1
|
Sloane S, Subramony R, Olandt CA, Campbell C. Rapidly Progressive Myonecrosis Diagnosed by Point-of-Care Ultrasound. J Emerg Med 2024; 66:e728-e731. [PMID: 38782661 DOI: 10.1016/j.jemermed.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 12/06/2023] [Accepted: 02/02/2024] [Indexed: 05/25/2024]
Affiliation(s)
- Skyler Sloane
- University of California San Diego, San Diego, California
| | | | | | | |
Collapse
|
2
|
Hobbs H, Millington S, Wiskar K. Multiorgan Point-of-Care Ultrasound Assessment in Critically Ill Adults. J Intensive Care Med 2024; 39:187-195. [PMID: 37552930 PMCID: PMC10845831 DOI: 10.1177/08850666231192047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/14/2023] [Accepted: 07/19/2023] [Indexed: 08/10/2023]
Abstract
Traditional point-of-care ultrasound (POCUS) training highlights discrete techniques, single-organ assessment, and focused protocols. More recent developments argue for a whole-body approach, where the experienced clinician-ultrasonographer crafts a personalized POCUS protocol depending on specific clinical circumstances. This article describes this problem-based approach, focusing on common acute care scenarios while highlighting practical considerations and performance characteristics.
Collapse
Affiliation(s)
- Hailey Hobbs
- Department of Critical Care Medicine, Queen's University, Kingston, Canada
| | - Scott Millington
- Critical Care Medicine, The University of Ottawa/The Ottawa Hospital, Ottawa, Canada
| | - Katie Wiskar
- Clinical Instructor, Division of General Internal Medicine, University of British Columbia, Vancouver, Canada
| |
Collapse
|
3
|
Ultrasound Guidelines: Emergency, Point-of-Care, and Clinical Ultrasound Guidelines in Medicine. Ann Emerg Med 2023; 82:e115-e155. [PMID: 37596025 DOI: 10.1016/j.annemergmed.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 06/01/2023] [Indexed: 08/20/2023]
|
4
|
Marks A, Patel D, Sundaram T, Johnson J, Gottlieb M. Ultrasound for the diagnosis of necrotizing fasciitis: A systematic review of the literature. Am J Emerg Med 2023; 65:31-35. [PMID: 36580698 DOI: 10.1016/j.ajem.2022.12.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 12/14/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Necrotizing fasciitis (NF) is a deadly disorder that can be challenging to diagnose on history and examination alone. Point-of-care ultrasound (POCUS) is widely available and has been increasingly used for diagnosing skin and soft tissue infections. We performed a systematic review to determine the accuracy of POCUS for diagnosing NF with subgroup analyses of the accuracy of specific POCUS examination components. METHODS PubMed, Scopus, CINAHL, LILACS, the Cochrane databases, Google Scholar, and bibliographies of selected articles were assessed for all retrospective, prospective, and randomized control trials evaluating the accuracy of POCUS for diagnosing NF. Data were dual extracted into a predefined worksheet and quality analysis was performed with the QUADAS-2 tool. Data were summarized and an overall summary was completed. RESULTS We identified three papers (n = 221 patients; 33% NF) that met our inclusion criteria. The overall sensitivity ranged from 85.4%-100% while the specificity ranged from 44.7% to 98.2%. Fluid accumulation along the fascial plane was the most sensitive (85.4%; 95% CI 72.2% - 93.9%), while subcutaneous emphysema was the most specific (100%; 95% CI 92.5% - 100%). CONCLUSIONS POCUS has good sensitivity and specificity for the diagnosis of NF. POCUS should be considered as an adjunct to the initial clinical decision making for the diagnosis of NF.
Collapse
Affiliation(s)
- Amy Marks
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, United States of America.
| | - Daven Patel
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, United States of America
| | - Tina Sundaram
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, United States of America
| | - Jordan Johnson
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, United States of America
| | - Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, United States of America
| |
Collapse
|
5
|
Huang YH, Lin YW, Ho MP. Diagnosing Necrotizing Fasciitis: The role of POCUS. Am J Emerg Med 2023:S0735-6757(23)00063-3. [PMID: 36774276 DOI: 10.1016/j.ajem.2023.01.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open
Affiliation(s)
- Yu-Hsiang Huang
- Department of Medical Education, Division of General Practice, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan
| | - Yu-Wei Lin
- Department of Medical Education, Division of General Practice, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan
| | - Min-Po Ho
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan.
| |
Collapse
|
6
|
Gan RK, Sanchez Martinez A, Abu Hasan MAS, Castro Delgado R, Arcos González P. Point-of-care ultrasonography in diagnosing necrotizing fasciitis-a literature review. J Ultrasound 2023:10.1007/s40477-022-00761-5. [PMID: 36694072 DOI: 10.1007/s40477-022-00761-5] [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: 09/07/2022] [Accepted: 10/29/2022] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION Necrotizing fasciitis (NF) is a rapidly progressive necrosis of the fascial layer with a high mortality rate. It is a life-threatening medical emergency that requires urgent treatment. Lack of skin finding in NF made diagnosis difficult and required a high clinical index of suspicion. The use of ultrasound may guide clinicians in improving diagnostic speed and accuracy, thus leading to improved management decisions and patient outcomes. This literature search aims to review the use of point-of-care ultrasonography in diagnosing necrotizing fasciitis. METHOD We searched relevant electronic databases, including PUBMED, MEDLINE, and SCOPUS, and performed a systematic review. Keywords used were "necrotizing fasciitis" or "necrotising fasciitis" or "necrotizing soft tissue infections" and "point-of-care ultrasonography" "ultrasonography" or "ultrasound". No temporal limitation was set. An additional search was performed via google scholar, and the top 100 entry was screened. RESULTS Among 540 papers screened, only 21 were related to diagnosing necrotizing fasciitis using ultrasonography. The outcome includes three observational studies, 16 case reports, and two case series, covering the period from 1976 to 2022. CONCLUSION Although the use of ultrasonography in diagnosing NF was published in several papers with promising results, more studies are required to investigate its diagnostic accuracy and potential to reduce time delay before surgical intervention, morbidity, and mortality.
Collapse
Affiliation(s)
- Rick Kye Gan
- Unit for Research in Emergency and Disaster, Public Health Area, Department of Medicine, University of Oviedo, Oviedo, Asturias, Spain.
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
| | - Antoni Sanchez Martinez
- Unit for Research in Emergency and Disaster, Public Health Area, Department of Medicine, University of Oviedo, Oviedo, Asturias, Spain
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Muhammad Abdus-Syakur Abu Hasan
- Emergency Medicine Department, Kulliyyah of Medicine, International Islamic University Malaysia (IIUM), Kuantan, Pahang, Malaysia
- Emergency and Trauma Department, Sultan Ahmad Shah Medical Center, IIUM, Kuantan, Pahang, Malaysia
| | - Rafael Castro Delgado
- Unit for Research in Emergency and Disaster, Public Health Area, Department of Medicine, University of Oviedo, Oviedo, Asturias, Spain
- SAMU-Asturias, Asturias, Spain
| | - Pedro Arcos González
- Unit for Research in Emergency and Disaster, Public Health Area, Department of Medicine, University of Oviedo, Oviedo, Asturias, Spain
| |
Collapse
|
7
|
Imaging of Musculoskeletal Soft-Tissue Infections in Clinical Practice: A Comprehensive Updated Review. Microorganisms 2022; 10:microorganisms10122329. [PMID: 36557582 PMCID: PMC9784663 DOI: 10.3390/microorganisms10122329] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/19/2022] [Accepted: 11/22/2022] [Indexed: 11/27/2022] Open
Abstract
Musculoskeletal soft-tissue infections include a wide range of clinical conditions that are commonly encountered in both emergency departments and non-emergency clinical settings. Since clinical signs, symptoms, and even laboratory tests can be unremarkable or non-specific, imaging plays a key role in many cases. MRI is considered the most comprehensive and sensitive imaging tool available for the assessment of musculoskeletal infections. Ultrasound is a fundamental tool, especially for the evaluation of superficially located diseases and for US-guided interventional procedures, such as biopsy, needle-aspiration, and drainage. Conventional radiographs can be very helpful, especially for the detection of foreign bodies and in cases of infections with delayed diagnosis displaying bone involvement. This review article aims to provide a comprehensive overview of the radiological tools available and the imaging features of the most common musculoskeletal soft-tissue infections, including cellulitis, necrotizing and non-necrotizing fasciitis, foreign bodies, abscess, pyomyositis, infectious tenosynovitis, and bursitis.
Collapse
|
8
|
Zeaiter N, Maassarani D, Ghanime G, Sleiman Z. A Case Report of Rapidly Necrotizing Fasciitis Post-Falling Down Treated Reconstructively. Cureus 2022; 14:e28055. [PMID: 36120191 PMCID: PMC9476833 DOI: 10.7759/cureus.28055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2022] [Indexed: 11/17/2022] Open
Abstract
Necrotizing fasciitis (NF) is a necrotizing soft tissue infection that can result in fast tissue loss, necrosis, and potentially fatal acute sepsis. Diabetes, cancer, alcohol abuse, and chronic liver and renal disease are all risk factors for NF. In this case report, a 19-year-old man with a negative past medical and surgical history was diagnosed with aggressive rapidly progressive necrotizing fasciitis of the left lower extremity after a recent history of falling down from a skateboard. A successful treatment with long-term debridement surgeries followed by reconstructive surgery with skin grafting was made. Although the severity of this condition, the patient was able to resume a normal range of motion of the concerned extremity. NF has been described in the literature, but early diagnosis, which is crucial for successful management, rests a challenge.
Collapse
|
9
|
Pramanik I, Domozick A, Jackson J, Cabrera Correa G, Gomez Acevedo H, Kalivoda EJ. Point‐of‐care ultrasound evaluation of lower extremity erythema. J Am Coll Emerg Physicians Open 2022; 3:e12691. [PMID: 35280920 PMCID: PMC8897660 DOI: 10.1002/emp2.12691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 02/09/2022] [Indexed: 12/02/2022] Open
Affiliation(s)
- Itnia Pramanik
- Department of Emergency Medicine HCA Healthcare/USF Morsani College of Medicine GME/Brandon Hospital Brandon Florida USA
| | - Alexander Domozick
- Department of Emergency Medicine HCA Healthcare/USF Morsani College of Medicine GME/Brandon Hospital Brandon Florida USA
| | - Jordan Jackson
- Department of Internal Medicine HCA Healthcare/USF Morsani College of Medicine GME/Brandon Hospital Brandon Florida USA
| | - Gabriel Cabrera Correa
- Department of Emergency Medicine HCA Healthcare/USF Morsani College of Medicine GME/Brandon Hospital Brandon Florida USA
| | - Harold Gomez Acevedo
- Department of Emergency Medicine HCA Healthcare/USF Morsani College of Medicine GME/Brandon Hospital Brandon Florida USA
| | - Eric J. Kalivoda
- Department of Emergency Medicine HCA Healthcare/USF Morsani College of Medicine GME/Brandon Hospital Brandon Florida USA
| |
Collapse
|