We provide an updated overview of standard and advanced neuroimaging techniques used in the evaluation of brain abnormalities in fetuses, newborns, and young infants, emphasizing how imaging can identify patterns and estimate the timing of brain injury, helping to distinguish between static malformations, acquired injuries, and progressive or metabolic conditions. Common developmental abnormalities (e.g., neural tube defects, disorders of brain folding and growth, and structural anomalies like cephaloceles and Dandy–Walker malformation) are discussed. The chapter also covers trauma, stroke, brain hemorrhage, infections before or around birth (cytomegalovirus, toxoplasmosis, and rubella), and bacterial infections like meningitis or abscesses. Inherited and acquired metabolic disorders affecting gray and white matter are also illustrated. Techniques such as functional imaging, brain perfusion studies, and chemical analysis using spectroscopy are included. Practical considerations regarding radiation safety, sedation, and use of infant-friendly equipment are addressed, alongside recent technological advances like artificial intelligence–based image enhancement and low-dose CT.

Deep vein thrombosis (DVT) commonly presents as unilateral leg swelling and pain. Risk factors for DVT include malignancy, recent surgery, history of DVT/PE, genetic predisposition to a hypercoagulable state, hospitalization, OCP/hormone replacement, pregnancy, and prolonged immobilization. D-dimer can help rule out DVT in patients with a low suspicion for DVT. Ultrasound, specifically compression ultrasonography, is a reliable way to diagnose DVT. Failure of a vein to completely compress with compression ultrasonography is diagnostic of a thrombus. Outpatient treatment with direct oral anticoagulants such as rivaroxaban and apixaban is typical. Some patients may be treated with low-molecular-weight heparin (LMWH), or LMWH bridge to warfarin. Patients with a DVT should also be evaluated for signs or symptoms of a pulmonary embolism (PE).

A case to prepare the reader for the emergency medicine oral boards examination. it discusses appropriate management of tension pneumothorax, including case presentation, key actions, and clinical reasoning.

Care of the patient with traumatic injuries begins with the ABCs. Airway must be secured before proceeding with other evaluation and treatment. Penetrating chest trauma can cause a pericardial effusion and cardiac tamponade. Recognition of pericardial effusion and diagnosis of cardiac tamponade is an imperative skill for the emergency physician. Identifying Beck’s triad of hypotension, distended neck veins, and muffled heart sounds can assist in the diagnosis of cardiac tamponade. Bedside ultrasound and the eFAST exam can confirm the diagnosis. On a cardiac view of the eFAST, pericardial effusion appears as an anechoic or hypoechoic stripe between the visceral and parietal layers of the pericardium. Tamponade is the collapse of the right ventricle during diastole, preventing filling of the heart. Traumatic pericardial effusions are typically caused by bleeding into the pericardium. Initial treatment of cardiac tamponade begins with fluid resuscitation, thus increasing preload capacity. Needle pericardiocentesis of traumatic pericardial effusions are temporizing measures, as blood quickly reaccumulates into the pericardium. Cardiac arrest may occur due to cardiac tamponade. ED thoracotomy should be performed to directly tamponade bleeding from the ventricle, and surgery should be consulted to take the patient to the OR for definitive repair.

This chapter reviews the normal anatomy, fractures and challenges of the upper extremity frequently encountered in child abuse imaging. Specifically, fracture types of the humerus, the elbow and the forearm are examined with attention to imaging techniques and protocols, particularly radiography and ultrasound.

This chapter provides a summary of longstanding and updated research for the accurate diagnosis of fractures of the clavicle, sternum and scapula in the setting of suspected physical abuse of infants and young children. Findings key to diagnosing fractures by radiographic skeletal survey, computed tomography, ultrasound and magnetic resonance imaging are demonstrated with numerous representative examples. A section for each of these anatomical regions includes a detailed review of anatomy and injury mechanisms in addition to characteristic imaging features. Considerations for differential diagnosis and pitfalls in interpretation are presented specific to each anatomic area. Attention to imaging technique and careful evaluation of findings are emphasized to promote proper diagnosis.

This chapter reviews the imaging approach in suspected child physical abuse, including differing presentations of child physical abuse as well as recommendations for screening children at risk. Imaging strategy of the skeleton, including radiography, chest CT, ultrasound, whole-body MR and radionuclide bone imaging is reviewed.

This chapter discusses skeletal injuries associated with obstetric trauma during the birth process. The prevalence of obstetric injuries has decreased with modern obstetric techniques, but major injuries still occur, providing valuable insights into the mechanisms involved in similar lesions seen in abuse cases.

This chapter highlights specific types of injuries, such as clavicular fractures, long bone injuries (including subperiosteal new bone formation and fractures) and rib fractures. Clavicular fractures are the most common site of obstetric fracture, often occurring with relatively uneventful vaginal births of large babies. Long bone injuries include subperiosteal new bone formation and fractures, which may present similarly to abuse-related injuries. Radiographs and sonography play a crucial role in characterizing the extent and nature of these injuries.

This chapter emphasizes the importance of understanding and differentiating obstetric injuries from abuse-related injuries, as well as providing valuable information about the biomechanics, natural history and imaging characteristics of inflicted skeletal injuries during birth.

This clinical vignette explores the complex decision-making involved in terminating resuscitation after prolonged, unsuccessful advanced cardiac life support (ACLS) for a 72-year-old female in unwitnessed cardiac arrest. Despite high-quality CPR, PEA persisted without return of spontaneous circulation (ROSC), and serial assessments showed a non-perfusing rhythm, absent cardiac motion on ultrasound, and persistently low end-tidal CO₂. Reversible causes were systematically ruled out using the Hs and Ts framework. After 20 minutes of resuscitation and no signs of ROSC, the code team, led by the resident, called time of death. This case emphasizes the use of ETCO₂, point-of-care ultrasound, and AHA termination of resuscitation (TOR) criteria, while modeling collaborative leadership and thoughtful clinical judgment in high-stakes decision-making.

Ultrasound is the most commonly used medical imaging method in pregnancy. In early pregnancy a scan is performed to confirm the presence of a normally sited pregnancy, establish viability, determine number of embryos, determine gestational age and hopefully to reassure about the absence of complications. Ultrasound used with standard presets for clinical reasons in early pregnancy is safe and the benefits outweigh any theoretical risks.

This case involves likely casualties that may present to a facility following a mass gathering stampede incident. Patients within this context may present with blunt polytrauma and subtle signs of impending decompensation that portend catastrophic outcomes if not caught early during the standardized trauma evaluation. The nature of a mass gathering, mass casualty event is such that external factors and players may provide unanticipated barriers to care at critical moments. Rapid identification and mitigation of these confounders and confederates are critical, in order to prevent degradation of high-efficacy trauma care for potentially complex and critical ill patients.

The final chapter in the book covers some specific electrical devices used in surgery, anaesthesia and critical care. Firstly, we discuss defibrillators where exam candidates are expected to have a good working knowledge and be able to both draw and explain the relevant electrical circuit. Secondly we discuss surgical equipment in LASER and diathermy, both of which carry detail in their different types, risks of harm and safety requirements. Finally the chapter discusses medical ultrasound, how it is generated and used in clinical practice.

Vascular access is a fundamental skill in anaesthesia and intensive care, not only for drug administration but also for delivery of fluids and blood products, and for sampling for blood tests. Peripheral venous access is used for all patients undergoing surgery, but for major surgery and/or very unwell patients, central venous access and arterial access may also be required.

Flow rates through cannulae are key in determining the size of cannula chosen, and are proportional to the fourth power of their internal radius. All vascular access must be inserted aseptically, and removed if signs of infection develop. Serious complications, particularly after central venous access are well described including pneumothorax, haemothorax and cardiac tamponade. The use of ultrasound for facilitating access is mandated for central access, but is also increasing for both more difficult arterial and peripheral venous access.

Transvaginal ultrasound scan is the mainstay of diagnosis of miscarriage. Evidence based criteria should be fulfilled in all cases, with interval scans as needed to avoid inadvertent interventions when the pregnancy may be viable. Incomplete, inevitable and complete miscarriages have specific ultrasound findings. Several ultrasound factors, including slow embryonic heart rate, small embryo or gestation sac size and an enlarged yolk sac, alone or in combination, help predict impending pregnancy loss. Uterine factors such as fibroids, adenomyosis and adhesions after previous caesarean birth may make ultrasound assessment for early pregnancy more challenging.