Srikar R Adhikari

Interests

Research

Point-of-care ultrasound, Cardiac Arrest, Hypertension

Teaching

Emergency ultrasound, Point-of care ultrasound

Courses

Scholarly Contributions

Books

• Adhikari, S. R. (2015). Ultimate Guide to Ultrasound Guided Procedures.

Chapters

• Acuna, J., & Adhikari, S. R. (2019). Small Parts: Testicular Ultrasound. In Sonoguide.
• Friedman, L., & Adhikari, S. R. (2021). SonoGuide: ENT Ultrasound. In American College of Emergency Physicians.
• Situ-LaCasse, E., & Adhikari, S. R. (2021). SonoGuide: Airway Ultrasound. In American College of Emergency Physicians.
• Situ-LaCasse, E., & Adhikari, S. R. (2021). SonoGuide: Ocular Emergencies. In American College of Emergency Physicians.
• Adhikari, S. R. (2020). Testicular Ultrasound. In Emergency Ultrasound.(pp 433-462.). McGraw-Hill Publishers.
• Situ-LaCasse, E., & Adhikari, S. R. (2020). Soft tissue infections. In Emergency Ultrasound.(pp 523-534). McGraw-Hill Publishers.
• Adhikari, S. R. (2017). Brown B, Adhikari S. Airway/Ear, Nose and Throat (ENT) Sonography. In Connolly J, Dean A, Hoffmann B, Jarman R (editors) Emergency Point-of-Care Ultrasound, 2nd Edition. Wiley-Blackwell publishers, Hoboken, New Jersey, 2017; 2nd edition, 251.. In Emergency Ultrasound Management.
• Stolz, L., & Adhikari, S. R. (2016). Ultrasound in pregnancy. In Emergency Medicine Procedures. McGraw-Hill.
• Stolz, L., & Adhikari, S. R. (2016). Ultrasound-guided Vascular Access. In Emergency Medicine Procedures, 3rd ed.. McGraw-Hill.
• Adhikari, S. R. (2015). Ultrasound fellowship. In Emergency Ultrasound Management.
• Stolz, L. A., & Adhikari, S. R. (2015). Infection - Paracentesis and Abscess Drainage. In Comprehensive Critical Care Ultrasound.
• Stolz, L. A., & Adhikari, S. R. (2015). Infection - Paracentesis and Abscess Drainage. In Ultrasound in Critical Care.
• Stolz, L. A., & Adhikari, S. R. (2015). Point-of-Care Pelvic Ultrasound. In Critical Care Ultrasound(pp 229-237). Philadelphia: Elsevier.

Journals/Publications

• Acuna, J. G., Adhikari, S. R., McNinch, N., Situ-LaCasse, E. H., Yarnish, A., Yarnish, A., McNinch, N., Situ-LaCasse, E. H., Acuna, J. G., & 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.
• Adhikari, S., Leo, M., Liu, R., Johnston, M., Keehbauch, J., Barton, M., & Kendall, J. (2023).

  The 2023 Core Content of advanced emergency medicine ultrasonography

  . Journal of the American College of Emergency Physicians Open, 4(4). doi:10.1002/emp2.13015
• Weaver, C., Heath, D. M., Makin, I. R., Hanamaika’i, K., Kanumalla, R., Matsushita, S., Chatta, P., & Adhikari, S. (2023).

  Effects of a focused training on first-year osteopathic medical students’ ability to incorporate point-of-care ultrasound in assessment of the anterior knee

  . Journal of Osteopathic Medicine, 123(10), 475-484. doi:10.1515/jom-2022-0186
• Acuna, J., Pacheco, G., Yarnish, A., Haight, S., Carter, J., Coe, I., & Adhikari, S. R. (2022). A Novel Simulation Model for Training Emergency Medicine Residents in the Ultrasound Identification of Landmarks for Cricothyrotomy. Cureus, 12(12). doi:10.7759/cureus.33003
• Acuna, J., Yarnish, A., & Adhikari, S. R. (2022). The Status of Women in Emergency Ultrasound Fellowships: A Potential Light for the Future of Gender Inclusion in Academic Medicine. Cureus, 14(9).
• Adhikari, S. R., & Abramowicz, J. (2022). Ocular Ultrasound: Review of Bioeffects and Safety, Including Fetal and Point of Care Perspective: Review of Bioeffects and Safety, Including Fetal and Point-of-Care Perspective. . Journal of Ultrasound in Medicine, 41(7). doi:10.1002/jum.15864
• Abramowicz, J. S., Adhikari, S., Dickman, E., Estroff, J. A., Harris, G. R., Nomura, J., Silverman, R. H., Taylor, L. A., & Barr, R. G. (2021). Ocular Ultrasound: Review of Bioeffects and Safety, Including Fetal and Point of Care Perspective. Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine.
  More info

  Ocular ultrasound is an invaluable tool for the evaluation of the eye and orbit. However, the eye and orbit are potentially sensitive to the thermal and mechanical effects of ultrasound. When performing B-mode imaging, dedicated ocular settings should be used. If these settings are not available, limiting the acoustic output to Food and Drug Administration (FDA) recommended maximum levels is strongly advised. Especially important is the acoustic output in spectral (pulsed) and color Doppler modes, which can exceed the FDA's maximum recommended levels for the eye. Adjusting settings to decrease acoustic output and limiting the time of the examination should be done when performing a Doppler examination. The acoustic output of shear wave elastography is significantly higher than FDA guidelines for the eye and should be considered experimental.
• Acuna, J., & Adhikari, S. R. (2019). Point of Care Ultrasound in United States Pediatric Emergency Medicine Fellowship Programs: The Current State of Practice and Training. Pediatric Emergency Care.
• Acuna, J., Amini, R., Adhikari, S. R., & Situ-LaCasse, E. (2018). Identification of Gender Differences in Ultrasound Milestone Assessments during Emergency Medicine Residency Training: A Pilot Study. Advances in Medical Education and Practice.
• 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.
• Acuña, J., & Adhikari, S. (2021). Point-of-care Ultrasound to Distinguish Subgaleal and Cephalohematoma: Case Report. Clinical practice and cases in emergency medicine, 5(2), 198-201.
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  Cephalohematomas generally do not pose a significant risk to the patient and resolve spontaneously. Conversely, a subgaleal hematoma is a rare but more serious condition. While it may be challenging to make this diagnostic distinction based on a physical examination alone, the findings that differentiate these two conditions can be appreciated on point-of-care ultrasound (POCUS). We describe two pediatric patient cases where POCUS was used to distinguish between a subgaleal hematoma and a cephalohematoma.
• Acuña, J., Drachman, M., Stea, N., & Adhikari, S. R. (2020). Handheld ultrasound: Overcoming the challenge of difficult peripheral intravenous access in the emergency department. Journal of Ultrasound in Medicine.
• Acuña, J., Pierre, C. M., Sorenson, J., & Adhikari, S. (2021). Point-of-care Ultrasound to Evaluate Breast Pathology in the Emergency Department. The western journal of emergency medicine, 22(2), 284-290.
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  As physician-performed point-of-care ultrasound (POCUS) becomes more prevalent in the evaluation of patients presenting with various complaints in the emergency department (ED), one application that is significantly less used is breast ultrasound. This study evaluates the utility of POCUS for the assessment of patients with breast complaints who present to the ED and the impact of POCUS on medical decision-making and patient management in the ED.
• Acuña, J., Pierre, C., Sorenson, J., & Adhikari, S. R. (2020). Point-of-Care Ultrasound for Evaluating Breast Pathology and its Role in the Emergency Department. Western Journal of Emergency Medicine.
• Acuña, J., Shockey, D., & Adhikari, S. (2021). The Use of Point-of-care Ultrasound in the Diagnosis of Pott's Puffy Tumor: A Case Report. Clinical practice and cases in emergency medicine, 5(4), 422-424.
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  Pott's puffy tumor (PPT) is a rare clinical disease characterized by forehead swelling from a subperiosteal abscess coupled with frontal bone osteomyelitis. It is often associated with severe complications and poor outcomes if left undiagnosed; thus, rapid recognition is crucial. Point-of-care ultrasound (POCUS) may provide an alternative pathway to diagnosis. It can be performed rapidly at the bedside and assist in early screening of patients, identifying those with high suspicion for PPT and prioritizing imaging and consultation.
• Adhikari, S. R., Biffar, D. E., Patanwala, A. E., Samsel, K., Irving, S., Amini, R., Huynh, D., Acuna, J., & Situ-LaCasse, E. (2020). Can ultrasound novices develop image acquisition skills after reviewing online ultrasound modules?. BMC Medical Education.
• 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.
• Dessie, A. S., Lewiss, R. E., Stolz, L. A., Acuña, J., Adhikari, S., Amponsah, D., Del Rios, M., Huang, R. D., Knight, R. S., Landry, A., Liu, R. B., Gottlieb, M., Ng, L., Panebianco, N. L., Rosario, J., Weekes, A. J., & Jones, J. D. (2021). The state of gender inclusion in the point-of-care ultrasound community. The American journal of emergency medicine.
• Gaspari, R., Weekes, A., Adhikari, S., Noble, V. E., Nomura, J. T., Theodoro, D., Woo, M. Y., Atkinson, P., Blehar, D., Brown, S. M., Caffery, T., Haines, C., Lam, S., Lanspa, M., Lewis, M., Liebmann, O., Limkakeng, A., Platz, E., Moore, C., & Raio, C. (2021). Comparison of outcomes between pulseless electrical activity by electrocardiography and pulseless myocardial activity by echocardiography in out-of-hospital cardiac arrest; secondary analysis from a large, prospective study. Resuscitation, 169, 167-172.
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  To measure prevalence of discordance between electrical activity recorded by electrocardiography (ECG) and myocardial activity visualized by echocardiography (echo) in patients presenting after cardiac arrest and to compare survival outcomes in cohorts defined by ECG and echo.
• Sheehan, P., Alper, Y., & Adhikari, S. R. (2021). POCFormer: A Lightweight Transformer Architecture for Detection of COVID-19 Using Point of Care Ultrasound. ArXiv, abs/2105.09913..
• Sheehan, P., Michael, K., Adhikari, S. R., & Alper, Y. (2021). Adaptive Few-Shot Learning PoC Ultrasound COVID-19 Diagnostic System.. 2021 IEEE Biomedical Circuits and Systems Conference (BioCAS), 1-6.
• 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.
• Situ-LaCasse, E., Guirguis, H., Friedman, L., Patanwala, A. E., & Adhikari, S. R. (2018). Can Emergency Physicians Perform Extended Compression Ultrasound for the Diagnosis of Lower Extremity Deep Vein Thrombosis?. World Journal of EM.
• 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.
• Teran, F., Paradis, N. A., Dean, A. J., Delgado, M. K., Linn, K. A., Kramer, J. A., Morgan, R. W., Sutton, R. M., Gaspari, R., Weekes, A., Adhikari, S., Noble, V., Nomura, J. T., Theodoro, D., Woo, M. Y., Panebianco, N. L., Chan, W., Centeno, C., Mitchell, O., , Peberdy, M. A., et al. (2021). Quantitative characterization of left ventricular function during pulseless electrical activity using echocardiography during out-of-hospital cardiac arrest. Resuscitation, 167, 233-241.
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  Several prospective studies have demonstrated that the echocardiographic detection of any myocardial activity during PEA is strongly associated with higher rates of return of spontaneous circulation (ROSC). We hypothesized that PEA represents a spectrum of disease in which not only the presence of myocardial activity, but more specifically that the degree of left ventricular (LV) function would be a predictor of outcomes. The purpose of this study was to retrospectively assess the association between LV function and outcomes in patients with OHCA.
• Acuña, J., Rubin, M., Hahn, B., Das, D., Kapoor, M., Adhikari, S., & Greenstein, J. (2020). Point-of-Care Ultrasound in United States Pediatric Emergency Medicine Fellowship Programs: The Current State of Practice and Training. Pediatric emergency care.
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  In 2015, the American Academy of Pediatrics (AAP) released a policy statement regarding point-of-care ultrasonography (POCUS) by pediatric emergency physicians, which included recommendations on education and training. In the 3 years since the AAP policy statement and its accompanying technical report were published, it is unclear which aspects of the recommendations set forth by this policy have been instituted by POCUS programs throughout the country. The objective of this study was to conduct a survey of pediatric emergency medicine (PEM) fellowship directors throughout the United States regarding the current state of education and training of POCUS in their department.
• Acuña, J., Sorenson, J., Gades, A., Wyatt, R., Stea, N., Drachman, M., & Adhikari, S. (2020). Handheld Ultrasound: Overcoming the Challenge of Difficult Peripheral Intravenous Access in the Emergency Department. Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine, 39(10), 1985-1991.
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  The purpose of this study was to evaluate the performance of a handheld ultrasound device for difficult peripheral intravenous (PIV) access performed by nurses and paramedics in the emergency department (ED).
• Acuña, J., Stolz, U., Stolz, L. A., Situ-LaCasse, E. H., Bell, G., Berkeley, R. P., Boyd, J. S., Castle, D., Carmody, K., Fong, T., Grewal, E., Jones, R., Hilberts, S., Kanter, C., Kelley, K., Leetch, S. J., Pazderka, P., Shaver, E., Stowell, J. R., , Josephson, E. B., et al. (2020). Evaluation of Gender Differences in Ultrasound Milestone Evaluations During Emergency Medicine Residency Training: A Multicenter Study. AEM education and training, 4(2), 94-102.
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  Prior literature has demonstrated incongruities among faculty evaluation of male and female residents' procedural competency during residency training. There are no known studies investigating gender differences in the assessment of procedural skills among emergency medicine (EM) residents, such as those required by ultrasound. The objective of this study was to determine if there are significant gender differences in ultrasound milestone evaluations during EM residency 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., 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., Adhikari, S., Savitsky, E. A., Blaivas, L. N., & Liu, Y. T. (2020). Artificial intelligence versus expert: a comparison of rapid visual inferior vena cava collapsibility assessment between POCUS experts and a deep learning algorithm. Journal of the American College of Emergency Physicians open, 1(5), 857-864.
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  We sought to create a deep learning algorithm to determine the degree of inferior vena cava (IVC) collapsibility in critically ill patients to enable novice point-of-care ultrasound (POCUS) providers.
• Shokoohi, H., Duggan, N. M., Adhikari, S. R., Selame, L. A., Amini, R., & 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
• 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.
• Adhikari, S. R. (2019). AIUM Practice Parameter for the Performance of Point-of-Care Ultrasound Examinations. Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine, 38(4), 833-849.
• Adhikari, S. R. (2019). Impact of Point-of-Care Ultrasound in Critically Ill Patients: Flawed Data and Wrong Conclusions. Critical Care Explorations, Volume 1(9), e0042..
• Adhikari, S. R. (2019). Point-of-care Head and Neck Sonography for Clinical Problem-solving: Impact of One-day Training Sessions on Medical Student Education.. Cureus.
• Amini, R., Camacho, L. D., Valenzuela, J., Ringleberg, J. K., Patanwala, A. E., Stearns, J., Situ-LaCasse, E. H., Acuña, J., & Adhikari, S. (2019). 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.
• Liu, R., Theodoro, D., Fields, J. M., Jones, R., Adhikari, S., Noble, V., & Tayal, V. (2019). Regarding the article entitled "Do emergency physicians rely on point-of-care ultrasound for clinical decision making without additional confirmatory testing?". Journal of clinical ultrasound : JCU, 47(3), 161-162.
• 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., 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.
• 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., Rukh, S., & Adhikari, S. R. (2018). Point-of-care ultrasound identification of yolk stalk sign in a case of failed first trimester pregnancy. World Journal of Emergency Medicine.
• 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., Rukh, S., & Adhikari, S. (2018). Point-of-care ultrasound identification of yolk stalk sign in a case of failed first trimester pregnancy. World journal of emergency medicine, 9(2), 149-151.
• Adhikari, S. R. (2018). Do emergency physicians rely on point-of-care ultrasound for clinical decision making without additional confirmatory testing?. J Clin Ultrasound.
• Adhikari, S. R. (2018). Response to letter.. Am J Emerg Med.
• 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.
• Au, A. K., Adhikari, S., Slovis, B. H., Sachs, P. B., & Lewiss, R. E. (2018). Hospital Information Technology is critical to the success of a point-of-care ultrasound program. The American journal of emergency medicine.
• 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.
• Javedani, P. P., Metzger, G. S., Oulton, J. R., & Adhikari, S. (2018). Use of Focused Assessment with Sonography in Trauma Examination Skills in the Evaluation of Non-trauma Patients. Cureus, 10(1), e2076.
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  Study objectives Although the focused assessment with sonography in trauma (FAST) examination was initially developed for rapid evaluation of trauma patients, the basic skillset required to perform a FAST examination provides valuable information that may alter a non-trauma patient's clinical course. The objective of this study was to determine the utility of the FAST examination in the emergency department management of non-trauma patients. Methods Cases in which the FAST examination was used to direct care in non-trauma patients were retrospectively reviewed. Following the completion of the patient's care, emergency physicians were asked to complete a questionnaire indicating how information from the FAST examination was utilized to direct care of their non-trauma patients. Results A total of 63 non-trauma cases with average age of 48 years (range 16-94 years) were enrolled. The FAST examination positively impacted care in 57/63 (90.5%) cases. In 18/63 (28.6%) cases, the patient's ultimate disposition changed because of FAST examination findings. In 9/63 (14.3%) cases, paracentesis was avoided by obtaining a FAST examination, and in 8/63 cases (12.7%) paracentesis was performed due to FAST examination results. In 16/63 (25.4%) cases, anticipated imaging changed due to FAST examination findings and 4/63 (6.3%) cases did not receive the anticipated computed tomography (CT) scan. Conclusions Although initially developed for evaluation of trauma patients, the FAST examination can provide valuable information that can positively impact care in non-trauma patients. The FAST examination can provide information to determine appropriate patient disposition, obtain appropriate additional imaging, ensure timely consultation, and eliminate risk from unnecessary procedures.
• Kummer, T., Oh, L., Phelan, M. B., Huang, R. D., Nomura, J. T., & Adhikari, S. (2018). Emergency and critical care applications for contrast-enhanced ultrasound. The American journal of emergency medicine, 36(7), 1287-1294.
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  Contrast-enhanced ultrasound (CEUS) using intravascular microbubbles has potential to revolutionize point-of-care ultrasonography by expanding the use of ultrasonography into clinical scenarios previously reserved for computed tomography (CT), magnetic resonance imaging, or angiography.
• Needleman, L., Cronan, J. J., Lilly, M. P., Merli, G. J., Adhikari, S., Hertzberg, B. S., DeJong, M. R., Streiff, M. B., & Meissner, M. H. (2018). Ultrasound for Lower Extremity Deep Venous Thrombosis: Multidisciplinary Recommendations From the Society of Radiologists in Ultrasound Consensus Conference. Circulation, 137(14), 1505-1515.
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  Venous ultrasound is the standard imaging test for patients suspected of having acute deep venous thrombosis (DVT). There is variability and disagreement among authoritative groups regarding the necessary components of the test. Some protocols include scanning the entire lower extremity, whereas others recommend scans limited to the thigh and knee supplemented with serial testing. Some protocols use gray-scale ultrasound alone, whereas others include Doppler interrogation. Point-of-care ultrasound is recommended in some settings, and there is heterogeneity of these protocols as well. Heterogeneity of recommendations can lead to errors including incorrect application of guidelines, confusion among requesting physicians, and incorrect follow-up. In October 2016, the Society of Radiologists in Ultrasound convened a multidisciplinary panel of experts to evaluate the current evidence to develop recommendations regarding ultrasound protocols for DVT and the terminology used to communicate results to clinicians. Recommendations were made after open discussion and by unanimous consensus.The panel recommends a comprehensive duplex ultrasound protocol from thigh to ankle with Doppler at selected sites rather than a limited or complete compression-only examination. This protocol is currently performed in many facilities and is achievable with standard ultrasound equipment and personnel. The use of these recommendations will increase the diagnosis of calf DVT and provide better data to explain the presenting symptoms. The panel recommends a single point-of-care protocol that minimizes underdiagnoses of proximal DVT.The panel recommends the term chronic postthrombotic change to describe the residual material that persists after the acute presentation of DVT to avoid potential overtreatment of prior thrombus.Adoption of a single standardized comprehensive duplex ultrasound and a single point-of-care examination will enhance patient safety and clinicians' confidence.
• 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., Acuna, J. G., Gaskin, K., Murphy, A. M., Friedman, L., Stears-Ellis, S., Javedani, P., Stolz, U., & Adhikari, S. (2018). Echogenicity and ultrasound visibility of peripheral nerves of the upper extremity. Medical ultrasonography, 20(2), 199-204.
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  Regional anesthesia with ultrasound-guidance is an excellent option for pain control if nerves are adequately visualized. Gender, body mass index (BMI), history of diabetes, neck and forearm circumference may affect echotexture and visualization. This study evaluates patient characteristics for their ability to predict the echogenicity or visibility of upper extremity peripheral nerves.
• 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.
• Stolz, L. A., Stolz, L. A., Amini, R., Amini, R., Situ-LaCasse, E., Situ-LaCasse, E., Acuna, J., Acuna, J., Irving, S., Irving, S., Friedman, L., Friedman, L., Fiorello, A. B., Fiorello, A. B., Stea, N., Stea, N., Fan, H., Fan, H., Adhikari, S. R., & 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., Acuna, J., Gaskin, K., Murphy, A., Friedman, L., Stears-Ellis, S., Javedani, P., Stolz, U., & Adhikari, S. R. (2018). Echogenicity and ultrasound visibility of peripheral nerves of the upper extremity. Medical Ultrsonography.
• 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., 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.
• 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.
• Flannigan, M. J., & Adhikari, S. (2017). Point-of-Care Ultrasound Work Flow Innovation: Impact on Documentation and Billing. Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine.
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  To evaluate the impact that an innovative automated ultrasound (US) work flow, which allows for bedside performance of examination documentation and order placement, has on point-of-care US billing compared to ordering US examinations through an electronic medical record.
• Gaspari, R., Weekes, A., Adhikari, S., Noble, V. E., Nomura, J. T., Theodoro, D., Woo, M., Atkinson, P., Blehar, D., Brown, S. M., Caffery, T., Douglass, E., Fraser, J., Haines, C., Lam, S., Lanspa, M., Lewis, M., Liebmann, O., Limkakeng, A., , Lopez, F., et al. (2017). Reply to Letter: Letter to the Editor regarding Gaspari and colleague's "Emergency department point-of-care ultrasound in out-of-hospital and in-ED cardiac arrest". Resuscitation, 114, e7-e8.
• Gaspari, R., Weekes, A., Adhikari, S., Noble, V., Nomura, J. T., Theodoro, D., Woo, M., Atkinson, P., Blehar, D., Brown, S., Caffery, T., Douglass, E., Fraser, J., Haines, C., Lam, S., Lanspa, M., Lewis, M., Liebmann, O., Limkakeng, A., , Lopez, F., et al. (2017). A retrospective study of pulseless electrical activity, bedside ultrasound identifies interventions during resuscitation associated with improved survival to hospital admission. A REASON Study. Resuscitation, 120, 103-107.
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  Our objective was to determine whether organized or disorganized cardiac activity is associated with increased survival in patients who present in pulseless electrical activity (PEA) treated with either 1) standard advanced cardiac life support (ACLS) medications or 2) other interventions.
• Jamplis, R. P., Friedman, L., & Adhikari, S. (2017). Point of Care Ultrasound Diagnosis of Upper Gastrointestinal Bleeding. Cureus, 9(12), e1956.
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  A 28-year-old male was brought to the emergency department by the Emergency medical services (EMS) after being found unconscious and unresponsive. Upon arrival, he was hypotensive, intubated with a Glasgow Coma Scale (GCS) 3T, without the signs of trauma or the evidence of bleeding. A focused assessment with sonography in trauma (FAST), point-of-care ultrasound (POCUS) was performed, obscuring part of the spleen from the distended stomach, which was filled with the heterogeneous contents, with the internal movement being identified. This was found to be blood after orogastric (OG) tube was placed for suction. The bedside endoscopy confirmed active variceal bleeding. This case illustrates the potential utility of the ultrasound in detecting the upper gastrointestinal bleeding.
• Lema, P. C., Mantuani, D., Nagdev, A., & Adhikari, S. (2017). Asteroid Hyalosis Masquerading as Vitreous Hemorrhage on Point-of-Care Sonography. Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine.
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  Point-of-care ocular sonography is frequently used in the emergency department to evaluate patients with vision disorders. We describe a case series of 3 patients who ultimately had a diagnosis of asteroid hyalosis, a lesser-known condition that on point-of-care sonography may be mistaken for vitreous hemorrhage. Asteroid hyalosis is considered a benign degenerative condition. In contrast, vitreous hemorrhage may be an ocular emergency that warrants an urgent ophthalmologic consultation if there is an underlying retinal tear or detachment. Although similar in appearance on sonography, recognition of the subtle pathognomonic sonographic features along with their clinical presentations can differentiate these diseases, with vastly different management strategies and dispositions.
• Matthew Fields, J., Davis, J., Alsup, C., Bates, A., Au, A., Adhikari, S., & Farrell, I. (2017). Accuracy of Point-of-care Ultrasonography for Diagnosing Acute Appendicitis: A Systematic Review and Meta-analysis. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 24(9), 1124-1136.
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  The use of ultrasonography (US) to diagnose appendicitis is well established. More recently, point-of-care ultrasonography (POCUS) has also been studied for the diagnosis of appendicitis, which may also prove a valuable diagnostic tool. The purpose of this study was through systematic review and meta-analysis to identify the test characteristics of POCUS, specifically US performed by a nonradiologist physician, in accurately diagnosing acute appendicitis in patients of any age.
• 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.
• Parikh, T., Czuzak, M., Bui, N., Wildner, C., Koch, B., Leko, E., Rappaport, W., Adhikari, S., Gordon, P., Gura, M., & Ellis, S. (2017). Novel Use of Ultrasound to Teach Reproductive System Physical Examination Skills and Pelvic Anatomy. Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine.
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  To determine whether integration of ultrasound (US) into a reproductive system examination clinical skills lab can increase confidence in palpating key reproductive structures during testicular and bimanual pelvic examinations, reduce anxiety about conducting testicular and bimanual pelvic examinations, and improve performance on multiple-choice questions based on structure identification using US images.
• 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.
• 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.
• Adhikari, S., Mathiasen, R., & Lander, L. (2016). Elevated blood pressure in the emergency department: lack of adherence to clinical practice guidelines. Blood pressure monitoring, 21(1), 54-8.
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  To determine emergency physician's adherence to American College of Emergency Physicians policy recommendations in the assessment of patients with asymptomatic elevated blood pressure (BP) in the emergency department (ED).
• Adhikari, S., Schmier, C., & Marx, J. (2016). Focused simulation training: emergency department nurses' confidence and comfort level in performing ultrasound-guided vascular access. The journal of vascular access, 16(6), 515-20.
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  The objective of this study is to assess Emergency Department (ED) nurses' confidence, comfort level, and competency in performing ultrasound-guided vascular access after a focused ultrasound simulation training session.
• 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., 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.
• Gaspari, R., Weekes, A., Adhikari, S., Noble, V. E., Nomura, J. T., Theodoro, D., Woo, M., Atkinson, P., Blehar, D., Brown, S. M., Caffery, T., Douglass, E., Fraser, J., Haines, C., Lam, S., Lanspa, M., Lewis, M., Liebmann, O., Limkakeng, A., , Lopez, F., et al. (2016). Emergency Department Point-of-care Ultrasound in Out-of-Hospital and in-ED Cardiac Arrest. Resuscitation.
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  Mortality following cardiac arrest remains high, and point-of-care ultrasound has been suggested to improve outcomes from advanced cardiac life support (ACLS), but no large studies have explored how point-of-care ultrasound should be incorporated into ACLS. Our aim was to determine whether detection of cardiac activity by ultrasound during ACLS is associated with improved survival.
• 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.
• Jones, T., Stea, N., Stolz, U., & Adhikari, S. (2016). Ultrasound evaluation of saphenous vein for peripheral intravenous cannulation in adults. The journal of vascular access, 16(5), 418-21.
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  The objective of this study was to investigate variables that may affect sonographic cannulation of great saphenous vein and determine the ideal location for ultrasound-guided saphenous vein cannulation in adult emergency department (ED) patients.
• Lewiss, R. E., Adhikari, S., Carmody, K., Fields, J. M., Hunt, P., Liteplo, A. S., Nagdev, A., Raio, C., & Gaspari, R. (2016). The Society of Clinical Ultrasound Fellowships: An innovation in the point of care ultrasound fellowship application process. The American journal of emergency medicine, 34(7), 1303-5.
• Nelson, M., Abdi, A., Adhikari, S., Boniface, M., Bramante, R. M., Egan, D. J., Fields, J. M., Leo, M. M., Liteplo, A. S., Liu, R., Nomura, J. T., Pigott, D. C., Raio, C. C., Ruskis, J., Strony, R., Thom, C., & Lewiss, R. E. (2016). Goal Directed Focused Ultrasound Milestones Revised: A Multi-organizational Consensus. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.
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  In 2012 the Accreditation Council for Graduate Medical Education (ACGME) and the American Board of Emergency Medicine (ABEM) released the Emergency Medicine (EM) Milestones. The Patient Care 12 (PC12) subcompetency delineates staged and progressive accomplishment in emergency ultrasound (EUS). While valuable as an initial framework for ultrasound resident education, there are limitations to PC12. This consensus paper provides a revised description of criteria to define the subcompetency. A multi-organizational taskforce was formed between the American College of Emergency Physicians (ACEP) Ultrasound Section, the Council of Emergency Medicine Residency Directors (CORD), and the Academy of Emergency Ultrasound (AEUS) of the Society for Academic Emergency Medicine (SAEM). Representatives from each organization created this consensus document and revision. This article is protected by copyright. All rights reserved.
• 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.
• Stolz, L. A., Stolz, U., Fields, J. M., Saul, T., Secko, M., Flannigan, M. J., Sheele, J. M., Rifenburg, R. P., Weekes, A. J., Josephson, E. B., Bedolla, J., Resop, D. M., Dela Cruz, J., Boysen-Osborn, M., Caffery, T., Derr, C., Bengiamin, R., Chiricolo, G., Backlund, B., , Heer, J., et al. (2016). Emergency Medicine Resident Assessment of the Emergency Ultrasound Milestones and Current Training Recommendations. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.
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  Emergency ultrasound (EUS) has been recognized as integral to the training and practice of emergency medicine (EM). The Council of Emergency Medicine Residency-Academy of Emergency Ultrasound (CORD-AEUS) consensus document provides guidelines for resident assessment and progression. The Accredited Council for Graduate Medical Education (ACGME) has adopted the EM Milestones for assessment of residents' progress during their residency training which includes demonstration of procedural competency in bedside ultrasound. The objective of this study was to assess EM residents' use of ultrasound and perceptions of the proposed ultrasound milestones and guidelines for assessment.
• Stolz, L. A., Stolz, U., Howe, C., Farrell, I. J., & Adhikari, S. (2016). Ultrasound-guided peripheral venous access: a meta-analysis and systematic review. The journal of vascular access, 16(4), 321-6.
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  The objective of this study was to determine through a systematic review of the literature and meta-analysis whether success rates, time to cannulation, and number of punctures required for peripheral venous access are improved with ultrasound guidance compared with traditional techniques in patients with difficult peripheral venous access.
• Adhikari, S., & Zeger, W. (2015). Non-thrombotic abnormalities on lower extremity venous duplex ultrasound examinations. The western journal of emergency medicine, 16(2), 250-4.
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  Emergency physician-performed compression ultrasonography focuses primarily on the evaluation of the proximal veins of the lower extremity in patients with suspected deep venous thrombosis (DVT). A detailed sonographic evaluation of lower extremity is not performed. The objective of this study was to determine the prevalence of non-thrombotic findings on comprehensive lower extremity venous duplex ultrasound (US) examinations performed on emergency department (ED) patients.
• Adhikari, S., Theodoro, D., Raio, C., Nelson, M., Lyon, M., Leech, S., Akhtar, S., & Stolz, U. (2015). Central Venous Catheterization: Are We Using Ultrasound Guidance?. Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine, 34(11), 2065-70.
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  To assess the self-reported frequency of use of ultrasound guidance for central venous catheterization by emergency medicine (EM) residents, describe residents' perceptions regarding the use of ultrasound guidance, and identify barriers to the use of ultrasound guidance.
• Adhikari, S., Zeger, W., Thom, C., & Fields, J. M. (2015). Isolated Deep Venous Thrombosis: Implications for 2-Point Compression Ultrasonography of the Lower Extremity. Annals of emergency medicine, 66(3), 262-6.
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  Two-point compression ultrasonography focuses on the evaluation of common femoral and popliteal veins for complete compressibility. The presence of isolated thrombi in proximal veins other than the common femoral and popliteal veins should prompt modification of 2-point compression technique. The objective of this study is to determine the prevalence and distribution of deep venous thrombi isolated to lower-extremity veins other than the common femoral and popliteal veins in emergency department (ED) patients with clinically suspected deep venous thrombosis.
• 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.
• Davis, J., Czerniski, B., Au, A., Adhikari, S., Farrell, I., & Fields, J. M. (2015). Diagnostic Accuracy of Ultrasonography in Retained Soft Tissue Foreign Bodies: A Systematic Review and Meta-analysis. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 22(7), 777-87.
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  Open wounds with the potential for retained foreign bodies are frequently seen in the emergency department (ED). Common foreign bodies, such as wood or glass, are often missed on physical examination and conventional radiography. The increased use of ultrasonography (US) in the ED presents an opportunity to better identify retained soft tissue foreign bodies, and understanding of its test characteristics is desirable. The authors set out to determine the test characteristics of US for detection of soft tissue foreign bodies by performing a systematic review and meta-analysis of the existing literature.
• Jones, T., Stea, N., Stolz, U., Adhikari, S. R., Jones, T., Stea, N., Stolz, U., & Adhikari, S. R. (2015). Ultrasound evaluation of saphenous vein for peripheral intravenous cannulation in adults. Journal of Vascular Access, 5, 418-421.
• 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.
• Stolz, L. A., Mosier, J. M., Gross, A. M., Douglas, M. J., Blaivas, M., & Adhikari, S. (2015). Can emergency physicians perform common carotid Doppler flow measurements to assess volume responsiveness?. The western journal of emergency medicine, 16(2), 255-9.
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  Common carotid flow measurements may be clinically useful to determine volume responsiveness. The objective of this study was to assess the ability of emergency physicians (EP) to obtain sonographic images and measurements of the common carotid artery velocity time integral (VTi) for potential use in assessing volume responsiveness in the clinical setting.
• Stolz, L. A., Muruganandan, K. M., Bisanzo, M. C., Sebikali, M. J., Dreifuss, B. A., Hammerstedt, H. S., Nelson, S. W., Nayabale, I., Adhikari, S., & Shah, S. P. (2015). Point-of-care ultrasound education for non-physician clinicians in a resource-limited emergency department. Tropical medicine & international health : TM & IH, 20(8), 1067-72.
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  To describe the outcomes and curriculum components of an educational programme to train non-physician clinicians working in a rural, Ugandan emergency department in the use of POC ultrasound.
• Stolz, L., O'Brien, K. M., Miller, M. L., Winters-Brown, N. D., Blaivas, M., & Adhikari, S. (2015). A review of lawsuits related to point-of-care emergency ultrasound applications. The western journal of emergency medicine, 16(1), 1-4.
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  New medical technology brings the potential of lawsuits related to the usage of that new technology. In recent years the use of point-of-care (POC) ultrasound has increased rapidly in the emergency department (ED). POC ultrasound creates potential legal risk to an emergency physician (EP) either using or not using this tool. The aim of this study was to quantify and characterize reported decisions in lawsuits related to EPs performing POC ultrasound.
• Waterbrook, A. L., Shah, A., Jannicky, E., Stolz, U., Cohen, R. P., Gross, A., & Adhikari, S. (2015). Sonographic inferior vena cava measurements to assess hydration status in college football players during preseason camp. Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine, 34(2), 239-45.
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  The purpose of this study was to determine whether sonographic measurement of the inferior vena cava (IVC) in college football players during preseason camp is a reliable way to detect and monitor dehydration. Our primary hypothesis was that IVC diameter measurements, the postpractice caval index, and expiratory diameter were significantly related to percent weight loss after a preseason football practice.
• Mosier, J. M., Stolz, L. A., Bloom, J. W., Malo, J., Snyder, L. S., Fiorello, A. B., & Adhikari, S. R. (2014). Resuscitative Echocardiography for the Evaluation and Management of Shock: The RECES protocol. Southwest Journal of Pulmonary and Critical Care, 8(2), 110-25.

Proceedings Publications

• Adhikari, S. R. (2015, October/Fall). Quality of Research and Level of Evidence in Point-of-Care Ultrasound Literature Where Are We Now?. In ACEP Scientific Assembly.

Presentations

• Adhikari, S. R., Cheng, V., Pratt, L., Lisowksi, M., Demirjian, J., Wallace, N., Lee, E., Garcia, J., French, J., Arif, M. S., Raslan, W., Dandashi, J., Brzycki, R., & Situ-LaCasse, E. (2021). Point-of-Care Cardiac Ultrasound Findings in Emergency Department Patients Who Present with Syncope. Society for Academic Emergency Medicine Annual Meeting 2022.
• Daniel, T., & Adhikari, S. R. (2021). Interpreter Variability Of Lung Point-of-Care Ultrasound Rubric in a Population of Non-Critically Ill COVID Patients. American College of Emergency Physicians Research Forum-Special Edition: COVID.
• Martin, T., & Adhikari, S. R. (2021). An Evaluation of Trainee-Executed Ultrasound-Guided Nerve Blocks in the Emergency Department. 46th Annual Regional Anesthesiology and Acute Pain Medicine Meeting, Lake Buena Vista, Florida.
• 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.
• 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.
• Halasa, R., Nuno, T., & Adhikari, S. 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.
• Rukh, S., Nuno, T., & Adhikari, S. 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 Annual Meeting. Las Vegas, NV: Society of Academic Emergency Medicine.
• Acuna, J., Acuna, J., Patanwala, A. E., Patanwala, A. E., Situ-LaCasse, E., Situ-LaCasse, E., Stolz, L., Stolz, L., Amini, R., Amini, R., Friedman, L., Friedman, L., Adhikari, S. R., & 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.
• Acuna, J., Patanwala, A. E., Situ-LaCasse, E., Stolz, L., Amini, R., Friedman, L., & Adhikari, S. R. (2018, May). Evaluation of Gender Differences in Ultrasound Milestone Assessments During Emergency Medicine Residency Training. Society of Academic Emergency Medicine Annual Meeting. Indianapolis, IN.
• Adhikari, S. R., Samsel, K., Irving, S., Diffar, D., Patanwala, A. E., Acuna, J., Huynh, D., & Situ-LaCasse, E. (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.
• 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., 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., Situ-LaCasse, E., Amini, R., Amini, R., Bain, V., Bain, V., Patanwala, A. E., Patanwala, A. E., Samsel, K., Samsel, K., Acuna, J., Acuna, J., Biffar, D., Biffar, D., Weaver, C., Weaver, C., Valenzuela, J., Valenzuela, J., Pratt, L., , Pratt, L., 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.
• 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.
• Adhikari, S. R., Thompson, M., Hawbaker, N., Stolz, U., Situ-LaCasse, E., Valenzuela, J., & Stolz, L. (2016, April). Clinical and Historical Features of Emergency Department Patients with Pericardial Effusions. Arizona Emergency Medicine Research Resident Forum. Tucson, Arizona.
• 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.
• Adhikari, S. R., Stolz, L., Amini, R., & Stea, N. (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.
• 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.
• 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.
• 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.
• Stolz, L. A., Stolz, U., & Adhikari, S. R. (2015, Fall). Emergency Medicine Ultrasound Milestones: Resident Opinion and Perceptions of the Guidelines. American College of Emergency Physicians Research Forum. Boston, MA.

Poster Presentations

• Acuna, J., Cabrera-Ramirez, J., & Adhikari, S. R. (2021, April). The Use of Point-of-Care Ultrasound in the Diagnosis of Mullerian Abnormality in the Pediatric Emergency Department.. American Institute of Ultrasound in Medicine Annual Convention. Virtual: American Institute of Ultrasound in Medicine.
• Adhikari, S. R. (2016, October). Novel use of ultrasound to teach reproductive physical examination skills and pelvic anatomy. American College of Emergency Physicians Research Forum. Las Vegas, NV: American College of Emergency Physicians.
• Adhikari, S. R., Acuna, J., Amini, R., Yarnish, A., Situ-LaCasse, E., Situ-LaCasse, E., Yarnish, A., Amini, R., Acuna, J., & Adhikari, S. R. (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.
• Milligan, R., Roy-Chaudhary, A., Morrisette, K., Adhikari, S. R., Stolz, L., Hypes, C., Cairns, C. B., & Mosier, J. M. (2018, Feb). Utilization of Point-of-Care Ultrasound in the Management of Critically Ill Patients in the ED.. Society of Critical Care Medicine Annual Congress. San Antonio, TX: Society of Critical Care Medicine.
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  28. Milligan R, Roy-Chaudhary A, Morrissette K, Adhikari S, Stolz L, Hypes C, Cairns C, Mosier J. Utilization of Point-of-Care Ultrasound in the Management of Critical Ill Patients in the ED. Society of Critical Care Medicine Annual Congress; February 2018; San Antonio, TX
• Adhikari, S. R., Shirazi, F., Acuna, J., Situ-LaCasse, E., Situ-LaCasse, E., Acuna, J., Shirazi, F., & Adhikari, S. R. (2020, October/Fall). Point-of-care Ultrasound in the Evaluation of Rattlesnake Envenomation. ACEP Research forum.
• Adhikari, S. R., Wesley, A., Ratesic, A., & Kelley, R. (2020, October/Fall). Diagnostic Utility of Point-of-care Ultrasound in The Evaluation of Necrotizing Soft Tissue Infections. ACEP Annual Research forum.
• Acuna, J., & Adhikari, S. R. (2019, April). Feasibility of Using a Handheld Ultrasound Device for Difficult Peripheral Intravenous Access in the Emergency Department. American Institute of Ultrasound in Medicine Annual Conference. Orlando, Florida: American Institute of Ultrasound in Medicine.
• 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.
• Stolz, L., Fiorello, A. B., & Adhikari, S. R. (2019, October). Emergency Medicine Ultrasound Milestones: Resident Opinion and Perceptions of the Guidelines. American College of Emergency Medicine Scientific Assembly. Boston, MA: American College of Emergency Physicians.
• Adhikari, S. R., Sandoval, M., Sandoval, L., & Situ-LaCasse, E. (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.
• Adhikari, S. R., Adhikari, S. R., Situ-LaCasse, E., Situ-LaCasse, E., Irving, S., Irving, S., Acuna, J., & Acuna, J. (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., Friedman, L., Lakshmanan, R., Grieger, R., & Situ-LaCasse, E. (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.
• Adhikari, S. R., Grieger, R., & Situ-LaCasse, E. (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.
• Adhikari, S. R., Irving, S., Acuna, J., & Situ-LaCasse, E. (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.
• Blaivas, M., Tsung, J., Tay, E., Friedman, L., Acuna, J., Situ-LaCasse, E., & Adhikari, S. R. (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., Adhikari, S. R., Irving, S., Situ-LaCasse, E., Acuna, J., Acuna, J., Irving, S., Situ-LaCasse, E., Friedman, L., Adhikari, S. R., Adhikari, S. R., Irving, S., Acuna, J., Situ-LaCasse, E., & Friedman, L. (2017, March). Point-of-Care Ultrasound Diagnosis of Imperforate Hymen in Pediatric Abdominal Pain. American Institute of Ultrasound in Medicine Annual Meeting. Orlando, Florida.
• Parikh, T. M., Adhikari, S. R., Czuzak, M. H., Koch, B. D., Gura, M., Ellis, S. C., Gordon, P. R., Adamas-Rappaport, W., Leko, E. O., & Wildner, C. M. (2017, June). "Novel Use of Ultrasound to Aid in Medical Student Reproductive Physical Examination Skills and Pelvic Anatomy". Association of Standardized Patient Education. Alexandria, Virginia.
• Parikh, T. M., Czuzak, M. H., Adhikari, S. R., Koch, B., Gura, M., Leko, E. O., Gordon, P. R., Wildner, C., Ellis, S. C., & Adamas-Rappaport, W. (2017, June). Using standardized patients and ultrasound to enhance reproductive physical exam skills & pelvic anatomy identification. Association of Standardized Patient Educators Annual Conference. Alexandria, VA: ASPE.
• Wildner, C. M., Leko, E. O., Adamas-Rappaport, W., Gordon, P. R., Ellis, S. C., Gura, M., Koch, B. D., Czuzak, M. H., Adhikari, S. R., & Parikh, T. M. (2017, April). "Novel Use of Ultrasound to Aid in Medical Student Reproductive Physical Examination Skills and Pelvic Anatomy". AMES Medical Education Research Day. University of Arizona College of Medicine: AMES.
• Adhikari, S. R., & Farrell, I. (2016, May). How Accurate Is Ultrasound In Diagnosing Pneumoperitoneum? A Meta-analysis. Society of Academic Emergency Medicine Annual National Meeting. New Orleans, Louisiana: Society of Academic Emergency 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.

Others

• Adhikari, S. R., & Situ-LaCasse, E. (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.