1
|
Choi W, Cho YS, Ha YR, Oh JH, Lee H, Kang BS, Kim YW, Koh CY, Lee JH, Jung E, Sohn Y, Kim HB, Kim SJ, Kim H, Suh D, Lee DH, Hong JY, Lee WW. Role of point-of-care ultrasound in critical care and emergency medicine: update and future perspective. Clin Exp Emerg Med 2023; 10:363-381. [PMID: 38225778 PMCID: PMC10790072 DOI: 10.15441/ceem.23.101] [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: 07/29/2023] [Revised: 10/01/2023] [Accepted: 10/05/2023] [Indexed: 01/17/2024] Open
Abstract
Point-of-care ultrasound (POCUS) is a rapidly developing technology that has the potential to revolutionize emergency and critical care medicine. The use of POCUS can improve patient care by providing real-time clinical information. However, appropriate usage and proper training are crucial to ensure patient safety and reliability. This article discusses the various applications of POCUS in emergency and critical care medicine, the importance of training and education, and the future of POCUS in medicine.
Collapse
Affiliation(s)
- Wookjin Choi
- Department of Emergency Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Young Soon Cho
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Young Rock Ha
- Department of Intensive Care Medicine, Seongnam Citizens Medical Center, Seongnam, Korea
| | - Je Hyeok Oh
- Department of Emergency Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Heekyung Lee
- Department of Emergency Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Bo Seung Kang
- Department of Emergency Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Yong Won Kim
- Department of Emergency Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
| | - Chan Young Koh
- Department of Emergency Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Ji Han Lee
- Department of Emergency Medicine, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Euigi Jung
- Department of Emergency Medicine, VHS Medical Center, Seoul, Korea
| | - Youdong Sohn
- Department of Emergency Medicine, Kangdong Sacred Heart Hospital, Hallym University, Seoul, Korea
| | - Han Bit Kim
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Su Jin Kim
- Department of Emergency Medicine, Korea University College of Medicine, Seoul, Korea
| | - Hohyun Kim
- Department of Trauma and Surgical Critical Care, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Dongbum Suh
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Dong Hyun Lee
- Department of Intensive Care Medicine, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea
| | - Ju Young Hong
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Won Woong Lee
- Department of Intensive Care Medicine, Seongnam Citizens Medical Center, Seongnam, Korea
| | - on behalf of the Society Emergency and Critical Care Imaging (SECCI)
- Department of Emergency Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
- Department of Intensive Care Medicine, Seongnam Citizens Medical Center, Seongnam, Korea
- Department of Emergency Medicine, Chung-Ang University College of Medicine, Seoul, Korea
- Department of Emergency Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
- Department of Emergency Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
- Department of Emergency Medicine, Dankook University College of Medicine, Cheonan, Korea
- Department of Emergency Medicine, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
- Department of Emergency Medicine, VHS Medical Center, Seoul, Korea
- Department of Emergency Medicine, Kangdong Sacred Heart Hospital, Hallym University, Seoul, Korea
- Department of Emergency Medicine, Korea University College of Medicine, Seoul, Korea
- Department of Trauma and Surgical Critical Care, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Intensive Care Medicine, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
2
|
Braig ZV, Pradhan P, Tibbo ME, Padua H, Shaughnessy WJ, Stans AA, Larson AN, Shore BJ, Milbrandt TA. Bedside hip aspiration results in decrease in total general anesthesia time in pediatric patients: A multicenter study. J Child Orthop 2022; 16:512-518. [PMID: 36483652 PMCID: PMC9723871 DOI: 10.1177/18632521221135191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 10/08/2022] [Indexed: 11/07/2022] Open
Abstract
PURPOSE The purpose of this study is to compare pediatric hip aspiration in the operating room under general anesthesia or via bedside aspiration under moderate sedation and delineate the anesthetic time required. METHODS A database query conducted at two academic institutions identified all patients under the age of 17 who underwent hip aspiration between 2000 and 2017. At one institution, aspiration was performed in the operating room under general anesthesia. Patients were kept anesthetized until cell count was complete. At the second institution, aspiration was performed in the emergency room at bedside under sedation. The medical record was reviewed for demographic data, hip aspiration results, diagnoses, treatment, and anesthesia time. RESULTS A total of 233 patients (233 hips) with a mean age of 7.2 years were identified. Seventy-five patients underwent aspiration in the operating room, and 158 patients underwent bedside aspiration. Patients with a negative aspiration averaged 87 min under anesthesia when performed in the operating room and 29 min under sedation when performed at bedside. Patients with a negative aspiration performed in the operating room after 5 pm averaged 99 min under anesthesia, and 73 min under anesthesia when performed between 7 am and 5 pm (p < 0.01). Seventy-eight (49%) patients who underwent bedside aspiration did not require operative intervention and therefore avoided general anesthesia. CONCLUSION Pediatric hip aspiration performed in the operating room results in prolonged anesthesia times while synovial fluid is transported and processed. Anesthesia times are significantly longer after 5 pm. Bedside aspiration resulted in significantly less anesthesia exposure, with half of patients undergoing bedside aspiration avoiding general anesthesia altogether. LEVEL OF EVIDENCE Level III.
Collapse
Affiliation(s)
- Zachary V Braig
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Pratik Pradhan
- Department of Orthopedic Surgery, Boston Children’s Hospital, Boston, MA, USA
| | - Meagan E Tibbo
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Horacio Padua
- Department of Orthopedic Surgery, Boston Children’s Hospital, Boston, MA, USA,Department of Radiology, Boston Children’s Hospital, Boston, MA, USA
| | | | - Anthony A Stans
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - A Noelle Larson
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Benjamin J Shore
- Department of Orthopedic Surgery, Boston Children’s Hospital, Boston, MA, USA
| | - Todd A Milbrandt
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA,Todd A Milbrandt, Department of Orthopedic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA.
| |
Collapse
|
3
|
Educational Effectiveness of an Easily Made New Simulator Model for Ultrasound-Guided Vascular Access and Foreign Body Management Procedures on Pediatric Patients. Pediatr Emerg Care 2019; 35:407-411. [PMID: 29461427 DOI: 10.1097/pec.0000000000001410] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study aimed to introduce an easily made chicken breast simulator for ultrasound (US)-guided vascular access, foreign body (FB) detection, and hydrodissection in pediatric patients and to validate the effectiveness for training using this phantom tissue model. METHODS The authors made the tissue phantom simulator using a chicken breast and rubber tourniquet for vascular access and fragments of a tongue blade and steel clip for FB detection and hydrodissection using a very simple method. We provided training on US-guided vascular access (following the tip [FTT] method), FB detection, and hydrodissection using this model for novice physicians to learn US-guided procedures for pediatric patients. In addition, we provided a questionnaire to solicit their thoughts on their knowledge and confidence to perform these procedures before and after training and to learn their thoughts on the similarity to actual patients and usefulness of this model on a 10-point Likert scale. RESULTS A total of 16 emergency residents participated in this study. We obtained US images during vascular access (FTT) and FB detection/ hydrodissection procedures using this phantom tissue model. Residents' knowledge of and confidence to perform US-guided FTT method and FB detection/hydrodissection procedures after training increased to a statistically significant degree (P < 0.001 in all items). The median Likert scores regarding the similarity to actual patients and usefulness of this model were 8.5 (interquartile range, 7.5-9) and 10 (interquartile range, 8-10), respectively. CONCLUSIONS The model for US-guided procedures used in this study can be constructed by simple and easy methods, presents realistic procedural images, and was useful for training novice physicians to conduct US-guided procedures on pediatric patients.
Collapse
|
4
|
Pediatric musculoskeletal ultrasound: a pictorial essay. J Ultrasound 2018; 22:491-502. [PMID: 30414082 DOI: 10.1007/s40477-018-0337-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 10/25/2018] [Indexed: 10/27/2022] Open
Abstract
Ultrasound (US) is the main imaging modality for the evaluation of pediatric patients with musculoskeletal diseases; particularly, it is an appropriate and reliable tool for diagnosis, follow-up and treatment of several musculoskeletal pathologies affecting the pediatric age. High-frequency (10-15 MHz) and high-resolution probes provide very lofty quality images, allowing a detailed study of the pediatric musculoskeletal system. Among the well-known advantages of this technique-such as the absence of ionizing radiations, its low cost and wide availability-US can as well rely on some intrinsic characteristics of the pediatric musculoskeletal system that can improve its diagnostic capability. The unossified portions of the pediatric skeleton and the absence of a thickened adipose tissue allow US to be highly effective and reliable in the study of muscles, tendons and cartilage. Lower-frequency sectoral transducers can be required in the study of some joints such as the shoulder or the hip, as well as in the examination of deep soft-tissue lesions. Furthermore, both color and spectral Doppler play an important role in the examination of soft-tissue lesions and synovial phlogosis. In this pictorial essay the main pathological conditions of pediatric musculoskeletal system will be examined, such as painful hip, evolutionary hip dysplasia, osteochondrosis, trauma-related pathologies and juvenile idiopathic arthritis.
Collapse
|
5
|
Sperandeo M, Trovato FM, Melillo N, Dimitri L, Musumeci G, Guglielmi G. The role of ultrasound-guided fine needle aspiration biopsy in musculoskeletal diseases. Eur J Radiol 2017; 90:234-244. [PMID: 28583640 DOI: 10.1016/j.ejrad.2017.02.042] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 02/22/2017] [Accepted: 02/27/2017] [Indexed: 12/13/2022]
Abstract
Ultrasonography (US) is a readily available non-invasive tool useful for the detection of musculoskeletal and soft tissue masses. Although X-Ray is often the first imaging study for evaluating both bone and soft tissue lesions, and magnetic resonance imaging and computed tomography are mandatory in lesions staging, US is increasingly used for the early assessment of musculoskeletal and soft-tissue masses and for guiding procedures and biopsies. Surgical biopsy or fine needle aspiration biopsy (FNAB) is needed to ascertain the nature of any lesion. FNAB is a low cost technique, safer and less traumatic than an open surgical biopsy. Significant complications are rare, mostly related to the site of biopsy. Knowledge of indications, limitations, anatomical and pathological access, adequate technical expertise in US imaging and in intervention skills are the critical factors of the appropriate and safe use of FNAB. By now, the role of FNAB in musculoskeletal diseases is controversial and there is still a heated debate in the scientific community.
Collapse
Affiliation(s)
- Marco Sperandeo
- Unit of Intervenional Ultrasound of Internal Medicine, Scientific Institute Hospital "Casa Sollievo della Sofferenza", Viale Cappuccini 1, San Giovanni Rotondo, FG, Italy
| | - Francesca Maria Trovato
- Department of Clinical and Experimental Medicine, Internal Medicine Division, School of Medicine, University of Catania, Italy
| | - Nadia Melillo
- Rheumatology Unit, Department of Medical Science, University of Foggia, Italy
| | - Lucia Dimitri
- Histology and Pathology Unit, Scientific Institute Hospital "Casa Sollievo della Sofferenza", Viale Cappuccini 1, San Giovanni Rotondo, FG, Italy
| | - Giuseppe Musumeci
- Department of Biomedical and Biotechnological Sciences, Human Anatomy and Histology Section, School of Medicine, University of Catania, Italy
| | - Giuseppe Guglielmi
- Department of Radiology, University of Foggia, Viale Luigi Pinto 1, Foggia, Italy; Department of Radiology, Scientific Institute Hospital "Casa Sollievo della Sofferenza", Viale Cappuccini 1, San Giovanni Rotondo, FG, Italy.
| |
Collapse
|
6
|
Aparici CM, Aslam R, Win AZ. Initial Experience of Utilizing Real-Time Intra-Procedural PET/CT Biopsy. J Clin Imaging Sci 2014; 4:54. [PMID: 25337440 PMCID: PMC4204304 DOI: 10.4103/2156-7514.141941] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 08/24/2014] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES Nonreal-time Positron Emission Tomography/Computed Tomography (PET/CT) biopsies that use the image co-registration of a prior PET with an intra-procedural CT have been reported. The aim of this study was to report the initial experience of performing real-time intra-procedural PET/CT-guided biopsies. MATERIALS AND METHODS All patients (n = 4) had a prior PET/CT examination of the concerning lesion and no significant CT correlate. On the day of the biopsy, 5 mCi of 18F-fluorodeoxyglucose (FDG) or NaF18 was intravenously injected. After 60 min of biodistribution of the molecular probe, PET/CT images were obtained in a limited one bed position over the region of the concerning lesion to be biopsied. RESULTS One patient had a mesenteric mass and the other three had bone lesions, one located in the rib and two in the iliac bone. The pathology report revealed that two lesions (50%) were malignant and two lesions (50%) were benign. The results of the biopsy changed management in all cases. There was 0% complication rate. CONCLUSIONS No additional software or hardware is required to perform real-time intra-procedural PET/CT-guided biopsies. It can optimize the yield, especially in cases where there are no anatomical abnormalities. Real-time intra-procedural PET/CT biopsy may have benefits over conventional biopsy techniques in terms of accuracy.
Collapse
Affiliation(s)
- Carina Mari Aparici
- Department of Radiology, University California San Francisco, California, USA
| | - Rizwan Aslam
- Department of Radiology, University California San Francisco, California, USA
| | - Aung Zaw Win
- San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| |
Collapse
|