rappaport, D., Schmier, C., Jones, T., Stolz, L. A., Kaplan, S. J., Adamas-Rappaport, W. J., & Amini, R. (2015). Ultrasound-guided procedures in medical education: a fresh look at cadavers. Internal and emergency medicine.
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  Demand for bedside ultrasound in medicine has created a need for earlier exposure to ultrasound education during the clinical years of undergraduate medical education. Although bedside ultrasound is often used for invasive medical procedures, there is no standardized educational model for procedural skills that can provide the learner a real-life simulated experience. The objective of our study was to describe a unique fresh cadaver preparation model, and to determine the impact of a procedure-focused ultrasound training session. This study was a cross-sectional study at an urban academic medical center. A sixteen-item questionnaire was administered at the beginning and end of the session. Fifty-five third year medical students participated in this 1-day event during their surgical clerkship. Students were trained to perform the following ultrasound-guided procedures: internal jugular vein cannulation, femoral vein cannulation femoral artery cannulation and pericardiocentesis. Preparation of the fresh cadaver is easily replicated and requires minor manipulation of cadaver vessels and pericardial space. Fifty-five medical students in their third year participated in this study. All of the medical students agreed that US could help increase their confidence in performing procedures in the future. Eighty percent (95 % CI 70-91 %) of students felt that there was a benefit of learning ultrasound-based anatomy in addition to traditional methods. Student confidence was self-rated on a five-point Likert scale. Student confidence increased with statistical significance in all of the skills taught. The most dramatic increase was noted in central venous line placement, which improved from 1.95 (SD = 0.11) to 4.2 (SD = 0.09) (p 
• Keim, S. M., Kartchner, J., Farrell, I., Amini, R., & Adhikari, S. (2015). 69 Quality of Research and Level of Evidence in Point-of-Care Ultrasound Literature: Where Are We Now?. Annals of Emergency Medicine, 66(4), S24-S25. doi:10.1016/j.annemergmed.2015.07.101
• Mhayamaguru, K. M., Means, R., Sanders, A. B., & Amini, R. (2015). Vaginal bulge. The western journal of emergency medicine, 16(3), 424-5.
• Miller, R., Ho, H., Ng, V., Yeaton, J., Adamas-Rappaport, W., Jack, H., Rappaport, D., Brandis, D., Nematollahi, S., Viscusi, R. K., Alvarado, J., & Amini, R. (2014). Introduction of a fresh cadaver model for ultrasound-guided central venous access training: Maximizing use of the willed-body for educational training. Journal of Emergency Medicine.
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  Approximately 2.5 hours spent on project for 2015
• Nagdev, A., Kartchner, J. Z., Amini, R., & Adhikari, S. (2015). 2092251 Ultrasound Guided Nerve Blocks in Emergency Medicine Practice. Ultrasound in Medicine and Biology, 41(4), S172. doi:10.1016/j.ultrasmedbio.2014.12.655
• O'Brien, K. M., Stolz, L. A., Amini, R., Gross, A., Stolz, U., & Adhikari, S. (2015). Focused Assessment With Sonography for Trauma Examination: Reexamining the Importance of the Left Upper Quadrant View. Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine, 34(8), 1429-34.
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  The purpose of this study was to determine the frequency and predominant location of isolated free fluid in the left upper quadrant (LUQ) on focused assessment with sonography for trauma (FAST) examinations of adult patients with trauma presenting to the emergency department.
• Situ-LaCasse, E., Adhikari, S. R., Amini, R., & Acuna, J. (2018). 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., 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.
• Stolz, L. A., Fiorello, A. B., Stolz, L. A., Fiorello, A. B., Amini, R., & Adhikari, S. (2015). 2092216 Point-Of-Care Ultrasound in the Evaluation Of Intravenous Drug Users With Soft Tissue Infection. Ultrasound in Medicine and Biology, 41(4), S171. doi:10.1016/j.ultrasmedbio.2014.12.653
• Stolz, U., Wyatt, R. G., Stolz, U., Stolz, L. A., Minckler, M. R., Cappa, A. R., Binger, C. W., Amini, R., & Adhikari, S. (2015). 291 Effect of Ultrasound-Guided Peripheral Intravenous Catheter Placement by Nurses and Paramedics on Central Line Placement in the Emergency Department. Annals of Emergency Medicine, 66(4), S105. doi:10.1016/j.annemergmed.2015.07.325
• Thompson, M., Stolz, L. A., Stea, N., Sanders, A. B., Hawbaker, N., Breshears, E., Amini, R., & Adhikari, S. (2015). 168 SNAPPY Teaching and Assessing Medical Students: Sonographic Assistance for Procedures in Preclinical Years. Annals of Emergency Medicine, 66(4), S60. doi:10.1016/j.annemergmed.2015.07.200
• Adhikari, S. R., Amini, R., Stolz, L. A., & Blaivas, M. (2014). Impact of point-of-care ultrasound on quality of care in clinical practice.. Reports in Medical Imaging, 7, 81-93.
• Adhikari, S., Amini, R., Stolz, L., O'Brien, K., Gross, A., Jones, T., Fiorello, A., & Keim, S. M. (2014). Implementation of a novel point-of-care ultrasound billing and reimbursement program: fiscal impact. The American journal of emergency medicine, 32(6), 592-5.
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  The aim of this study was to determine the fiscal impact of implementation of a novel emergency department (ED) point-of-care (POC) ultrasound billing and reimbursement program.
• Adhikari, S., Fiorello, A., Stolz, L., Jones, T., Amini, R., Gross, A., O'Brien, K., Mosier, J., & Blaivas, M. (2014). Ability of emergency physicians with advanced echocardiographic experience at a single center to identify complex echocardiographic abnormalities. The American journal of emergency medicine, 32(4), 363-6.
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  To determine the ability of emergency physicians to detect complex abnormalities on point-of-care (POC) echocardiograms.
• Amini, R. (2014). Procedural Guidance with Ultrasound in the Emergency Patient. Ultrasound Clinics, 9(2), 217-226. doi:10.1016/j.cult.2014.01.001
• Amini, R., Adhikari, S., & Fiorello, A. (2014). Ultrasound competency assessment in emergency medicine residency programs. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 21(7), 799-801.
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  In the Model of the Clinical Practice of Emergency Medicine (EM), bedside ultrasound (US) is listed as one of the essential procedural skills. EM milestones released by Accreditation Council for Graduate Medical Education and American Board of Emergency Medicine require residents to demonstrate competency in bedside US. The purpose of this study was to assess the current methods used by EM residency training programs to evaluate resident competency in bedside US.
• Amini, A., Faucett, E. A., Watt, J. M., Amini, R., Sakles, J. C., Rhee, P., Erstad, B. L., & Patanwala, A. E. (2013). Effect of a pharmacist on timing of postintubation sedative and analgesic use in trauma resuscitations. American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists, 70(17), 1513-7.
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  Pharmacists' impact in reducing the time interval from intubation to sedative and analgesic use during trauma patient resuscitations is investigated.
• Chan, L., Drummond, B. S., Stolz, L. A., Sanders, A. B., Reilly, K. M., Panchal, A. R., O'brien, K., Gross, A., Drummond, B. S., Chan, L., Amini, R., & Adhikari, S. (2013). Theme-Based Ultrasound Education: A Novel Approach to Teaching Point-of-Care Ultrasound to Medical Students. Annals of Emergency Medicine, 62(4), S136. doi:10.1016/j.annemergmed.2013.07.206
• Stolz, L. A., Fiorello, A. B., Stolz, L. A., O'brien, K., Mosier, J., Gross, A., Fiorello, A. B., Blaivas, M., Amini, R., & Adhikari, S. (2013). Can Emergency Physicians Accurately Identify Complex Abnormalities on Point-of-Care Echocardiogram?. Annals of Emergency Medicine, 62(4), S78. doi:10.1016/j.annemergmed.2013.07.034
• Watt, J. M., Amini, A., Traylor, B. R., Amini, R., Sakles, J. C., & Patanwala, A. E. (2013). Effect of paralytic type on time to post-intubation sedative use in the emergency department. Emergency medicine journal : EMJ, 30(11), 893-5.
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  To determine the difference between rocuronium and succinylcholine with regard to post-intubation sedative initiation in the emergency department.
• Wenderoth, B. R., Kaneda, E. T., Amini, A., Amini, R., & Patanwala, A. E. (2013). Morphine versus fentanyl for pain due to traumatic injury in the emergency department. Journal of trauma nursing : the official journal of the Society of Trauma Nurses, 20(1), 10-5.
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  The analgesic response and safety of intravenous morphine versus fentanyl for adult trauma patients who presented to the emergency department (ED) were evaluated. Median pain reduction on the numeric rating scale (0-10; 0 = no pain and 10 = worst possible pain) after opioid administration was similar between the groups (2 vs 2; P = .67). The lowest postdose pain score was recorded sooner in the fentanyl group than in the morphine group (22 vs 47 minutes, respectively; P < .001). There were no significant differences in drug-induced adverse effects between groups. Fentanyl produced a similar but more rapid analgesic response compared with morphine in trauma patients.
• Edwards, C. J., Stolz, U., Stolz, U., Stolz, L. A., Patanwala, A. E., Edwards, C. J., Desai, A., & Amini, R. (2012). Should morphine dosing be weight based for analgesia in the emergency department?. Journal of opioid management, 8(1), 51-5. doi:10.5055/jom.2012.0096
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  To determine if patient weight is predictive of the degree of analgesic response to morphine in opioid naïve patients in the emergency department (ED)..Prospective observational study..Academic, tertiary ED, designated as a level 1 trauma center..Fifty opioid naive adult patients who were administered a single fixed intravenous dose of 4 mg morphine on initial presentation to the ED..Pain was assessed at baseline and then repeated at 15- and 30-minute postdose using an 11-point (0-10) verbal numerical rating scale (NRS)..The primary outcome was maximum analgesic response, which is defined as the difference between initial pain score and lowest pain score achieved postdose at 15 or 30 minutes. Linear regression was used to analyze the relationship between maximum pain reduction and patient weight..Mean patient weight was 85.4 kg (standard deviation = +/- 24.2; range 47.6-170). Median initial pain score was 8 (range 6-10) and median lowest pain score achieved postdose was 4 (range 0-10). In the linear regression analysis, patient weight did not predict the degree of pain reduction on the NRS (coefficient = 0.002 [95% confidence interval (CI) = -0.029-0.032], R2 < 0.001, p = 0.91). The only variable predictive of the degree of pain reduction was initial pain score (coefficient = 0.537/95% CI = 0.013-1.0611, R2 = 0.081,p = 0.045)..Patient weight was not significantly associated with the degree of analgesic response to morphine in opioid naive adults. Morphine dosing based on patient weight alone is not necessary in adults in the ED.
• Patanwala, A. E., Edwards, C. J., Stolz, L. A., Amini, R., Desai, A., & Stolz, U. (2013). Should morphine dosing be weight based for analgesia in the emergency department?. Journal of opioid management, 8(1), 51-5.
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  To determine if patient weight is predictive of the degree of analgesic response to morphine in opioid naïve patients in the emergency department (ED).
• Patanwala, A. E., Amini, R., Hays, D. P., & Rosen, P. (2010). Antiemetic therapy for nausea and vomiting in the emergency department. The Journal of emergency medicine, 39(3), 330-6.
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  Antiemetic agents are among the most frequently prescribed medications in the emergency department (ED). Nevertheless, there are no widely accepted evidence-based guidelines to optimize the use of these medications for nausea or vomiting in this setting.

Presentations

• Adhikari, S. R., Adhikari, S. R., Acuna, J., Friedman, L., Friedman, L., Patanwala, A. E., Amini, R., Amini, R., Situ-LaCasse, E., Stolz, L., Stolz, L., Stolz, L., Situ-LaCasse, E., Situ-LaCasse, E., Amini, R., Friedman, L., Patanwala, A. E., Patanwala, A. E., Acuna, J., , Acuna, J., et al. (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., Adhikari, S. R., Pratt, L., Pratt, L., Valenzuela, J., Valenzuela, J., Weaver, C., Weaver, C., Biffar, D., Biffar, D., Acuna, J., Acuna, J., Samsel, K., Samsel, K., Patanwala, A. E., Patanwala, A. E., Bain, V., Bain, V., Amini, R., , Amini, R., et al. (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.
• 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.
• 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.
• Amini, R., Adamas-Rappaport, W., Situ-LaCasse, E., Bates, J., Kelley, R., Johnsone, C., Ratesic, A., Viscusi, R. K., & Fisher, J. (2017, February). Clinical Skills Temporal Degradation Assessment in Undergraduate Medical Education. Western Group on Educational Affairs. Salt Lake City, Utah.
• Amini, R., Adamas-Rappaport, W., Situ-LaCasse, E., Bates, J., Kelley, R., Johnsone, C., Ratesic, A., Viscusi, R. K., & Fisher, J. (2017, March). Clinical Skills Temporal Degradation Assessment in Undergraduate Medical Education. American Institute of Ultrasound in Medicine Annual Meeting. Orlando, Florida.
• Adhikari, S. R., Friedman, L., Amini, R., Stolz, L., Situ-LaCasse, E., Patanwala, A. E., & Acuna, J. (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., Pratt, L., Valenzuela, J., Weaver, C., Biffar, D., Acuna, J., Samsel, K., Patanwala, A. E., Bain, V., Amini, R., & Situ-LaCasse, E. (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.
• Adhikari, S. R., Stolz, L. A., Amini, R., & Fiorello, A. B. (2015, April). Point-of-care ultrasound in the evaluation of intravenous drug users with soft tissue infection.. American Institute of Ultrasound in Medicine Annual Convention. Las Vegas, NV: American Institute of Ultrasound in Medicine.
• Amini, R., Stolz, L. A., Thompson, M., Stea, N., Hawbaker, N., Kartchner, J. Z., Joshi, R., Fiorello, A. B., & Adhikari, S. R. (2015, May). Ultrasound-Based Algorithm as an Educational and Competency Assessment Tool for Emergency Medicine Residents. Society of Academic Emergency Medicine Annual Meeting.
• Cappa, A. R., Minckler, M. R., Wyatt, R. G., Binger, C. W., Stolz, U., Amini, R., Adhikari, S. R., & Stolz, L. A. (2015, October). Effect of Ultrasound-Guided Peripheral Intravenous Catheter Placement by Nurses and Paramedics on Central Line Placement in the Emergency Department. Research Forum of the American College of Emergency Physicians. Boston, MA: American College of Emergency Physicians.
• Stea, N., Amini, R., & Adhikari, S. R. (2015, May). Bedside Echo For Chest Pain: An Algorithm For Education and Assessment. Western Regional Meeting. Tucson, AZ.
• Stea, N., Amini, R., Stolz, L., & Adhikari, S. R. (2015, May). Bedside Echo For Chest Pain: An Algorithm For Education and Assessment; Society for Academic Emergency Medicine. Society for Academic Emergency Medicine. San Diego, CA.

Poster Presentations

• Keim, S. M., Tolby, N., Plitt, J., Min Simpkins, A. A., Ng, V., Berkman, M. R., Williams, C., Medina, T., Stea, N., Bradshaw, H. R., Situ-LaCasse, E. H., & Amini, R. (2023, November). Emergency Medicine Advising Program 2.0: An Innovative Approach to Medical Student Advising. Association of American Medical Colleges Learn Serve Lead. Seattle, WA: Association of American Medical Colleges.
• Acuna, J., Adhikari, S. R., Yarnish, A., Amini, R., Situ-LaCasse, E., Situ-LaCasse, E., Amini, R., Yarnish, A., Adhikari, S. R., & Acuna, J. (2021, April). Teaching Arthrocentesis Protocol in Trainess (TAPiT) An Educational Intervention to Facilitate the Use of Point-of-Care Ultrasound when Performing Arthrocentesis. American Institute of Ultrasound in Medicine Annual Convention. Virtual: American Institute of Ultrasound in Medicine.
• Amini, R., Breshears, E., Stolz, L. A., Stea, N., Hawbaker, N., Thompson, M., Sanders, A. B., & Adhikari, S. R. (2015, October). SNAPPY Teaching and Assessing Medical Students: Sonographic Assistance for Procedures in Preclinical Years. Research Forum of the American College of Emergency Physicians. Boston, MA: American College of Emergency Physicians.
• Amini, R., Javedani, P., Stolz, L. A., Baker, N., Gaskin, K., Ng, V., & Adhikari, S. R. (2015, March). Point-of-Care Echocardiography in Simulations Education. Western Regional Society for Academic Emergency Medicine Annual Meeting. Tucson, AZ: Society for Academic Emergency Medicine.
• Minckler, M. R., Cappa, A. R., Stolz, L. A., Stolz, U., Wyatt, R., Amini, R., & Adhikari, S. R. (2015, May). What is the Learning Curve for Long-axis (In-plane) Ultrasound-guided Peripheral Intravenous Catheter Placement?. Society of Academic Emergency Medicine Annual Meeting. San Diego, California: Society of Academic Emergency Medicine.