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Bouros GC, Popa TO, Nedelea PL, Manolescu E, Haisan A, Roca I, Morosanu P, Hauta A, Grigorasi G, Corlade-Andrei M, Cimpoesu D. A Modern Diagnostic Procedure-The Introduction of Point-of-Care Ultrasound in Romanian Emergency Physicians' Daily Routine. Clin Pract 2024; 14:1137-1148. [PMID: 38921268 PMCID: PMC11203034 DOI: 10.3390/clinpract14030090] [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: 04/30/2024] [Revised: 06/04/2024] [Accepted: 06/12/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND Emergency medicine in Romania has developed fast since inception. The need for faster diagnostic capabilities due to the high workload pre- and in-hospital made point-of-care ultrasound (POCUS) a logical next step. The advantages of POCUS are well known, but implementation presents challenges. Our goal was to study how a straightforward method of implementation would work locally. METHODS Two prospective observational studies were conducted at 6 months (prehospital) and 4 months (in-hospital). The protocol used was extended focused assessment sonography in trauma (eFAST), and the shock index (SI) was used to stratify patients. Voluntary sampling was conducted by emergency physicians. The primary outcomes were patient numbers, type of case use, results, and accuracy. RESULTS The prehospital study registered 34 patients: 41% traumas, 35% cardiac arrest, 18% shock, and 6% acute respiratory distress. The in-hospital study patients were 78: 36% traumas, 6% cardiac arrests, 41% shock, and 17% acute respiratory distress. A total of 88.5% of the cases were confirmed with definitive imagistic findings. CONCLUSION The studies mark an increase in POCUS usage and use in complicated cases. Providing supervision and feedback into clinical practice resulted in a further increase in POCUS usage, the second study having an 88.5% accuracy when compared to the final diagnostic proving the increased efficiency of a longitudinal training approach.
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Affiliation(s)
- George-Catalin Bouros
- Department of Emergency Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (G.-C.B.); (P.L.N.); (E.M.); (A.H.); (I.R.); (P.M.); (A.H.); (G.G.); (D.C.)
| | - Tudor Ovidiu Popa
- Department of Emergency Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (G.-C.B.); (P.L.N.); (E.M.); (A.H.); (I.R.); (P.M.); (A.H.); (G.G.); (D.C.)
- Emergency Department, “St. Spiridon” Emergency Clinical County Hospital, 700111 Iasi, Romania
| | - Paul Lucian Nedelea
- Department of Emergency Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (G.-C.B.); (P.L.N.); (E.M.); (A.H.); (I.R.); (P.M.); (A.H.); (G.G.); (D.C.)
- Emergency Department, “St. Spiridon” Emergency Clinical County Hospital, 700111 Iasi, Romania
| | - Emilian Manolescu
- Department of Emergency Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (G.-C.B.); (P.L.N.); (E.M.); (A.H.); (I.R.); (P.M.); (A.H.); (G.G.); (D.C.)
- Emergency Department, “St. Spiridon” Emergency Clinical County Hospital, 700111 Iasi, Romania
| | - Anca Haisan
- Department of Emergency Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (G.-C.B.); (P.L.N.); (E.M.); (A.H.); (I.R.); (P.M.); (A.H.); (G.G.); (D.C.)
- Emergency Department, “St. Spiridon” Emergency Clinical County Hospital, 700111 Iasi, Romania
| | - Iulia Roca
- Department of Emergency Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (G.-C.B.); (P.L.N.); (E.M.); (A.H.); (I.R.); (P.M.); (A.H.); (G.G.); (D.C.)
- Emergency Department, “St. Spiridon” Emergency Clinical County Hospital, 700111 Iasi, Romania
| | - Petruta Morosanu
- Department of Emergency Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (G.-C.B.); (P.L.N.); (E.M.); (A.H.); (I.R.); (P.M.); (A.H.); (G.G.); (D.C.)
- Emergency Department, “St. Spiridon” Emergency Clinical County Hospital, 700111 Iasi, Romania
| | - Alexandra Hauta
- Department of Emergency Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (G.-C.B.); (P.L.N.); (E.M.); (A.H.); (I.R.); (P.M.); (A.H.); (G.G.); (D.C.)
- Emergency Department, “St. Spiridon” Emergency Clinical County Hospital, 700111 Iasi, Romania
| | - Gabriela Grigorasi
- Department of Emergency Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (G.-C.B.); (P.L.N.); (E.M.); (A.H.); (I.R.); (P.M.); (A.H.); (G.G.); (D.C.)
| | - Mihaela Corlade-Andrei
- Department of Emergency Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (G.-C.B.); (P.L.N.); (E.M.); (A.H.); (I.R.); (P.M.); (A.H.); (G.G.); (D.C.)
- Emergency Department, “St. Spiridon” Emergency Clinical County Hospital, 700111 Iasi, Romania
| | - Diana Cimpoesu
- Department of Emergency Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (G.-C.B.); (P.L.N.); (E.M.); (A.H.); (I.R.); (P.M.); (A.H.); (G.G.); (D.C.)
- Emergency Department, “St. Spiridon” Emergency Clinical County Hospital, 700111 Iasi, Romania
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Osterwalder J, Polyzogopoulou E, Hoffmann B. Point-of-Care Ultrasound-History, Current and Evolving Clinical Concepts in Emergency Medicine. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2179. [PMID: 38138282 PMCID: PMC10744481 DOI: 10.3390/medicina59122179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 12/10/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023]
Abstract
Point-of-care ultrasound (PoCUS) has become an indispensable standard in emergency medicine. Emergency medicine ultrasound (EMUS) is the application of bedside PoCUS by the attending emergency physician to assist in the diagnosis and management of many time-sensitive health emergencies. In many ways, using PoCUS is not only the mere application of technology, but also a fusion of already existing examiner skills and technology in the context of a patient encounter. EMUS practice can be defined using distinct anatomy-based applications. The type of applications and their complexity usually depend on local needs and resources, and practice patterns can vary significantly among regions, countries, or even continents. A different approach suggests defining EMUS in categories such as resuscitative, diagnostic, procedural guidance, symptom- or sign-based, and therapeutic. Because EMUS is practiced in a constantly evolving emergency medical setting where no two patient encounters are identical, the concept of EMUS should also be practiced in a fluid, constantly adapting manner driven by the physician treating the patient. Many recent advances in ultrasound technology have received little or no attention from the EMUS community, and several important technical advances and research findings have not been translated into routine clinical practice. The authors believe that four main areas have great potential for the future growth and development of EMUS and are worth integrating: 1. In recent years, many articles have been published on novel ultrasound applications. Only a small percentage has found its way into routine use. We will discuss two important examples: trauma ultrasound that goes beyond e-FAST and EMUS lung ultrasound for suspected pulmonary embolism. 2. The more ultrasound equipment becomes financially affordable; the more ultrasound should be incorporated into the physical examination. This merging and possibly even replacement of aspects of the classical physical exam by technology will likely outperform the isolated use of stethoscope, percussion, and auscultation. 3. The knowledge of pathophysiological processes in acute illness and ultrasound findings should be merged in clinical practice. The translation of this knowledge into practical concepts will allow us to better manage many presentations, such as hypotension or the dyspnea of unclear etiology. 4. Technical innovations such as elastography; CEUS; highly sensitive color Doppler such as M-flow, vector flow, or other novel technology; artificial intelligence; cloud-based POCUS functions; and augmented reality devices such as smart glasses should become standard in emergencies over time.
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Affiliation(s)
| | - Effie Polyzogopoulou
- Emergency Medicine Department, Attikon University Hospital, 12462 Athens, Greece;
| | - Beatrice Hoffmann
- Department of Emergency Medicine BIDMC, One Deaconess Rd., WCC2, Boston, MA 02215, USA
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