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Michels G, Horn R, Helfen A, Hagendorff A, Jung C, Hoffmann B, Jaspers N, Kinkel H, Greim CA, Knebel F, Bauersachs J, Busch HJ, Kiefl D, Spiel AO, Marx G, Dietrich CF. [Standardized contrast-enhanced ultrasound (CEUS) in clinical acute and emergency medicine and critical care (CEUS Acute) : Consensus statement of DGIIN, DIVI, DGINA, DGAI, DGK, ÖGUM, SGUM and DEGUM]. Med Klin Intensivmed Notfmed 2022; 117:1-23. [PMID: 35006320 DOI: 10.1007/s00063-021-00891-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The present document describes the possible applications of contrast-enhanced ultrasound (CEUS) in emergency examinations. Guidelines on contrast medium ultrasound in acute and emergency care and intensive care medicine have not yet been published. Evidence-based CEUS guidelines were first provided by the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) and the World Federation for Ultrasound in Medicine and Biology (WFUMB). The presented recommendations describe the possible applications and protocols of CEUS in acute care.
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Affiliation(s)
- Guido Michels
- Klinik für Akut- und Notfallmedizin, St.-Antonius-Hospital gGmbH, Eschweiler, Deutschland. .,Klinik für Akut- und Notfallmedizin, St.-Antonius-Hospital gGmbH, Akademisches Lehrkrankenhaus der RWTH Aachen, Dechant-Deckers-Str. 8, 52249, Eschweiler, Deutschland.
| | - Rudolf Horn
- Center da sandà Val Müstair, Notfallmedizin, Sta. Maria Val Müstair, Schweiz
| | - Andreas Helfen
- St.-Marien-Hospital Lünen, Medizinische Klinik I, Katholisches Klinikum Lünen Werne GmbH, Lünen, Deutschland
| | - Andreas Hagendorff
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - Christian Jung
- Klinik für Kardiologie, Pneumologie und Angiologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - Beatrice Hoffmann
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Natalie Jaspers
- Klinik für Gastroenterologie und Hepatologie, Universitätsklinikum Köln, Köln, Deutschland
| | - Horst Kinkel
- Praxis für Gastroenterologie, Düren, Deutschland
| | - Clemens-Alexander Greim
- Klinik für Anästhesiologie, Intensiv- und Notfallmedizin, Klinikum Fulda, Pacelliallee 4, 36043, Fulda, Deutschland
| | - Fabian Knebel
- Klinik für Innere Medizin, Sana Klinikum Lichtenberg, Berlin, Deutschland
| | - Johann Bauersachs
- Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Hans-Jörg Busch
- Universitätsklinikum, Universitäts-Notfallzentrum, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
| | - Daniel Kiefl
- Klinik für Interdisziplinäre Notfallmedizin, Sana Klinikum Offenbach, Offenbach am Main, Deutschland
| | - Alexander O Spiel
- Klinik Ottakring, Zentrale Notaufnahme, Wiener Gesundheitsverbund, Wien, Österreich
| | - Gernot Marx
- Klinik für operative Intensivmedizin, Universitätsklinikum Aachen, Aachen, Deutschland
| | - Christoph F Dietrich
- Department für Allgemeine Innere Medizin Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Schweiz. .,Department Allgemeine Innere Medizin DAIM, Schänzlihalde 11, 3013, Bern, Schweiz.
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Michels G. [Bedside imaging in emergency and critical care medicine : Integration of ultrasound in a clinical context]. Med Klin Intensivmed Notfmed 2019; 114:488-489. [PMID: 31506811 DOI: 10.1007/s00063-019-0557-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- G Michels
- Klinik III für Innere Medizin, Herzzentrum, Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
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Jaspers N, Holzapfel B, Kasper P. [Abdominal ultrasound in emergency and critical care medicine]. Med Klin Intensivmed Notfmed 2019; 114:509-518. [PMID: 30840096 DOI: 10.1007/s00063-019-0551-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 02/02/2019] [Accepted: 02/02/2019] [Indexed: 12/29/2022]
Abstract
Abdominal ultrasound is established as an important and low-risk diagnostic procedure in emergency and intensive care medicine that allows rapid and precise diagnosis in symptomatic patients and helps to evaluate which further diagnostic steps are needed. Abdominal ultrasound should be performed as the initial imaging modality in all symptomatic patients in an emergency or intensive care unit and can be used with great accuracy to detect the presence of various abdominal pathologies, such as abdominal aortic aneurysm, abscess, ureterolithiasis or free fluid. Furthermore ultrasound represents the imaging modality of choice for guiding many diagnostic and interventional percutaneous procedures in emergency and intensive care medicine and can be used e. g. to drain pleural fluid or abdominal abscesses. Contrast-enhanced ultrasound (CEUS) can additionally be performed to provide a more reliable assessment of solid organ injuries and has the potential to detect parenchymal lesions or active bleeding from a variety of traumatic origins. Abdominal ultrasound is aimed to integrate rapidly detectable sonographic findings into the clinical context. To ensure required standards, regular training is necessary and it is important to understand methodological limitations.
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Affiliation(s)
- N Jaspers
- Klinik für Gastroenterologie und Hepatologie, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
| | - B Holzapfel
- Klinik für Gastroenterologie und Hepatologie, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - P Kasper
- Klinik für Gastroenterologie und Hepatologie, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland
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[The devil is in the details: wrong side thoracic drainage]. Med Klin Intensivmed Notfmed 2019; 115:334-339. [PMID: 30725268 DOI: 10.1007/s00063-019-0540-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 01/03/2019] [Accepted: 01/09/2019] [Indexed: 10/27/2022]
Abstract
This is a case report of a chest tube incorrectly placed on the healthy left side in a patient with a spontaneous right-sided pneumothorax based on misguiding radiological findings. This erroneous chest tube placement was a result of an inconclusive clinical examination in a patient with a history of pulmonary fibrosis as well as the side-inverted digital production of the chest X‑ray. Follow-up chest X‑ray after chest tube placement on the wrong side displayed this serious adverse event. To avoid such errors, team training, bedside sonography, and checklists are important tools. Correctly documented radiological images should also be ensured.
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Michels G, Pfister R, Hempel D. [Focused echocardiography in acute medicine]. Med Klin Intensivmed Notfmed 2018; 113:625-630. [PMID: 30302525 DOI: 10.1007/s00063-018-0493-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 09/12/2018] [Indexed: 12/17/2022]
Abstract
Focused echocardiography has become increasingly important for bedside diagnostics in acute medicine. Focused echocardiography can detect various cardiac pathologies, such as pericardial effusion, left ventricular dysfunction, right heart strain, relevant heart valve defects and dissection of the ascending aorta. Echocardiographic findings should be interpreted in the clinical context.
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Affiliation(s)
- G Michels
- Klinik III für Innere Medizin, Herzzentrum der Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
| | - R Pfister
- Klinik III für Innere Medizin, Herzzentrum der Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - D Hempel
- Zentrale Notaufnahme, Medizinische Fakultät, Universitätsklinikum Magdeburg A.ö.R., Otto-von-Guericke-Universität, Magdeburg, Deutschland
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Michels G, Hempel D, Pfister R, Janssens U. Emergency ultrasound and echocardiography in patients with infarct-related cardiogenic shock : A survey among members of the German Society of Medical Intensive Care and Emergency Medicine. Med Klin Intensivmed Notfmed 2018; 114:434-438. [PMID: 29632969 DOI: 10.1007/s00063-018-0431-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 02/13/2018] [Accepted: 03/07/2018] [Indexed: 02/07/2023]
Abstract
Current international and national guidelines promote the use of emergency echocardiography in patients with cardiogenic shock. We assessed whether these recommendations are followed in clinical practice of infarct-related cardiogenic shock patients. For this purpose we conducted a web-based survey among all members of the German Society of Medical Intensive Care and Emergency Medicine (DGIIN); 40% of the DGIIN members completed the survey. Participants reported that in their department emergency echocardiography/ultrasound is performed on most patients in infarct-related cardiogenic shock presenting to the emergency department/chest pain unit or intensive care unit (58.6% versus 81.4%). Only 33% stated that on patients admitted directly to the catheterization laboratory emergency ultrasound/echocardiography is applied in their institution. Local availability of a standardized algorithm was lacking in the majority of departments (77.2%). A great proportion (38.3%) of participants stated that they personally had no formal training in emergency ultrasound. In order to meet the demands of the current guidelines, in addition to integration of ultrasound examinations into diagnostic algorithms, a structured training of all emergency and intensive care physicians is necessary.
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Affiliation(s)
- G Michels
- Department III of Internal Medicine, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
| | - D Hempel
- Department of Emergency Medicine, University Hospital Jena, Jena, Germany
| | - R Pfister
- Department III of Internal Medicine, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - U Janssens
- Department of Cardiology, St Antonius Hospital, Eschweiler, Germany
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