Clinical Focus

  • Emergency Medicine

Academic Appointments

Administrative Appointments

  • Director, Stanford Emergency Ultrasound (2011 - Present)
  • Associate Director, Stanford Emergency Ultrasound (2008 - 2011)
  • Co-Director, Emergency Ultrasound Fellowship (2008 - Present)

Honors & Awards

  • Faculty Clinical Teaching Honorable Mention, Stanford Emergency Medicine (2015)
  • Faculty Clinical Teaching Award, Stanford Emergency Medicine (2012)
  • Faculty Clinical Teaching Award, Stanford Emergency Medicine (2011)
  • Long Beach Memorial Medical Center Applause Award for Outstanding Service, Long Beach Memorial Medical Center (2005)
  • Cal-ACEP Scientific Assembly Best Research Project, CalACEP (2006)
  • Faculty Clinical Teaching Award, Stanford Emergency Medicine (2007)

Professional Education

  • Residency:UCI Medical Center Dept of Emergency Medicine (2007) CA
  • Medical Education:UC Irvine School of Medicine (2004) CA
  • Board Certification: Emergency Medicine, American Board of Emergency Medicine (2008)
  • MD, Stanford University Med Ctr, Emergency Ultrasound fellowship (2008)
  • MD, UC Irvine School of Medicine, Emergency Medicine (2007)

Community and International Work

  • Ultrasound Education, Guatemala, Iran, India, Mexico


    Emergency ultrasound

    Populations Served

    villagers, clinics



    Ongoing Project


    Opportunities for Student Involvement


Research & Scholarship

Current Research and Scholarly Interests

Emergency Ultrasound,
Resident Education,
Interesting Cases,
Visual Diagnosis


All Publications

  • Spontaneous pneumomediastinum on bedside ultrasound: case report and review of the literature. The western journal of emergency medicine Zachariah, S., Gharahbaghian, L., Perera, P., Joshi, N. 2015; 16 (2): 321-324


    Spontaneous pneumomediastinum is a rare disease process with no clear etiology, although it is thought to be related to changes in intrathoracic pressure causing chest pain and dyspnea. We present a case of a 17-year-old male with acute chest pain evaluated initially by bedside ultrasound, which showed normal lung sliding but poor visualization of the parasternal and apical cardiac views due to significant air artifact, representing air in the thoracic cavity. The diagnosis was later verified by chest radiograph. We present a case report on ultrasound-diagnosed pneumomediastinum, and we review the diagnostic modalities to date.

    View details for DOI 10.5811/westjem.2015.1.24514

    View details for PubMedID 25834681

  • Diagnosis of pneumoperitoneum with bedside ultrasound. The western journal of emergency medicine Chao, A., Gharahbaghian, L., Perera, P. 2015; 16 (2): 302-?

    View details for DOI 10.5811/westjem.2014.12.24945

    View details for PubMedID 25834673

  • Clinical Correlation Needed: What Do Emergency Physicians Do After an Equivocal Ultrasound for Pediatric Acute Appendicitis? JOURNAL OF CLINICAL ULTRASOUND Ramarajan, N., Krishnamoorthi, R., Gharahbaghian, L., Pirrotta, E., Barth, R. A., Wang, N. E. 2014; 42 (7): 385-394


    Although follow-up CT is recommended for pediatric appendicitis if initial ultrasound (US) is equivocal, many physicians observe the patient at home. There are limited data to understand currently how common or safe this practice is. Our objectives are to assess prevalence of acute appendicitis and outcomes in patients with equivocal US with and without follow-up CT and to identify variables associated with ordering a follow-up CT.Retrospective analysis of the prevalence of appendicitis and outcomes of patients 1-18 years old with an equivocal US at a pediatric emergency department from 2003 to 2008. Recursive partitioning analysis and multivariate logistic regression were used to identify variables associated with ordering follow-up CT.Fifty-five percent (340/620) of children with equivocal US did not receive CT, none of whom returned with a missed appendicitis. The prevalence of appendicitis in children with equivocal US was 12.5% (78/620). In children with follow-up CT, the prevalence was 22.1% (62/280); in those without follow-up CT, the prevalence was 4.7% (16/340). Recursive partitioning identified age >11 years, leukocytosis >15,000 cells/ml, and secondary signs predisposing toward acute appendicitis on US as significant predictors of CT.We view our study as a fundamental part of the incremental progress to understand how best to use US and CT imaging to diagnose pediatric appendicitis while minimizing ionizing radiation. Children at low risk for appendicitis with equivocal US are amenable to observation and reassessment prior to reimaging with US or CT.

    View details for DOI 10.1002/jcu.22153

    View details for Web of Science ID 000340536300001

    View details for PubMedID 24700515

  • Cardiac Echocardiography CRITICAL CARE CLINICS Perera, P., Lobo, V., Williams, S. R., Gharahbaghian, L. 2014; 30 (1): 47-?


    Focused cardiac echocardiography has become a critical diagnostic tool for the emergency physician and critical care physician caring for patients in shock and following trauma to the chest, and those presenting with chest pain and shortness of breath,. Cardiac echocardiography allows for immediate diagnosis of pericardial effusions and cardiac tamponade, evaluation of cardiac contractility and volume status, and detection of right ventricular strain possibly seen with a significant pulmonary embolus. This article addresses how to perform cardiac echocardiography using the standard windows, how to interpret a focused goal-directed examination, and how to apply this information clinically at the bedside.

    View details for DOI 10.1016/j.ccc.2013.08.003

    View details for Web of Science ID 000329255600004

    View details for PubMedID 24295841

  • Thoracic Ultrasonography CRITICAL CARE CLINICS Lobo, V., Weingrow, D., Perera, P., Williams, S. R., Gharahbaghian, L. 2014; 30 (1): 93-?


    Thoracic ultrasonography (US) has proved to be a valuable tool in the evaluation of the patient with shortness of breath, chest pain, hypoxia, or after chest trauma. Its sensitivity and specificity for detecting disease is higher than that of a chest radiograph, and it can expedite the diagnosis for many emergent conditions. This article describes the technique of each thoracic US application, illustrating both normal and abnormal findings, as well as discussing the literature. Bedside thoracic US has defined imaging benefits in a wide range of thoracic disease, and US guidance has been shown to facilitate thoracic and airway procedures.

    View details for DOI 10.1016/j.ccc.2013.08.002

    View details for Web of Science ID 000329255600005

  • The FAST and E-FAST in 2013: Trauma Ultrasonography Overview, Practical Techniques, Controversies, and New Frontiers CRITICAL CARE CLINICS Williams, S. R., Perera, P., Gharahbaghian, L. 2014; 30 (1): 119-?


    This article reviews important literature on the FAST and E-FAST examinations in adults. It also reviews key pitfalls, limitations, and controversies. A practical "how-to" guide is presented. Lastly, new frontiers are explored.

    View details for DOI 10.1016/j.ccc.2013.08.005

    View details for Web of Science ID 000329255600006

    View details for PubMedID 24295843

  • FOCUSED CARDIAC ULTRASOUND TRAINING: HOW MUCH IS ENOUGH? JOURNAL OF EMERGENCY MEDICINE Chisholm, C. B., Dodge, W. R., Balise, R. R., Williams, S. R., Gharahbaghian, L., Beraud, A. 2013; 44 (4): 818-822


    Focused transthoracic echocardiography (F-TTE) is an important tool to assess hemodynamically unstable patients in the Emergency Department. Although its scope has been defined by the American College of Emergency Physicians, more research is needed to define an optimal F-TTE training program, including assessment of proficiency.The goal of this study was to determine the effectiveness of current standards in post-residency training to reach proficiency in F-TTE.Fourteen staff Emergency Physicians were enrolled in a standardized teaching curriculum specifically designed to meet the 2008 American College of Emergency Physicians' guidelines for general ultrasound training applied to echocardiography. This training program consisted of 6 h of didactics and 6 h of scanning training, followed by independent scanning over a 5-month period. Acquisition of echocardiographic knowledge was assessed by an online pre- and post-test. At the conclusion of the study, a hands-on skills test assessed the trainees' ability to perform and interpret F-TTE.Ninety percent of trainees passed the written post-test. Two views, the parasternal long and short axis, were easily obtainable, regardless of the level of training or the number of ultrasounds completed. Other views were more difficult to master, but strong trends toward increased competency were evident after 10 h of mixed didactic and scanning training and > 45 ultrasounds.A short, 12-h didactic training in F-TTE provided proficiency in image interpretation and in obtaining adequate images from the parasternal window. More extensive training is needed to master the apical and subcostal windows in a timely manner.

    View details for DOI 10.1016/j.jemermed.2012.07.092

    View details for Web of Science ID 000317282000024



    As the use of bedside emergency ultrasound (US) increases, so does the need for effective US education.To determine 1) what pathology can be reliably simulated and identified by US in human cadavers, and 2) feasibility of using cadavers to improve the comfort of emergency medicine (EM) residents with specific US applications.This descriptive, cross-sectional survey study assessed utility of cadaver simulation to train EM residents in diagnostic US. First, the following pathologies were simulated in a cadaver: orbital foreign body (FB), retrobulbar (RB) hematoma, bone fracture, joint effusion, and pleural effusion. Second, we assessed residents' change in comfort level with US after using this cadaver model. Residents were surveyed regarding their comfort level with various US applications. After brief didactic sessions on the study's US applications, participants attempted to identify the simulated pathology using US. A post-lab survey assessed for change in comfort level after the training.Orbital FB, RB hematoma, bone fracture, joint effusion, and pleural effusion were readily modeled in a cadaver in ways typical of a live patient. Twenty-two residents completed the pre- and post-lab surveys. After training with cadavers, residents' comfort improved significantly for orbital FB and RB hematoma (mean increase 1.6, p<0.001), bone fracture (mean increase 2.12, p<0.001), and joint effusion (1.6, p<0.001); 100% of residents reported that they found US education using cadavers helpful.Cadavers can simulate orbital FB, RB hematoma, bone fracture, joint effusion, and pleural effusion, and in our center improved the comfort of residents in identifying all but pleural effusion.

    View details for DOI 10.1016/j.jemermed.2012.01.057

    View details for Web of Science ID 000309576700044

    View details for PubMedID 22504086

  • Anorexia Nervosa A Case Report of a Teenager Presenting With Bradycardia, General Fatigue, and Weakness PEDIATRIC EMERGENCY CARE Grover, C. A., Robin, J. K., Gharahbaghian, L. 2012; 28 (2): 174-177


    Anorexia nervosa is a disease with high prevalence in adolescents and carries the highest mortality of any psychiatric disorder.We present a case of a 17-year-old female presenting to the emergency department with bradycardia that was subsequently diagnosed with anorexia nervosa. We also review the clinical features, diagnosis, complications, and emergency department management of this disease.Patients with anorexia may present with multiple medical complaints, and it is imperative that the emergency physician be familiar with the syndrome so as to correctly identify and treat patients with this disease.

    View details for Web of Science ID 000300339500018

    View details for PubMedID 22307188

  • Unilateral facial swelling with fever. Parotitis. Annals of emergency medicine Grover, C. A., Gharahbaghian, L. 2011; 58 (6): e5-6

    View details for DOI 10.1016/j.annemergmed.2011.06.017

    View details for PubMedID 22099003

  • Test characteristics of focused assessment of sonography for trauma for clinically significant abdominal free fluid in pediatric blunt abdominal trauma. Academic emergency medicine Fox, J. C., Boysen, M., Gharahbaghian, L., Cusick, S., Ahmed, S. S., Anderson, C. L., Lekawa, M., Langdorf, M. I. 2011; 18 (5): 477-482


    Focused assessment of sonography in trauma (FAST) has been shown useful to detect clinically significant hemoperitoneum in adults, but not in children. The objectives were to determine test characteristics for clinically important intraperitoneal free fluid (FF) in pediatric blunt abdominal trauma (BAT) using computed tomography (CT) or surgery as criterion reference and, second, to determine the test characteristics of FAST to detect any amount of intraperitoneal FF as detected by CT.This was a prospective observational study of consecutive children (0-17 years) who required trauma team activation for BAT and received either CT or laparotomy between 2004 and 2007. Experienced physicians performed and interpreted FAST. Clinically important FF was defined as moderate or greater amount of intraperitoneal FF per the radiologist CT report or surgery.The study enrolled 431 patients, excluded 74, and analyzed data on 357. For the first objective, 23 patients had significant hemoperitoneum (22 on CT and one at surgery). Twelve of the 23 had true-positive FAST (sensitivity = 52%; 95% confidence interval [CI] = 31% to 73%). FAST was true negative in 321 of 334 (specificity = 96%; 95% CI = 93% to 98%). Twelve of 25 patients with positive FAST had significant FF on CT (positive predictive value [PPV] = 48%; 95% CI = 28% to 69%). Of 332 patients with negative FAST, 321 had no significant fluid on CT (negative predictive value [NPV] = 97%; 95% CI = 94% to 98%). Positive likelihood ratio (LR) for FF was 13.4 (95% CI = 6.9 to 26.0) while the negative LR was 0.50 (95% CI = 0.32 to 0.76). Accuracy was 93% (333 of 357, 95% CI = 90% to 96%). For the second objective, test characteristics were as follows: sensitivity = 20% (95% CI = 13% to 30%), specificity = 98% (95% CI = 95% to 99%), PPV = 76% (95% CI = 54% to 90%), NPV = 78% (95% CI = 73% to 82%), positive LR = 9.0 (95% CI = 3.7 to 21.8), negative LR = 0.81 (95% CI = 0.7 to 0.9), and accuracy = 78% (277 of 357, 95% CI = 73% to 82%).In this population of children with BAT, FAST has a low sensitivity for clinically important FF but has high specificity. A positive FAST suggests hemoperitoneum and abdominal injury, while a negative FAST aids little in decision-making.

    View details for DOI 10.1111/j.1553-2712.2011.01071.x

    View details for PubMedID 21569167

  • Test Characteristics of Focused Assessment of Sonography for Trauma for Clinically Significant Abdominal Free Fluid in Pediatric Blunt Abdominal Trauma ACADEMIC EMERGENCY MEDICINE Fox, J. C., Boysen, M., Gharahbaghian, L., Cusick, S., Ahmed, S. S., Anderson, C. L., Lekawa, M., Langdorf, M. I. 2011; 18 (5): 476-481
  • THE EFFECT OF EMERGENCY DEPARTMENT OBSERVATIONAL EXPERIENCE ON MEDICAL STUDENT INTEREST IN EMERGENCY MEDICINE JOURNAL OF EMERGENCY MEDICINE Gharahbaghian, L., Hindiyeh, R., Langdorf, M. I., Vaca, F., Anderson, C. L., Kahn, J. A., Wiechmann, W., Lotfipour, S. 2011; 40 (4): 458-461


    In many different health care educational models, shadowing, or observational experience, is accepted as integral to introducing students to the specifics of medical specialties.We investigated whether emergency department (ED) observational experiences (EDOs) affect medical students' (MSs') interest in emergency medicine (EM). Additionally, we examined how the subjective quality of clinical exposures influences this interest and the decision to recommend EDOs to other students.This is a survey of MSs at a Level 1 tertiary care university hospital during a 2-year period. The study focused on assessing perception of ED exposure, post-EDO change in EM interest, and decision to recommend EDOs to others.The majority of MSs had a change in EM interest post-EDO and recommended EDOs. Both variables correlated to ED exposure ratings.The EDO significantly influenced MS interest in EM by providing exposure to various aspects of the ED.

    View details for DOI 10.1016/j.jemermed.2010.02.020

    View details for Web of Science ID 000289828600024

    View details for PubMedID 20381989

  • Patellar tendonitis. The western journal of emergency medicine Zaia, B., Gharahbaghian, L. 2011; 12 (1): 139-140

    View details for PubMedID 21691492

  • Methemoglobinemia and sulfhemoglobinemia in two pediatric patients after ingestion of hydroxylamine sulfate. The western journal of emergency medicine Gharahbaghian, L., Massoudian, B., DiMassa, G. 2009; 10 (3): 197-201


    This case report describes two pediatric cases of immediate oxygen desaturation from methemoglobinemia and sulfhemoglobinemia after one sip from a plastic water bottle containing hydroxylamine sulfate used by a relative to clean shoes. Supplemental oxygen and two separate doses of methylene blue given to one of the patients had no effect on clinical symptoms or pulse oximetry. The patients were admitted to the pediatric Intensive Care Unit (ICU) with subsequent improvement after exchange transfusion. Endoscopy showed ulcer formation in one case and sucralafate was initiated; both patients were discharged after a one-week hospital stay.

    View details for PubMedID 19718385

  • Clitoral priapism with no known risk factors. The western journal of emergency medicine Gharahbaghian, L. 2008; 9 (4): 235-237


    Clitoral priapism is a rare condition that is associated with an extended duration of clitoral erection due to local engorgement of clitoral tissue resulting in pain. Although the pathophysiology is not completely understood, it has been associated with specific classes of medications, diseases that alter clitoral blood flow or others associated with small to large vessel disease. We present a case report of a 26-year-old patient who developed clitoral priapism without a clear medication or disease related etiology. The patient was treated with opiates, imipramine, non-steroidal anti-inflammatory medication, and local ice packs. She recovered uneventfully.

    View details for PubMedID 19561754

  • Welcome to the Resident/Student/Fellow Section of WestJEM! The western journal of emergency medicine Gharahbaghian, L. 2008; 9 (1): 46-?

    View details for PubMedID 19561703

  • Welcome to the Resident/Fellow/Student Section. Western Journal of Emergency Medicine Gharahbaghian, L. 2008; 9 (4)
  • . Central Diabetes Insipidus Misdiagnosed as Acute Gastroenteritis in a Pediatric Patient: a Case Report. Canadian Journal of Emergency Medicine Gharahbaghian, L., McCoy, C., Lotfipour, S., Langdorf, M. 2008; April
  • New Onset Thyrotoxicosis Presenting as Vomiting, Abdominal Pain and Transaminitis in the Emergency Department: a Case Report. Western Journal of Emergency Medicine Gharahbaghian, L., Brosnan, D., Fox JC., Stratton, S., Langdorf, M. 2007; 8 (3)
  • Sarin and Other Nerve Agents of the Organophosphate Class: Properties, Medical Effects and Management. International Journal of Disaster Medicine Gharahbaghian, L., Bey, T. 2003; 2: 103-108
  • Survival After Ethylene Glycol Poisoning in a Patient With an Arterial pH of 6.58 Veterinary and Human Toxicology Bey, T., Walter, F., Gilby, R., James, S.T., Gharahbaghian, L. 2002

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