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Knott D, Siegl L, Siegl K. [Sonography in Pre-clinical Care]. Dtsch Med Wochenschr 2024; 149:912-924. [PMID: 39013411 DOI: 10.1055/a-2323-3146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2024]
Abstract
Sonography is an established noninvasive diagnostic tool in the clinical context of an emergency department. Its use in the prehospital setting is still rare despite its importance to use someone's resources purposeful and its importance in emergency medicine guidelines. In this article we show the advantages and disadvantages of prehospital point-of-care ultrasound (pPOCUS). We reflect organizational hurdles implementing pPOCUS as well as describing the technical preconditions for an easy and meaningful use. Furthermore, we explain teaching issues for pPOCUS and with a standard operating procedure (SOP) we show how pPOCUS could be implemented in the prehospital setting using some cardinal symptoms as examples.
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Affiliation(s)
- Dominik Knott
- Klinik X Anästhesiologie,Intensivmedizin, Schmerztherapie und Notfallmedizin, Bundeswehrkrankenhaus Berlin, Berlin, Deutschland
| | - Lutz Siegl
- Klinik X Anästhesiologie,Intensivmedizin, Schmerztherapie und Notfallmedizin, Bundeswehrkrankenhaus Berlin, Berlin, Deutschland
| | - Katharina Siegl
- Klinik X Anästhesiologie,Intensivmedizin, Schmerztherapie und Notfallmedizin, Bundeswehrkrankenhaus Berlin, Berlin, Deutschland
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2
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Briggs B, Cline D. Diagnosing aortic dissection: A review of this elusive, lethal diagnosis. J Am Coll Emerg Physicians Open 2024; 5:e13225. [PMID: 38983974 PMCID: PMC11231041 DOI: 10.1002/emp2.13225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 06/03/2024] [Accepted: 06/04/2024] [Indexed: 07/11/2024] Open
Abstract
Aortic dissection (AD) remains a difficult diagnosis in the emergency setting. Despite its rare occurrence, it is a life-threatening pathology that, if missed, is typically fatal. Previous studies have documented minimal improvement in timely and accurate diagnoses despite the advancement of computed tomography. Previous literature has highlighted aortic dissections as a major cause of serious misdiagnosis-related harm. The aim of this article is to review the available literature on AD, discussing the diversity in presentations and the prevalence of historical and exam features to better aid in the diagnosis of AD. AD remains a difficult diagnosis, even with the widespread prevalence of computed tomography angiography usage. No single feature of the history or physical examination is enough to raise suspicion. The diagnosis should be strongly considered in any patient with chest pain that is severe and unexplained by other findings or testing. Those who do not present with acute pain are often complicated by neurologic deficits, hypotension, or syncope. These patients suffer from a change in mental status limiting their ability to participate in the history and physical examination and have a higher rate of complications and mortality. An educated understanding of the atypical presentations of aortic dissection helps the clinician to realistically rank it on the differential diagnosis, culminating in judicious use of definitive imaging.
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Affiliation(s)
- Blake Briggs
- Division of Emergency MedicineDepartment of SurgeryUniversity of Tennessee Graduate School of MedicineKnoxvilleTennesseeUSA
| | - David Cline
- Department of Emergency MedicineWake Forest University School of MedicineWinston‐SalemNorth CarolinaUSA
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3
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Wang B, Hui K, Xiong J, Yang C, Cao X, Zhu G, Ang Y, Duan M. Effect of subclavian vein diameter combined with perioperative fluid therapy on preventing post-induction hypotension in patients with ASA status I or II. BMC Anesthesiol 2024; 24:138. [PMID: 38600439 PMCID: PMC11005262 DOI: 10.1186/s12871-024-02514-9] [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: 01/20/2024] [Accepted: 03/28/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Perioperative hypotension is frequently observed following the initiation of general anesthesia administration, often associated with adverse outcomes. This study assessed the effect of subclavian vein (SCV) diameter combined with perioperative fluid therapy on preventing post-induction hypotension (PIH) in patients with lower ASA status. METHODS This two-part study included patients aged 18 to 65 years, classified as ASA physical status I or II, and scheduled for elective surgery. The first part (Part I) included 146 adult patients, where maximum SCV diameter (dSCVmax), minimum SCV diameter (dSCVmin), SCV collapsibility index (SCVCI) and SCV variability (SCVvariability) assessed using ultrasound. PIH was determined by reduction in mean arterial pressure (MAP) exceeding 30% from baseline measurement or any instance of MAP < falling below 65 mmHg for ≥ a duration of at least 1 min during the period from induction to 10 min after intubation. Receiver Operating Characteristic (ROC) curve analysis was employed to determine the predictive values of subclavian vein diameter and other relevant parameters. The second part comprised 124 adult patients, where patients with SCV diameter above the optimal cutoff value, as determined in Part I study, received 6 ml/kg of colloid solution within 20 min before induction. The study evaluated the impact of subclavian vein diameter combined with perioperative fluid therapy by comparing the observed incidence of PIH after induction of anesthesia. RESULTS The areas under the curves (with 95% confidence intervals) for SCVCI and SCVvariability were both 0.819 (0.744-0.893). The optimal cutoff values were determined to be 45.4% and 14.7% (with sensitivity of 76.1% and specificity of 86.7%), respectively. Logistic regression analysis, after adjusting for confounding factors, demonstrated that both SCVCI and SCVvariability were significant predictors of PIH. A threshold of 45.4% for SCVCI was chosen as the grouping criterion. The incidence of PIH in patients receiving fluid therapy was significantly lower in the SCVCI ≥ 45.4% group compared to the SCVCI < 45.4% group. CONCLUSIONS Both SCVCI and SCVvariability are noninvasive parameters capable of predicting PIH, and their combination with perioperative fluid therapy can reduce the incidence of PIH.
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Affiliation(s)
- Bin Wang
- Department of Anesthesiology, Jinling College affiliated to Nanjing Medical University, Zhongshan East Road #305, Nanjing, Jiangsu Province, 210002, China
| | - Kangli Hui
- Department of Anesthesiology, Jinling College affiliated to Nanjing Medical University, Zhongshan East Road #305, Nanjing, Jiangsu Province, 210002, China
| | - Jingwei Xiong
- Department of Anesthesiology, Jinling College affiliated to Nanjing Medical University, Zhongshan East Road #305, Nanjing, Jiangsu Province, 210002, China
| | - Chongya Yang
- College of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, 221004, China
| | - Xinyu Cao
- College of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, 221004, China
| | - Guangli Zhu
- College of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, 221004, China
| | - Yang Ang
- Department of Anesthesiology, Affiliated Jinling Hospital, Medical School, Nanjing University, Nanjing, Jiangsu Province, 210002, China
| | - Manlin Duan
- Department of Anesthesiology, Jinling College affiliated to Nanjing Medical University, Zhongshan East Road #305, Nanjing, Jiangsu Province, 210002, China.
- Department of Anesthesiology, Nanjing BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210019, China.
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Müller-Wirtz LM, Patterson WM, Ott S, Brauchle A, Meiser A, Volk T, Berwanger U, Conrad D. Teaching Medical Students Rapid Ultrasound for shock and hypotension (RUSH): learning outcomes and clinical performance in a proof-of-concept study. BMC MEDICAL EDUCATION 2024; 24:360. [PMID: 38566149 PMCID: PMC10988853 DOI: 10.1186/s12909-024-05331-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 03/20/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Point-of-care ultrasound (POCUS) is a critical diagnostic tool in various medical settings, yet its instruction in medical education is inconsistent. The Rapid Ultrasound for Shock and Hypotension (RUSH) protocol is a comprehensive diagnostic tool, but its complexity poses challenges for teaching and learning. This study evaluates the effectiveness of a single-day training in RUSH for medical students by assessing their performance in clinical scenarios. METHODS In this prospective single-center observational proof-of-concept study, 16 medical students from Saarland University Medical Center underwent a single-day training in RUSH, followed by evaluations in clinical settings and on a high-fidelity simulator. Performance was assessed using a standardized scoring tool and time to complete the RUSH exam. Knowledge gain was measured with pre- and post-training written exams, and diagnostic performance was evaluated with an objective structured clinical examination (OSCE). RESULTS Students demonstrated high performance in RUSH exam views across patients (median performance: 85-87%) and improved scanning times, although not statistically significant. They performed better on simulators than on live patients. Written exam scores significantly improved post-training, suggesting a gain in theoretical knowledge. However, more than a third of students could not complete the RUSH exam within five minutes on live patients. CONCLUSIONS Single-day RUSH training improved medical students' theoretical knowledge and simulator performance but translating these skills to clinical settings proved challenging. The findings suggest that while short-term training can be beneficial, it may not suffice for clinical proficiency. This study underscores the need for structured and possibly longitudinal training programs to ensure skill retention and clinical applicability.
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Affiliation(s)
- Lukas Martin Müller-Wirtz
- Saarland University, Anaesthesiology, 66424, Homburg, Saarland, Germany.
- Department of Anaesthesiology, Intensive Care and Pain Therapy, Saarland University Medical Center, 66424, Homburg, Saarland, Germany.
- Outcomes Research Consortium, Department of Anesthesiology, Cleveland Clinic, 44195, Cleveland, OH, USA.
| | - William M Patterson
- Outcomes Research Consortium, Department of Anesthesiology, Cleveland Clinic, 44195, Cleveland, OH, USA
| | - Sascha Ott
- Outcomes Research Consortium, Department of Anesthesiology, Cleveland Clinic, 44195, Cleveland, OH, USA
| | - Annika Brauchle
- Saarland University, Anaesthesiology, 66424, Homburg, Saarland, Germany
- Department of Anaesthesiology, Intensive Care and Pain Therapy, Saarland University Medical Center, 66424, Homburg, Saarland, Germany
| | - Andreas Meiser
- Saarland University, Anaesthesiology, 66424, Homburg, Saarland, Germany
- Department of Anaesthesiology, Intensive Care and Pain Therapy, Saarland University Medical Center, 66424, Homburg, Saarland, Germany
| | - Thomas Volk
- Saarland University, Anaesthesiology, 66424, Homburg, Saarland, Germany
- Department of Anaesthesiology, Intensive Care and Pain Therapy, Saarland University Medical Center, 66424, Homburg, Saarland, Germany
- Outcomes Research Consortium, Department of Anesthesiology, Cleveland Clinic, 44195, Cleveland, OH, USA
| | - Ulrich Berwanger
- Saarland University, Anaesthesiology, 66424, Homburg, Saarland, Germany
- Department of Anaesthesiology, Intensive Care and Pain Therapy, Saarland University Medical Center, 66424, Homburg, Saarland, Germany
| | - David Conrad
- Saarland University, Anaesthesiology, 66424, Homburg, Saarland, Germany
- Department of Anaesthesiology, Intensive Care and Pain Therapy, Saarland University Medical Center, 66424, Homburg, Saarland, Germany
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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.
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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
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6
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He M, Gong C, Chen Y, Chen R, Qian Y. Effect of remimazolam vs. propofol on hemodynamics during general anesthesia induction in elderly patients: Single-center, randomized controlled trial. J Biomed Res 2023; 38:66-75. [PMID: 37907250 PMCID: PMC10818176 DOI: 10.7555/jbr.37.20230110] [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: 04/28/2023] [Revised: 07/14/2023] [Accepted: 07/19/2023] [Indexed: 11/02/2023] Open
Abstract
The current study aimed to compare the effects between remimazolam and propofol on hemodynamic stability during the induction of general anesthesia in elderly patients. We used propofol at a rate of 60 mg/(kg·h) in the propofol group (group P) or remimazolam at a rate of 6 mg/(kg·h) in the remimazolam group (group R) for the induction. A processed electroencephalogram was used to determine whether the induction was successful and when to stop the infusion of the study drug. We measured when patients entered the operating room (T 0), when the induction was successful (T 1), and when before (T 2) and 5 min after successful endotracheal intubation (T 3). We found that mean arterial pressure (MAP) was lower at T 1-3, compared with T 0 in both groups, but higher at T 2 in the group R, while ΔMAP T0-T2 and ΔMAP max were smaller in the group R (ΔMAP T0-T2: the difference between MAP at time point T 0 and T 2, ΔMAP max: the difference between MAP at time point T 0 and the lowest value from T 0 to T 3). Cardiac index and stroke volume index did not differ between groups, whereas systemic vascular resistance index was higher at T 1-3 in the group R. These findings show that remimazolam, compared with propofol, better maintains hemodynamic stability during the induction, which may be attributed to its ability to better maintain systemic vascular resistance levels.
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Affiliation(s)
- Mingfeng He
- Department of Anesthesiology and Perioperative Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Chanjuan Gong
- Department of Anesthesiology and Perioperative Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Yinan Chen
- Department of Anesthesiology and Perioperative Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Rongting Chen
- Department of Anesthesiology and Perioperative Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Yanning Qian
- Department of Anesthesiology and Perioperative Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
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Ramadan A, Abdallah T, Abdelsalam H, Mokhtar A, Razek AA. Evaluation of parameters used in echocardiography and ultrasound protocol for the diagnosis of shock etiology in emergency setting. BMC Emerg Med 2023; 23:132. [PMID: 37946147 PMCID: PMC10636955 DOI: 10.1186/s12873-023-00902-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 10/30/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Early recognition and appropriate treatment has shown to decrease morbidity and mortality in patients with undifferentiated shock. There are many ultrasound protocols in shock; each protocol combines core ultrasound elements such as IVC and cardiac assessment which includes detection of cardiac tamponade, left ventricular function and right ventricular strain.Valvular assessment is absent in majority of ultasound protocols, while lung ultrasound is included in some of them. OBJECTIVE In this study we investigated which parameters used in Echo - US protocol help differentiate shock types. METHODS This cross sectional study was conducted on 150 patients with shock (140 patients were included while, 10 patients were excluded).Sensitivity and specificity of different parameters used in the Echo-US protocol were analyzed to detect which parameters can diffentiate shock types. RESULTS Velocity time integral of Aorta and IVC maximum diameter were good discriminators for distributive shock, with area under the ROC curve (AUC) = 0.8885 (95% CI 0.8144 to 0.9406) and 0.7728 (95% CI 0.6832 to 0.8473) (Z = 10.256 p < 0.0001) and (Z = 5.079 p < 0.0001) respectively. Left ventricular systolic function, presence of pneumonia, pneumothorax or valve vegetations were of great value in differentiating shock types, while CUST, FAST, TAPSE and RV diameter were not useful in differentiating shock types. CONCLUSION Ultrasound and echocardiography are powerful tools that can be used to identify shock etiology when the clinical picture overlaps.
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Affiliation(s)
- Asmaa Ramadan
- Department of Emergency Medicine, Alexandria University, Alexandria, Egypt.
| | - Tamer Abdallah
- Department of Critical Care Medicine, Alexandria University, Alexandria, Egypt
| | | | - Ahmed Mokhtar
- Department of Cardiology and Angiology, Alexandria University, Alexandria, Egypt
| | - Assem Abdel Razek
- Department of Anesthesia and Surgical Intensive Care Unit, Alexandria University, Alexandria, Egypt
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Walsh C, Duggan N, Egan DJ, Wittels KA. A Woman in Severe Pain. J Emerg Med 2023; 65:e158-e162. [PMID: 37455219 DOI: 10.1016/j.jemermed.2023.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 04/10/2023] [Indexed: 07/18/2023]
Affiliation(s)
- Carrie Walsh
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts; Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Nicole Duggan
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts; Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Daniel J Egan
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts; Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Kathleen A Wittels
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts; Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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Donroe JH, Soares S, Sofair AN. Strategies to Improve Teaching Point-of-Care Ultrasound at the Bedside. MEDICAL SCIENCE EDUCATOR 2023; 33:577-581. [PMID: 37261030 PMCID: PMC10226959 DOI: 10.1007/s40670-023-01772-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/10/2023] [Indexed: 06/02/2023]
Abstract
Point-of care-ultrasound (POCUS) is becoming a core clinical skill in many medical specialties. Teaching POCUS at the bedside allows for observation of learners during actual patient encounters, provides a medium for role modeling skills and behaviors, and incorporates all core POCUS competencies. Nonetheless, bedside teaching can be time consuming and intimidating for learners and teachers, and the full benefits of teaching at the bedside can be difficult to attain. We provide strategies for improving bedside POCUS teaching based on our collective experience as medical educators and POCUS instructors at both the undergraduate and graduate levels in medical education.
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Affiliation(s)
- Joseph H. Donroe
- Department of Internal Medicine, Yale School of Medicine, Office MOB 210, 1450 Chapel Street, New Haven, CT 06511 USA
| | - Sarita Soares
- Department of Internal Medicine, Yale School of Medicine, Office MOB 210, 1450 Chapel Street, New Haven, CT 06511 USA
| | - André N. Sofair
- Department of Internal Medicine, Yale School of Medicine, Office MOB 210, 1450 Chapel Street, New Haven, CT 06511 USA
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10
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Advances in Trauma Ultrasound. Emerg Med Clin North Am 2023; 41:131-142. [DOI: 10.1016/j.emc.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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11
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Muacevic A, Adler JR. RUSHing to the Diagnosis: Aortic Abdominal Aneurysm Detected Using the Rapid Ultrasound for Shock and Hypotension (RUSH) Protocol in the Wards. Cureus 2022; 14:e32565. [PMID: 36540318 PMCID: PMC9754670 DOI: 10.7759/cureus.32565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2022] [Indexed: 12/23/2022] Open
Abstract
The rapid ultrasound for shock and hypotension (RUSH) protocol is a useful tool used in the emergency department (ED) when addressing the severity and etiology of shock. It was designed to be performed in under two minutes with evaluation of the pump (heart), tank (inferior vena cava, thoracic and abdominal compartments) and the pipes (large arteries and veins). However, its application or one similar should extend beyond the ED and into the hospital floor. Here we present an 80-year-old gentleman with a history of atrial fibrillation (A-Fib) on anticoagulation who arrived at the ED due to an episode of pre-syncope just prior to arrival. Initial EKG is concerning for A-Fib with rapid ventricular response (RVR) with a rate in the 130s. After fluid resuscitation patient improved and he was admitted to the telemetry floor for further cardiac workup and cardiology consultation. While waiting for a room in the ED, patient became hypotensive, diaphoretic and pale. After complaining of lower abdominal pain, the ED physician performed a RUSH which showed an abdominal aorta of 8 cm concerning for dissection. Diagnosis was confirmed with CT angiography of the abdomen and he was taken to the OR with successful repair of the abdominal aortic aneurysm (AAA). Patient made meaningful recovery and was discharged to in-patient rehab. The patient described in this vignette was delayed in the ED due to lack of beds on the floor. This allowed for quick ultrasound work-up by the ED physician which led to immediate recognition of the AAA and immediate response by the vascular surgery team. Should this patient have been on the hospital floor, it is unclear if such prompt steps would have occurred prior to patient's further hemodynamic demise.
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12
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Hazan Y, Nagli M, Levi A, Rosenthal A. Miniaturized ultrasound detector arrays in silicon photonics using pulse transmission amplitude monitoring. OPTICS LETTERS 2022; 47:5660-5663. [PMID: 37219297 DOI: 10.1364/ol.467652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 10/05/2022] [Indexed: 05/24/2023]
Abstract
Silicon photonics holds promise for a new generation of ultrasound-detection technology, based on optical resonators, with unparalleled miniaturization levels, sensitivities, and bandwidths, creating new possibilities for minimally invasive medical devices. While existing fabrication technologies are capable of producing dense resonator arrays whose resonance frequency is pressure sensitive, simultaneously monitoring the ultrasound-induced frequency modulation of numerous resonators has remained a challenge. Conventional techniques, which are based on tuning a continuous wave laser to the resonator wavelength, are not scalable due to the wavelength disparity between the resonators, requiring a separate laser for each resonator. In this work, we show that the Q-factor and transmission peak of silicon-based resonators can also be pressure sensitive, exploit this phenomenon to develop a readout scheme based on monitoring the amplitude, rather than frequency, at the output of the resonators using a single-pulse source, and demonstrate its compatibility with optoacoustic tomography.
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13
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Dewberry D, Kalivoda EJ, Cabrera Correa G, Cruz‐Menoyo P. Bedside echocardiography evaluation of a male with transient global amnesia. J Am Coll Emerg Physicians Open 2022; 3:e12716. [PMID: 35434712 PMCID: PMC9000156 DOI: 10.1002/emp2.12716] [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: 02/24/2022] [Accepted: 03/17/2022] [Indexed: 11/10/2022] Open
Affiliation(s)
- Dasha Dewberry
- Department of Emergency Medicine HCA Healthcare/USF Morsani College of Medicine GME/Brandon Regional Hospital Brandon Brandon FL USA
| | - Eric J. Kalivoda
- Department of Emergency Medicine HCA Healthcare/USF Morsani College of Medicine GME/Brandon Regional Hospital Brandon Brandon FL USA
| | - Gabriel Cabrera Correa
- Department of Emergency Medicine HCA Healthcare/USF Morsani College of Medicine GME/Brandon Regional Hospital Brandon Brandon FL USA
| | - Priscilla Cruz‐Menoyo
- Department of Emergency Medicine HCA Healthcare/USF Morsani College of Medicine GME/Brandon Regional Hospital Brandon Brandon FL USA
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Berg I, Walpot K, Lamprecht H, Valois M, Lanctôt JF, Srour N, van den Brand C. A Systemic Review on the Diagnostic Accuracy of Point-of-Care Ultrasound in Patients With Undifferentiated Shock in the Emergency Department. Cureus 2022; 14:e23188. [PMID: 35444920 PMCID: PMC9009815 DOI: 10.7759/cureus.23188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2022] [Indexed: 11/05/2022] Open
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15
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Chandy GM, Sathyendra S, Pichamuthu K, Hazra D, Abhilash KPP. Differentiating Cardiac and Pulmonary Causes of Dyspnea Using Ultrasonography and Dyspnea Discrimination Index. Indian J Crit Care Med 2022; 26:33-38. [PMID: 35110841 PMCID: PMC8783246 DOI: 10.5005/jp-journals-10071-24089] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background One of the most common reasons for emergency room (ER) visits is acute dyspnea. The challenge is in differentiating a cardiac and pulmonary cause of acute breathlessness. Hence, we have studied the effectiveness of the dyspnea discrimination index (DDI) used in conjunction with ultrasonography (USG) in distinguishing between cardiac and pulmonary causes of dyspnea. Methods This was a prospective study conducted in the ER and general medicine wards to evaluate the efficacy of the DDI and USG in dyspneic patients. Data were entered in a standard data sheet and analysis was done using SPSS software. Results The majority of the patients were between the ages of 45 and 60, with a male predominance. Risk factors like smoking were more common in the pulmonary group (36%). Pulmonary cause of breathlessness was seen in 62% of patients and cardiac pathology was noted in 28%. The mean (SD) DDI value and DDI% are as follows: pulmonary group (DDI)—5.47 (SD: 2.82); cardiac group (DDI)—8.34 (SD: 3.75); pulmonary group (DDI%)—1.31 (SD: 0.68); cardiac group (DDI%)—2.34 (SD: 1.14). There was a significant difference in DDI% between the pulmonary and cardiac groups (p = 0.001). DDI was found to have a sensitivity and specificity of 77.3% and 70%, respectively. While for DDI%, sensitivity and specificity were 72.7% and 72%, respectively. Lung USG had 98% sensitivity and 95.5% specificity, with a narrow confidence interval. The positive likelihood ratio was noted to be 21.6, indicating a very high post-test probability. Conclusion The DDI and USG in conjunction had good discriminative power, when it came to distinguishing between cardiac and pulmonary causes of dyspnea. USG had a high specificity and sensitivity, making it suitable for identifying the cause of dyspnea in a tertiary care ER setting. How to cite this article Chandy GM, Sathyendra S, Pichamuthu K, Hazra D, Abhilash KPP. Differentiating Cardiac and Pulmonary Causes of Dyspnea Using Ultrasonography and Dyspnea Discrimination Index. Indian J Crit Care Med 2022;26(1):33–38.
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Affiliation(s)
- Gina M Chandy
- Department of Emergency Medicine, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
- Gina M Chandy, Department of Emergency Medicine, Christian Medical College and Hospital, Vellore, Tamil Nadu, India, Phone: +91 9894047479, e-mail:
| | - Sowmya Sathyendra
- Department of Medicine, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Kishore Pichamuthu
- Medical Intensive Care Unit, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Darpanarayan Hazra
- Department of Emergency Medicine, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Kundavaram PP Abhilash
- Department of Emergency Medicine, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
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Rice JA, Brewer J, Speaks T, Choi C, Lahsaei P, Romito BT. The POCUS Consult: How Point of Care Ultrasound Helps Guide Medical Decision Making. Int J Gen Med 2021; 14:9789-9806. [PMID: 34938102 PMCID: PMC8685447 DOI: 10.2147/ijgm.s339476] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 12/01/2021] [Indexed: 12/30/2022] Open
Affiliation(s)
- Jake A Rice
- Department of Anesthesiology and Pain Management, The University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Emergency Medicine, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jonathan Brewer
- Department of Emergency Medicine, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Tyler Speaks
- Department of Anesthesiology and Pain Management, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Christopher Choi
- Department of Anesthesiology and Pain Management, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Peiman Lahsaei
- Department of Anesthesiology and Pain Management, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Bryan T Romito
- Department of Anesthesiology and Pain Management, The University of Texas Southwestern Medical Center, Dallas, TX, USA
- Correspondence: Bryan T Romito Department of Anesthesiology and Pain Management, The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390-9068, USATel +1 214 648 7674Fax +1 214 648 5461 Email
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Mareev YV, Dzhioeva ON, Zorya OT, Pisaryuk AS, Verbilo SL, Skaletsky KV, Ionin VA, Drapkina OM, Alekhin MN, Saidova MA, Safarova AF, Garganeeva AA, Boshchenko AA, Ovchinnikov AG, Chernov MY, Ageev FT, Vasyuk YA, Kobalava ZD, Nosikov AV, Safonov DV, Khudorozhkova ED, Belenkov YN, Mitkov VV, Mitkova MD, Matskeplishvili ST, Mareev VY. [Focus ultrasound for cardiology practice. Russian consensus document]. KARDIOLOGIIA 2021; 61:4-23. [PMID: 34882074 DOI: 10.18087/cardio.2021.11.n1812] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 09/13/2021] [Indexed: 06/13/2023]
Abstract
This document is a consensus document of Russian Specialists in Heart Failure, Russian Society of Cardiology, Russian Association of Specialists in Ultrasound Diagnostics in Medicine and Russian Society for the Prevention of Noncommunicable Diseases. In the document a definition of focus ultrasound is stated and discussed when it can be used in cardiology practice in Russian Federation.
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Affiliation(s)
- Yu V Mareev
- National Medical Research Centre for Therapy and Preventive Medicine, Moscow, Russia Robertson Centre for Biostatistics, Glasgow, Great Britain
| | - O N Dzhioeva
- National Medical Research Centre for Therapy and Preventive Medicine, Moscow, Russia Moscow State Medical and Dental University named after Evdokimov, Moscow, Russia
| | - O T Zorya
- Russian State University of Peoples' Friendship, Moscow, Russia
| | - A S Pisaryuk
- Russian State University of Peoples' Friendship, Moscow, Russia
| | - S L Verbilo
- LLC «Centre for Family Medicine MEDIKA», St. Petersburg, Russia
| | - K V Skaletsky
- Scientific Research Institute «Ochapovsky Regional Clinical Hospital №1», Krasnodar, Russia
| | - V A Ionin
- Pavlov University, St. Petersburg, Russia
| | - O M Drapkina
- National Medical Research Centre for Therapy and Preventive Medicine, Moscow, Russia Moscow State Medical and Dental University named after Evdokimov, Moscow, Russia
| | - M N Alekhin
- Central Clinical Hospital of the Presidential Administration of Russian Federation, Moscow, Russia Central State Medical Academy of the Presidential Administration of Russian Federation, Moscow, Russia
| | - M A Saidova
- Scientific Medical Research Center of Cardiology, Moscow, Russia
| | - A F Safarova
- Russian State University of Peoples' Friendship, Moscow, Russia
| | - A A Garganeeva
- "Research Institute for Cardiology", Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia
| | - A A Boshchenko
- "Research Institute for Cardiology", Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia Siberian State Medical University, Tomsk, Russia
| | - A G Ovchinnikov
- Moscow State Medical and Dental University named after Evdokimov, Moscow, Russia Scientific Medical Research Center of Cardiology, Moscow, Russia
| | - M Yu Chernov
- Center for Diagnostic Research, N.N. Burdenko Main Military Clinical Hospital, Moscow, Russia
| | - F T Ageev
- Scientific Medical Research Center of Cardiology, Moscow, Russia
| | - Yu A Vasyuk
- Moscow State Medical and Dental University named after Evdokimov, Moscow, Russia
| | - Zh D Kobalava
- Russian State University of Peoples' Friendship, Moscow, Russia
| | - A V Nosikov
- Acibadem City Clinic Mladost, Sofia, Bulgaria
| | - D V Safonov
- Privolzhsky Research Medical University, Nizhniy Novgorod, Russia
| | - E D Khudorozhkova
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - Yu N Belenkov
- Sechenov Moscow State Medical University, Moscow, Russia
| | - V V Mitkov
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - M D Mitkova
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - S T Matskeplishvili
- Medical Research and Educational Center of the M. V. Lomonosov Moscow State University, Moscow, Russia
| | - V Yu Mareev
- Medical Research and Educational Center of the M. V. Lomonosov Moscow State University, Moscow, Russia Faculty of Fundamental Medicine, Lomonosov Moscow State University, Moscow, Russia
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Fatima H, Amador Y, Walsh DP, Qureshi NQ, Chaudhary O, Mufarrih SH, Bose RR, Mahmood F, Matyal R. Simplified Algorithm for Evaluation of Perioperative Hypoxia and Hypotension (SALVATION): A Practical Echo-guided Approach Proposal. J Cardiothorac Vasc Anesth 2021; 35:2273-2282. [PMID: 34006466 DOI: 10.1053/j.jvca.2021.04.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/08/2021] [Accepted: 04/11/2021] [Indexed: 01/17/2023]
Abstract
Despite the valuable use of modern applications of perioperative ultrasound across multiple disciplines, there have been limitations to its implementation, restricting its impact on patient-based clinical outcomes. Point-of-care ultrasound evaluation of hypoxia and hypotension is an important tool to assess the underlying undifferentiated etiologies in a timely manner. However, there is a lack of consensus on the formal role of ultrasound during evaluation of perioperative hypoxia or hypotension. The previous ultrasound algorithms have adopted a complex technique that possibly ignore the pathophysiologic mechanisms underlying the conditions presenting in a similar fashion. The authors here propose a simple, sequential and focused multiorgan approach, applicable for the evaluation of perioperative hypotension and hypoxia in emergency scenarios. The authors believe this approach will enhance the care provided in the postanesthesia care unit, operating room, and intensive care unit.
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Affiliation(s)
- Huma Fatima
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Centre, Harvard Medical School, Boston, MA
| | - Yannis Amador
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Centre, Harvard Medical School, Boston, MA
| | - Daniel P Walsh
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Centre, Harvard Medical School, Boston, MA
| | - Nada Qaisar Qureshi
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Centre, Harvard Medical School, Boston, MA
| | - Omar Chaudhary
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Centre, Harvard Medical School, Boston, MA
| | - Syed Hamza Mufarrih
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Centre, Harvard Medical School, Boston, MA
| | - Ruma R Bose
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Centre, Harvard Medical School, Boston, MA
| | - Feroze Mahmood
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Centre, Harvard Medical School, Boston, MA
| | - Robina Matyal
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Centre, Harvard Medical School, Boston, MA.
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Winkler S, Hey F, Galow L, Brenner S. Erkennen des kritisch kranken Kindes. Notf Rett Med 2021. [DOI: 10.1007/s10049-020-00812-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Barjaktarevic I, Kenny JÉS, Berlin D, Cannesson M. The Evolution of Ultrasound in Critical Care: From Procedural Guidance to Hemodynamic Monitor. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:401-405. [PMID: 32750199 PMCID: PMC7855649 DOI: 10.1002/jum.15403] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 05/30/2020] [Accepted: 06/08/2020] [Indexed: 05/05/2023]
Affiliation(s)
- Igor Barjaktarevic
- Division of Pulmonary and Critical Care, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Jon-Émile S Kenny
- Health Sciences North Research Institute and Flosonics Medical, Sudbury, Ontario, Canada
| | - David Berlin
- Division of Pulmonary and Critical Care, Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Maxime Cannesson
- Department of Anesthesiology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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21
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Dewan N, Zuluaga D, Osorio L, Krienke ME, Bakker C, Kirsch J. Ultrasound in Dengue: A Scoping Review. Am J Trop Med Hyg 2021; 104:826-835. [PMID: 33534759 PMCID: PMC7941833 DOI: 10.4269/ajtmh.20-0103] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 12/14/2020] [Indexed: 01/21/2023] Open
Abstract
To improve dengue triage and treatment decisions, the WHO recommends classifying the disease as dengue with or without warning signs or severe dengue. Vascular leakage is a key component of the pathophysiology of severe dengue and is detectable by ultrasound. The objective of this scoping review is to describe the primary literature on the use of ultrasound in dengue, summarize the findings, and identify knowledge gaps. Our database search retrieved 1,489 records which were reduced to 177 studies following eligibility screening. Descriptive analyses were conducted. Results showed most studies are from South Asia (n = 92, 52%) and assessed hospitalized dengue patients (130, 82%). Radiologists were the most reported ultrasonographers (14, 8%), and conventional ultrasound (39, 68%) was preferred over portable (9, 16%). The most common ultrasound findings in dengue were ascites (107, 60%), pleural effusion (102, 58%), and gallbladder wall thickening (97, 55%). However, the lack of a standard protocol to perform the ultrasound examination in dengue patients hinders conclusions about the frequency of ultrasound findings in dengue. Given the progress of current ultrasound technology, a focused point-of-care ultrasound protocol for early detection of vascular leakage in dengue is needed to generate the evidence required for its implementation in routine care.
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Affiliation(s)
- Neelesh Dewan
- University of Miami Miller School of Medicine, Miami, Florida
- Epidemiology and Population Health Research Group (GESP), School of Public Health, Universidad del Valle, Cali, Colombia
- University of Minnesota Medical School, Minneapolis, Minnesota
| | - Daniela Zuluaga
- Epidemiology and Population Health Research Group (GESP), School of Public Health, Universidad del Valle, Cali, Colombia
| | - Lyda Osorio
- Epidemiology and Population Health Research Group (GESP), School of Public Health, Universidad del Valle, Cali, Colombia
| | | | - Caitlin Bakker
- University of Minnesota, Health Sciences Libraries, Minneapolis, Minnesota
| | - Jonathan Kirsch
- Section of Hospital Medicine, Division of General Internal Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
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Sheth A, Dabo-Trubelja A. Perioperative focused cardiac ultrasound: a brief report. JOURNAL OF ANESTHESIA & CRITICAL CARE : OPEN ACCESS 2021; 13:55-60. [PMID: 33816785 PMCID: PMC8018677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The anesthesiologist's emerging role as a perioperative physician has challenged the field to broaden its scope of practice to meet the demands of the patient undergoing surgery today. This brief report aims to identify the indications, clinical impact on management decisions, and perioperative focused cardiac ultrasound accuracy in patients scheduled for non-cardiac surgery. METHODS A review from the Department of Anesthesia Perioperative Echocardiography database on transthoracic echocardiography was performed, including clinical, demographic, indications, therapeutic impact, and accuracy from February 1, 2017 to October 10, 2019. RESULTS A total of 220 FoCUS exams were identified. FoCUS was performed in 55% males and 45% females. The average age was 66.5 years, and 68% of patients were designated ASA 3 classification. The majority underwent thoracic procedures with a history of cardiovascular disease for hemodynamic instability in the post-anesthesia care unit (PACU). In this group, 94% had a change in management. New findings in 9 patients resulted in pre-induction management change. FoCUS was also performed intraoperatively to differentiated hemodynamic instability, significantly altering care. Postoperatively, new wall motion abnormalities findings escalated care to the cardiology service. Immediate assessment of hemodynamic instability altered care and postoperative recovery location in a significant number of patients. In all cases, FoCUS was used to guide management in the differential diagnosis of the acute event and to assess treatment response. CONCLUSION This review demonstrates that FoCUS is an excellent clinical adjunct in the perioperative period. Diagnostic accuracy and efficiency by pattern recognition helped answer clinically significant questions and guide management. The non-invasive approach of POCUS and its rapid adaptation makes it an exciting area of future research.
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Affiliation(s)
- Amish Sheth
- Department of Anesthesiology and Critical Care, Memorial Sloan Kettering Cancer Center, USA
| | - Anahita Dabo-Trubelja
- Department of Anesthesiology and Critical Care, Director, Perioperative Echocardiography and Ultrasound Director, Onco-Anesthesia Fellowship, Memorial Sloan Kettering Cancer Center, USA
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Davis B, Brockshus A, Merritt C, Donaldson C. Ruptured Abdominal Aortic Aneurysm Presenting as Septic Shock. Mil Med 2020; 185:e2189-e2191. [DOI: 10.1093/milmed/usaa205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
A patient presented to the emergency department with undifferentiated shock 4 days after discharge from a hospitalization for a lower gastrointestinal bleed. The patient fulfilled 4/4 of the Systemic Inflammatory Response Syndrome criteria and 3/3 of the quick Sequential Organ Failure Assessment criteria on presentation to the emergency department, notably, without a localized source of infection and no localizing symptoms. After admission, the patient’s hemoglobin was found to have dropped more than expected after intravenous (IV) fluid administration, suggesting a potential alternative or concurrent etiology of the patient’s shock state. A digital rectal and focused assessment with sonography in trauma exam were performed and negative. The patient was then diagnosed with a ruptured infrarenal abdominal aortic aneurysm contained in the retroperitoneum by repeat point-of-care ultrasound. The patient was hemodynamically stabilized and taken for emergent grafting without confirmatory imaging. The patient was later found to also have 4/4 blood cultures positive with methicillin-sensitive Staphylococcus aureus associated with an aortic valvular vegetation and a mycotic aneurysm which contributed to the abdominal aortic aneurysm rupture. This case supports the use of comprehensive point-of-care ultrasound imaging to more rapidly and more definitively differentiate types of shock and etiologies of a shock state which can lead to more timely changes in management and improvement in outcomes.
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Affiliation(s)
- Bryon Davis
- William Beaumont Army Medical Center, 5005 N. Piedras, El Paso, Texas
| | - Aaron Brockshus
- William Beaumont Army Medical Center, 5005 N. Piedras, El Paso, Texas
| | - Clay Merritt
- William Beaumont Army Medical Center, 5005 N. Piedras, El Paso, Texas
| | - Chase Donaldson
- William Beaumont Army Medical Center, 5005 N. Piedras, El Paso, Texas
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James V, Samuel J, Kee CY, Ong GYK. Point-of-care ultrasound for evaluating intra-abdominal calcification in the pediatric emergency department: case series and review of literature. Ultrasound J 2020; 12:51. [PMID: 33270182 PMCID: PMC7714802 DOI: 10.1186/s13089-020-00199-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 11/27/2020] [Indexed: 12/23/2022] Open
Abstract
Background The presence of intra-abdominal calcification in the pediatric population can be due to a wide range of conditions. Calcification in the abdomen can be seen in normal or abnormal anatomical structures. In some patients, abnormal calcification points towards the pathology; whereas in others, calcification itself is the pathology. After a thorough history and clinical examination, point-of-care ultrasound (POCUS) would complement the assessment of acute abdominal pain, based on the list of differentials generated as per the abdominal region. The main objective of this article is to review commonly encountered causes of intra-abdominal calcifications in the pediatric population and help in clinical decision-making in a Pediatric Emergency Department. Case presentation We describe a series of pediatric patients who presented to the Pediatric Emergency Department with acute abdominal pain, in whom point-of-care ultrasound helped expedite the diagnosis by identifying varying types of calcification and associated sonological findings. For children who present to the Pediatric Emergency Department with significant abdominal pain, a rapid distinction between emergencies and non-emergencies is vital to decrease morbidity and mortality. Conclusions In a child presenting to the Pediatric Emergency Department with abdominal pain, POCUS and the findings of calcifications can narrow or expand the differential diagnosis when integrated with history and physical exam, to a specific anatomic structure. Integrating these findings with additional sonological findings of an underlying pathology might raise sufficient concerns in the emergency physicians to warrant further investigations for the patient in the form of a formal radiological ultrasound and assist in the patient's early disposition. The use of POCUS might also help to categorize the type of calcification to one of the four main categories of intra-abdominal calcifications, namely concretions, conduit wall calcification, cyst wall calcification, and solid mass-type calcification. POCUS used thoughtfully can give a diagnosis and expand differential diagnosis, reduce cognitive bias, and reduce physician mental load. By integrating the use of POCUS with the history and clinical findings, it will be possible to expedite the management in children who present to the Pediatric Emergency Department with acute abdominal pain.
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Affiliation(s)
- Vigil James
- Children's Emergency, C/O KK Women's and Children's Hospital PTE. LTD, 100 Bukit Timah Road, Singapore, 229899, Singapore.
| | - John Samuel
- Department of Radiodiagnosis, Christian Fellowship Hospital, Oddanchatram, Tamilnadu, 624619, India
| | - Chor Yek Kee
- Paediatric Intensive Care Unit, Department of Pediatrics, Sarawak General Hospital, Kuching, Malaysia
| | - Gene Yong-Kwang Ong
- Children's Emergency, C/O KK Women's and Children's Hospital PTE. LTD, 100 Bukit Timah Road, Singapore, 229899, Singapore
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Goldsmith AJ, Shokoohi H, Loesche M, Patel RC, Kimberly H, Liteplo A. Point-of-care Ultrasound in Morbidity and Mortality Cases in Emergency Medicine: Who Benefits the Most? West J Emerg Med 2020; 21:172-178. [PMID: 33207163 PMCID: PMC7673874 DOI: 10.5811/westjem.2020.7.47486] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 05/13/2020] [Accepted: 07/09/2020] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Point-of-care ultrasound (POCUS) is an essential tool in the timely evaluation of an undifferentiated patient in the emergency department (ED). Our primary objective in this study was to determine the perceived impact of POCUS in high-risk cases presented at emergency medicine (EM) morbidity and mortality (M&M) conferences. Additionally, we sought to identify in which types of patients POCUS might be most useful, and which POCUS applications were considered to be highest yield. METHODS This was a retrospective survey of cases submitted to M&M at an EM residency program that spans two academic EDs, over one academic year. Postgraduate year 4 (PGY) residents who presented M&M cases at departmental sessions were surveyed on perceived impacts of POCUS on individual patient outcomes. We evaluated POCUS use and indications while the POCUS was used. RESULTS Over the 12-month period, we reviewed 667 cases from 18 M&M sessions by 15 PGY-4 residents and a supervising EM attending physician who chairs the M&M committee. Of these cases, 75 were selected by the M&M committee for review and presentation. POCUS was used in 27% (20/75) of the cases and not used in 73% (55/75). In cases where POCUS was not used, retrospective review determined that if POCUS had been used it would have "likely prevented the M&M" in 45% (25/55). Of these 25 cases, the majority of POCUS applications that could have helped were cardiac (32%, 8/25) and lung (32%, 8/25) ultrasound. POCUS was felt to have greatest potential in identifying missed diagnoses (92%, 23/25), and decreasing the time to diagnosis (92%, 23/25). Patients with cardiopulmonary chief complaints and abnormal vital signs were most likely to benefit. There were seven cases (35%, 7/20, 95% CI 15-59%) in which POCUS was performed and thought to have possibly adversely affected the outcome of the M&M. CONCLUSION POCUS was felt to have the potential to reduce or prevent M&M in 45% of cases in which it was not used. Cardiac and lung POCUS were among the most useful applications, especially in patients with cardiopulmonary complaints and in those with abnormal vital signs.
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Affiliation(s)
- Andrew J. Goldsmith
- Harvard Medical School, Department, Boston, Massachusetts
- Brigham and Women’s Hospital, Department of Emergency Medicine, Boston, Massachusetts
| | - Hamid Shokoohi
- Harvard Medical School, Department, Boston, Massachusetts
- Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts
| | - Michael Loesche
- Harvard Medical School, Department, Boston, Massachusetts
- Brigham and Women’s Hospital, Department of Emergency Medicine, Boston, Massachusetts
- Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts
| | - Ravish C. Patel
- Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts
- Medical College of Georgia School of Medicine, Department, Augusta, Georgia
| | - Heidi Kimberly
- Harvard Medical School, Department, Boston, Massachusetts
- Brigham and Women’s Hospital, Department of Emergency Medicine, Boston, Massachusetts
| | - Andrew Liteplo
- Harvard Medical School, Department, Boston, Massachusetts
- Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts
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Martins SR, Nogué R. Vertical displacement of pleura: a new method for bronchospasm evaluation? Ultrasound J 2020; 12:42. [PMID: 32839914 PMCID: PMC7445216 DOI: 10.1186/s13089-020-00184-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 08/04/2020] [Indexed: 12/24/2022] Open
Abstract
Background Lung ultrasonography has been increasingly recognized has a valuable diagnostic tool. In adult patients with asthma/chronic obstructive pulmonary disease and wheezing, LUS usually presents as an A/nude profile (normal profile, with sliding and A-lines, and without any abnormal findings) or at most reveals a decrease/absence of lung sliding. Therefore, until now simple point-of-care ultrasonography appeared to be unable to assess the severity of airflow limitation. Case presentation We report the case of a woman presenting to the emergency department with an asthma exacerbation. Bedside ultrasound showed the usual A/normal profile, but also an associated vertical pleural displacement, probably secondary to hyperinflation and accessory muscle recruitment. We evaluated the described movement with M-mode and established a comparison index between end-inspiration and end-expiration, using the skin as reference. This index showed improvement and complete normalization during treatment. Conclusions Pleural vertical displacement appears to be a sonographic alteration associated to bronchospasm and accessory muscle recruitment. It is easily identifiable and measurable on LUS, thus possibly representing a new method to evaluate bronchospasm and monitoring treatment response. Further research is needed to confirm or refute this finding.
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Eikelboom R, Katz N. Acute aortic dissection presenting as status epilepticus. CMAJ 2020; 192:E283-E285. [PMID: 32179537 DOI: 10.1503/cmaj.190822] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Rachel Eikelboom
- Cardiac Surgery (Eikelboom), St. Boniface Hospital; Faculty of Medicine (Eikelboom), University of Manitoba; Emergency Department (Katz), St. Boniface Hospital; Department of Emergency Medicine (Katz), Winnipeg, Man.
| | - Noam Katz
- Cardiac Surgery (Eikelboom), St. Boniface Hospital; Faculty of Medicine (Eikelboom), University of Manitoba; Emergency Department (Katz), St. Boniface Hospital; Department of Emergency Medicine (Katz), Winnipeg, Man
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Sonographic Assessment of Intravascular Fluid Estimate (SAFE) Score by Using Bedside Ultrasound in the Intensive Care Unit. Crit Care Res Pract 2020; 2020:9719751. [PMID: 32185080 PMCID: PMC7060409 DOI: 10.1155/2020/9719751] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 01/06/2020] [Accepted: 02/01/2020] [Indexed: 12/03/2022] Open
Abstract
Objective The objective of the study was to use an ultrasound-based numerical scoring system for assessment of intravascular fluid estimate (SAFE) and test its validity. Methods A prospective, observational study was carried out in the surgical intensive care unit (ICU) of an urban tertiary care teaching hospital. Patient's intravascular volume status was assessed using the standard methods of heart rate, blood pressure, central venous pressure, cardiac output, lactate and saturation of venous oxygen, and others. This was compared with assessment using bedside ultrasound evaluation of the cardiac function, inferior vena cava, lungs, and the internal jugular vein. Applying a numerical scoring system was evaluated by Fisher's exact testing and multinomial logistic model to predict the volume status based on ultrasound scores and the classification accuracy. Results 61 patients in the ICU were evaluated. 21 (34.4% of total) patients diagnosed with hypovolemia, and their ultrasound volume score was −4 in 14 (66.7%) patients, −3 in 5 (23.8%) patients, and 0 in 2 (9.5%) patients (p < 0.001). 18 (29.5% of total) patients diagnosed with euvolemia, and their ultrasound volume score was 0 in 11 (61.1%) patients, +1 in 4 (22.2%) patients, and −1 in 1 (5.6%) patient (p < 0.001). 18 (29.5% of total) patients diagnosed with euvolemia, and their ultrasound volume score was 0 in 11 (61.1%) patients, +1 in 4 (22.2%) patients, and −1 in 1 (5.6%) patient (p < 0.001). 18 (29.5% of total) patients diagnosed with euvolemia, and their ultrasound volume score was 0 in 11 (61.1%) patients, +1 in 4 (22.2%) patients, and −1 in 1 (5.6%) patient (p < 0.001). 18 (29.5% of total) patients diagnosed with euvolemia, and their ultrasound volume score was 0 in 11 (61.1%) patients, +1 in 4 (22.2%) patients, and −1 in 1 (5.6%) patient ( Conclusion Using the SAFE scoring system to identify the IVV status in critically ill patients significantly correlates with the standard measures. A SAFE score of −4 to −2 more likely represents hypovolemia, −1 to +1 more likely represents euvolemia, and +2 to +4 more likely to be hypervolemia.
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The Right Ventricle-You May Forget it, but It Will Not Forget You. J Clin Med 2020; 9:jcm9020432. [PMID: 32033368 PMCID: PMC7074056 DOI: 10.3390/jcm9020432] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 01/23/2020] [Accepted: 01/27/2020] [Indexed: 01/21/2023] Open
Abstract
Right ventricular (RV) dysfunction and failure are common and often overlooked causes of perioperative deterioration and adverse outcomes. Due to its unique pathophysiologic underpinnings, RV failure often does not respond to typical therapeutic measures such as volume resuscitation and often worsens when therapy is escalated and mechanical ventilation is begun, with a danger of irreversible cardiovascular collapse and death. The single most important factor in improving outcomes in the context of RV failure is anticipating and recognizing it. Once established, a vicious circle of systemic hypotension, and RV ischemia and dilation is set in motion, rapidly spiraling down into a state of shock culminating in multi-organ failure and ultimately death. Therapy of RV failure must focus on rapidly reestablishing RV coronary perfusion, lowering pulmonary vascular resistance and optimizing volemia. In parallel, underlying reversible causes should be sought and if possible treated. In all stages of diagnostics and therapy, echocardiography plays a central role. In severe cases of RV dysfunction there remains a role for the use of the pulmonary artery catheter. When these mostly simple measures are undertaken in a timely fashion, the spiral of death of RV failure can often be broken or even prevented altogether.
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Rosario J, Mangal R, Houck J, Slome MC, Ganti L. Pericardial effusion with tamponade: bedside ultrasonography saves another life. Int J Emerg Med 2020; 13:3. [PMID: 31992190 PMCID: PMC6988296 DOI: 10.1186/s12245-019-0257-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 11/25/2019] [Indexed: 11/10/2022] Open
Abstract
In these video clinical images, the authors present the cause for an elderly gentleman’s shortness of breath. It was presumed to be an exacerbation of chronic obstructive pulmonary disease, a condition for which he was in the process of being evaluated. However, bedside ultrasonography revealed a large pericardial effusion with tamponade. This timely diagnosis resulted in the patient being taken expeditiously to the operating room and saving his life.
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Affiliation(s)
- Javier Rosario
- Envision Physician Services, Nashville, TN, USA.,UCF HCA Emergency Medicine Residency Program of Greater Orlando, University of Central Florida College of Medicine, Orlando, FL, USA
| | | | | | - Mary Cate Slome
- Envision Physician Services, Nashville, TN, USA.,UCF HCA Emergency Medicine Residency Program of Greater Orlando, University of Central Florida College of Medicine, Orlando, FL, USA
| | - Latha Ganti
- Envision Physician Services, Nashville, TN, USA. .,UCF HCA Emergency Medicine Residency Program of Greater Orlando, University of Central Florida College of Medicine, Orlando, FL, USA.
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Vázquez Reyes JM, Millán-Hernández M, Ramírez Terán OA, Fernández Saldívar F, Cortés Algara A, González Ramírez PA, Rodríguez Molina VM. El ultrasonido, de la cabecera del paciente al aula. REVISTA DE LA FACULTAD DE MEDICINA 2020. [DOI: 10.22201/fm.24484865e.2020.63.1.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
In recent years, ultrasound at the patient’s bedside has exponentially grown. Its application has been observed in the operating room, intensive care units, emergency rooms, first-level care and even in field work. It is so versatile that it facilitates diagnosis, improves patient monitoring and supports invasive procedures, all in a safe and effective manner. It has been used as a didactic tool in medical education that helps create a link between basic sciences and clinical application. Ultrasound is one of the most versatile instruments in contemporary medicine, hence, more training and research in the subject is a must and a priority.
Key words: Point-of-care ultrasonography; insonation; medical education; anatomy; physiology
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Affiliation(s)
- José Manuel Vázquez Reyes
- Universidad Nacional Autónoma de México (UNAM), Facultad de Medicina, Departamento de Fisiología- Ciudad de México. México
| | - Manuel Millán-Hernández
- Universidad Nacional Autónoma de México (UNAM). Facultad de Medicina. Secretaría de Educación Médica. Departamento de Investigación en Educación Médica. Ciudad de México. México
| | - Oscar Andrés Ramírez Terán
- Universidad Nacional Autónoma de México (UNAM), Facultad de Medicina, Departamento de Fisiología- Ciudad de México. México
| | - Fabián Fernández Saldívar
- Universidad Nacional Autónoma de México (UNAM). Facultad de Medicina. Departamento de Informática Biomédica. Ciudad de México. México
| | - Alfredo Cortés Algara
- Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE). Centro Médico Nacional 20 de Noviembre. Servicio de Endoscopia y Robótica Ginecológica. Ciudad de México. México
| | | | - Víctor Manuel Rodríguez Molina
- Universidad Nacional Autónoma de México (UNAM), Facultad de Medicina, Departamento de Fisiología- Ciudad de México. México
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Magalhães L, Martins SRP, Nogué R. The role of point-of-care ultrasound in the diagnosis and management of necrotizing soft tissue infections. Ultrasound J 2020; 12:3. [PMID: 31970543 PMCID: PMC6977785 DOI: 10.1186/s13089-020-0153-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 01/09/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Necrotizing soft tissue infections are associated with high morbidity and mortality, even when the correct treatment is initiated. The diagnosis of these conditions is hard and the most sensitive methods are time-consuming, expensive and not readily available. Point-of-care ultrasound can complement clinical evaluation to increase the diagnostic accuracy. CASE PRESENTATION We bring a case of a woman, without comorbidities, who presented to the emergency department with signs of soft tissue infection. Bedside ultrasound showed subcutaneous tissue thickening, with fluid accumulation, and subcutaneous gas in the affected area. Based on the clinical suspicion and the ultrasound findings, the patient underwent prompt medical treatment and surgical debridement. CONCLUSIONS This case shows the utility of bedside ultrasound for the decision-making process in a disease where an early diagnosis is important. This information should always be used together with the clinical judgement, as it has a relative low sensitivity.
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Affiliation(s)
- Luís Magalhães
- Hospital da Luz-Arrábida, Praceta de Henrique Moreira 150, 4400-346, Vila Nova de Gaia, Portugal.
| | | | - Ramon Nogué
- Universitat de Lleida, Plaça de Víctor Siurana, 1, 25003, Lleida, Spain
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Senniappan K, Sreedhar R, Babu MSS, Dash PK, Gadhinglajkar SV, Sukesan S. Bedside Lung Ultrasound for Postoperative Lung Conditions in Cardiothoracic Intensive Care Unit: Diagnostic Value and Comparison with Bedside Chest Roentgenogram. Anesth Essays Res 2019; 13:649-653. [PMID: 32009710 PMCID: PMC6937893 DOI: 10.4103/aer.aer_125_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 10/01/2019] [Accepted: 10/05/2019] [Indexed: 11/08/2022] Open
Abstract
Background: The postoperative settings in cardiothoracic intensive care unit (ICU) patients pose a certain risk with pulmonary dysfunction causing morbidity and mortality. Lung ultrasound (LUS) has a potential to supplant or replace Chest X-rays (CXR) in these subset of patients, who will require bed side pulmonary pathology diagnosis and interventions. Aims and Objectives: Aim of the study is to compare the diagnosis predicted from LUS to the diagnosis made from routine bedside CXR and to find the degree of agreement in diagnosis made by both modalities in different cardiopulmonary pathologies in ICUs. Materials and Methods: Prospective observational study involving 250 postoperative patients, admitted in cardio-thoracic and vascular ICU of a tertiary referral centre. LUS was done in the study patients after the scheduled CXR in the immediate postoperative period and postoperative day one. Findings of pulmonary pathologies by each imaging modality were independently interpreted by two different team of specialist investigators. The findings were evaluated for the degree of agreement between the two imaging modalities using Cohen's kappa statistical test. Results: CXR and LUS imaging showed substantial agreement in the diagnosing cardiopulmonary pathologies (κ = 0.652) in the immediate postoperative period as well as on the postoperative day one (κ = 0.740). For specific cardiopulmonary pathologies, the degree of agreement was moderate for pleural effusion (κ = 0.561), substantial for atelectasis (κ = 0.673) and interstitial edema (κ = 0.707) and perfect for pneumothorax (κ = 0.931). Conclusions: LUS can effectively replace CXR with reduction in radiation exposure in the immediate postoperative period and also in the follow up period. It can be used as a bedside diagnostic and monitoring tool in postoperative cardiothoracic and ICUs for diagnosing pneumothorax, pleural effusion, atelectasis and interstitial edema.
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Affiliation(s)
- Kirubanand Senniappan
- Divison of Cardiothoracic and Vascular Anesthesiology, Department of Anesthesiology, SCTIMST, Trivandrum, Kerala, India
| | - Rupa Sreedhar
- Divison of Cardiothoracic and Vascular Anesthesiology, Department of Anesthesiology, SCTIMST, Trivandrum, Kerala, India
| | - M S Saravana Babu
- Divison of Cardiothoracic and Vascular Anesthesiology, Department of Anesthesiology, SCTIMST, Trivandrum, Kerala, India
| | - Prasanta Kumar Dash
- Divison of Cardiothoracic and Vascular Anesthesiology, Department of Anesthesiology, SCTIMST, Trivandrum, Kerala, India
| | - Shrinivas V Gadhinglajkar
- Divison of Cardiothoracic and Vascular Anesthesiology, Department of Anesthesiology, SCTIMST, Trivandrum, Kerala, India
| | - Subin Sukesan
- Divison of Cardiothoracic and Vascular Anesthesiology, Department of Anesthesiology, SCTIMST, Trivandrum, Kerala, India
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Abstract
How to cite this article: Chandran J, Krishna B. Initial Management of Poisoned Patient. Indian J Crit Care Med 2019;23(Suppl 4):S234-S240.
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Affiliation(s)
- Jagadish Chandran
- Department of Critical Care Medicine, St. John's Medical College and Hospital, Bengaluru, Karnataka, India
| | - Bhuvana Krishna
- Department of Critical Care Medicine, St. John's Medical College and Hospital, Bengaluru, Karnataka, India
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Atrial Myxoma Presenting as Acute Bilateral Limb Ischemia. J Emerg Med 2019; 57:710-712. [PMID: 31492590 DOI: 10.1016/j.jemermed.2019.06.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 05/27/2019] [Accepted: 06/08/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND Cardiac myxoma is the most common primary benign tumor of the heart and it has diverse clinical presentations. It is known to embolize into systemic circulation. However, presentation with complete occlusion of the aorta is uncommon. CASE REPORT We report an 18-year-old female who presented to the emergency department with features of acute bilateral limb ischemia. Arterial Doppler ultrasonography showed infrarenal aortic occlusion. A bedside cardiac ultrasound was done in the emergency department which clinched the diagnosis of atrial myxoma. Complete surgical excision of the tumor and subsequent histopathologic examination confirmed the diagnosis of atrial myxoma. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This report puts emphasis on the fact that atrial myxoma, though rare, may be considered as a source of embolism in patients presenting with acute limb ischemia. The importance of bedside ultrasonography for early diagnosis in such presentations is also highlighted.
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Tavares J, Ivo R, Gonzalez F, Lamas T, Mendes JJ. Global Ultrasound Check for the Critically lll (GUCCI)-a new systematized protocol unifying point-of-care ultrasound in critically ill patients based on clinical presentation. Open Access Emerg Med 2019; 11:133-145. [PMID: 31372068 PMCID: PMC6628156 DOI: 10.2147/oaem.s199137] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 05/02/2019] [Indexed: 01/13/2023] Open
Abstract
Ultrasound technology is an essential tool in the management of critically ill patients. Point-of-care ultrasonography (POCUS) enables data collection from different anatomic areas to achieve the most probable diagnosis and administer the right therapy at the right time. Despite the increasing utilization of POCUS, there is still a lack of standards to establish how to use different bedside ultrasound protocols, and it is imperative to develop a unifying protocol. Thus, the aim of this paper is to establish a new systematized approach that can be adopted by all physicians to implement POCUS for critically ill patient management. To achieve this, we propose a new systematized approach—Global Ultrasound Check for the Critically Ill (GUCCI)—that integrates multiple protocols. This protocol is organized based on three syndromes (acute respiratory failure, shock, and cardiac arrest) and includes ultrasound-guided procedures.
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Affiliation(s)
- João Tavares
- Internal Medicine Department, Hospital da Luz, Lisbon, Portugal
| | - Rita Ivo
- Internal Medicine Department, Hospital Egas Moniz, Lisbon, Portugal
| | - Filipe Gonzalez
- Intensive Care Unit, Hospital Garcia de Orta, Almada, Portugal
| | - Tomás Lamas
- Intensive Care Unit, Hospital CUF Infante Santo, Lisbon, Portugal
| | - João João Mendes
- Intensive Care Unit, Hospital CUF Infante Santo, Lisbon, Portugal
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The diagnostic accuracy of a point-of-care ultrasound protocol for shock etiology: A systematic review and meta-analysis. CAN J EMERG MED 2019; 21:406-417. [PMID: 30696496 DOI: 10.1017/cem.2018.498] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE The aim of this study was to perform a systematic review and meta-analysis of the diagnostic accuracy of a point-of-care ultrasound exam for undifferentiated shock in patients presenting to the emergency department. METHODS Ovid MEDLINE, Scopus, Cochrane Central Register of Controlled Trials, and research meeting abstracts were searched from 1966 to June 2018 for relevant studies. QUADAS-2 was used to assess study quality, and meta-analysis was conducted to pool performance data of individual categories of shock. RESULTS A total of 5,097 non-duplicated studies were identified, of which 58 underwent full-text review; 4 were included for analysis. Study quality by QUADAS-2 was considered overall a low risk of bias. Pooled positive likelihood ratio values ranged from 8.25 (95% CI 3.29 to 20.69) for hypovolemic shock to 40.54 (95% CI 12.06 to 136.28) for obstructive shock. Pooled negative likelihood ratio values ranged from 0.13 (95% CI 0.04 to 0.48) for obstructive shock to 0.32 (95% CI 0.16 to 0.62) for mixed-etiology shock. CONCLUSION The rapid ultrasound for shock and hypotension (RUSH) exam performs better when used to rule in causes of shock, rather than to definitively exclude specific etiologies. The negative likelihood ratios of the exam by subtype suggest that it most accurately rules out obstructive shock.
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Jerg A, Denkinger M, Jerg-Bretzke L. Development of an innovative physical examination course involving handheld ultrasound devices. MEDEDPUBLISH 2019; 7:164. [PMID: 38074619 PMCID: PMC10701831 DOI: 10.15694/mep.2018.0000164.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024] Open
Abstract
This article was migrated. The article was marked as recommended. Several studies in recent years have shown that the physical examination skills of medical students are inadequate. In response to this deficit, a new teaching intervention has been developed consisting of five physical examination courses and a set of corresponding bedside teaching modules. The bedside modules are primarily intended to provide the opportunity for practical application of the examination techniques learned. One particularity of the bedside teaching was the use of handheld ultrasound (HHU) units in order to be able to visualize and verify/falsify diagnostic findings immediately. Since this demonstration of findings was standardized according to the specifications of the Rapid Ultrasound in Shock and Hypotension (RUSH) protocol, it constituted the basis for the communication of basic emergency ultrasound skills. A pilot study, which included an initial evaluation, has demonstrated this concept is feasible and is met with great interest on the part of the students.
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Affiliation(s)
- Achim Jerg
- University Hospital Ulm
- University Hospital Ulm
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Mahendran M, Gupta K, Kumar A, Bhatt M, Khan MA, Vyas S, Makkar N, Baitha U, Jadon RS, Wig N. Bedside sonography by medicine residents in critically Ill patients: A retrospective study from a teaching hospital in India. J Family Med Prim Care 2019; 8:2517-2521. [PMID: 31463287 PMCID: PMC6691465 DOI: 10.4103/jfmpc.jfmpc_379_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Context: Ultrasonography has become the frontline diagnostic tool for emergency care because of its non-invasive nature and the feasibility to perform repeated quick assessments in sick patients. The effectiveness of this modality, when used by trainee doctors to take clinically important decisions in patients requiring emergency care, is not much explored. In this pilot study, we analyzed whether use of this technology by Medicine resident doctors can help in better decision making in acutely and critical ill patients. Setting and Design: This is a retrospective study conducted in the Department of Medicine, All India Institute of Medical Sciences, New Delhi. Methods and Materials: The study was conducted using patient data collected from acutely ill and critical care patients, who underwent bedside ultrasonography from August 2017 to August 2018. In all cases, resident doctor's finding had been assessed by an experienced operator before a treatment decision was made. Statistical Analysis Used: Continuous variables with normal distribution were computed using t test. Ordinal variables and variables following non-normal distribution were analyzed using the Wilcoxon rank-sum test. Results: Thirty-two patients were recruited. There was agreement on 78% (25/32) ultrasound records between the trainee and the experienced operator. Among patients evaluated for shock, agreement reached 83% (15/18). Among patients who underwent transthoracic echocardiography, agreement was 66.7% (4/6). Among patients who underwent lung ultrasound, agreement was 70% (7/10). In both the patients in whom abdominal ultrasound was done, final inferences were consistent between the residents and experts. Conclusions: The results show that in majority of critically ill patients, Medicine residents made sonographic observations correctly and took clinically precise sonography guided decisions on par with expert sonologists even with minimal training and ultrasound exposure.
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Affiliation(s)
- Manjit Mahendran
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Kartik Gupta
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Arvind Kumar
- Department of Medicine, Faculty of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Manasvini Bhatt
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Maroof A Khan
- Department of Biostatistics, Faculty of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Surabhi Vyas
- Department of Radiology, Faculty of Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Nayani Makkar
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Upendra Baitha
- Department of Medicine, Faculty of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ranveer S Jadon
- Department of Medicine, Faculty of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Naveet Wig
- Department of Medicine, Faculty of Medicine, All India Institute of Medical Sciences, New Delhi, India
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Weir A, Bartlett E, Bowling K, Andrews S, Guest T. A rare late complication of traumatic diaphragmatic hernia repair. Anaesth Rep 2019; 7:26-28. [PMID: 32051941 PMCID: PMC6931299 DOI: 10.1002/anr3.12008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2019] [Indexed: 11/10/2022] Open
Abstract
We report a case of sudden cardiovascular collapse several weeks following surgical repair of a traumatic diaphragmatic hernia. The patient presented with features of circulatory shock without a clear diagnosis, therefore an urgent computed tomography scan of the chest and abdomen was undertaken, which revealed a pericardial effusion with evidence of cardiac tamponade. Ultrasound-guided needle pericardiocentesis with aspiration of blood from the pericardial sac in the Emergency Department provided an immediate response and her cardiac output improved. On review of the imaging, it is likely a surgically-placed permanent metallic fixation device, sitting near the pericardium, caused bleeding into the pericardial sac due to local trauma as a delayed postoperative complication.
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Affiliation(s)
- A. Weir
- Department of Anaesthesia and Intensive Care MedicineTorbay HospitalTorquayUK
| | - E. Bartlett
- Department of Anaesthesia and Intensive Care MedicineTorbay HospitalTorquayUK
| | - K. Bowling
- Department of SurgeryTorbay HospitalTorquayUK
| | - S. Andrews
- Department of SurgeryTorbay HospitalTorquayUK
| | - T. Guest
- Department of Anaesthesia and Intensive Care MedicineTorbay HospitalTorquayUK
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Weile J, Laursen CB, Frederiksen CA, Graumann O, Sloth E, Kirkegaard H. Point-of-care ultrasound findings in unselected patients in an emergency department -results from a prospective observational trial. BMC Emerg Med 2018; 18:60. [PMID: 30587153 PMCID: PMC6307264 DOI: 10.1186/s12873-018-0211-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 12/06/2018] [Indexed: 12/22/2022] Open
Abstract
Background Point-of-care ultrasound (POCUS) can improve patient management in the emergency department (ED). However, previous studies have focused only on selected groups of patients, such as trauma, shock, dyspnea, or critically ill patients, or patients with an already known diagnosis. Most patients seen in the ED do not match these criteria. We aim to present total prevalence of positive findings when basic POCUS is applied to the broad population of patients seen in an emergency department. Methods We conducted a single-center prospective explorative observational study of 405 unselected patients aged 18 years or over. A structured whole-body ultrasound examination was performed on all patients within 2 h of arrival to the ED. The ultrasound examination consisted of focused cardiac ultrasound, focused abdominal ultrasound, focused assessment with sonography for trauma (FAST), and focused lung ultrasound. Results We managed to perform 94.5% of all planned examinations. The study revealed positive findings in 39.3% of all included patients. This study presents the prevalence of positive findings among subgroups of patients. Divided among the categories of chief complaint, we found 62 positive examinations in 58 (14.3%; 95% CI, 10.9–17.7) unique patients with orthopedic complaints, 77 positive examinations among 59 (14.6%; 95% CI, 11.1–18.0) unique patients with medical complaints, and 55 positive examinations among 42 (10.4%; 95% CI, 7.4–13.3) unique patients with abdominal surgical complaints. Conclusion POCUS revealed positive findings in more than one third of unselected patients in the emergency department. The study presents the findings and distribution among categories of chief complaints. Future investigations are necessary to elucidate the implication of the findings. Electronic supplementary material The online version of this article (10.1186/s12873-018-0211-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jesper Weile
- Emergency Department, Regional Hospital Herning, Herning, Denmark. .,Research Center for Emergency Medicine, Aarhus University Hospital, Palle Juul-Jensens Blvd. 161, 8200, Aarhus, Denmark.
| | - Christian B Laursen
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark.,Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | - Ole Graumann
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Radiology, Odense University Hospital, Odense, Denmark
| | - Erik Sloth
- University of Cape Town, Cape Town, South Africa
| | - Hans Kirkegaard
- Research Center for Emergency Medicine, Aarhus University Hospital, Palle Juul-Jensens Blvd. 161, 8200, Aarhus, Denmark
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Brief training increases nurses' comfort using tele-ultrasound: A feasibility study. Intensive Crit Care Nurs 2018; 51:45-49. [PMID: 30514602 DOI: 10.1016/j.iccn.2018.11.004] [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: 03/16/2018] [Revised: 10/29/2018] [Accepted: 11/15/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND Nurses and other non-physician providers have demonstrated proficiency at obtaining images in the tele-ultrasound system. However, use of this skill requires comfort with the procedure and willingness to incorporate it into practice. OBJECTIVES To assess 1) level of comfort of non-physician providers performing tele-ultrasound before and after brief training and 2) feasibility of implementing an educational programme that improves level of comfort. METHODS Feasibility study including a brief training session followed by hands-on tele-ultrasound. The pilot cohort performed tele-ultrasound on a healthy volunteer. The clinical cohort performed tele-ultrasound on criticalli ill patients with shock or respiratory failure. Remote intensivists provided real-time guidance via tele-medicine technology. Each participant completed a survey assessing training experience and level of comfort before and after training. RESULTS Sixteen non-physician providers participated. All participants agreed that the training session prepared them for image acquisition and that the training experience was positive. The number of participants comfortable with ultrasound improved significantly (before vs. after training: 5/16 [31%] vs. 16/16 [100%], mean Likert score 2.7 vs. 4.8, p = 0.001). CONCLUSIONS After brief training, participants could comfortably perform tele-ultrasound and were more willing to incorporate it into tele-ICU-directed care. Results support conducting a larger-scale trial of tele-US to assess clinical utility.
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Roche D, Iohom G. Point-of-care Ultrasound in Anaesthesia and Intensive Care Medicine. Rom J Anaesth Intensive Care 2018; 25:95-96. [PMID: 30393764 DOI: 10.21454/rjaic.7518.252.ioh] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- David Roche
- Department of Anaesthesia and Intensive Care Medicine, Cork University Hospital, Cork, Ireland
| | - Gabriella Iohom
- Department of Anaesthesia and Intensive Care Medicine, Cork University Hospital, Cork, Ireland
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Abd Samat AH, Embong H. Ortner’s syndrome: Focused cardiac ultrasound and rapid ultrasound in shock examination at emergency department unfold the life-threatening cause for a cardiovocal condition. HONG KONG J EMERG ME 2018. [DOI: 10.1177/1024907918755163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction: Ortner’s syndrome is a rare condition, known as cardiovocal condition as patients present with hoarseness of voice due to cardiovascular causes. Case presentation: We present a case of Ortner’s syndrome secondary to leaking thoracic aortic aneurysm in a patient who came to emergency department with hypotension and hoarseness of voice for 3 months. Focused cardiac ultrasound (FOCUS) and rapid ultrasound in shock (RUSH) were performed which revealed a thoracic aortic arch aneurysm. Discussion: Focused cardiac ultrasound and rapid ultrasound in shock examination in the emergency department had expedited the diagnosis of this rare condition, hence the subsequent definitive investigation and management. Conclusion: This case highlights the need for high index of suspicion for thoracic aneurysm in patients with unexplained cardiovocal symptoms. It also highlights the importance of point-of-care ultrasound in the emergency department and the significance of utilizing the suprasternal view to look for pathology at the arch of aorta.
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Affiliation(s)
- Azlan Helmy Abd Samat
- Department of Emergency Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Hashim Embong
- Department of Emergency Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
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Accuracy and outcome of rapid ultrasound in shock and hypotension (RUSH) in Egyptian polytrauma patients. Chin J Traumatol 2018; 21:156-162. [PMID: 29784591 PMCID: PMC6033727 DOI: 10.1016/j.cjtee.2017.06.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 12/12/2017] [Accepted: 01/12/2018] [Indexed: 02/04/2023] Open
Abstract
PURPOSE "Polytrauma" patients are of a higher risk of complications and death than the summation of expected mortality and morbidity of their individual injuries. The ideal goal in trauma resuscitation care is to identify and treat all injuries. With clinical and technological advanced imaging available for diagnosis and treatment of traumatic patients, point of care-rapid ultrasound in shock and hypotension (RUSH) significantly affects modern trauma services and patient outcomes. This study aims to evaluate the accuracy of RUSH and patient outcomes by early detection of the causes of unstable polytrauma. METHODS This cross-sectional, prospective study included 100 unstable polytrauma patients admitted in Suez Canal University Hospital. Clinical exam, RUSH and pan-computed tomography (pan-CT) were conducted. The result of CT was taken as the standard. Patients were managed according to the advanced trauma life support (ATLS) guidelines and treated of life threatening conditions if present. Patients were followed up for 28 days for a short outcome. RESULTS The most diagnostic causes of unstability in polytrauma patients by RUSH are hypovolemic shock (64%), followed by obstructive shock (14%), distributive shock (12%) and cardiogenic shock (10%) respectively. RUSH had 94.2% sensitivity in the diagnosis of unstable polytrauma patients; the accuracy of RUSH in shock patients was 95.2%. CONCLUSION RUSH is accurate in the diagnosis of unstable polytrauma patients; and 4% of patients were diagnosed during follow-up after admission by RUSH and pan-CT.
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Cohen A, Foster M, Stankard B, Owusu M, Nelson M. The "Black-and-White Cookie" Sign - A Case Series of a Novel Ultrasonographic Sign in Gastric Outlet Obstruction. Clin Pract Cases Emerg Med 2018; 2:21-25. [PMID: 29849289 PMCID: PMC5965133 DOI: 10.5811/cpcem.2017.11.35890] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 10/17/2017] [Accepted: 11/08/2017] [Indexed: 12/21/2022] Open
Abstract
Gastric outlet obstruction (GOO) is a rare condition occurring as a consequence of numerous processes that prevent gastric emptying. Presenting symptoms of GOO are non-specific and include nausea, vomiting, epigastric discomfort and decreased appetite. The diagnosis of GOO is often challenging. Emergency physicians must have a heightened awareness of GOO to ensure proper diagnosis and rapid treatment. Although the gold standard for diagnoses of GOO is endoscopy, many patients are identified by computerized tomography imaging. Point-of-care ultrasound (POCUS) is a rapid and non-invasive technique for evaluating patients in the emergency department. Previous literature has validated the use of ultrasound in diagnosing various intra-abdominal pathologies including bowel obstructions and appendicitis; however, there is limited research on evaluating gastric disease.1 We report three cases of GOO diagnosed with the “black-and-white cookie” sign on POCUS.
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Affiliation(s)
- Allison Cohen
- North Shore University Hospital, Department of Emergency Medicine, Manhasset, New York
| | - Mark Foster
- North Shore University Hospital, Department of Emergency Medicine, Manhasset, New York
| | - Brendon Stankard
- North Shore University Hospital, Department of Emergency Medicine, Manhasset, New York
| | - Maxine Owusu
- North Shore University Hospital, Department of Emergency Medicine, Manhasset, New York
| | - Mathew Nelson
- North Shore University Hospital, Department of Emergency Medicine, Manhasset, New York
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Laher AE, Richards G. Cardiac arrest due to pulmonary embolism. Indian Heart J 2018; 70:731-735. [PMID: 30392514 PMCID: PMC6204441 DOI: 10.1016/j.ihj.2018.01.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 12/18/2017] [Accepted: 01/08/2018] [Indexed: 01/21/2023] Open
Abstract
Pulmonary embolism (PE) is a potentially life threatening clinical condition that is fairly non-specific in presentation. Massive pulmonary embolism (PE) without cardiac arrest has been associated with a mortality rate of 30%. However, when cardiac arrest ensues, mortality may be as high as 95%. Since outcomes of cardiac arrest following PE are generally dismal, any available potentially life-saving measure must be instituted when the diagnosis of PE is suspected. Despite a lack of randomized controlled trials guiding the management of suspected PE in the cardiac arrest victim, thrombolysis and other therapies have been associated with good outcomes in the handful of published case reports and other small studies.
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Affiliation(s)
- Abdullah Ebrahim Laher
- Department of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, 7 Jubilee Road, Parktown, Johannesburg, 2193, South Africa; Department of Critical Care, Faculty of Health Sciences, University of the Witwatersrand, 7 Jubilee Road, Parktown, Johannesburg, 2193, South Africa.
| | - Guy Richards
- Department of Critical Care, Faculty of Health Sciences, University of the Witwatersrand, 7 Jubilee Road, Parktown, Johannesburg, 2193, South Africa.
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Lim W, Desai S, Mok MS, Mathews AV. Severe aortic stenosis in a parturient with twins: The challenges. JOURNAL OF OBSTETRIC ANAESTHESIA AND CRITICAL CARE 2018. [DOI: 10.4103/joacc.joacc_50_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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IVC Measurements in Critically Ill Patients with Acute Renal Failure. Crit Care Res Pract 2017; 2017:3598392. [PMID: 29057120 PMCID: PMC5605903 DOI: 10.1155/2017/3598392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 07/19/2017] [Accepted: 08/02/2017] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To determine whether the inferior vena cava (IVC) measurement by bedside ultrasound (US-IVC) predicts improvement in renal function in patients with acute kidney injury (AKI). DESIGN Prospective observational study. SETTING Medical intensive care unit. PATIENTS 33 patients with AKI were included. INTERVENTION US-IVC was done on admission. The patients' management was done by the primary teams, who were unaware of the US-IVC findings. Two groups of patients were identified. Group 1 included patients who were managed in concordance with their US-IVC (potential volume responders who had a positive fluid balance at 48 h after admission and potential volume nonresponders who had an even or negative fluid balance at 48 hours after admission). Group 2 included patients in whom the fluid management was discordant with their US-IVC. MEASUREMENTS AND MAIN RESULTS At 48 hours, Group 1 patients had a greater improvement in creatinine [85% versus 31%, p = 0.0002], creatinine clearance (78 ± 93% versus 8 ± 64%, p = 0.002), and urine output (0.86 ± 0.54 versus 0.45 ± 0.36 ml/Kg/h, p = 0.03). CONCLUSION In critically ill patients with AKI, concurrence of fluid therapy with IVC predicted fluid management, as assessed by bedside ultrasound, was associated with improved renal function at 48 hours. This trial is registered with ClinicalTrials.gov registration number: NCT02064244.
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