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Topical steroids for shingles is flixotide a steroid

Topical steroids for shingles

The rash looks like chickenpox but only appears on the band of skin supplied by the affected nerve. New blisters may appear for up to a week. The soft tissues under and around the rash may become swollen for a while due to inflammation caused by the virus. The blisters then dry up, form scabs and gradually fade away. Slight scarring may occur where the blisters have been. The picture shows a scabbing rash a few days old of a fairly bad bout of shingles.

In this person, it has affected a nerve and the skin that the nerve supplies, on the left side of the abdomen. An episode of shingles usually lasts weeks. In some cases there is a rash but no pain. Rarely, there is no rash but just a band of pain. Did you know your local pharmacist can provide treatment for shingles? Book a consultation today.

Shingles is a painful, blistery rash in one specific area of your body. Most of us get chickenpox in our lives, usually when we are children. Shingles is a reactivation of that chickenpox virus but only in one nerve root.

So instead of getting spots all over your body, as you do when you have chickenpox, you get them just in one area of your body. It is almost always just on one side of your body, although it may go right around from front to back, following the skin the nerve affects. The affected skin hurts, and it may start to hurt before the rash appears, and may keep hurting for some time after the rash has gone. You may feel generally off-colour and not yourself. You can catch chickenpox from someone with shingles if you have not had chickenpox before.

But most adults and older children have already had chickenpox and so are immune from catching chickenpox again. You cannot get shingles from someone who has shingles. The shingles rash is contagious for someone else to catch chickenpox until all the blisters vesicles have scabbed and are dry. If the blisters are covered with a dressing, it is unlikely that the virus will pass on to others.

This is because the virus is passed on by direct contact with the blisters. If you have a job, you can return to work once the blisters have dried up, or earlier if you keep the rash covered and feel well enough.

Similarly children with shingles can go to school if the rash is covered by clothes and the children do not feel unwell. Pregnant women who have not had chickenpox should avoid people with shingles. See the separate leaflet called Chickenpox Contact in Pregnancy for more details. Also, if you have a poor immune system immunosuppression , you should avoid people with shingles.

See below for a list of people who have a poor immune system. These general rules are to be on the safe side, as it is direct contact with the rash that usually passes on the virus. This one is confusing! You can catch chickenpox from other people, but you can't catch shingles from other people. You only get shingles from a reactivation of your own chickenpox infection in the past.

So if you have shingles, and you come into contact with somebody else, they cannot 'catch' your shingles. But if they have never had chickenpox, it is possible that they could catch chickenpox from you.

And if you had chickenpox, and came into contact with somebody else who had never had chickenpox, they could catch chickenpox. But they couldn't 'catch' shingles from your chickenpox. To put it another way, no, you don't 'catch' shingles. It comes from a virus hiding out in your own body, not from someone else. But if you have shingles, you may be infectious, as it is possible for people to catch chickenpox from you.

Only people who have never had chickenpox are likely to be at risk of catching chickenpox from your shingles. People who have had chickenpox should be immune from catching it again. If the rash is in a covered area of skin, the risk of anyone with whom you are not in close contact catching chickenpox is very low. Shingles is an infection of a nerve and the area of skin supplied by the nerve. It is caused by a virus called the varicella-zoster virus.

It is the same virus that causes chickenpox. Anyone who has had chickenpox in the past may develop shingles. Shingles is sometimes called herpes zoster. Note : this is very different to genital herpes which is caused by a different virus called herpes simplex.

About 1 in 4 people have shingles at some time in their lives. It can occur at any age but it is most common in older adults over the age of 50 years. After the age of 50, it becomes increasingly more common as you get older. It is uncommon to have shingles more than once but some people do have it more than once.

Most people have chickenpox at some stage usually as a child. The virus does not completely go after you have chickenpox. Some virus particles remain inactive in the nerve roots next to your spinal cord.

They do no harm there and cause no symptoms. For reasons that are not clear, the virus may begin to multiply again reactivate. This is often years later. The reactivated virus travels along the nerve to the skin to cause shingles. In most cases, an episode of shingles occurs for no apparent reason. Sometimes a period of stress or illness seems to trigger it. A slight ageing of the immune system may account for it being more common in older people. The immune system keeps the virus inactive and prevents it from multiplying.

A slight weakening of the immune system in older people may account for the virus reactivating and multiplying to cause shingles. The risk of getting shingles increases in people with a poor immune system immunosuppression. Loose-fitting cotton clothes are best to reduce irritating the affected area of skin. Pain may be eased by cooling the affected area with ice cubes wrapped in a plastic bag , wet dressings, or a cool bath.

A non-adherent dressing that covers the rash when it is blistered and raw may help to reduce pain caused by contact with clothing. Simple creams emollients may be helpful if the rash is itchy. Calamine lotion can help to cool the skin and reduce mild itchiness. Painkillers - for example, paracetamol , or paracetamol combined with codeine such as co-codamol , or anti-inflammatory painkillers such as ibuprofen - may give some relief.

Strong painkillers such as oxycodone and tramadol may be needed in some cases. Some painkillers are particularly useful for nerve pain. If the pain during an episode of shingles is severe, or if you develop postherpetic neuralgia PHN , you may be advised to take:. If an antidepressant or anticonvulsant is advised, you should take it regularly as prescribed. It may take up to two or more weeks for it to become fully effective to ease pain.

In addition to easing pain during an episode of shingles, they may also help to prevent PHN. See the separate leaflet called Postherpetic Neuralgia for more information. Antiviral medicines used to treat shingles include aciclovir , famciclovir and valaciclovir.

An antiviral medicine does not kill the virus but works by stopping the virus from multiplying. So, it may limit the severity of symptoms of the shingles episode. Antiviral agents are not used in combination, and selection of an agent is based on dosage schedule and cost. Orally administered corticosteroids are commonly used in the treatment of herpes zoster, even though clinical trials have shown variable results.

Prednisone used in conjunction with acyclovir has been shown to reduce the pain associated with herpes zoster. Some studies designed to evaluate the effectiveness of prednisone therapy in preventing postherpetic neuralgia have shown decreased pain at three and 12 months. If the use of orally administered prednisone is not contraindicated, adjunctive treatment with this agent is justified on the basis of its effects in reducing pain, despite questionable evidence for its benefits in decreasing the incidence of postherpetic neuralgia.

Given the theoretic risk of immunosuppression with corticosteroids, some investigators believe that these agents should be used only in patients more than 50 years of age because they are at greater risk of developing postherpetic neuralgia. The pain associated with herpes zoster ranges from mild to excruciating. Patients with mild to moderate pain may respond to over-the-counter analgesics. Patients with more severe pain may require the addition of a narcotic medication.

Lotions containing calamine e. Once the lesions have crusted over, capsaicin cream Zostrix may be applied. Topically administered lidocaine Xylocaine and nerve blocks have also been reported to be effective in reducing pain. Ocular herpes zoster is treated with orally administered antiviral agents and corticosteroids, the same as involvement elsewhere.

Although most patients with ocular herpes zoster improve without lasting sequelae, some may develop severe complications, including loss of vision. When herpes zoster involves the eyes, ophthalmologic consultation is usually recommended. The morbidity and mortality of herpes zoster could be reduced if a safe and effective preventive treatment were available. It is unusual for a patient to develop herpes zoster more than once, suggesting that the first reactivation of varicella-zoster virus usually provides future immunologic protection.

Studies are currently being conducted to evaluate the efficacy of the varicella-zoster vaccine in preventing or modifying herpes zoster in the elderly. Although postherpetic neuralgia is generally a self-limited condition, it can last indefinitely. Treatment is directed at pain control while waiting for the condition to resolve. Pain therapy may include multiple interventions, such as topical medications, over-the-counter analgesics, tricyclic antidepressants, anticonvulsants and a number of nonmedical modalities.

Occasionally, narcotics may be required. Dosage recommendations are provided in Table 2. Drug levels for clinical use are not available. Capsaicin, an extract from hot chili peppers, is currently the only drug labeled by the U. Food and Drug Administration for the treatment of postherpetic neuralgia.

Substance P, a neuropeptide released from pain fibers in response to trauma, is also released when capsaicin is applied to the skin, producing a burning sensation. Analgesia occurs when substance P is depleted from the nerve fibers.

To achieve this response, capsaicin cream must be applied to the affected area three to five times daily. Patients must be counseled about the need to apply capsaicin regularly for continued benefit. They also need to be counseled that their pain will likely increase during the first few days to a week after capsaicin therapy is initiated.

Patients should wash their hands thoroughly after applying capsaicin cream in order to prevent inadvertent contact with other areas. Patches containing lidocaine have also been used to treat postherpetic neuralgia. One study found that compared with no treatment, lidocaine patches reduced pain intensity, with minimal systemic absorption.

Although lidocaine was efficacious in relieving pain, the effect was temporary, lasting only four to 12 hours with each application. Over-the-counter analgesics such as acetaminophen e. However, these agents are often useful for potentiating the pain-relieving effects of narcotics in patients with severe pain.

Because of the addictive properties of narcotics, their chronic use is discouraged except in the rare patient who does not adequately respond to other modalities. Tricyclic antidepressants can be effective adjuncts in reducing the neuropathic pain of postherpetic neuralgia. These agents most likely lessen pain by inhibiting the reuptake of serotonin and norepinephrine neurotransmitters.

Tricyclic antidepressants commonly used in the treatment of postherpetic neuralgia include amitriptyline Elavil , nortriptyline Pamelor , imipramine Tofranil and desipramine Norpramin. These drugs are best tolerated when they are started in a low dosage and given at bedtime.

The dosage is increased every two to four weeks to achieve an effective dose. The tricyclic antidepressants share common side effects, such as sedation, dry mouth, postural hypotension, blurred vision and urinary retention. Nortriptyline and amitriptyline appear to have equal efficacy; however, nortriptyline tends to produce fewer anticholinergic effects and is therefore better tolerated.

Treatment with tricyclic antidepressants can occasionally lead to cardiac conduction abnormalities or liver toxicity. The potential for these problems should be considered in elderly patients and patients with cardiac or liver disease. Because tricyclic antidepressants do not act quickly, a clinical trial of at least three months is required to judge a patient's response.

The onset of pain relief using tricyclic antidepressants may be enhanced by beginning treatment early in the course of herpes zoster infection in conjunction with antiviral medications. Phenytoin Dilantin , carbamazepine Tegretol and gabapentin Neurontin are often used to control neuropathic pain. A recent double-blind, placebo-controlled study showed gabapentin to be effective in treating the pain of postherpetic neuralgia, as well as the often associated sleep disturbance.

The anticonvulsants appear to be equally effective, and drug selection often involves trial and error. Lack of response to one of these medications does not necessarily portend a poor response to another. The dosages required for analgesia are often lower than those used in the treatment of epilepsy.

Anticonvulsants are associated with a variety of side effects, including sedation, memory disturbances, electrolyte abnormalities, liver toxicity and thrombocytopenia. Side effects may be reduced or eliminated by initiating treatment in a low dosage, which can then be slowly titrated upward.

There are no specific contraindications to using anticonvulsants in combination with antidepressants or analgesics. However, the risk of side effects increases when multiple medications are used. Effective treatment of postherpetic neuralgia often requires multiple treatment approaches. In addition to medications, modalities to consider include transcutaneous electric nerve stimulation TENS , biofeedback and nerve blocks.

Herpes zoster and postherpetic neuralgia are relatively common conditions, primarily in elderly and immunocompromised patients. Although the diagnosis of the conditions is generally straightforward, treatment can be frustrating for the patient and physician.

Approaches to management include treatment of the herpes zoster infection and associated pain, prevention of postherpetic neuralgia, and control of the neuropathic pain until the condition resolves. Primary treatment modalities include antiviral agents, corticosteroids, tricyclic antidepressants and anticonvulsants. Already a member or subscriber? Log in. Packer is board certified by the American Board of Family Practice. Reprints are not available from the authors.

The views expressed herein are exclusively those of the authors and do not necessarily represent the opinions of the United States Army or Department of Defense. The incidence of herpes zoster. Arch Intern Med. Herpes zoster and progression to AIDS in a cohort of individuals who seroconverted to human immunodeficiency virus. Clin Infect Dis. Herpes zoster and internal malignancy. South Med J. Racial differences in the occurrence of herpes zoster. J Infect Dis.

Brody MB, Moyer D. Varicella-zoster virus infection. Postgrad Med. Risk factors for postherpetic neuralgia. Strauss SE. Overview: the biology of varicella-zoster virus infection. Ann Neurol. Oxman MN. Immunization to reduce the frequency and severity of herpes zoster and its complications. Bowsher D. Pathophysiology of postherpetic neuralgia: towards a rational treatment. Goh L, Khoo L. A retrospective study of the clinical presentation and outcome of herpes zoster in a tertiary dermatology outpatient referral clinic.

Int J Dermatol. Nurmikko T. Clinical features and pathophysiologic mechanisms of postherpetic neuralgia. Schmader K. Management of herpes zoster in elderly patients. Infect Dis Clin Pract. Zoster-associated chronic pain: an overview of clinical trials with acyclovir. Scand J Infect Dis Suppl. Valaciclovir compared with acyclovir for improved therapy for herpes zoster in immunocompetent adults. Antimicrob Agents Chemother. Acylclovir with and without prednisone for the treatment of herpes zoster.

A randomized, placebo-controlled trial. Ann Intern Med. The effects of early corticosteroid therapy on the skin eruption and pain of herpes zoster. Keczkes K, Basheer AM. Do corticosteroids prevent post-herpetic neuralgia? Br J Dermatol. Prednisolone does not prevent post-herpetic neuralgia.

Lee PJ, Annunziato P. Current management of herpes zoster. Infect Med. Chronic neuropathic pain and its control by drugs. Pharmacol Ther. Lidocaine patch: double-blind controlled study of a new treatment method for post-herpetic neuralgia. Ardid D, Guilbaud G. Gabapentin for the treatment of postherpetic neuralgia. Guest editor of the series is Ted D. This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference.

This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact afpserv aafp. Want to use this article elsewhere?

STEROID CREAM FOR RASH OVER THE COUNTER

A narrative synthesis was appropriate given the small number of studies. However, in the narration, attention was not drawn to higher quality studies though the deficiencies in the evidence base were discussed. No comment was made on the likelihood that studies reporting no significant difference could be underpowered.

The evidence presented appears to support the author's conclusions although, as the author correctly acknowledged, the evidence base is weak. Practice: The author stated that there is no evidence that corticosteroids prevent postherpetic neuralgia. Any small reduction in pain from oral corticosteroids may be outweighed by harm in people with medical conditions that could be made worse by corticosteroids.

The author also stated that topical corticosteroids should be avoided where possible in herpes zoster opthalmicus. The use of epidural, intramuscular or subcutaneous corticosteroids was not recommended. However, it was recommended that intrathecal corticosteroids be used only for people with postherpetic neuralgia who have not responded to adequate trials of other treatments, and that only trained personnel should perform the injection.

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn. Corticosteroids for herpes zoster: what do they accomplish? Santee J A Authors' objectives. To examine the effectiveness and safety of corticosteroids in the treatment of herpes zoster.

Study designs of evaluations included in the review Reviews, letters editorials and single case reports were excluded, but otherwise, the inclusion criteria were not explicitly defined in terms of the study design. Specific interventions included in the review Studies that focused on the use of corticosteroids for treatment or prevention were eligible for inclusion.

Outcomes assessed in the review Studies that reported effectiveness and tolerability were eligible for inclusion. How were decisions on the relevance of primary studies made? How were the studies combined? How were differences between studies investigated? Oral corticosteroids for the prevention of postherpetic neuralgia 9 studies including 7 RCTs. Injectable corticosteroids 2 RCTs with patients and 8 case series with patients. Research: The author did not state any implications for further research.

Santee J A. American Journal of Clinical Dermatology ; 3 8 : Message for DARE database users. Authors' objectives To examine the effectiveness and safety of corticosteroids in the treatment of herpes zoster. Study selection Study designs of evaluations included in the review Reviews, letters editorials and single case reports were excluded, but otherwise, the inclusion criteria were not explicitly defined in terms of the study design. Assessment of study quality Validity was not formally assessed, but some aspects of validity were discussed in the text: the adequacy of information on the intervention; statistical analysis; baseline comparability of the treatment groups; potential confounding by cointerventions; aspects of study design; and sample size.

Data extraction The author did not state how the data were extracted for the review, or how many reviewers performed the data extraction. Methods of synthesis How were the studies combined? Results of the review Twenty-four studies were included the number of patients per intervention is given in the results. Authors' conclusions Most studies of topical and injectable corticosteroids were of a low quality. CRD commentary The review question was clear in terms of the intervention, participants and outcomes, but the inclusion criteria were not defined in terms of the study design.

Implications of the review for practice and research Practice: The author stated that there is no evidence that corticosteroids prevent postherpetic neuralgia. Bibliographic details Santee J A. PubMed record.

Original research. New blisters may appear for up to a week. The soft tissues under and around the rash may become swollen for a while due to inflammation caused by the virus. The blisters then dry up, form scabs and gradually fade away. Slight scarring may occur where the blisters have been. The picture shows a scabbing rash a few days old of a fairly bad bout of shingles. In this person, it has affected a nerve and the skin that the nerve supplies, on the left side of the abdomen. An episode of shingles usually lasts weeks.

In some cases there is a rash but no pain. Rarely, there is no rash but just a band of pain. Did you know your local pharmacist can provide treatment for shingles? Book a consultation today. Shingles is a painful, blistery rash in one specific area of your body. Most of us get chickenpox in our lives, usually when we are children. Shingles is a reactivation of that chickenpox virus but only in one nerve root. So instead of getting spots all over your body, as you do when you have chickenpox, you get them just in one area of your body.

It is almost always just on one side of your body, although it may go right around from front to back, following the skin the nerve affects. The affected skin hurts, and it may start to hurt before the rash appears, and may keep hurting for some time after the rash has gone.

You may feel generally off-colour and not yourself. You can catch chickenpox from someone with shingles if you have not had chickenpox before. But most adults and older children have already had chickenpox and so are immune from catching chickenpox again. You cannot get shingles from someone who has shingles. The shingles rash is contagious for someone else to catch chickenpox until all the blisters vesicles have scabbed and are dry.

If the blisters are covered with a dressing, it is unlikely that the virus will pass on to others. This is because the virus is passed on by direct contact with the blisters. If you have a job, you can return to work once the blisters have dried up, or earlier if you keep the rash covered and feel well enough.

Similarly children with shingles can go to school if the rash is covered by clothes and the children do not feel unwell. Pregnant women who have not had chickenpox should avoid people with shingles. See the separate leaflet called Chickenpox Contact in Pregnancy for more details. Also, if you have a poor immune system immunosuppression , you should avoid people with shingles. See below for a list of people who have a poor immune system. These general rules are to be on the safe side, as it is direct contact with the rash that usually passes on the virus.

This one is confusing! You can catch chickenpox from other people, but you can't catch shingles from other people. You only get shingles from a reactivation of your own chickenpox infection in the past.

So if you have shingles, and you come into contact with somebody else, they cannot 'catch' your shingles. But if they have never had chickenpox, it is possible that they could catch chickenpox from you. And if you had chickenpox, and came into contact with somebody else who had never had chickenpox, they could catch chickenpox.

But they couldn't 'catch' shingles from your chickenpox. To put it another way, no, you don't 'catch' shingles. It comes from a virus hiding out in your own body, not from someone else. But if you have shingles, you may be infectious, as it is possible for people to catch chickenpox from you. Only people who have never had chickenpox are likely to be at risk of catching chickenpox from your shingles. People who have had chickenpox should be immune from catching it again.

If the rash is in a covered area of skin, the risk of anyone with whom you are not in close contact catching chickenpox is very low. Shingles is an infection of a nerve and the area of skin supplied by the nerve. It is caused by a virus called the varicella-zoster virus.

It is the same virus that causes chickenpox. Anyone who has had chickenpox in the past may develop shingles. Shingles is sometimes called herpes zoster. Note : this is very different to genital herpes which is caused by a different virus called herpes simplex. About 1 in 4 people have shingles at some time in their lives. It can occur at any age but it is most common in older adults over the age of 50 years.

After the age of 50, it becomes increasingly more common as you get older. It is uncommon to have shingles more than once but some people do have it more than once. Most people have chickenpox at some stage usually as a child. The virus does not completely go after you have chickenpox. Some virus particles remain inactive in the nerve roots next to your spinal cord. They do no harm there and cause no symptoms. For reasons that are not clear, the virus may begin to multiply again reactivate.

This is often years later. The reactivated virus travels along the nerve to the skin to cause shingles. In most cases, an episode of shingles occurs for no apparent reason. Sometimes a period of stress or illness seems to trigger it. A slight ageing of the immune system may account for it being more common in older people. The immune system keeps the virus inactive and prevents it from multiplying. A slight weakening of the immune system in older people may account for the virus reactivating and multiplying to cause shingles.

The risk of getting shingles increases in people with a poor immune system immunosuppression. Loose-fitting cotton clothes are best to reduce irritating the affected area of skin. Pain may be eased by cooling the affected area with ice cubes wrapped in a plastic bag , wet dressings, or a cool bath. A non-adherent dressing that covers the rash when it is blistered and raw may help to reduce pain caused by contact with clothing.

Simple creams emollients may be helpful if the rash is itchy. Calamine lotion can help to cool the skin and reduce mild itchiness. Painkillers - for example, paracetamol , or paracetamol combined with codeine such as co-codamol , or anti-inflammatory painkillers such as ibuprofen - may give some relief. Strong painkillers such as oxycodone and tramadol may be needed in some cases. Some painkillers are particularly useful for nerve pain.

If the pain during an episode of shingles is severe, or if you develop postherpetic neuralgia PHN , you may be advised to take:. If an antidepressant or anticonvulsant is advised, you should take it regularly as prescribed. It may take up to two or more weeks for it to become fully effective to ease pain. In addition to easing pain during an episode of shingles, they may also help to prevent PHN.

See the separate leaflet called Postherpetic Neuralgia for more information. Antiviral medicines used to treat shingles include aciclovir , famciclovir and valaciclovir. An antiviral medicine does not kill the virus but works by stopping the virus from multiplying. So, it may limit the severity of symptoms of the shingles episode.

An antiviral medicine is most useful when started in the early stages of shingles within 72 hours of the rash appearing.

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Whether these improvements are clinically significant is uncertain. Thus, oral corticosteroids may confer a slight benefit for initial symptoms as long as the patient is not at risk for complications resulting from corticosteroid therapy. Most trials of topical and injectable corticosteroids are limited by several shortcomings. Therefore, topical and most forms of parenteral corticosteroids have yet to be proven effective for the treatment of acute pain or prevention of complications.

Two controlled, blinded trials investigating the use of intrathecal corticosteroid administration for intractable postherpetic neuralgia suggest that corticosteroid administration results in a significant improvement in pain. Despite this, several authors have voiced concern over possible serious adverse events with the intrathecal administration of corticosteroids. Intrathecal corticosteroids may provide a benefit for intractable postherpetic neuralgia, but because of risks of serious complications, this is a last-line option and should only be administered by experienced personnel.

An summary of a Cochrane review published in November see reference 1 below looked at 6 randomized controlled trials 5 with acyclovir and 1 with famciclovir versus placebo to assess incidence of post-herpetic neuralgia up to 6 months post illness in patients taking antivirals versus placebo. Although they did not appreciate a difference when comparing antivirals with placebo at 4 and 6 months, they did note a reduction in reported pain at 1 month in the experimental group And, antivirals did not cause an increase in adverse effects.

Another Cochrane review, also published in November see reference 2 below , looked at 5 randomized controlled trials comparing steroid use versus placebo given within 7 days of rash onset in patients with zoster. Unfortunately, they also did not appreciate a decreased incidence of post-herpetic neuralgia in patients receiving steroids, this time at 3, 6 and 12 months out. However, they did note a possible trend towards a reduction in acute pain within the first month and did not appreciate any increased side effects in the steroid group.

Given the lack of adverse effects with both medications, as well as an improvement in pain reported during the acute illness, it is probably still worth it to treat patients presenting with shingles with the usual combo of antivirals and steroids. Unfortunately neither of these appear to be helpful in preventing post-herpetic neuralgia.

If you get the chance, remember to stress the importance of prevention by recommending the zoster vaccine to your patients, friends and family over Acad Emerg Med. It serves as an information resource for residents, fellows, medical students and others seeking information about point-of-care ultrasound.

There is a lot of Read more. Ultrasound Orientation day for new interns: July 15, Read more. The Emergency Ultrasound Fellowship at the Mount Sinai School of Medicine is built upon a foundation of clinical excellence, cutting-edge research, administrative experience, and education. We are pleased to offer a wide array of experiences Read more. In the evaluation and treatment of acute illness, seconds count.

Focused bedside ultrasound has gained widespread use in emergency and critical care settings as an adjunct to physical examination and to aid in the performance Read more.