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Sabath E. Point of care ultrasonography as the new "Laennec Sthetoscope". World J Nephrol 2024; 13:90542. [PMID: 38596268 PMCID: PMC11000039 DOI: 10.5527/wjn.v13.i1.90542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/19/2024] [Accepted: 02/29/2024] [Indexed: 03/22/2024] Open
Abstract
Point of care ultrasonography (POCUS) has evolved to become the fifth pillar of the conventional physical examination, and use of POCUS protocols have significantly decreased procedure complications and time to diagnose. However, lack of experience in POCUS by preceptors in medical schools and nephrology residency programs are significant barriers to implement a broader use. In rural and low-income areas POCUS may have a transformative effect on health care management.
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Affiliation(s)
- Ernesto Sabath
- Renal and Metabolism Unit, Hospital General de Querétaro, Queretaro 76180, Mexico
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Kirkpatrick AW, Clements TW, McKee JL, Ball CG. Topography of occult pneumothoraces: its importance for efficiency in diagnosis and avoiding sono-paralysis during POCUS. Can J Surg 2021; 64:E537-E539. [PMID: 34649922 PMCID: PMC8526135 DOI: 10.1503/cjs.017619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2020] [Indexed: 11/01/2022] Open
Abstract
Traumatic pneumothoraces remain a life-threatening problem that may be resolved quickly with timely diagnosis. Unfortunately, they are still not optimally managed. The most critically injured patients with hemodynamic instability require immediate diagnoses of potentially correctible conditions in the primary survey. Point-of-care ultrasonography (POCUS) performed by the responsible physician can be a tremendous adjunct to expediting diagnoses in the primary surgery and can typically be done in seconds rather than minutes. If more detailed sonographic examination is required, the secondary survey of the hemodynamically unstable patient is more appropriate. All involved in bedside care need to be conscious to efficiently integrate POCUS into resuscitation with the right intentions and goals to avoid sono-paralysis of the resuscitation sequence. Sono-paralysis has recently been described as critical situations wherein action is delayed through unnecessary imaging after a critical diagnosis has been made or unnecessary imaging details are sought despite an urgent diagnosis being made.
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Affiliation(s)
- Andrew W Kirkpatrick
- From the Regional Trauma Services, Foothills Medical Centre, Calgary, Alta. (Kirkpatrick, McKee, Ball); the Department of Surgery, University of Calgary, Calgary, Alta. (Kirkpatrick, Clements, Ball); and the Department of Critical Care Medicine, University of Calgary, Calgary, Alta. (Kirkpatrick).
| | - Thomas West Clements
- From the Regional Trauma Services, Foothills Medical Centre, Calgary, Alta. (Kirkpatrick, McKee, Ball); the Department of Surgery, University of Calgary, Calgary, Alta. (Kirkpatrick, Clements, Ball); and the Department of Critical Care Medicine, University of Calgary, Calgary, Alta. (Kirkpatrick)
| | - Jessica L McKee
- From the Regional Trauma Services, Foothills Medical Centre, Calgary, Alta. (Kirkpatrick, McKee, Ball); the Department of Surgery, University of Calgary, Calgary, Alta. (Kirkpatrick, Clements, Ball); and the Department of Critical Care Medicine, University of Calgary, Calgary, Alta. (Kirkpatrick)
| | - Chad G Ball
- From the Regional Trauma Services, Foothills Medical Centre, Calgary, Alta. (Kirkpatrick, McKee, Ball); the Department of Surgery, University of Calgary, Calgary, Alta. (Kirkpatrick, Clements, Ball); and the Department of Critical Care Medicine, University of Calgary, Calgary, Alta. (Kirkpatrick)
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Pioneering Remotely Piloted Aerial Systems (Drone) Delivery of a Remotely Telementored Ultrasound Capability for Self Diagnosis and Assessment of Vulnerable Populations-the Sky Is the Limit. J Digit Imaging 2021; 34:841-845. [PMID: 34173090 PMCID: PMC8232562 DOI: 10.1007/s10278-021-00475-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 04/27/2021] [Accepted: 06/09/2021] [Indexed: 11/01/2022] Open
Abstract
Remotely Piloted Aerial Systems (RPAS) are poised to revolutionize healthcare in out-of-hospital settings, either from necessity or practicality, especially for remote locations. RPAS have been successfully used for surveillance, search and rescue, delivery, and equipping drones with telemedical capabilities being considered. However, we know of no previous consideration of RPAS-delivered tele-ultrasound capabilities. Of all imaging technologies, ultrasound is the most portable and capable of providing real-time point-of-care information regarding anatomy, physiology, and procedural guidance. Moreover, remotely guided ultrasound including self-performed has been a backbone of medical care on the International Space Station since construction. The TeleMentored Ultrasound Supported Medical Interventions Group of the University of Calgary partnered with the Southern Alberta Institute of Technology to demonstrate RPAS delivery of a smartphone-supported tele-ultrasound system by the SwissDrones SDO50 RPAS. Upon receipt of the sanitized probe, a completely ultrasound-naïve volunteer was guided by a remote expert located 100 km away using online video conferencing (Zoom), to conduct a self-performed lung ultrasound examination. It proved feasible for the volunteer to examine their anterior chest, sides, and lower back bilaterally, correlating with standard recommended examinations in trauma/critical care, including the critical locations of a detailed COVID-19 lung diagnosis/surveillance examination. We contend that drone-delivered telemedicine including a tele-ultrasound capability could be leveraged to enhance point-of-care diagnostic accuracy in catastrophic emergencies, and allow diagnostic capabilities to be delivered to vulnerable populations in remote locations for whom transport is impractical or undesirable, speeding response times, or obviating the risk of disease transmission depending on the circumstances.
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Vives M, Hernández A, González AD, Torres J, Cuesta P, Villen T, Carmona P, Nagore D, Serna M, Bengoetxea U, Borrat X, García de Casasola G, Sánchez E, Campo R, Mercadal J. Diploma on Ultrasound training and competency for Intensive Care and Emergency Medicine: Consensus document of the Spanish Society of Anesthesia (SEDAR), Spanish Society of Internal Medicine (SEMI) and Spanish Society of Emergency Medicine (SEMES). REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2021; 68:143-148. [PMID: 33172655 DOI: 10.1016/j.redar.2020.06.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 06/24/2020] [Accepted: 06/25/2020] [Indexed: 06/11/2023]
Abstract
The use of ultrasound as a clinical diagnostic tool and guide of bedside procedures has become an indispensable examination in the acute critically ill patient. The training of professionals in minimum skills of knowledge, management and indications of use of ultrasound required to be defined by the Scientific Societies. The Intensive Care Ultrasound Working Group of the Spanish Society of Anesthesiology and Resuscitation (SEDAR), of the Spanish Society of Internal Medicine (SEMI) and the Spanish Society of Emergency Medicine (SEMES) has developed this consensus document in which the recommended training program and the minimum competencies to be achieved with regard to the use of Ultrasound in Intensive Care, Anesthesia and Emergency medicine are defined. This document defines the training program and the skills to acquire in order to achieve the diploma in lung, abdominal and vascular ultrasound. This document can serve as a guide to define the skills to be acquired in the training programs of residents (MIRs) of specialists working in intensive care, anesthesia, and emergency medicine.
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Affiliation(s)
- M Vives
- Co-director del grupo de trabajo de Ecografía Clínica en Cuidados Intensivos de la SEDAR; Servicio de Anestesia y Reanimación, Hospital Universitario de Girona Dr. J. Trueta. Universidad de Girona, Girona, España.
| | - A Hernández
- Servicio de Anestesia y Reanimación, Grupo Policlínica, Ibiza, España
| | - A D González
- Servicio de Anestesia y Reanimación, Clínica Universidad de Navarra, Pamplona, España
| | - J Torres
- Servicio de Medicina Interna, Hospital Universitario Infanta Cristina Parla, Madrid, España; Co-director del grupo de trabajo de Ecografía Clínica de la SEMI
| | - P Cuesta
- Servicio de Anestesia y Reanimación, Hospital Universitario de Albacete, Albacete, España
| | - T Villen
- Servicio de Urgencias, Hospital Universitario La Paz, Madrid, España; Director del grupo de trabajo de Ecografía Clínica de la SEMES
| | - P Carmona
- Servicio de Anestesia y Reanimación, Hospital Universitario La Fe, Valencia, España
| | - D Nagore
- Department of Anaesthesia & Intensive Care, Barts Heart Center. Barts Health NHS Trust, London, Reino Unido
| | - M Serna
- Servicio de Anestesia y Reanimación, Hospital Universitario de Denia, Denia, Alicante, España
| | - U Bengoetxea
- Servicio de Anestesia y Reanimación, Hospital de Urduliz, Bilbao, España
| | - X Borrat
- Servicio de Anestesia y Reanimación, Hospital Clínic de Barcelona, Barcelona, España
| | - G García de Casasola
- Servicio de Medicina Interna, Hospital Universitario Infanta Cristina. Parla, Madrid, España; Co-director del grupo de trabajo de Ecografía Clínica de la SEMI
| | - E Sánchez
- Servicio de Anestesia y Reanimación, Hospital Gregorio Marañón, Madrid, España
| | - R Campo
- Servicio de Urgencias, Hospital Santa Bárbara de Puertollano, Ciudad Real, España
| | - J Mercadal
- Co-director del grupo de trabajo de Ecografía Clínica en Cuidados Intensivos de la SEDAR; Servicio de Anestesia y Reanimación, Hospital Clinic de Barcelona, Barcelona, España
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Kalagara H, Coker B, Gerstein NS, Kukreja P, Deriy L, Pierce A, Townsley MM. Point-of-Care Ultrasound (POCUS) for the Cardiothoracic Anesthesiologist. J Cardiothorac Vasc Anesth 2021; 36:1132-1147. [PMID: 33563532 DOI: 10.1053/j.jvca.2021.01.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 01/06/2021] [Accepted: 01/09/2021] [Indexed: 12/21/2022]
Abstract
Point-of-Care Ultrasound (POCUS) is a valuable bedside diagnostic tool for a variety of expeditious clinical assessments or as guidance for a multitude of acute care procedures. Varying aspects of nearly all organ systems can be evaluated using POCUS and, with the increasing availability of affordable ultrasound systems over the past decade, many now refer to POCUS as the 21st-century stethoscope. With the current available and growing evidence for the clinical value of POCUS, its utility across the perioperative arena adds enormous benefit to clinical decision-making. Cardiothoracic anesthesiologists routinely have used portable ultrasound systems for nearly as long as the technology has been available, making POCUS applications a natural extension of existing cardiothoracic anesthesia practice. This narrative review presents a broad discussion of the utility of POCUS for the cardiothoracic anesthesiologist in varying perioperative contexts, including the preoperative clinic, the operating room (OR), intensive care unit (ICU), and others. Furthermore, POCUS-related education, competence, and certification are addressed.
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Affiliation(s)
- Hari Kalagara
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Bradley Coker
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Neal S Gerstein
- Department of Anesthesiology and Critical Care Medicine, University of New Mexico School of Medicine, Albuquerque, NM
| | - Promil Kukreja
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Lev Deriy
- Department of Anesthesiology and Critical Care Medicine, University of New Mexico School of Medicine, Albuquerque, NM
| | - Albert Pierce
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Matthew M Townsley
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL.
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