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Al-Absi DT, Simsekler MCE, Omar MA, Soliman-Aboumarie H, Abou Khater N, Mehmood T, Anwar S, Kashiwagi DT. Evaluation of point-of-care ultrasound training among healthcare providers: a pilot study. Ultrasound J 2024; 16:12. [PMID: 38383673 PMCID: PMC10881927 DOI: 10.1186/s13089-023-00350-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 12/07/2023] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND The use of Point-of-Care Ultrasound (POCUS) has become prevalent across a variety of clinical settings. Many healthcare professionals have started getting hands-on training. To evaluate the effectiveness of such training programs, this study aimed to assess a 4 day POCUS training course on healthcare providers' skills and knowledge acquisition. A secondary objective of this study is to gain valuable insights into the degree of perception, attitude, interest levels and perceived barriers of medical providers performing POCUS. METHODS This is a prospective cohort study performed on healthcare providers in an integrated healthcare facility in Abu Dhabi undergoing the POCUS training course in February 2022. Course participants took a pre-course survey to evaluate their baseline knowledge, skills, confidence, perception, and interest in POCUS. The same survey was repeated immediately post-course. In total, seven healthcare professionals responded to the survey with a response rate of 53.8%. All data and information gathered were used to understand the effectiveness of POCUS training and gain insights into the degree of perception, interest and preparedness of POCUS among healthcare professionals in practice. RESULTS Our results demonstrated that the brief POCUS course was effective in improving POCUS skills, knowledge and confidence amongst in-practice healthcare providers from varying medical specialties. The median skill score increased from 25% pre-course to 50% post-course. There is a notable increase in all skills scores after the POCUS training course with the greatest change in scores seen for adjusting 'gain and depth of image (54.84%), assessing VeXUS score (52.38%) and evaluating lung congestion (50%). The study also provided valuable insights into the perception, attitude, interest and potential barriers of POCUS implementation. Although significant barriers to POCUS are present including the lack of POCUS curriculum, what is challenging is lack of expertise and skills to perform POCUS. Therefore, medical providers must acquire prespecified skills to fully utilize POCUS effectively. CONCLUSION The study confirmed the effectiveness of short POCUS training in improving the skills, knowledge and confidence of medical providers in practice. Healthcare professionals can master POCUS skills and techniques and gain confidence through brief training courses.
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Affiliation(s)
- Dima Tareq Al-Absi
- Department of Management Science and Engineering, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Mecit Can Emre Simsekler
- Department of Management Science and Engineering, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Mohammed Atif Omar
- Department of Management Science and Engineering, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Hatem Soliman-Aboumarie
- Department of Anaesthesia and Intensive Care, Harefield Hospital, Royal Brompton and Harefield Hospitals, Guy's and St Thomas NHS Foundation Trust, London, UK
- School of Cardiovascular, Metabolic Sciences and Medicine, King's College London, London, UK
| | - Noha Abou Khater
- Department of Medicine, Sheikh Shakhbout Medical City, P.O.Box 11001, Abu Dhabi, United Arab Emirates
| | - Tahir Mehmood
- Department of Medicine, Sheikh Shakhbout Medical City, P.O.Box 11001, Abu Dhabi, United Arab Emirates
| | - Siddiq Anwar
- Department of Medicine, Sheikh Shakhbout Medical City, P.O.Box 11001, Abu Dhabi, United Arab Emirates.
- College of Medicine and Health Sciences, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates.
| | - Deanne Tomie Kashiwagi
- Department of Medicine, Sheikh Shakhbout Medical City, P.O.Box 11001, Abu Dhabi, United Arab Emirates
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2
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Joyce A, Snelling PJ, Elsayed T, Keijzers G. Point-of-care ultrasound to diagnose acute cholecystitis in the emergency department: A scoping review. Australas J Ultrasound Med 2024; 27:26-41. [PMID: 38434543 PMCID: PMC10902832 DOI: 10.1002/ajum.12371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024] Open
Abstract
Introduction/Purpose Ultrasound is the first-line imaging modality for suspected acute cholecystitis. This can be radiology-performed ultrasound or point-of-care ultrasound (POCUS). POCUS can potentially streamline patient assessment in the emergency department (ED). The primary objective was to evaluate the literature for the diagnostic accuracy of POCUS performed for acute cholecystitis in the ED. Secondary objectives were to assess the effect of POCUS operator training on diagnostic accuracy for acute cholecystitis, utility of POCUS measurement of the common bile duct and POCUS impact on resource utilisation. Methods A systematic scoping review of articles was conducted using Medline, Embase, CENTRAL and CINAHL. Original studies of adults with POCUS performed for the diagnosis of acute cholecystitis in the ED were included. The study was reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist (PRISMA-ScR). Results A total of 1090 publications were identified. Forty-six met the eligibility criteria. Studies were thematically grouped into categories according to specified objectives. Point-of-care ultrasound was of acceptable but variable accuracy, contributed to by the absence of a consistent reference standard and uniform training requirements. It may positively impact ED resource utilisation through reduced ED length of stay and radiology-performed imaging, whilst improving patient experience. Conclusion This review highlights the heterogeneity of existing research, emphasising the need for standardisation of training and reference standards in order to precisely define the utility of POCUS for acute cholecystitis in the ED and its benefits on ED resource utilisation.
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Affiliation(s)
- Alexander Joyce
- Department of Emergency MedicineGold Coast University HospitalSouthportQueenslandAustralia
| | - Peter J Snelling
- Department of Emergency MedicineGold Coast University HospitalSouthportQueenslandAustralia
- School of Medicine and DentistryGriffith UniversitySouthportQueenslandAustralia
- Sonography Innovation and Research GroupSouthportQueenslandAustralia
| | - Tarek Elsayed
- Department of Emergency MedicineGold Coast University HospitalSouthportQueenslandAustralia
- Faculty of Health Sciences and MedicineBond UniversityGold CoastQueenslandAustralia
| | - Gerben Keijzers
- Department of Emergency MedicineGold Coast University HospitalSouthportQueenslandAustralia
- School of Medicine and DentistryGriffith UniversitySouthportQueenslandAustralia
- Faculty of Health Sciences and MedicineBond UniversityGold CoastQueenslandAustralia
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3
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Brooks D, Smiles JP, Murphy AP, Cowan T, Soeyland T, Hullick C, Arendts G. Assessment and management of older patients with abdominal pain in the emergency department. Emerg Med Australas 2024; 36:149-158. [PMID: 38176903 DOI: 10.1111/1742-6723.14361] [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: 11/29/2023] [Accepted: 12/02/2023] [Indexed: 01/06/2024]
Affiliation(s)
- Daniel Brooks
- Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | - John P Smiles
- John Hunter Hospital, Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | - Andrew P Murphy
- Gosford Hospital, Central Coast Local Health District, Gosford, New South Wales, Australia
| | - Timothy Cowan
- John Hunter Hospital, Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | - Torgrim Soeyland
- Port Macquarie Base Hospital, Mid-North Coast Local Health District, Port Macquarie, New South Wales, Australia
| | - Caroyln Hullick
- Hunter New England Local Health District, Newcastle, New South Wales, Australia
- School of Medicine and Public Health, University of Newcastle and Staff Specialist in Emergency Medicine, Belmont Hospital, Newcastle, New South Wales, Australia
| | - Glenn Arendts
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
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4
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Mori T, Nomura O, Mikami N, Hataya H. A Case of Unilateral Renal Agenesis Detected by Abdominal Point-Of-Care Ultrasound. Cureus 2024; 16:e51453. [PMID: 38298313 PMCID: PMC10829426 DOI: 10.7759/cureus.51453] [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: 12/31/2023] [Indexed: 02/02/2024] Open
Abstract
As the interest in point-of-care ultrasound (POCUS) for investigating pediatric abdominal emergencies has been growing, an increasing number of literatures about abdominal POCUS has been published. We describe a noteworthy instance of a systematic approach using abdominal POCUS for detecting unilateral renal agenesis (URA) in previously healthy children with suspected intussusception. A previously healthy three-year-old girl was brought to our emergency department (ED) due to abdominal pain and bloody diarrhea. POCUS was performed to investigate the presence of intussusception. POCUS was able to rule out intussusception and detect URA. The investigation led the patient to a proper nephrology follow-up. When performing abdominal POCUS to evaluate gastrointestinal pathologies, it is important to pay attention to concomitant congenital anomalies of the kidney and urinary tract (CAKUT).
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Affiliation(s)
- Takaaki Mori
- Department of Pediatric Emergency Medicine and Critical Care, Tokyo Metropolitan Children's Medical Center, Tokyo, JPN
| | - Osamu Nomura
- Department of Health Sciences Education, Hirosaki University, Hirosaki, JPN
| | - Naoaki Mikami
- Department of Nephrology, Tokyo Metropolitan Children's Medical Center, Tokyo, JPN
| | - Hiroshi Hataya
- Department of Nephrology, Tokyo Metropolitan Children's Medical Center, Tokyo, JPN
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5
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Elhag H, Al-Tairy F, Dahdaha MS, Shaeshaa A, Yigit Y. Inferior Vena Cava Thrombosis in a Patient with Factor V Leiden Syndrome Presenting with Scrotal Pain. Case Rep Med 2023; 2023:6234371. [PMID: 37790840 PMCID: PMC10545471 DOI: 10.1155/2023/6234371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 09/03/2023] [Accepted: 09/07/2023] [Indexed: 10/05/2023] Open
Abstract
Thrombosis in the inferior vena cava (IVC) is a rare but serious condition that can lead to significant morbidity and mortality. We present a case report of a 39-year-old male who presented to the emergency department with right flank pain that had progressed to severe back pain, bilateral flank pain, scrotal pain, and leg pain over the course of two days. The pain was severe enough to affect his daily activities. Laboratory investigations revealed a D-dimer level of 17 ng/mL, creatinine level of 110 µmol/L, and a white blood cell count of 10 × 109/L with a CRP level of 5 mg/L. Urine analysis was positive for blood. Doppler ultrasound of both legs showed deep vein thrombosis extending from the external iliac veins to the distal veins of both legs. Further investigation with computed tomography of the abdomen revealed a large thrombus in the distal vena cava extending to the renal artery and both external and internal iliac veins. The patient was diagnosed with Factor V Leiden syndrome based on genetic testing, which revealed a heterozygous mutation in the F5 gene. He was successfully treated with low molecular weight heparin and warfarin, and after five days of hospitalization, he was discharged with warfarin for long-term anticoagulation. This case report emphasizes the importance of considering IVC thrombosis in patients with a constellation of symptoms, including scrotal pain, and the role of genetic testing in identifying underlying hypercoagulable states.
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Affiliation(s)
- Helmy Elhag
- Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Fadl Al-Tairy
- Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
| | | | - Ahmed Shaeshaa
- Department of Emergency Medicine, Lincoln County Hospital, Lincolnshire, UK
| | - Yavuz Yigit
- Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
- Blizard Institute, Queen Mary University, London, UK
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6
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Ang JS. Gastric outlet obstruction: not to be missed on ultrasound. Intern Emerg Med 2023; 18:1863-1864. [PMID: 37039935 DOI: 10.1007/s11739-023-03270-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 03/31/2023] [Indexed: 04/12/2023]
Affiliation(s)
- Joo Shiang Ang
- Emergency Department, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, 308433, Singapore, Singapore.
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7
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Polyzogopoulou E, Velliou M, Verras C, Ventoulis I, Parissis J, Osterwalder J, Hoffmann B. Point-of-Care Ultrasound: A Multimodal Tool for the Management of Sepsis in the Emergency Department. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1180. [PMID: 37374384 DOI: 10.3390/medicina59061180] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 06/15/2023] [Accepted: 06/17/2023] [Indexed: 06/29/2023]
Abstract
Sepsis and septic shock are life-threatening emergencies associated with increased morbidity and mortality. Hence, early diagnosis and management of both conditions is of paramount importance. Point-of-care ultrasound (POCUS) is a cost-effective and safe imaging modality performed at the bedside, which has rapidly emerged as an excellent multimodal tool and has been gradually incorporated as an adjunct to physical examination in order to facilitate evaluation, diagnosis and management. In sepsis, POCUS can assist in the evaluation of undifferentiated sepsis, while, in cases of shock, it can contribute to the differential diagnosis of other types of shock, thus facilitating the decision-making process. Other potential benefits of POCUS include prompt identification and control of the source of infection, as well as close haemodynamic and treatment monitoring. The aim of this review is to determine and highlight the role of POCUS in the evaluation, diagnosis, treatment and monitoring of the septic patient. Future research should focus on developing and implementing a well-defined algorithmic approach for the POCUS-guided management of sepsis in the emergency department setting given its unequivocal utility as a multimodal tool for the overall evaluation and management of the septic patient.
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Affiliation(s)
- Effie Polyzogopoulou
- Emergency Medicine Department, Attikon University Hospital, 12462 Athens, Greece
| | - Maria Velliou
- Emergency Medicine Department, Attikon University Hospital, 12462 Athens, Greece
| | - Christos Verras
- Emergency Medicine Department, Attikon University Hospital, 12462 Athens, Greece
- National Centre of Emergency Care (EKAB), 11527 Athens, Greece
| | - Ioannis Ventoulis
- Department of Occupational Therapy, University of Western Macedonia, 50200 Ptolemaida, Greece
| | - John Parissis
- Emergency Medicine Department, Attikon University Hospital, 12462 Athens, Greece
| | | | - Beatrice Hoffmann
- Department of Emergency Medicine BIDMC, One Deaconess Rd, WCC2, Boston, MA 02215, USA
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8
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D’Andrea A, Del Giudice C, Fabiani D, Caputo A, Sabatella F, Cante L, Palermi S, Desiderio A, Tagliamonte E, Liccardo B, Russo V. The Incremental Role of Multiorgan Point-of-Care Ultrasounds in the Emergency Setting. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2088. [PMID: 36767456 PMCID: PMC9915087 DOI: 10.3390/ijerph20032088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/10/2023] [Accepted: 01/13/2023] [Indexed: 06/18/2023]
Abstract
Point-of-care ultrasonography (POCUS) represents a goal-directed ultrasound examination performed by clinicians directly involved in patient healthcare. POCUS has been widely used in emergency departments, where US exams allow physicians to make quick diagnoses and to recognize early life-threatening conditions which require prompt interventions. Although initially meant for the real-time evaluation of cardiovascular and respiratory pathologies, its use has been extended to a wide range of clinical applications, such as screening for deep-vein thrombosis and trauma, abdominal ultrasonography of the right upper quadrant and appendix, and guidance for invasive procedures. Moreover, recently, bedside ultrasounds have been used to evaluate the fluid balance and to guide decongestive therapy in acutely decompensated heart failure. The aim of the present review was to discuss the most common applications of POCUS in the emergency setting.
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Affiliation(s)
- Antonello D’Andrea
- Department of Cardiology and Intensive Coronary Care, Umberto I Hospital, 84014 Nocera Inferiore, Italy
| | - Carmen Del Giudice
- Division of Cardiology, Department of Traslational Medical Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Dario Fabiani
- Division of Cardiology, Department of Traslational Medical Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Adriano Caputo
- Division of Cardiology, Department of Traslational Medical Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Francesco Sabatella
- Division of Cardiology, Department of Traslational Medical Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Luigi Cante
- Division of Cardiology, Department of Traslational Medical Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Stefano Palermi
- Public Health Department, University of Naples Federico II, 80131 Naples, Italy
| | - Alfonso Desiderio
- Department of Cardiology and Intensive Coronary Care, Umberto I Hospital, 84014 Nocera Inferiore, Italy
| | - Ercole Tagliamonte
- Department of Cardiology and Intensive Coronary Care, Umberto I Hospital, 84014 Nocera Inferiore, Italy
| | - Biagio Liccardo
- Division of Cardiology, Department of Traslational Medical Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Vincenzo Russo
- Division of Cardiology, Department of Traslational Medical Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
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9
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Huang D, Al-Bassam M, Leon LN, Ganti L. Emergency Department Point-of-Care Ultrasound Diagnosis of a Large Bowel Obstruction Due to Metastatic Rectal Cancer: A Case Report. Cureus 2022; 14:e28817. [PMID: 36225420 PMCID: PMC9535202 DOI: 10.7759/cureus.28817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2022] [Indexed: 11/13/2022] Open
Abstract
Large bowel obstruction (LBO) is a life-threatening condition seen most often in the geriatric population. LBO can present with nonspecific abdominal pain that can overlap with other pathologies, such as abdominal infection, acute aortic disease, intestinal perforation, and atypical acute coronary syndrome in the geriatric population. Delays in diagnosis of colonic obstruction result in significant mortality due to complications involving bowel necrosis, perforation, and sepsis. In the emergency department (ED), abdominal point-of-care ultrasound (POCUS) can diagnose LBO and facilitate the assessment of the wide differential inherent to elderly abdominal pain. The authors report a rare ED application of abdominal POCUS to facilitate rapid diagnosis of an LBO secondary to rectal cancer.
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10
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Huang D, Huttleston A, Fraunfelter F, Leon LN, Ganti L. Penetrating Aortic Ulceration With Pseudoaneurysm and Intramural Hematoma: Emergency Department Management and Point-of-Care Ultrasound Diagnosis. Cureus 2022; 14:e27536. [PMID: 36060360 PMCID: PMC9427664 DOI: 10.7759/cureus.27536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2022] [Indexed: 11/14/2022] Open
Abstract
Penetrating aortic ulcer (PAU) complicated by an intramural hematoma is a rare and potentially life-threatening emergency department (ED) presentation that is defined by progressive ulceration through the intima layer into the media layer of the aorta. Symptomatic PAUs can be clinically indistinguishable from other life-threatening pathologies such as aortic dissection, acute coronary syndrome (ACS), intrabdominal catastrophes as well as less lethal processes such as musculoskeletal back pain. Given the potential of PAUs to result in lethal aortic
rupture and dissection, the emergency provider should maintain a high index of suspicion in patients with risk factors for aortic pathologies and utilize diagnostic modalities such as point-of-care ultrasound (POCUS) to expedite diagnosis.
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11
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Adams AJ, Songster JC, Harig JP, Markin NW. Perioperative gastric ultrasound: utility and limitations. Int Anesthesiol Clin 2022; 60:45-54. [PMID: 35499911 DOI: 10.1097/aia.0000000000000365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Austin J Adams
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Jeffrey C Songster
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Jason P Harig
- Department of Anesthesiology, University of Utah Health, Salt Lake City, Utah
| | - Nicholas W Markin
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha, Nebraska
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12
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Shibata A. Point-of-care ultrasound for abdominal pain in obstetrics and gynecological diseases. J Med Ultrason (2001) 2022; 49:629-637. [PMID: 35689711 DOI: 10.1007/s10396-022-01218-2] [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: 08/15/2021] [Accepted: 03/29/2022] [Indexed: 11/25/2022]
Abstract
Ultrasound is a minimally invasive technique recommended for the evaluation of abdominal pain in young, premenopausal women and pregnant women. Ectopic pregnancy, ovarian cyst torsion, ovarian hemorrhage, myoma degeneration, and pyometra can be detected with point-of-care ultrasound (POCUS) in the case of acute abdominal pain. This article describes the utility of POCUS in females with abdominal pain in obstetrics and gynecological diseases.
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Affiliation(s)
- Ayako Shibata
- Obstetrics and Gynecology, Yodogawa Christian Hospital, 1-7-50 Kunijima, Higashiyodogawa-ku, Osaka, 533-0024, Japan.
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13
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FAST exam for the anesthesiologist. Int Anesthesiol Clin 2022; 60:55-64. [PMID: 35536999 DOI: 10.1097/aia.0000000000000363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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Integrating Point of Care Ultrasound Education into Clinical Practice at the Emergency Department. Tomography 2022; 8:1052-1059. [PMID: 35448719 PMCID: PMC9028775 DOI: 10.3390/tomography8020085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 03/29/2022] [Accepted: 04/02/2022] [Indexed: 11/17/2022] Open
Abstract
Point of care ultrasound (POCUS) competency is now required learning for emergency medicine trainees. However, there is a wide range of areas that need to be assessed when determining competence. Therefore, this study aims to evaluate competence levels of POCUS skill acquisition including the areas of image acquisition, image interpretation and clinical integration of the emergency medicine residents while on shift in real clinical practice situations. This was a retrospective descriptive study. This study was conducted at Srinagarind Hospital, Thailand from January 2021 through December 2021. The data were collected and reviewed from electronic medical records, ultrasound images and video clips. All POCUS competency skills were assessed by researcher staff. Our results demonstrated that our learners had overall satisfactory competence of image acquisition, satisfactory image interpretation skills, and good clinical integration skills. However, obstetrics and gynecology (OB-GYN) ultrasound scores were poor and cardiac ultrasound had the most varied score of image quality. This study clearly showed the measurable benefits of a POCUS course being integrated into real clinical practice.
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15
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Li RT, Zhao Y, Zou XJ, Shu HQ, Zhou T, Pan SW, Gao XH, Huang HY, Liu H, Shang Y. Overview of point-of-care ultrasound in diagnosing intestinal obstruction. World J Emerg Med 2022; 13:135-140. [PMID: 35237368 PMCID: PMC8861339 DOI: 10.5847/wjem.j.1920-8642.2022.048] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 01/06/2022] [Indexed: 12/12/2023] Open
Affiliation(s)
- Rui-ting Li
- Department of Critical Care Medicine, Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Yue Zhao
- Department of Critical Care Medicine, Jin Yin-tan Hospital, Wuhan 430048, China
| | - Xiao-jing Zou
- Department of Critical Care Medicine, Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Hua-qing Shu
- Department of Critical Care Medicine, Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Ting Zhou
- Department of Critical Care Medicine, Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Shang-wen Pan
- Department of Critical Care Medicine, Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Xue-hui Gao
- Department of Critical Care Medicine, Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Hai-yan Huang
- Department of Critical Care Medicine, Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Hong Liu
- Department of Critical Care Medicine, Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - You Shang
- Department of Critical Care Medicine, Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
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Hughes M, Huang D, Elbadri S, Falgiani M, Ganti L. Acute Gastric Volvulus in the Setting of a Paraesophageal Hernia With Hemoperitoneum: Emergency Department Diagnosis and Management. Cureus 2021; 13:e20404. [PMID: 35047248 PMCID: PMC8756554 DOI: 10.7759/cureus.20404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2021] [Indexed: 11/09/2022] Open
Abstract
Acute gastric volvulus is an uncommon emergency department (ED) presentation associated with high mortality from gastric ischemia and perforation. The diagnosis of this pathology is complicated by its intermittent symptoms and similarity in presentation to more common disorders encountered in the ED. Assessing for key risk factors, such as the presence of a hiatal hernia, and the use of expeditious imaging modalities, such as bedside radiography and point-of-care ultrasonography, are essential in rapid diagnosis and time-sensitive, definitive surgical intervention.
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17
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Felipe N, King SA, Salerno A. 'Diagnosis of Boerhaave's Syndrome With Aid of Bedside Ultrasound. J Emerg Med 2021; 61:568-573. [PMID: 34193358 DOI: 10.1016/j.jemermed.2021.05.017] [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: 02/03/2021] [Revised: 04/17/2021] [Accepted: 05/30/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Boerhaave's syndrome is characterized by transmural rupture of the distal esophagus in the setting of increased intraluminal pressures combined with negative intrathoracic pressure. It is a rare condition with high mortality (20-50% mortality rate). CASE REPORT This is a case of a 47-year-old man who appeared acutely ill, presenting with shortness of breath, chest and abdominal pain, and diagnosed with Boerhaave's syndrome with the assistance of bedside ultrasound. WHY SHOULD AN EMERGENCY PHYSICIANS BE AWARE OF THIS?: Emergency physicians must have a heightened suspicion of this diagnosis in patients presenting with chest and abdominal pain and can use bedside ultrasound skills to aid with diagnosis.
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Affiliation(s)
- Naillid Felipe
- Department of Emergency Medicine, University of Maryland Medical Center, Baltimore, Maryland
| | - Samantha A King
- Department of Emergency Medicine, University of Maryland Medical Center, Baltimore, Maryland
| | - Alexis Salerno
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland
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James V, Samuel J, Ong GYK. Pediatric Abdominal Tuberculosis With Calcified Intra-abdominal Lymph Nodes Identified by Point-of-Care Ultrasound. Pediatr Emerg Care 2021; 37:226-229. [PMID: 33780407 DOI: 10.1097/pec.0000000000002320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Tuberculosis of the abdomen is one of the most common extrapulmonary manifestations of tuberculosis. Even in areas where tuberculosis is endemic, intra-abdominal tuberculous can pose a diagnostic and management challenge because of the lack of presence of overt clinical signs and availability of expertise for point of care diagnostics. Point-of-care ultrasound (POCUS) of the abdomen performed by emergency physicians is increasingly being used for a variety of clinical presentations to facilitate accurate diagnoses in the emergency department. CASE REPORT We describe the case of a patient presenting to the pediatric emergency department with acute abdominal pain, in whom POCUS helped expedite the diagnosis of abdominal tuberculosis. CONCLUSIONS In the right clinical setting, the concurrent presence of intra-abdominal lymphadenopathy, ascites, mesenteric thickening, ileocecal thickening, and splenic microabscesses on ultrasound imaging should lead to consideration of the diagnosis of intra-abdominal tuberculosis. Although typically diagnosed on computed tomography or magnetic resonance imaging, in our case, POCUS helped facilitate the bedside diagnosis of abdominal tuberculosis in the emergency department.
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Affiliation(s)
- Vigil James
- From the Children's Emergency, KK Women's and Children's Hospital, Singapore
| | - John Samuel
- Department of Radiodiagnosis, Christian Fellowship Hospital, Oddanchatram, Tamilnadu, India
| | - Gene Yong-Kwang Ong
- From the Children's Emergency, KK Women's and Children's Hospital, Singapore
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19
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Kameda T, Mizuma Y, Taniguchi H, Fujita M, Taniguchi N. Point-of-care lung ultrasound for the assessment of pneumonia: a narrative review in the COVID-19 era. J Med Ultrason (2001) 2021; 48:31-43. [PMID: 33438132 PMCID: PMC7803468 DOI: 10.1007/s10396-020-01074-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 11/15/2020] [Indexed: 12/12/2022]
Abstract
In the coronavirus disease-2019 (COVID-19) era, point-of-care lung ultrasound (LUS) has attracted increased attention. Prospective studies on LUS for the assessment of pneumonia in adult patients were extensively carried out for more than 10 years before this era. None of these prospective studies attempted to differentiate bacterial and viral pneumonia in adult patients using LUS. The majority of studies considered the LUS examination to be positive if sonographic consolidations or multiple B-lines were observed. Significant differences existed in the accuracy of these studies. Some studies revealed that LUS showed superior sensitivity to chest X-ray. These results indicate that point-of-care LUS has the potential to be an initial imaging modality for the diagnosis of pneumonia. The LUS diagnosis of ventilator-associated pneumonia in intensive care units is more challenging in comparison with the diagnosis of community-acquired pneumonia in emergency departments due to the limited access to the mechanically ventilated patients and the high prevalence of atelectasis. However, several studies have demonstrated that the combination of LUS findings with other clinical markers improved the diagnostic accuracy. In the COVID-19 era, many case reports and small observational studies on COVID-19 pneumonia have been published in a short period. Multiple B-lines were the most common and consistent finding in COVID-19 pneumonia. Serial LUS showed the deterioration of the disease. The knowledge and ideas on the application of LUS in the management of pneumonia that are expected to accumulate in the COVID-19 era may provide us with clues regarding more appropriate management.
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Affiliation(s)
- Toru Kameda
- Department of Clinical Laboratory Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi, 329-0498, Japan. .,Department of Emergency Medicine, Red Cross Society Azumino Hospital, 5685 Toyoshina, Azumino-shi, Nagano, 399-8293, Japan.
| | - Yoshihiro Mizuma
- Department of Internal Medicine, Higashi Kobe Hospital, 1-24-13 Sumiyoshihonmachi, Higashinada-ku, Kobe-shi, Hyogo, 658-0051, Japan
| | - Hayato Taniguchi
- Advanced Critical Care and Emergency Center, Yokohama City University Medical Center, 4-57 Urafunecho, Minami-ku, Yokohama-shi, Kanagawa, 232-0044, Japan
| | - Masato Fujita
- Department of Emergency Medicine, Red Cross Society Azumino Hospital, 5685 Toyoshina, Azumino-shi, Nagano, 399-8293, Japan
| | - Nobuyuki Taniguchi
- Department of Clinical Laboratory Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi, 329-0498, Japan
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20
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Allocca M, Furfaro F, Fiorino G, Peyrin-Biroulet L, Danese S. Point-of-Care Ultrasound in Inflammatory Bowel Disease. J Crohns Colitis 2021; 15:143-151. [PMID: 32674146 DOI: 10.1093/ecco-jcc/jjaa151] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Inflammatory bowel diseases [IBD], including Crohn's disease [CD] and ulcerative colitis [UC], are chronic, relapsing and destructive inflammatory disorders of the gastrointestinal tract which can lead to organ damage and impair quality of life. A 'treat-to-target' strategy based on activity and severity of disease and response to treatment with close monitoring of intestinal inflammation is recommended. Ileocolonoscopy [CS] is considered the first-line procedure for the assessment of IBD, and magnetic resonance enterography [MRE] is the current standard for assessing the small bowel and complications in CD, and has been proposed as an alternative procedure to CS in the evaluation of both ileo-colonic CD and UC. As that both CS and MRE are invasive and expensive procedures and unappealing to patients, they are unfeasible as frequent and repetitive tools for the monitoring of disease activity. Bowel ultrasound [US] represents a well-tolerated, non-invasive and cost-effective modality to manage IBD patients in clinical practice. Compared to CS and MRE, bowel US has been shown to have the same level of accuracy in assessing and monitoring disease activity and severity of both CD and UC. It can be performed at the point-of-care and therefore allow for real-time clinical decision-making. Point-of-care ultrasound [POCUS] is suggested as the stethoscope of the future and is gaining interest and diffusion in the medical field because it can be used for the bedside examination of patients. The aim of this review is to discuss point-of-care bowel ultrasound [POCBUS] in the management of patients with IBD.
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Affiliation(s)
- Mariangela Allocca
- Humanitas Clinical and Research Center - IRCCS, via Manzoni 56, Rozzano (Mi), Italy.,Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, Pieve Emanuele - Milan, Italy
| | - Federica Furfaro
- Humanitas Clinical and Research Center - IRCCS, via Manzoni 56, Rozzano (Mi), Italy
| | - Gionata Fiorino
- Humanitas Clinical and Research Center - IRCCS, via Manzoni 56, Rozzano (Mi), Italy.,Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, Pieve Emanuele - Milan, Italy
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology and Inserm U954, University Hospital of Nancy, Lorraine University, Nancy, France
| | - Silvio Danese
- Humanitas Clinical and Research Center - IRCCS, via Manzoni 56, Rozzano (Mi), Italy.,Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, Pieve Emanuele - Milan, Italy
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21
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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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22
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Singh Y, Tissot C, Fraga MV, Yousef N, Cortes RG, Lopez J, Sanchez-de-Toledo J, Brierley J, Colunga JM, Raffaj D, Da Cruz E, Durand P, Kenderessy P, Lang HJ, Nishisaki A, Kneyber MC, Tissieres P, Conlon TW, De Luca D. International evidence-based guidelines on Point of Care Ultrasound (POCUS) for critically ill neonates and children issued by the POCUS Working Group of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC). Crit Care 2020; 24:65. [PMID: 32093763 PMCID: PMC7041196 DOI: 10.1186/s13054-020-2787-9] [Citation(s) in RCA: 281] [Impact Index Per Article: 70.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 02/14/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Point-of-care ultrasound (POCUS) is nowadays an essential tool in critical care. Its role seems more important in neonates and children where other monitoring techniques may be unavailable. POCUS Working Group of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC) aimed to provide evidence-based clinical guidelines for the use of POCUS in critically ill neonates and children. METHODS Creation of an international Euro-American panel of paediatric and neonatal intensivists expert in POCUS and systematic review of relevant literature. A literature search was performed, and the level of evidence was assessed according to a GRADE method. Recommendations were developed through discussions managed following a Quaker-based consensus technique and evaluating appropriateness using a modified blind RAND/UCLA voting method. AGREE statement was followed to prepare this document. RESULTS Panellists agreed on 39 out of 41 recommendations for the use of cardiac, lung, vascular, cerebral and abdominal POCUS in critically ill neonates and children. Recommendations were mostly (28 out of 39) based on moderate quality of evidence (B and C). CONCLUSIONS Evidence-based guidelines for the use of POCUS in critically ill neonates and children are now available. They will be useful to optimise the use of POCUS, training programs and further research, which are urgently needed given the weak quality of evidence available.
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Affiliation(s)
- Yogen Singh
- Department of Paediatrics - Neonatology and Paediatric Cardiology, Cambridge University Hospitals and University of Cambridge School of Clinical Medicine, Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK.
- Addenbrooke's Hospital, Box 402, Cambridge, UK.
| | - Cecile Tissot
- Paediatric Cardiology, Centre de Pédiatrie, Clinique des Grangettes, Geneva, Switzerland
| | - María V Fraga
- Department of Paediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine, Philadelphia, USA
| | - Nadya Yousef
- Division of Paediatrics and Neonatal Critical Care, APHP - Paris Saclay University Hospitals, "A. Béclère" Medical centre, Paris, France
| | - Rafael Gonzalez Cortes
- Department of Paediatric Intensive Care, Gregorio Marañón General University Hospital, Madrid, Spain
| | - Jorge Lopez
- Department of Paediatric Intensive Care, Gregorio Marañón General University Hospital, Madrid, Spain
| | | | - Joe Brierley
- Department of Paediatric Intensive Care, Great Ormond Street Hospital, London, UK
| | - Juan Mayordomo Colunga
- Department of Paediatric Intensive Care, Hospital Universitario Central de Asturias, Oviedo. CIBER-Enfermedades Respiratorias. Instituto de Salud Carlos III, Madrid. Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | - Dusan Raffaj
- Department of Paediatric Intensive Care, Nottingham University Hospitals, Nottingham, UK
| | - Eduardo Da Cruz
- Department of Paediatric and Cardiac Intensive Care, Children's Hospital Colorado, Aurora, USA
| | - Philippe Durand
- Division of Paediatric Critical Care, APHP - Paris Saclay University Hospitals, "Kremlin Bicetre" Medical Centre, Paris, France
| | - Peter Kenderessy
- Department of Paediatric Anaesthesia and Intensive Care, Children's Hospital Banska Bystrica, Banska Bystrica, Slovakia
| | - Hans-Joerg Lang
- Department of Paediatrics, Medicins Sans Frontieres (Suisse), Geneva, Switzerland
| | - Akira Nishisaki
- Department of Anaesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia and Perelman School of Medicine, Philadelphia, USA
| | - Martin C Kneyber
- Department of Paediatrics, Division of Paediatric Critical Care Medicine, Beatrix Children's Hospital Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Pierre Tissieres
- Division of Paediatric Critical Care, APHP - Paris Saclay University Hospitals, "Kremlin Bicetre" Medical Centre, Paris, France
| | - Thomas W Conlon
- Department of Anaesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia and Perelman School of Medicine, Philadelphia, USA
| | - Daniele De Luca
- Division of Paediatrics and Neonatal Critical Care, APHP - Paris Saclay University Hospitals, "A. Béclère" Medical centre, Paris, France
- Physiopathology and Therapeutic Innovation Unit-INSERM Unit U999, South Paris Medical School, Paris Saclay University, Paris, France
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23
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Kameda T, Kimura A. Basic point-of-care ultrasound framework based on the airway, breathing, and circulation approach for the initial management of shock and dyspnea. Acute Med Surg 2020; 7:e481. [PMID: 31988793 PMCID: PMC6971464 DOI: 10.1002/ams2.481] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 12/17/2019] [Accepted: 12/18/2019] [Indexed: 01/06/2023] Open
Abstract
Ultrasound (US) carried out and interpreted by clinicians at the bedside is now called point‐of‐care US (POCUS). Clinical studies on POCUS have been carried out based on the ideas of “creation”, “extraction”, and “combination”. “Creation” refers to findings for the upper airway and lung being obtained at the bedside. “Extraction” refers to findings suitable for POCUS being extracted from comprehensive US, including echocardiography, abdominal US, and whole‐leg US. “Combination” refers to these POCUS applications being combined for the comprehensive assessment of patients with trauma, shock, or dyspnea. Emergency and critical care physicians have many opportunities to encounter trauma or non‐trauma patients with shock, dyspnea, or both. Furthermore, the scope of POCUS includes many diseases and injuries that present with both shock and dyspnea. Therefore, we propose a basic POCUS framework based on the systematic airway, breathing, and circulation approach for the initial management of shock and dyspnea in adult patients. In this article, we update and review each application of POCUS and their combination in this framework. Furthermore, we propose the practical usage of the framework based on clinical presentations to improve the management of shock and dyspnea.
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Affiliation(s)
- Toru Kameda
- Department of Emergency Medicine Red Cross Society Azumino Hospital Nagano Japan
| | - Akio Kimura
- Department of Emergency and Critical Care Center Hospital of the National Center for Global Health and Medicine Tokyo Japan
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24
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Khishfe B, El Majzoub I, Hamade H, Cheaito R. The use of evaluation tool for ultrasound skills development and education to assess the extent of point-of-care ultrasound adoption in lebanese emergency departments. J Emerg Trauma Shock 2020; 13:219-223. [PMID: 33304073 PMCID: PMC7717455 DOI: 10.4103/jets.jets_111_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 10/09/2019] [Accepted: 11/21/2019] [Indexed: 01/14/2023] Open
Abstract
Background: Previously acknowledged as “bedside ultrasound”, point-of-care ultrasound (PoCUS) is gaining great recognition nowadays and more physicians are using it to effectively diagnose and adequately manage patients. To measure previous, present and potential adoption of PoCUS and barriers to its use in Canada, Woo et al established the questionnaire “Evaluation Tool for Ultrasound skills Development and Education” (ETUDE) in 2007. This questionnaire sorted respondents into innovators, early adopters, majority, and nonadopters. Objectives: In this article, we attempt to evaluate the prevalence of PoCUS and the barriers to its adoption in Lebanese EDs, using the ETUDE. Materials and Methods: The same questionnaire was again utilized in Lebanon to assess the extent of PoCUS adoption. Our target population is emergency physicians (EPs). To achieve a high response rate, hospitals all over Lebanon were contacted to obtain contact details of their EPs. Questionnaires with daily reminders were sent on daily basis. Results: The response rate was higher in our population (78.8%) compared to Woo et al's (36.4%), as the questionnaire was sent by email to each physician with subsequent daily reminders to fill it. In fact, out of the total number of the surveyed (85 physicians), respondents were 67, of which 76.1% were males and of a median age of 43. Using ETUDE, results came as nonadopters (47.8%), majority (28.3%), early adopters (16.4%), and innovators (7.5%). Respondents advocated using PoCUS currently and in the future in five main circumstances: focused assessment with sonography in trauma (FAST) (current 22.9%/future 62.9%), first-trimester pregnancy (current 17.1%/future 68.6%), suspected abdominal aortic aneurysm (current 5.7%/future 51.4%), basic cardiac indications (current 8.6%/future 57.1%), and central venous catheterization (current 22.9%/future 85.7%). Conclusion: This study is the first to tackle the extent of use and the hurdles to PoCUS adoption in Lebanese emergency medicine practice, using ETUDE. The findings from this study can be used in Lebanon to strengthen PoCUS use in the future.
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25
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A Delayed Diagnosis of Hemorrhagic Shock in a Patient with Alcoholic Cirrhosis and Ascites on Bedside Ultrasound. Case Rep Crit Care 2019; 2019:5895801. [PMID: 31885937 PMCID: PMC6925761 DOI: 10.1155/2019/5895801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 11/20/2019] [Indexed: 11/17/2022] Open
Abstract
Undifferentiated shock is a common and challenging problem in critical care. We present a case of hemorrhagic shock due to splenic and hepatic lacerations diagnosed by bedside paracentesis, initially misclassified as septic shock due to suspected spontaneous bacterial peritonitis (SBP). Case. A 47-year old man with a history of reported alcoholic cirrhosis and ongoing heavy alcohol use was brought to the emergency room after a syncopal event. He was found to be anemic (hemoglobin 9.9 g/dl) and hypotensive with a blood pressure of 64/34. Despite crystalloid infusion he remained hypotensive and required vasopressor support with norepinephrine. Bedside ultrasound revealed moderate ascites and as there was no evidence of active bleeding, his shock was attributed to sepsis due to SBP. A bedside paracentesis was performed which revealed gross blood. A repeat hemoglobin returned at 4.4 g/dl. Massive transfusion protocol was initiated and interventional radiology was emergently consulted due to concerns for intraabdominal hemorrhage; general surgery deemed the patient too unstable for surgical intervention. Angiogram revealed a splenic laceration and possible hepatic laceration, both embolized successfully. Internal medicine practitioners should keep the differential of hemorrhagic shock due to intraabdominal organ injury in mind for patients with undifferentiated shock.
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26
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LoPresti CM, Jensen TP, Dversdal RK, Astiz DJ. Point-of-Care Ultrasound for Internal Medicine Residency Training: A Position Statement from the Alliance of Academic Internal Medicine. Am J Med 2019; 132:1356-1360. [PMID: 31400298 DOI: 10.1016/j.amjmed.2019.07.019] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 07/29/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Charles M LoPresti
- Section of Acute Care Medicine, Department of Medicine, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio; Case Western Reserve University School of Medicine, Cleveland, Ohio.
| | - Trevor P Jensen
- Department of Medicine, University of California San Francisco, San Francisco, California
| | - Renee K Dversdal
- Department of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Donna J Astiz
- Atlantic Health, Department of Medicine, Morristown Medical Center, Morristown, New Jersey
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27
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Rajagopalan A, Sathananthan D, An YK, Van De Ven L, Martin S, Fon J, Costello SP, Begun J, Bryant RV. Gastrointestinal ultrasound in inflammatory bowel disease care: Patient perceptions and impact on disease-related knowledge. JGH OPEN 2019; 4:267-272. [PMID: 32280776 PMCID: PMC7144798 DOI: 10.1002/jgh3.12268] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 07/30/2019] [Accepted: 09/12/2019] [Indexed: 12/13/2022]
Abstract
Background and Aim Objective monitoring of disease activity is integral to therapeutic decision-making in inflammatory bowel disease (IBD). Data are sparse on patients' perspectives of tools used to monitor disease activity in IBD. To evaluate patients' perspectives of gastrointestinal ultrasound (GIUS) performed during routine IBD clinical care, along with its impact on IBD-specific knowledge. Methods Patients with a formal diagnosis of IBD who underwent GIUS at two tertiary IBD services between March 2017 and January 2019 participated in this prospective study. Participants completed a questionnaire measuring the acceptability, tolerability, and usefulness of GIUS using a visual analogue scale (VAS) from 0 (disagree) to 10 (strongly agree). Comparative acceptability of IBD monitoring tools and the impact of GIUS on IBD-specific knowledge was measured. Results A total of 121 participants completed the questionnaire, with a mean age of 42 years (range 17-78), 54 (45%) males, and 79 (65%) Crohn's disease patients. In the overall population, GIUS was scored as highly acceptable for monitoring IBD (mean 9.20 ± 1.37) compared to colonoscopy (7.94 ± 2.30), stool sampling (8.17 ± 1.96), blood sampling (8.87 ± 1.62), and imaging (8.67 ± 1.60); P < 0.01 for each comparison. GIUS caused little patient discomfort (1.88 ± 1.83), and 98 (81%) participants ranked GIUS as their preferred IBD monitoring tool. GIUS also improved patients' overall IBD-specific knowledge (VAS IBD-specific knowledge 7.96 ± 1.92), including their understanding of the need for medical therapy and disease extent. Conclusion GIUS is a highly acceptable and well-tolerated tool for monitoring disease activity in IBD patients. GIUS is preferred by patients and enhances IBD-specific knowledge.
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Affiliation(s)
- Arvind Rajagopalan
- IBD Service, Department of Gastroenterology The Queen Elizabeth Hospital Adelaide South Australia Australia
| | - Dharshan Sathananthan
- IBD Service, Department of Gastroenterology The Queen Elizabeth Hospital Adelaide South Australia Australia.,School of Medicine, Faculty of Health Science University of Adelaide Adelaide South Australia Australia
| | - Yoon-Kyo An
- Department of Gastroenterology Mater Hospital Brisbane Queensland Australia
| | - Lucinda Van De Ven
- IBD Service, Department of Gastroenterology The Queen Elizabeth Hospital Adelaide South Australia Australia
| | - Serena Martin
- IBD Service, Department of Gastroenterology The Queen Elizabeth Hospital Adelaide South Australia Australia
| | - James Fon
- IBD Service, Department of Gastroenterology The Queen Elizabeth Hospital Adelaide South Australia Australia
| | - Samuel P Costello
- IBD Service, Department of Gastroenterology The Queen Elizabeth Hospital Adelaide South Australia Australia.,School of Medicine, Faculty of Health Science University of Adelaide Adelaide South Australia Australia
| | - Jakob Begun
- Department of Gastroenterology Mater Hospital Brisbane Queensland Australia.,Faculty of Medicine University of Queensland Brisbane Queensland Australia
| | - Robert V Bryant
- IBD Service, Department of Gastroenterology The Queen Elizabeth Hospital Adelaide South Australia Australia.,School of Medicine, Faculty of Health Science University of Adelaide Adelaide South Australia Australia
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28
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Shen G, Wang J, Fei F, Mao M, Mei Z. Bedside ultrasonography for acute appendicitis: An updated diagnostic meta-analysis. Int J Surg 2019; 70:1-9. [PMID: 31404675 DOI: 10.1016/j.ijsu.2019.08.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 07/28/2019] [Accepted: 08/06/2019] [Indexed: 12/12/2022]
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29
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Surgeon-performed point-of-care ultrasound for acute cholecystitis: indications and limitations: a European Society for Trauma and Emergency Surgery (ESTES) consensus statement. Eur J Trauma Emerg Surg 2019; 46:173-183. [PMID: 31435701 DOI: 10.1007/s00068-019-01197-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 07/26/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Acute cholecystitis (AC), frequently responsible for presentation to the emergency department, requires expedient diagnosis and definitive treatment by a general surgeon. Ultrasonography, usually performed by radiology technicians and reported by radiologists, is the first-line imaging study for the assessment of AC. Targeted point-of-care ultrasound (POCUS), particularly in the hands of the treating surgeon, may represent an evolution in surgical decision-making and may expedite care, reducing morbidity and cost. METHODS This consensus guideline was written under the auspices of the European Society of Trauma and Emergency Surgery (ESTES) by the POCUS working group. A systematic literature search identified relevant papers on the diagnosis and treatment of AC. Literature was critically-appraised according to the GRADE evidence-based guideline development method. Following a consensus conference at the European Congress of Trauma & Emergency Surgery (Valencia, Spain, May 2018), final recommendations were approved by the working group, using a modified e-Delphi process, and taking into account the level of evidence of the conclusion. RECOMMENDATIONS We strongly recommend the use of ultrasound as the first-line imaging investigation for the diagnosis of AC; specifically, we recommend that POCUS may be adopted as the primary imaging adjunct to surgeon-performed assessment of the patient with suspected AC. In line with the Tokyo guidelines, we strongly recommend Murphy's sign, in conjunction with the presence of gallstones and/or wall thickening as diagnostic of AC in the correct clinical context. We conditionally recommend US as a preoperative predictor of difficulty of cholecystectomy. There is insufficient evidence to recommend contrast-enhanced ultrasound or Doppler ultrasonography in the diagnosis of AC. We conditionally recommend the use of ultrasound to guide percutaneous cholecystostomy placement by appropriately-trained practitioners. CONCLUSIONS Surgeons have recently embraced POCUS to expedite diagnosis of AC and provide rapid decision-making and early treatment, streamlining the patient pathway and thereby reducing costs and morbidity.
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Gauthier S, Tattevin P, Soulat L, Bouget J, Abergel S, Hascoet J, Mathieu R, Beuzit L, Myhie D, Revest M, Bensalah K, Peyronnet B. Pain intensity and imaging at the initial phase of acute pyelonephritis. Med Mal Infect 2019; 50:507-514. [PMID: 31387815 DOI: 10.1016/j.medmal.2019.07.013] [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] [Received: 10/24/2017] [Revised: 02/12/2018] [Accepted: 07/15/2019] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To identify predictive factors of urological complication on imaging findings in women with pyelonephritis aged 18 to 65 years. METHODS We performed an observational, retrospective, single-center study. The medical charts of women diagnosed with pyelonephritis at the emergency department from 2010 to 2015 were reviewed. Only patients who underwent an imaging study at the emergency department and with microbiologically confirmed pyelonephritis were included for analysis. The primary endpoint was the presence of urological complications on imaging findings. The secondary endpoint was treatment changes after imaging diagnosis. RESULTS Of the 193 women enrolled, 88 (45.6%) had urological complication(s) on imaging findings. The multivariate analysis revealed that history of urolithiasis (OR=2.41; P=0.01) and pain requiring morphine use (OR=5.29; P=0.009) were predictive of urological complications on imaging findings. Of the 120 women with uncomplicated pyelonephritis who underwent imaging studies, 45% had urological complication, resulting in a treatment change in 36.7% of patients. The multivariate analysis revealed that age>40 years (OR=4.58; P=0.02) and pain requiring morphine use (OR=3.78; P=0.02) were predictive of urological complication(s) on imaging findings and of treatment change based on imaging findings (OR=6.76; P=0.005 and OR=4.19; P=0.01 respectively) in this subgroup. CONCLUSIONS Pain requiring morphine use, age, and history of urolithiasis are independent predictors of urological complications on imaging findings in patients with acute pyelonephritis.
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Affiliation(s)
- S Gauthier
- Service d'accueil des urgences, université de Rennes 1, 35000 Rennes, France.
| | - P Tattevin
- Service de maladies infectieuses, université de Rennes 1, 35000 Rennes, France
| | - L Soulat
- Service d'accueil des urgences, université de Rennes 1, 35000 Rennes, France
| | - J Bouget
- Service d'accueil des urgences, université de Rennes 1, 35000 Rennes, France
| | - S Abergel
- Service d'accueil des urgences, université de Rennes 1, 35000 Rennes, France
| | - J Hascoet
- Service d'urologie, université de Rennes 1, 35000 Rennes, France
| | - R Mathieu
- Service d'urologie, université de Rennes 1, 35000 Rennes, France
| | - L Beuzit
- Service de radiologie, université de Rennes 1, 35000 Rennes, France
| | - D Myhie
- Département de médecine générale, université de Rennes 1, 35000 Rennes, France
| | - M Revest
- Service de maladies infectieuses, université de Rennes 1, 35000 Rennes, France
| | - K Bensalah
- Service d'urologie, université de Rennes 1, 35000 Rennes, France
| | - B Peyronnet
- Service d'urologie, université de Rennes 1, 35000 Rennes, France
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Diagnostic Accuracy of Ultrasound in the Diagnosis of Small Bowel Obstruction. Diagnostics (Basel) 2019; 9:diagnostics9030088. [PMID: 31390727 PMCID: PMC6787646 DOI: 10.3390/diagnostics9030088] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 07/24/2019] [Accepted: 08/05/2019] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Small bowel obstruction (SBO) is a common presentation to the Emergency Department (ED). This study aimed to analyze the accuracy of ultrasound (US) in diagnosing and staging SBO. OBJECTIVES The main object of this study was to analyze the accuracy of ultrasound in diagnosing and staging SBO compared to CT. METHODS Retrospectively, stable patients with an ultrasonographic diagnosis of SBO who underwent abdominal CT immediately after US and before receiving naso-intestinal decompression, were included. US criteria for the diagnosis of SBO were related to morphological and functional findings. US diagnosis of obstruction was made if fluid-filled dilated small bowel loops were detected, peristalsis was abnormal and parietal abnormalities were present. Morphologic and functional sonographic findings were assigned to three categories: simple SBO, compensated SBO and decompensated SBO. US findings were compared with the results of CT examinations: Morphologic CT findings (divided into loop, vascular, mesenteric and peritoneal signs) allowed the classification of SBO in simple, decompensated and complicated. RESULTS US diagnostic accuracy rates in relation to CT results were calculated: ultrasound compared to CT imaging, had a sensitivity of 92.31% (95% CI, 74.87% to 99.05%) and a specificity of 94.12% (95% CI, 71.31% to 99.85%) in the diagnosis of SBO. CONCLUSIONS This study, similarly to the existing literature, suggests that ultrasound is highly accurate in the diagnosis of SBO, and that the most valuable sonographic signs are the presence of dilated bowel loops ad abnormal peristalsis.
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Kumar A, Kugler J, Jensen T. Evaluation of Trainee Competency with Point-of-Care Ultrasonography (POCUS): a Conceptual Framework and Review of Existing Assessments. J Gen Intern Med 2019; 34:1025-1031. [PMID: 30924088 PMCID: PMC6544692 DOI: 10.1007/s11606-019-04945-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Point-of-care ultrasonography (POCUS) has the potential to transform healthcare delivery through its diagnostic expediency. Trainee competency with POCUS is now mandated for emergency medicine through the Accreditation Council for Graduate Medical Education (ACGME), and its use is expanding into other medical specialties, including internal medicine. However, a key question remains: how does one define "competency" with this emerging technology? As our trainees become more acquainted with POCUS, it is vital to develop validated methodology for defining and measuring competency amongst inexperienced users. As a framework, the assessment of competency should include evaluations that assess the acquisition and application of POCUS-related knowledge, demonstration of technical skill (e.g., proper probe selection, positioning, and image optimization), and effective integration into routine clinical practice. These assessments can be performed across a variety of settings, including web-based applications, simulators, standardized patients, and real clinical encounters. Several validated assessments regarding POCUS competency have recently been developed, including the Rapid Assessment of Competency in Echocardiography (RACE) or the Assessment of Competency in Thoracic Sonography (ACTS). However, these assessments focus mainly on technical skill and do not expand upon other areas of this framework, which represents a growing need. In this review, we explore the different methodologies for evaluating competency with POCUS as well as discuss current progress in the field of measuring trainee knowledge and technical skill.
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Affiliation(s)
- Andre Kumar
- Department of Medicine, Stanford University School of Medicine, Pasteur Drive, Stanford, CA, USA.
| | - John Kugler
- Department of Medicine, Stanford University School of Medicine, Pasteur Drive, Stanford, CA, USA
| | - Trevor Jensen
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
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A practical approach to critical care ultrasound. J Crit Care 2019; 51:156-164. [DOI: 10.1016/j.jcrc.2019.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 01/06/2019] [Accepted: 01/07/2019] [Indexed: 12/22/2022]
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Jaspers N, Holzapfel B, Kasper P. [Abdominal ultrasound in emergency and critical care medicine]. Med Klin Intensivmed Notfmed 2019; 114:509-518. [PMID: 30840096 DOI: 10.1007/s00063-019-0551-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 02/02/2019] [Accepted: 02/02/2019] [Indexed: 12/29/2022]
Abstract
Abdominal ultrasound is established as an important and low-risk diagnostic procedure in emergency and intensive care medicine that allows rapid and precise diagnosis in symptomatic patients and helps to evaluate which further diagnostic steps are needed. Abdominal ultrasound should be performed as the initial imaging modality in all symptomatic patients in an emergency or intensive care unit and can be used with great accuracy to detect the presence of various abdominal pathologies, such as abdominal aortic aneurysm, abscess, ureterolithiasis or free fluid. Furthermore ultrasound represents the imaging modality of choice for guiding many diagnostic and interventional percutaneous procedures in emergency and intensive care medicine and can be used e. g. to drain pleural fluid or abdominal abscesses. Contrast-enhanced ultrasound (CEUS) can additionally be performed to provide a more reliable assessment of solid organ injuries and has the potential to detect parenchymal lesions or active bleeding from a variety of traumatic origins. Abdominal ultrasound is aimed to integrate rapidly detectable sonographic findings into the clinical context. To ensure required standards, regular training is necessary and it is important to understand methodological limitations.
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Affiliation(s)
- N Jaspers
- Klinik für Gastroenterologie und Hepatologie, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
| | - B Holzapfel
- Klinik für Gastroenterologie und Hepatologie, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - P Kasper
- Klinik für Gastroenterologie und Hepatologie, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland
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Mori T, Nomura O, Ihara T. Ultrasound-guided peripheral forearm nerve block for digit fractures in a pediatric emergency department. Am J Emerg Med 2019; 37:489-493. [DOI: 10.1016/j.ajem.2018.11.033] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 11/20/2018] [Accepted: 11/23/2018] [Indexed: 11/25/2022] Open
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Minardi J, Ressetar H, Foreman T, Craig K, Sharon M, Bassler J, Davis S, Machi A, Cottrell S, Denne N, Ferrari N, Landreth K, Palmer B, Schaefer G, Tallaksen R, Wilks D, Williams D. Longitudinal Ultrasound Curriculum Incorporation at West Virginia University School of Medicine: A Description and Graduating Students' Perceptions. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:63-72. [PMID: 29732601 DOI: 10.1002/jum.14662] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 02/27/2018] [Accepted: 03/19/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES Sonography is a clinical tool being incorporated in multiple medical specialties with evidence of improved patient care and cost. Some schools have begun implementing ultrasound curricula. We hope to build upon that foundation and provide another potential framework of incorporation. There are several barriers, including curricular space, equipment and physical space, adequate faculty, and performing assessment. METHODS At West Virginia University, we began a longitudinal ultrasound curriculum in 2012 with incorporation of didactic and practical sessions into gross anatomy, our systems-based second-year curriculum, physical diagnosis course, and clinical rotations. We included both written and practical assessment from the onset. After the initial 4 years, the first graduates were surveyed on their perceptions of the curriculum. Responses were correlated with specialty choice and clinical campus site. RESULTS Based on our survey (90% response rate), students felt sonography was useful for anatomical understanding and patient care. Overall, 93% of our respondents reviewed the curriculum favorably. Qualitative feedback was very positive, with students desiring more ultrasound education and more required components, specifically in clinical rotations. CONCLUSIONS Based on these results, some changes have already been implemented, including decreased student-to-instructor ratios, more open scan time, and more required components. The breadth of formal assessment has increased. Multiple pilot programs for clinical rotations are being developed. There is an ongoing need for faculty development and continued assessment of ultrasound competency.
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Affiliation(s)
- Joseph Minardi
- Department of Emergency Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Holly Ressetar
- Department of Pathology, Anatomy, and Laboratory Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Theresa Foreman
- Department of Emergency Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Kristen Craig
- Department of Emergency Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Melinda Sharon
- Department of Emergency Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - John Bassler
- Department of Emergency Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Stephen Davis
- Department of Emergency Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Anthony Machi
- Department of Family Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Scott Cottrell
- Department of Medical Education, West Virginia University, Morgantown, West Virginia, USA
| | - Nicolas Denne
- Department of Emergency Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Norman Ferrari
- Department of Medical Education, West Virginia University, Morgantown, West Virginia, USA
| | - Kenneth Landreth
- Department of Microbiology, West Virginia University, Morgantown, West Virginia, USA
| | - Bruce Palmer
- Department of Pathology, Anatomy, and Laboratory Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Gregory Schaefer
- Department of Surgery, West Virginia University, Morgantown, West Virginia, USA
| | - Robert Tallaksen
- Department of Radiology, West Virginia University, Morgantown, West Virginia, USA
| | - David Wilks
- Department of Anesthesiology, West Virginia University, Morgantown, West Virginia, USA
| | - Dorian Williams
- Department of Family Medicine, West Virginia University, Morgantown, West Virginia, USA
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Kozaci N, Avci M, Tulubas G, Ararat E, Karakoyun OF, Karaman C, Erol B. Role of emergency physician–performed ultrasound in the differential diagnosis of abdominal pain. HONG KONG J EMERG ME 2018. [DOI: 10.1177/1024907918808115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Objectives: This prospective study was performed to evaluate the diagnostic accuracy of bedside point-of-care abdominal ultrasonography performed by emergency physician in patients with non-traumatic acute abdominal pain. Methods: The patients, who were admitted to emergency department due to abdominal pain, were included in this study. The emergency physician obtained a routine history, physical examination, blood draws, and ordered diagnostic imaging. After the initial clinical examinations, all the patients underwent ultrasonography for abdominal pathologies by emergency physician and radiologist, respectively. Point-of-care abdominal ultrasonography compared with abdominal ultrasonography performed by radiologist as the gold standard. Results: The study included 122 patients. Gallbladder and appendix pathologies were the most commonly detected in the abdominal ultrasonography. Compared with abdominal ultrasonography, point-of-care abdominal ultrasonography was found to have 89% sensitivity and 94% specificity in gallbladder pathologies; 91% sensitivity and 91% specificity in acute appendicitis; 79% sensitivity and 97% specificity in abdominal free fluid; 83% sensitivity and 96% specificity in ovarian pathologies. Compared to final diagnosis, preliminary diagnoses of emergency physicians were correct in 92 (75.4%) patients. Conclusion: This study showed that emergency physicians were successful in identifying abdominal organ pathologies with point-of-care abdominal ultrasonography after training.
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Affiliation(s)
- Nalan Kozaci
- Department of Emergency Medicine, University of Health Sciences, Antalya Education and Research Hospital, Antalya, Turkey
| | - Mustafa Avci
- Department of Emergency Medicine, University of Health Sciences, Antalya Education and Research Hospital, Antalya, Turkey
| | - Gul Tulubas
- Department of Emergency Medicine, University of Health Sciences, Antalya Education and Research Hospital, Antalya, Turkey
| | - Ertan Ararat
- Department of Emergency Medicine, Uşak University Education and Research Hospital, Uşak, Turkey
| | - Omer Faruk Karakoyun
- Department of Emergency Medicine, University of Health Sciences, Antalya Education and Research Hospital, Antalya, Turkey
| | - Cagri Karaman
- Department of Emergency Medicine, University of Health Sciences, Antalya Education and Research Hospital, Antalya, Turkey
| | - Bekir Erol
- Department of Radiology, University of Health Sciences, Antalya Education and Research Hospital, Antalya, Turkey
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Lui CT, Ching WM, Tsui KL, Chu HC, Tsui ATS, Au TS, Wong TW, Fan KL, Leung LP. Feasibility of predictive model by clinical and laboratory parameters for risk stratification of geriatric abdominal pain. HONG KONG J EMERG ME 2018. [DOI: 10.1177/1024907918802070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Assessment of geriatric patients presented with abdominal pain had been challenge for emergency physicians with the ageing population. A rapid, reproducible risk stratification model for the assessment of the need for admission for geriatric abdominal pain would be required to identify low-risk patients to be managed as out-patient basis. Objective: Assess the feasibility of risk stratification model to predict the need of hospital admission based on readily available bedside parameters in emergency departments. Methods: This is a multicenter retrospective cohort study in four emergency departments. Patients aged at least 65 who presented with chief complaint of abdominal pain within the previous 7 days of attendance as the chief complaint were included. Chart review was performed for the included patients. The primary outcome was defined as a composite of mortality, abdominal surgery or endoscopic treatment, and other inpatient treatments for abdominal diseases within 14 days, surrogating the need of hospital admission. Logistic regression was modeled to identify independent predictors. The diagnostic accuracy of the risk model was evaluated with the receiver operating characteristic curve and compared with the clinical gestalt of decision for hospital admission by the attending physician. Results: In total, 553 patients were included. Symptoms of upper gastrointestinal bleeding, non-ambulatory presenting status, pain duration, focal abdominal tenderness, hyperglycemia, leukocytosis, and elevated creatinine were independent predictors of the outcome. The area under the receiver operating characteristic curve of the predicted probabilities of the logistic model was 0.741. In keeping for a low-risk criterion to achieve more than 90% sensitivity, the predictive model would only achieve 18.2% specificity which was inferior to clinical gestalt for hospital admission (sensitivity 99.3%, specificity 44.3%). Conclusion: Risk stratification model by clinical assessment and laboratory markers alone were inadequate and inferior to clinical gestalt for identification of the group of patients requiring inpatient treatment.
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Affiliation(s)
- Chun Tat Lui
- Accident and Emergency Department, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - Wei Ming Ching
- Accident and Emergency Department, Pok Oi Hospital, Yuen Long, Hong Kong
| | - Kwok Leung Tsui
- Accident and Emergency Department, Pok Oi Hospital, Yuen Long, Hong Kong
| | - Ho Cheung Chu
- Accident and Emergency Department, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
| | - Alex To Shing Tsui
- Accident and Emergency Department, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
| | - Tak Shun Au
- Accident and Emergency Department, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
| | - Tai Wai Wong
- Accident and Emergency Department, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
| | - Kit Ling Fan
- Accident and Emergency Department, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Ling Pong Leung
- Emergency Medicine Unit, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
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Elderly Woman With Abdominal Pain. Ann Emerg Med 2018; 72:e21-e22. [DOI: 10.1016/j.annemergmed.2018.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Indexed: 11/18/2022]
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Yamada T, Minami T, Soni NJ, Hiraoka E, Takahashi H, Okubo T, Sato J. Skills acquisition for novice learners after a point-of-care ultrasound course: does clinical rank matter? BMC MEDICAL EDUCATION 2018; 18:202. [PMID: 30134975 PMCID: PMC6106885 DOI: 10.1186/s12909-018-1310-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Accepted: 08/10/2018] [Indexed: 05/02/2023]
Abstract
BACKGROUND Few studies have compared the effectiveness of brief training courses on point-of-care ultrasound (POCUS) skill acquisition of novice attending physicians vs. trainees. The purpose of this study was to evaluate the change in POCUS image interpretation skills and confidence of novice attending physicians vs. trainees after a 1-day POCUS training course. METHODS A 1-day POCUS training course was held in March 2017 in Japan. A standardized training curriculum was developed that included online education, live lectures, and hands-on training. The pre-course assessment tools included a written examination to evaluate baseline knowledge and image interpretation skills, and a physician survey to assess confidence in performing specific ultrasound applications. The same assessment tools were administered post-course, along with a course evaluation. All learners were novices and were categorized as trainees or attending physicians. Data were analyzed using two-way analysis of variance. RESULTS In total, 60 learners attended the course, and 51 learners (85%) completed all tests and surveys. The 51 novice learners included 29 trainees (4 medical students, 9 PGY 1-2 residents, 16 PGY 3-5 residents) and 22 attending physicians (6 PGY 6-10 physicians, and 16 physicians PGY 11 and higher). The mean pre- and post-course test scores of novice trainees improved from 65.5 to 83.9% while novice attending physicians improved from 66.7 to 81.5% (p < 0.001). The post-course physician confidence scores in using ultrasound significantly increased in all skill categories for both groups. Both trainees and attending physicians demonstrated similar improvement in their post-course test scores and confidence with no statistically significant differences between the groups. The course evaluation scores for overall satisfaction and satisfaction with faculty members' teaching skills were 4.5 and 4.6 on a 5-point scale, respectively. CONCLUSIONS Both novice trainees and attending physicians showed similar improvement in point-of-care ultrasound image interpretation skills and confidence after a brief training course. Although separate training courses have traditionally been developed for attending physicians and trainees, novice learners of point-of-care ultrasound may acquire skills at similar rates, regardless of their ranking as an attending physician or trainee. Future studies are needed to compare the effectiveness of short training courses on image acquisition skills and determine the ideal course design.
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Affiliation(s)
- Toru Yamada
- Department of General Medicine/Family & Community Medicine, Nagoya University Graduate School of Medicine, Nagoya, Aichi Japan
- Department of Internal Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Chiba Japan
| | - Taro Minami
- Division of Pulmonary and Sleep Medicine, Care New England Medical Group, Primary Care and Specialty Services, 111 Brewster Street, Pawtucket, Rhode Island 02860 USA
- Department of Medicine, the Warren Alpert Medical School of Brown University, Providence, RI USA
| | - Nilam J. Soni
- Division of General & Hospital Medicine, University of Texas Health San Antonio, San Antonio, TX USA
| | - Eiji Hiraoka
- Department of Internal Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Chiba Japan
| | - Hiromizu Takahashi
- Department of General Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Tomoya Okubo
- Research Division, The National Center for University Entrance Examinations, Tokyo, Japan
| | - Juichi Sato
- Department of General Medicine/Family & Community Medicine, Nagoya University Graduate School of Medicine, Nagoya, Aichi Japan
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Le Coz J, Orlandini S, Titomanlio L, Rinaldi VE. Point of care ultrasonography in the pediatric emergency department. Ital J Pediatr 2018; 44:87. [PMID: 30053886 PMCID: PMC6064059 DOI: 10.1186/s13052-018-0520-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 07/02/2018] [Indexed: 11/10/2022] Open
Abstract
IMPORTANCE Point-of-care ultrasonography (POCUS) allows to obtain real-time images to correlate with the patient's presenting signs and symptoms. It can be used by various specialties and may be broadly divided into diagnostic and procedural applications. OBJECTIVE We aimed at reviewing current knowledge on the use of POCUS in Pediatric Emergency Departments (PEDs). FINDINGS US diagnostic capacity in paediatric patients with suspected pneumonia has been studied and debated whereas literature regarding the usefulness of point-of-care echocardiography in the pediatric setting is still limited. Similarly, Focused Assessment with Sonography for Trauma (FAST) has become a standard procedure in adult emergency medicine but it is still not well codified in the pediatric practice. Concerning procedural applications of POCUS we identified 4 main groups: peripheral vascular access, bladder catheterizations, identification and drainage of abnormal fluid collections and foreign body identification. CONCLUSIONS AND RELEVANCE Bedside emergency ultrasound is routinely used by adult emergency physicians and in the last 10 years its application is recognized and applied in PED. Pediatric emergency physicians are encouraged to familiarize with POCUS as it is a safe technology and can be extremely helpful in performing diagnosis, managing critical situations and guiding procedures, which results in globally improving pediatric patients care.
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Affiliation(s)
- Julien Le Coz
- Department of Pediatric Emergency Care, APHP - Hopital Robert Debré, 75019 Paris, France
| | - Silvia Orlandini
- Department of Pediatric Emergency Care, APHP - Hopital Robert Debré, 75019 Paris, France
- Department of Pediatrics, Ospedale della Donna e del Bambino, University of Verona, 37126 Verona, Italy
| | - Luigi Titomanlio
- Department of Pediatric Emergency Care, APHP - Hopital Robert Debré, 75019 Paris, France
- Sorbonne Paris Cité, INSERM U1141, DHU Protect, Paris Diderot University, 75019 Paris, France
- Pediatric Migraine and Neurovascular Diseases Unit, APHP - Hopital Robert Debré, 75019 Paris, France
- Pediatric Emergency Department, INSERM U1141 – Developmental Neurobiology & Neuroprotection, Paris Diderot -Sorbonne-Paris Cité University, Robert Debré Hospital, 48 Boulevard Serurier, 75019 Paris, France
| | - Victoria Elisa Rinaldi
- Department of Pediatric Emergency Care, APHP - Hopital Robert Debré, 75019 Paris, France
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Michels G, Zinke H, Möckel M, Hempel D, Busche C, Janssens U, Kluge S, Riessen R, Buerke M, Kelm M, von Bardeleben RS, Knebel F, Busch HJ. [Recommendations for education in ultrasound in medical intensive care and emergency medicine: position paper of DGIIN, DEGUM and DGK]. Med Klin Intensivmed Notfmed 2018; 112:314-319. [PMID: 28447145 DOI: 10.1007/s00063-017-0285-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Point-of-care ultrasound in acute care medicine is a prerequisite for diagnosis and therapy monitoring of critically ill patients. There is currently no uniform education strategy for medical intensive care and emergency medicine. As part of the basic level, the trainee takes theoretical and clinical training covering abdominal and thoracic ultrasonography and focused cardiovascular ultrasound. In a second step, special knowledge and skills can be acquired at an expert level. This two-stage concept is intended to guarantee quality assurance in ultrasound education in medical intensive care and emergency medicine.
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Affiliation(s)
- G Michels
- Klinik III für Innere Medizin, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
| | - H Zinke
- Klinik für konservative Intensivmedizin, Dietrich-Bonhoeffer-Klinikum, Neubrandenburg, Deutschland
| | - M Möckel
- Notfallmedizin der Charité, Campus Virchow-Klinikum, Universitätsmedizin Berlin, Berlin, Deutschland
| | - D Hempel
- Klinik für Innere Medizin IV, Universitätsklinikum Jena, Jena, Deutschland
| | - C Busche
- Universitäts-Notfallzentrum, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - U Janssens
- Klinik für Innere Medizin und Intensivmedizin, St.-Antonius-Hospital, Eschweiler, Deutschland
| | - S Kluge
- Klinik für Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - R Riessen
- Department für Innere Medizin, Internistische Intensivstation, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - M Buerke
- Klinik für Kardiologie, Angiologie und internistische Intensivmedizin, St. Marien-Krankenhaus Siegen gem. GmbH, Siegen, Deutschland
| | - M Kelm
- Klinik für Kardiologie, Pneumologie und Angiologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - R S von Bardeleben
- Kardiologie I, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz, Deutschland
| | - F Knebel
- Medizinische Klinik mit Schwerpunkt Kardiologie und Angiologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - H-J Busch
- Universitäts-Notfallzentrum, Universitätsklinikum Freiburg, Freiburg, Deutschland
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Feng YM, Wan D, Guo R. Case report of gastric distension due to superior mesenteric artery syndrome mimicking hollow viscus perforation: Considerations in critical care ultrasound. Medicine (Baltimore) 2018; 97:e10757. [PMID: 29768359 PMCID: PMC5976289 DOI: 10.1097/md.0000000000010757] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
RATIONALE Critical care ultrasound identifies the signs of free intraperitoneal air and echogenic free fluid always indicates hollow viscus perforation (HVP) and needs immediate surgical interventions. However, in rare cases, these classic signs may also mislead proper clinical decisions. We report perforated viscus associated large peritoneal effusion with initial critical care ultrasound findings, whereas computed tomography (CT) examination confirmed a giant stomach due to superior mesenteric artery syndrome (SMAS). PATIENT CONCERNS A 70-year-old man was admitted to our emergency department with a complaint of recurrent vomiting with coffee ground emesis for 15 hours and worsen with hypotension for 6 hours. During gastric tube placement, the sudden cardiac arrest occurred. With 22 minutes resuscitation, sinus rhythm was restored. DIAGNOSES Quick ultrasound screen showed large echogenic fluid distributed in the whole abdomen. Diagnostic paracentesis collected "unclotted blood" and combined with a past history of duodenal ulcer, HVP was highly suspected. However, surgical intervention was not performed immediately as unstable vital signs and unfavorable coma states. After adequate resuscitation in intensive care unit, the patient was transferred to perform enhanced CT. Surprisingly, there was no evidence of HVP. Instead, CT showed a giant stomach possibly explained by SMAS. INTERVENTIONS Continuous gastric decompression was performed and 3100 mL coffee ground content was drainage within 24 hours of admission. OUTCOMES Abdominal distension was significantly relieved with improved vital signs. However, as the poor neurological outcome, family members abandon further treatment, and the patient died. LESSONS SMAS is a rare disorder, characterized by small bowel obstruction and severe gastric distension. Nasogastric tube insertion should be aware to protect airway against aspiration. Caution should be utilized to avoid over interpretation of ultrasonography findings on this condition.
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Affiliation(s)
- Yan-Mei Feng
- Department of Respiratory and Critical Care Medicine
| | - Dong Wan
- Department of Critical Care Medicine, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Rui Guo
- Department of Critical Care Medicine, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Bryant RV, Friedman AB, Wright EK, Taylor KM, Begun J, Maconi G, Maaser C, Novak KL, Kucharzik T, Atkinson NSS, Asthana A, Gibson PR. Gastrointestinal ultrasound in inflammatory bowel disease: an underused resource with potential paradigm-changing application. Gut 2018; 67:973-985. [PMID: 29437914 DOI: 10.1136/gutjnl-2017-315655] [Citation(s) in RCA: 106] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 12/13/2017] [Accepted: 12/14/2017] [Indexed: 12/20/2022]
Abstract
Evolution of treatment targets in IBD has increased the need for objective monitoring of disease activity to guide therapeutic strategy. Although mucosal healing is the current target of therapy in IBD, endoscopy is invasive, expensive and unappealing to patients. GI ultrasound (GIUS) represents a non-invasive modality to assess disease activity in IBD. It is accurate, cost-effective and reproducible. GIUS can be performed at the point of care without specific patient preparation so as to facilitate clinical decision-making. As compared with ileocolonoscopy and other imaging modalities (CT and MRI), GIUS is accurate in diagnosing IBD, detecting complications of disease including fistulae, strictures and abscesses, monitoring disease activity and detecting postoperative disease recurrence. International groups increasingly recognise GIUS as a valuable tool with paradigm-changing application in the management of IBD; however, uptake outside parts of continental Europe has been slow and GIUS is underused in many countries. The aim of this review is to present a pragmatic guide to the positioning of GIUS in IBD clinical practice, providing evidence for use, algorithms for integration into practice, training pathways and a strategic implementation framework.
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Affiliation(s)
- Robert Venning Bryant
- Department of Gastroenterology, The Queen Elizabeth Hospital, Adelaide, Australia.,Faculty of Health Sciences, School of Medicine, University of Adelaide, Adelaide, Australia
| | - Antony B Friedman
- Department of Gastroenterology, Alfred Hospital, Melbourne, Australia.,Central Clinical School, Monash University, Melbourne, Australia
| | - Emily Kate Wright
- Department of Gastroenterology, St Vincent's Hospital, Melbourne, Australia.,University of Melbourne, Melbourne, Australia
| | - Kirstin M Taylor
- Department of Gastroenterology, Alfred Hospital, Melbourne, Australia.,Central Clinical School, Monash University, Melbourne, Australia
| | - Jakob Begun
- Department of Gastroenterology, Mater Hospital, Brisbane, Australia.,Mater Research Institute, University of Queensland, Brisbane, Australia
| | - Giovanni Maconi
- Department of Gastroenterology, Luigi Sacco University Hospital, Milan, Italy
| | - Christian Maaser
- Department of General Internal Medicine and Gastroenterology, University Teaching Hospital Lueneburg, Lueneburg, Germany
| | - Kerri L Novak
- Division of Gastroenterology, University of Calgary, Calgary, Canada
| | - Torsten Kucharzik
- Department of General Internal Medicine and Gastroenterology, University Teaching Hospital Lueneburg, Lueneburg, Germany
| | | | - Anil Asthana
- Department of Gastroenterology, Royal Melbourne Hospital, Melbourne, Australia
| | - Peter R Gibson
- Department of Gastroenterology, Alfred Hospital, Melbourne, Australia.,Central Clinical School, Monash University, Melbourne, Australia
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Radiation Exposure in Pediatric Urology Patients: How to Adhere to ALARA. J Urol 2017; 199:351-352. [PMID: 29154759 DOI: 10.1016/j.juro.2017.11.063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2017] [Indexed: 11/22/2022]
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Ultrasonography training and utilization in surgical critical care fellowships: a program director's survey. J Surg Res 2017; 218:292-297. [PMID: 28985864 DOI: 10.1016/j.jss.2017.06.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 05/24/2017] [Accepted: 06/16/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND Intensivist-performed ultrasound (IPUS) is an adjunctive tool used to assist in resuscitation and management of critically ill patients. It allows clinicians real-time information through noninvasive methods. We aimed to evaluate the types of IPUS performed and the methods surgical critical care (SCC) fellows are trained along with challenges in training. METHODS One hundred SCC fellowship directors were successfully sent an email inviting them to participate in a short Web-based survey. We inquired about program characteristics including hospital type, fellowship size, faculty size and training, dedicated surgical critical care beds, and ultrasound equipment availability. The survey contained questions regarding the program directors' perception on importance on cost effectiveness of IPUS, types of IPUS examinations performed, fellows experience with IPUS, challenges to training, and presence and methods of quality assurance (QA) programs. RESULTS A total of 38 (38.0%) program directors completed the survey. Using a 100-point Likert scale, the majority of the respondents indicated that IPUS is important to patient care in the SICU and is cost-effective (mean score 85.5 and 84.6, respectively). Most (34, 89.5%) utilize IPUS and conduct a mean of 5.1 different examination types with FAST being the most prevalent examination (33, 86.8%). Thirty-three (86.8%) programs include IPUS in their SCC training with varying amounts of time spent training. Of these programs, 19 (57.6%) have a specific curriculum. The most frequently used modalities for training fellows were informal bedside teaching (28, 84.8%), hands-on lectures (20, 60.6%) and formal lectures (19, 57.6%). The top three challenges program directors cited for IPUS education was time (23, 69.7%), followed by concerns for ongoing QA (19, 57.6%) and lack of faculty trained in IPUS (18, 53.9%). Only 20 (60.6%) programs review images as a part of QA/quality improvement. CONCLUSIONS Utilization and training of IPUS is common in SCC fellowships. There is varied education type and training time devoted to IPUS which could lead to gaps in knowledge and care. Development of a standard curriculum for SCC fellowships could assist surgical intensivists in achieving a base of knowledge in IPUS to create a more homogenously trained workforce and standards of care.
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Abstract
Ultrasound has evolved into a core bedside tool for diagnostic and management purposes for all subsets of adult and pediatric critically-ill patients. Teleintensive care unit coverage has undergone a similar rapid expansion period throughout the United States. Round-the-clock access to ultrasound equipment is very common in today's intensive care unit, but 24/7 coverage with staff trained to acquire and interpret point-of-care ultrasound in real time is lagging behind equipment availability. Medical trainees and physician extenders require attending level supervision to ensure consistent image acquisition and accurate interpretation. Teleintensivists can extend the utility of ultrasound by supervising and guiding providers without or with only partial training in ultrasound, and also by extending direct trainee ultrasound supervision to time periods when no direct bedside attending supervisor is available, and when treatment decisions otherwise would have been made without supervision and feedback on image acquisition and interpretation. Nursing staff without ultrasound training can also be directed to perform basic ultrasound exams, which may have immediate diagnostic and/or treatment consequences, thereby overcoming access barriers in the absence of physicians or physician extenders. We discuss 4 real-life clinical scenarios in which teleintensivist supervision extended and standardized bedside ultrasound exams to guide management decisions which significantly impacted patient outcomes.
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Abstract
OBJECTIVE The objective of this study is to determine the extent of ultrasound availability in Norwegian casualty clinics and estimate the prevalence of its use. DESIGN A retrospective study based on a national casualty clinic registry and data from reimbursement claims. SETTING Out-of-hours primary health care in Norway. SUBJECTS All Norwegian casualty clinics in 2016 and reimbursement claims from 2008 to 2015. MAIN OUTCOME MEASURES Percent of casualty clinics with ultrasound, types of ultrasound devices and probes, reasons for/against ultrasound access, characteristics of clinics with/without ultrasound, frequency of five ultrasound indications and characteristics of the physicians using/not using ultrasound. RESULTS Out of 182 casualty clinics, 41 (23%) reported access to ultrasound. Mobile (49%) and stationary (44%) devices were most frequent. Physician request was the most common cited reason for ultrasound access (66%). Neither population served by the casualty clinic nor distance to hospital showed any clear association with ultrasound access. All of the five ultrasound reimbursement codes showed a substantial increase from 2008 to 2015 with 14.1 ultrasound examinations being performed per 10,000 consultations in 2015. Only 6.5% of physicians performed ultrasound in 2015 and males were significantly more likely to use ultrasound than females (OR 1.85, 95% CI: 1.38-2.47, p < .001), even when adjusted for age, speciality status and geography. CONCLUSIONS Although the use of ultrasound is increasing in out-of-hours Norwegian primary health care, most casualty clinics do not have access and only a minority of physicians use ultrasound.
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Affiliation(s)
- Kjetil Myhr
- National Centre for Emergency Primary Health Care, Uni Research Health, Bergen, Norway
- CONTACT Kjetil Myhr National Centre for Emergency Primary Health Care, Uni Research Health, Bergen, Norway
| | - Hogne Sandvik
- National Centre for Emergency Primary Health Care, Uni Research Health, Bergen, Norway
| | - Tone Morken
- National Centre for Emergency Primary Health Care, Uni Research Health, Bergen, Norway
| | - Steinar Hunskaar
- National Centre for Emergency Primary Health Care, Uni Research Health, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Empfehlungen zur Ultraschallausbildung in der internistischen Intensiv- und Notfallmedizin: Positionspapier der DGIIN, DEGUM und DGK. DER KARDIOLOGE 2017. [DOI: 10.1007/s12181-017-0157-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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