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Javaudin F, Papin M, Le Bastard Q, Thibault M, Boishardy T, Brau F, Laribi S, Petrovic T, Peluchon T, Markarian T, Volteau C, Arnaudet I, Pes P, Le Conte P. Early point-of-care echocardiography as a predictive factor for absence of return of spontaneous circulatory in out-of-hospital cardiac arrests: A multicentre observational study. Resuscitation 2024; 203:110373. [PMID: 39174002 DOI: 10.1016/j.resuscitation.2024.110373] [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: 07/09/2024] [Revised: 08/12/2024] [Accepted: 08/17/2024] [Indexed: 08/24/2024]
Abstract
INTRODUCTION Early assessment of the prognosis of a patient in cardiac arrest during cardiopulmonary resuscitation is highly challenging. This study aims to evaluate the predictive outcome value of early point-of-care ultrasound (POCUS) in out-of-hospital settings. METHODS This observational, prospective, multicentre study's primary endpoint was the positive predictive value (PPV) of POCUS cardiac standstill within the first 12 min of advanced life support (ALS) initiation in determining the absence of return of spontaneous circulation (ROSC). A multivariate logistic regression model was constructed with adjustments for known predictive variables typically used in termination of resuscitation (TOR) rules. RESULTS A total of 293 patients were analysed, with a mean age of 66.6 ± 14.6 years, and a majority were men (75.8%). POCUS was performed on average 7.9 ± 2.6 min after ALS initiation. Among patients with cardiac standstill (72.4%), 16.0% achieved ROSC compared with 48.2% in those with visible cardiac motions. The PPV of early POCUS cardiac standstill for the absence of ROSC was 84.0%, 95% CI [78.3-88.6]. In multivariable analysis, only POCUS cardiac standstill (adjusted odds ratio [aOR] 3.89, 95% CI [1.86-8.17]) and end-tidal CO2 (ETCO2) value ≤37 mmHg (aOR 4.27, 95% CI [2.21-8.25]) were associated with the absence of ROSC. CONCLUSION Early POCUS cardiac standstill during CPR for out-of-hospital cardiac arrest was a reliable predictor of the absence of ROSC. However, its presence alone was not sufficient to determine the termination of resuscitation efforts. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03494153. Registered March 29, 2018.
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Affiliation(s)
- François Javaudin
- Service des Urgences, Centre Hospitalier Universitaire de Nantes, F-44000 Nantes, France; Nantes Université, CHU Nantes, Cibles et médicaments des infections et du cancer, IICiMed, UR 1155, F-44000 Nantes, France.
| | - Mathilde Papin
- Service des Urgences, Centre Hospitalier Universitaire de Nantes, F-44000 Nantes, France
| | - Quentin Le Bastard
- Service des Urgences, Centre Hospitalier Universitaire de Nantes, F-44000 Nantes, France; Nantes Université, CHU Nantes, Cibles et médicaments des infections et du cancer, IICiMed, UR 1155, F-44000 Nantes, France
| | - Matthieu Thibault
- Service des Urgences, Centre Hospitalier de Saint-Nazaire, F-44600 Saint-Nazaire, France
| | - Thomas Boishardy
- Service des Urgences, Centre Hospitalier Universitaire d'Angers, F-49100 Angers, France
| | - François Brau
- Service des Urgences, Centre Hospitalier Départemental Vendée, F-85000 La Roche-sur-Yon, France
| | - Said Laribi
- Service des Urgences, Centre Hospitalier Universitaire de Tours, F-37000 Tours, France; UR 7505 - Education Ethique Santé (EES), Université de Tours, F-37000 Tours, France
| | - Tomislav Petrovic
- SAMU 93 - UF Recherche-Enseignement-Qualité Université Paris 13, Sorbonne Paris Cité, Inserm U942, Hôpital Avicenne, F-93009 Bobigny, France
| | - Tanguy Peluchon
- Service des Urgences, Centre Hospitalier Châteaubriant Nozay Pouancé, F-44110 Châteaubriant, France
| | - Thibaut Markarian
- Service des Urgences, Hôpitaux Universitaires de Marseille Timone, F-13005 Marseille, France; UMR 1263 Centre de recherche en CardioVasculaire et Nutrition (C2VN), Aix-Marseille Université, INSERM, INRAE, F-13005 Marseille, France
| | - Christelle Volteau
- Département Promotion, Centre Hospitalier Universitaire de Nantes, F-44000 Nantes, France
| | - Idriss Arnaudet
- Service des Urgences, Centre Hospitalier Universitaire de Nantes, F-44000 Nantes, France
| | - Philippe Pes
- Service des Urgences, Centre Hospitalier Universitaire de Nantes, F-44000 Nantes, France
| | - Philippe Le Conte
- Service des Urgences, Centre Hospitalier Universitaire de Nantes, F-44000 Nantes, France
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Dupriez F, Niset A, Couvreur C, Marissiaux L, Gendebien F, Peyskens L, Germeau B, Fasseaux A, Rodrigues de Castro B, Penaloza A, Vanpee D, Bobbia X. Evaluation of point-of-care ultrasound use in the diagnostic approach for right upper quadrant abdominal pain management in the emergency department: a prospective study. Intern Emerg Med 2024; 19:803-811. [PMID: 38041765 DOI: 10.1007/s11739-023-03480-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 11/04/2023] [Indexed: 12/03/2023]
Abstract
Point-of-care ultrasound (PoCUS) is commonly used at the bedside in the emergency department (ED) as part of clinical examinations. Studies frequently investigate PoCUS diagnostic accuracy, although its contribution to the overall diagnostic approach is less often evaluated. The primary objective of this prospective, multicenter, cohort study was to assess the contribution of PoCUS to the overall diagnostic approach of patients with right upper quadrant abdominal pain. Two independent members of an adjudication committee, who were blind to the intervention, independently evaluated the diagnostic approaches before and after PoCUS for the same patient. The study included 62 patients admitted to the ED with non-traumatic right upper quadrant abdominal pain from September 1, 2022, to March 6, 2023. The contribution of PoCUS to the diagnostic approach was evaluated using a proportion test assuming that 75% of diagnostic approaches would be better or comparable with PoCUS. Wilcoxon signed-rank tests evaluated the impact of PoCUS on the mean number of differential diagnoses, planned treatments, and complementary diagnostic tests. Overall, 60 (97%) diagnostic approaches were comparable or better with PoCUS (χ2 = 15.9, p < 0.01). With PoCUS, the mean number of differential diagnoses significantly decreased by 2.3 (95% CI - 2.7 to - 1.5) (p < 0.01), proposed treatments by 1.3 (95% CI - 1.8 to - 0.9) (p < 0.01), and complementary diagnostic tests by 1.3 (95% CI - 1.7 to - 1.0) (p < 0.01). These findings show that PoCUS positively impacts the diagnostic approach and significantly decreases the mean number of differential diagnoses, treatments, and complementary tests.
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Affiliation(s)
- Florence Dupriez
- Emergency Department, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, 1200, Brussels, Belgium.
| | - Alexandre Niset
- Emergency Department, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, 1200, Brussels, Belgium
| | - Claire Couvreur
- Emergency Department, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, 1200, Brussels, Belgium
| | - Laurent Marissiaux
- Emergency Department, Centre Hospitalier Universitaire de Liège, Liège, Belgium
| | - Félix Gendebien
- Emergency Department, Hôpital de Jolimont, Lobbes, Lobbes, Belgium
| | - Laurent Peyskens
- Emergency Department, Grand Hôpital de Charleroi, Charleroi, Belgium
| | - Boris Germeau
- Emergency Department, Cliniques Saint-Pierre Ottignies, Ottignies, Belgium
| | - Antoine Fasseaux
- Emergency Department, Hôpital de Jolimont, Lobbes, Haine Saint Paul, Belgium
| | | | - Andrea Penaloza
- Emergency Department, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, 1200, Brussels, Belgium
| | - Dominique Vanpee
- Institute of Health and Society and CHU UCL Namur, UCLOUVAIN, Ottignies-Louvain-la-Neuve, Belgium
| | - Xavier Bobbia
- Emergency Department, CHU Montpellier, Montpellier, France
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Camard L, Liard R, Duverne S, Ibanez G, Skendi M. Consensus on relevant point-of-care ultrasound skills in General Practice: a two-round French Delphi study. BMC MEDICAL EDUCATION 2024; 24:341. [PMID: 38532436 DOI: 10.1186/s12909-024-05072-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 01/18/2024] [Indexed: 03/28/2024]
Abstract
CONTEXT Point-of-Care Ultrasound (POCUS) has become an important tool in the clinical practice of many specialties, but its use and impact in General Practice in France remains to be explored. OBJECTIVE The objective of this study is to obtain a consensus among experienced French general practitioners on a list of relevant POCUS skills in General Practice in 4 anatomical regions. METHOD We used a two-round Delphi method to obtain a consensus. An initial list of skills was drawn by conducting a literature review. To rate each skill, we used a nine-point Likert scale. An interactive meeting between experts took place between Delphi rounds. POCUS experts in General Practice were defined as general practitioners with theoretical training in ultrasound who regularly perform ultrasound, who have performed ultrasound for more than five years and/or are involved in providing ultrasound training. RESULTS 11 French general practitioners screened 83 skills in 4 anatomical regions: abdominal, urogenital, vascular, gynecology and obstetrics. An agreement was obtained for 36 POCUS skills as to their appropriateness in General Practice. There were 17 skills with a strong appropriate agreement (100% of "7-9" ratings) and 19 skills with a relative agreement (100% of "5-9" ratings). CONCLUSION These skills could serve as a basis for guidelines on the use and curriculum of POCUS in General Practice in France as well as in other countries with similar healthcare systems.
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Affiliation(s)
- Louis Camard
- Department of General Practice, Faculty of Medicine, Sorbonne University, Paris, France.
| | - Roxane Liard
- Department of General Practice, Faculty of Medicine, Sorbonne University, Paris, France
| | - Sophie Duverne
- Department of General Practice, Faculty of Medicine, Sorbonne University, Paris, France
| | - Gladys Ibanez
- Department of General Practice, Faculty of Medicine, Sorbonne University, Paris, France
- Pierre-Louis Institute of Epidemiology and Public Health, Paris, France
| | - Mariela Skendi
- Department of General Practice, Faculty of Medicine, Sorbonne University, Paris, France.
- Department of Adult Radiology, Necker Hospital, Paris, France.
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De Carvalho H, Godiveaux N, Javaudin F, Le Bastard Q, Kuczer V, Pes P, Montassier E, Le Conte P. Impact of Different Training Methods on Daily Use of Point-of-Care Ultrasound: Survey on 515 Physicians. Ultrasound Q 2024; 40:46-50. [PMID: 37756253 DOI: 10.1097/ruq.0000000000000660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
ABSTRACT Point-of-care ultrasound (POCUS) curriculum varies among countries. However, the length of training required for physicians is still under debate. We investigated the impact of different training methods: short hands-on courses (STS), long academic training sessions (LTS), or both (mixed training [MTS]), for POCUS daily use and self-reported confidence overall and specific to specific clinical situations. This was a descriptive study conducted over a 3-month period through a Web-based survey designed to assess the influence of different methods of POCUS training among physicians and residents on their daily practice. The survey was sent to 1212 emergency physicians with prior POCUS training; 515 answers (42%) could be analyzed. Participants in the STS group performed POCUS less frequently than physicians in the LTS or MTS group. Daily use in the STS group was 51% versus 82% in the LTS group and 83% in the MTS group ( P < 0.01). The overall self-reported confidence in POCUS was lower in the STS group ( P < 0.01) in all studied clinical situations. There was no significant difference between LTS and MTS groups ( P > 0.05). Method of POCUS training significantly influenced POCUS daily use. Physicians who underwent long training sessions used POCUS more frequently in their routine practice and were significantly more confident in their ability to perform and interpret a POCUS examination.
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Affiliation(s)
| | | | | | | | | | - Philippe Pes
- Emergency Department, Centre Hospitalier Universitaire
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Flamanc T, de Carvalho H, Le Bastard Q, Javaudin F, Pes P, Montassier E, Le Conte P. Impact of an enhanced focused cardiac ultrasound on treatment changes in a population of internal medicine patients. JOURNAL OF CLINICAL ULTRASOUND : JCU 2024; 52:219-224. [PMID: 38031392 DOI: 10.1002/jcu.23617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 11/04/2023] [Accepted: 11/13/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Hospitalized patients with acute shortness of breath (SOB) could benefit from an enhanced focused cardiac ultrasound (eFoCUS) with Doppler measurements to reassess treatment and diagnosis. METHODS This was a retrospective observational study performed in a medical ward. Included patients were those hospitalized for acute SOB. The objectives were to assess therapeutic and diagnosis changes associated with eFoCUS. The primary endpoint of the analysis was a composite of introduction or discontinuation of diuretics, antibiotics or anticoagulation following eFoCUS. RESULTS Between January 2018 and July 2021, 119 patients were included, 67 women and 52 men, mean age 84 ± 11 years old. The eFoCUS was performed within a median time of 55 h (1st-3rd IQ: 21-107) following hospital admission. Overall, eFoCUS was associated with a change in diagnostic in 40 patients (34% [CI 95%: 25%-43%], p < 10-4 ) and a change in treatment in 53 patients (45% [CI 95%: 35%-54%], p < 10-4 ). Diuretics were prescribed in 94 patients before eFoCUS and in 56 after (p = 10-4 ), antibiotics in 34 before and 27 after and anticoagulation in 30 before and 40 after. CONCLUSION eFoCUS was associated with both therapeutic and diagnostic changes in patients with SOB. Such results should be confirmed in multicentric prospective studies.
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Affiliation(s)
| | | | - Quentin Le Bastard
- Service des Urgences, CHU de Nantes, Nantes, France
- Faculté de Médecine, Nantes Université, Nantes, France
| | - François Javaudin
- Service des Urgences, CHU de Nantes, Nantes, France
- Faculté de Médecine, Nantes Université, Nantes, France
| | - Philippe Pes
- Service des Urgences, CHU de Nantes, Nantes, France
| | - Emmanuel Montassier
- Service des Urgences, CHU de Nantes, Nantes, France
- Faculté de Médecine, Nantes Université, Nantes, France
| | - Philippe Le Conte
- Service des Urgences, CHU de Nantes, Nantes, France
- Faculté de Médecine, Nantes Université, Nantes, France
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Dupriez F, de Castro BR, Gendebien F, Fasseaux A, Gensburger M, Marissiaux L, Penaloza A, Bobbia X, Jarman R. Is gallbladder PoCUS diagnostic accuracy accessible to medical students after PoCUS training exclusively on healthy volunteers? A pilot randomized control trial. Ultrasound J 2023; 15:18. [PMID: 37036612 PMCID: PMC10086079 DOI: 10.1186/s13089-023-00317-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 03/22/2023] [Indexed: 04/11/2023] Open
Abstract
BACKGROUND Point-of-care ultrasound (PoCUS) is increasingly used in clinical practice and is now included in many undergraduate curricula. Here, we aimed to determine whether medical students who participated in a PoCUS teaching program with several practical training sessions involving healthy volunteers could achieve a good level of diagnostic accuracy in identifying gallbladder pathologies. The intervention group (IG) was trained exclusively on volunteers with a healthy gallbladder, whereas the control group (CG) had access to volunteers with a pathological gallbladder as recommended in most PoCUS curricula. MATERIALS AND METHODS Twenty medical students were randomly assigned to the IG and CG. After completing the training program over 2 months, students were evaluated by three independent examiners. Students and examiners were blind to group allocation and study outcome. Sensitivity and specificity of students' PoCUS gallstone diagnosis were assessed. Secondary outcomes were students' confidence, image quality, acquisition time, and PoCUS skills. RESULTS Sensitivity and specificity for gallstone diagnosis were, respectively, 0.85 and 0.97 in the IG and 0.80 and 0.83 in the CG. Areas under the curve (AUC) based on the receiver operating characteristic curve analysis were 0.91 and 0.82 in the IG and CG, respectively, with no significant difference (p = 0.271) and an AUC difference of -0.092. No significant between-group difference was found for the secondary outcomes. CONCLUSIONS Our pilot study showed that medical students can develop PoCUS diagnostic accuracy after training on healthy volunteers. If these findings are confirmed in a larger sample, this could favor the delivery of large practical teaching sessions without the need to include patients with pathology, thus facilitating PoCUS training for students.
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Affiliation(s)
- Florence Dupriez
- Emergency Department, Cliniques Universitaires Saint Luc, Av Hippocrate 10, 1200, Brussels, Belgium.
| | | | - Félix Gendebien
- Emergency Department, Cliniques Universitaires Saint Luc, Av Hippocrate 10, 1200, Brussels, Belgium
- Emergency Department, Hôpital de Jolimont - Lobbes, Lobbes, Belgium
| | - Antoine Fasseaux
- Emergency Department, Hôpital de Jolimont - Lobbes, Haine-Saint-Paul, Belgium
| | - Matthieu Gensburger
- Emergency Department, Centre Hospitalier Universitaire de Liège, Liège, Belgium
| | - Laurent Marissiaux
- Emergency Department, Centre Hospitalier Universitaire de Liège, Liège, Belgium
| | - Andrea Penaloza
- Emergency Department, Cliniques Universitaires Saint Luc, Av Hippocrate 10, 1200, Brussels, Belgium
| | - Xavier Bobbia
- Emergency Department, CHU Montpellier, Montpellier, France
| | - Robert Jarman
- Emergency Department, Royal Victoria Infirmary, Newcastle, UK
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Ultrasonography performed by an infectiologist in hip and knee prosthetic joint and native joint infections. Infect Dis Now 2023; 53:104689. [PMID: 36870535 DOI: 10.1016/j.idnow.2023.104689] [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: 06/18/2022] [Revised: 02/06/2023] [Accepted: 02/23/2023] [Indexed: 03/06/2023]
Abstract
INTRODUCTION Clinical ultrasonography (US) by infectiologists has only recently been developing, and as now there is little literature on the subject. Our study focuses on the conditions and diagnostic performance of clinical ultrasound imaging by infectiologists in cases of hip and knee prosthetic and native joint infection. METHODS A retrospective study carried out between June 1st 2019 and March 31st 2021 in the University Hospital of Bordeaux, South-Western France. We measured US sensitivity (Se), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV), combined or not with the analysis of articular fluid, compared to the MusculoSketetal Infection Society (MSIS) score in prosthetic joints, or to expert diagnosis in native joints. RESULTS Fifty-four patients underwent US by an infectiologist in an infectious disease ward, including 11 (20.4%) for native joint and 43 (79.6%) for prosthetic joint. Joint effusion and/or periarticular collection were highlighted in 47 (87%) patients, and US led to 44 punctures. In all patients (n=54), Se, Sp, PPV and NPV of US alone were 91%, 19%, 64% and 57%, respectively. When US was combined with fluid analysis, Se, Sp, PPV, NPV were 68%, 100%, 100%, 64% in all patients (n=54), 86%, 100%, 100%, 60% in acute arthritis (n=17) and 50%, 100%, 100% and 65% respectively in non-acute arthritis (n=37). CONCLUSION These results suggest that US by infectiologists effectively diagnoses osteoarticular infections (OAIs). This approach has many applications in infectiology routines. Consequently, it would be interesting to define the contents of a first level of infectiologist competence in US clinical practice.
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Taalba M, Lefèvre-Scelles A, Roussel M. L’anévrysme de l’artère hépatique : une vésicule biliaire dont le contenu s’allume au Doppler couleur ? ANNALES FRANCAISES DE MEDECINE D URGENCE 2022. [DOI: 10.3166/afmu-2022-0420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Lafon T, Baisse A, Simonneau Y, Goudelin M, Hani Karam H, Desvaux E, Guillot MS, Evrard B, Vignon P. Identification précoce des phénotypes cardiovasculaires chez les patients en insuffisance respiratoire aiguë au cours de la première pandémie Covid-19. ANNALES FRANCAISES DE MEDECINE D URGENCE 2022. [DOI: 10.3166/afmu-2022-0400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Objectif : L'objectif principal était de comparer la prévalence de la dysfonction ventriculaire gauche (VG) et/ ou droite (VD) des patients admis au service d'urgence (SU) avec une insuffisance respiratoire aiguë (IRA) secondaire ou non à une pneumopathie à Covid-19.
Méthodes : Pendant un mois, nous avons inclus (24/7) de façon prospective les patients de l'unité de Covid-19 du SU qui présentaient une IRA. Pour chaque patient, un test RT-PCR, une tomodensitométrie thoracique et une échographie cardiaque de niveau 2 et pulmonaire étaient systématiquement réalisés avant toute intervention thérapeutique. Chaque patient était classé selon les phénotypes cardiovasculaires suivants : insuffisance VG, insuffisance VD, hypovolémie ± hyperkinésie et profil hémodynamique normal.
Résultats : Parmi les 517 patients admis pendant la période d'étude, 78 présentaient une IRA (15 %) et 62 ont bénéficié d'une échocardiographie de niveau 2 (âge : 73 ± 14 ans ; SpO2 : 90 ± 4 % ; lactate : 2,1 ± 1,3 mmol/l). Le diagnostic de la Covid-19 a été établi pour 22 patients (35 %). L'insuffisance VG (15 [38 %] vs 2 [9 %] ; p = 0,016) et celle VD (12 [30 %] vs 1 [5 %] ; p = 0,018) étaient plus souvent observées dans le groupe témoin que chez les patients ayant une pneumopathie à Covid-19. Inversement, les patients Covid-19 avaient plus fréquemment un profil hémodynamique normal ou une hypovolémie associée ou non à une vasoplégie (20 [91 %] vs 21 [53 %] ; p = 0,002). La mortalité intrahospitalière était de 18 % ( n = 11). Tous les patients atteints de la Covid-19 présentant une insuffisance VG et/ou VD précoce sont décédés pendant leur hospitalisation.
Conclusions : La dysfonction VG et celle VD étaient plus fréquentes chez les patients non atteints de la Covid-19, alors que les patients atteints de Covid-19 avaient un phénotype cardiovasculaire normal ou hypovolémique.
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Amiot F, Macrez R, Delomas T. Comparaison de deux cas de pseudoanévrismes post-traumatiques : avec et sans échographie clinique. ANNALES FRANCAISES DE MEDECINE D URGENCE 2022. [DOI: 10.3166/afmu-2022-0370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Hary T, Amiot F, Laborne FX, Delomas T. Apport de l’échographie clinique dans la prise en charge des douleurs abdominales aiguës non traumatiques chez l’adulte dans les services d’urgence : une étude rétrospective monocentrique dans un centre hospitalier général. ANNALES FRANCAISES DE MEDECINE D URGENCE 2021. [DOI: 10.3166/afmu-2021-0353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Objectif : Déterminer si la réalisation d’une échographie clinique en médecine d’urgence (ECMU) modifie la prise en charge des patients présentant une douleur abdominale aiguë d’origine non traumatique.
Matériel et méthodes : Étude rétrospective, monocentrique, incluant les patients qui ont consulté aux urgences pour douleur abdominale aiguë d’origine non traumatique entre le 1er juin 2019 et le 31 octobre 2019. Les données recueillies étaient le nombre d’examens complémentaires d’imagerie réalisés, le temps de prise en charge, le taux d’hospitalisation, le diagnostic et le taux de reconsultation à 30 jours. Le critère de jugement principal était le recours aux examens complémentaires d’imagerie spécialisée (parmi lesquels : échographie spécialisée, tomodensitométrie abdominopelvienne et abdomen sans préparation) chez les patients ayant bénéficié d’une échographie clinique (groupe « ECMU ») comparativement aux patients n’ayant pas bénéficié d’échographie (groupe « sans ECMU »).
Résultats : Mille cinquante-trois patients ont été inclus. Parmi ces patients, 16 % ont bénéficié d’une échographie clinique par le médecin urgentiste. Il existait une réduction significative du recours à l’échographie spécialisée dans le groupe ECMU (4 % dans le groupe « avec ECMU » versus 9 % dans le groupe « sans ECMU », OR = 0,45, IC 95 % : [0,17–1,00], p = 0,04), sans différence significative entre les deux groupes concernant le temps de prise en charge, l’orientation, le taux de reconsultation à 30 jours et la concordance diagnostique.
Conclusion : La réalisation d’une ECMU dans l’exploration des douleurs abdominales aiguës d’origine non traumatique entraînait une réduction significative du nombre d’échographies spécialisées, sans pour autant diminuer le temps de prise en charge ni la concordance entre le diagnostic posé aux urgences et celui en fin d’hospitalisation.
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Basic certification process for point-of care-ultrasound in emergency medicine: an European perspective. Eur J Emerg Med 2021; 28:254-256. [PMID: 34187989 DOI: 10.1097/mej.0000000000000843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Andolfo A, Maatoug R, Peiffer-Smadja N, Fayolle C, Blanckaert K. Emergency ward ultrasound: clinical audit on disinfection practices during routine and sterile examinations. Antimicrob Resist Infect Control 2021; 10:25. [PMID: 33516268 PMCID: PMC7847554 DOI: 10.1186/s13756-021-00896-w] [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: 07/26/2020] [Accepted: 01/21/2021] [Indexed: 11/10/2022] Open
Abstract
Context In the emergency ward, where the use of ultrasound is common (including for sterile procedures), ward equipment is constantly exposed to high risks of microbiological contamination. There are no clear guidelines for disinfection control practices in emergency departments, and it is not known how emergency ward doctors follow good hygiene practices. Method A multi-centre audit was conducted in 16 emergency services from Northern France regional hospitals, in form of a questionnaire. It was proposed to all emergency ward physicians. We excluded questionnaires when physicians mentioned that they did not use ultrasound on a daily basis. The questionnaire was designed using existing hygiene and ultrasound disinfection practices guidelines from varying French medical societies. It included three different clinical scenarios: (a) ultrasound on healthy skin, (b) on injured skin, and (c) ultrasound-guided punctures. All questions were closed-ended, with only one answer corresponding to the guidelines. We then calculated compliance rates for each question, each clinical situation, and an overall compliance rate for all the questions. Results 104 questionnaires were collected, and 19 were excluded. For the 85 analysed questionnaires, the compliance rates were 60.4% 95% CI [56.4–64.7] for ultrasound on healthy skin, 70.9% 95% CI [66.3–76.1] on injured skin and 69.4% 95% CI [65.1–73.6] for ultrasound-guided punctures. The overall compliance rate for the compliance questions was 66.1% 95% CI [62.8–69.1]. Analysis of the questionnaires revealed severe asepsis errors, misuse of gel, ignorance of infection control practices to be applied in the context of ultrasound-guided puncture and exposure of the probe to body fluids. Conclusion This study details areas for quality improvement in the disinfection of emergency ultrasound scanner use. Consequently, we propose a standardized protocol based upon the recommendations used for the questionnaire drafting, with a visual focus on the low compliance points that have been revealed in this audit. This protocol has been distributed to all the medical emergency services audited and included in the emergency resident’s ultrasound learning program.
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Affiliation(s)
- A Andolfo
- Service d'accueil des urgences/Structure mobile d'urgence et de reanimation, Centre Hospitalier de Dunkerque, 59140, Dunkirk, France.
| | - R Maatoug
- AP-HP, Service de Psychiatrie Adulte de la Pitié-Salpêtrière, Institut du Cerveau, ICM, Sorbonne Université, 75013, Paris, France
| | - N Peiffer-Smadja
- French Institute for Medical Research (Inserm), Infection Antimicrobials Modelling Evolution (IAME), UMR 1137, University Paris Diderot, Paris, France.,National Institute for Health Research Health Protection Research Unit in Healthcare. Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK
| | - C Fayolle
- Service de Réanimation et Unité de Soins Continus, Centre Hospitalier de Dunkerque, 59140, Dunkirk, France
| | - K Blanckaert
- Centre d'appui et de prevention des infections associees aux soins (CPIAS) Pays de la Loire, Centre Hospitalier Universitaire de Nantes, 44093, Nantes, France
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Leitao J, Martin L, Desclaux A, Dutronc H, Neau D, Dauchy FA. Experience of ultrasound performed by infectiologists, an innovating approach for the management of patients. Infect Dis Now 2020; 51:451-455. [PMID: 34366081 DOI: 10.1016/j.idnow.2020.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/25/2020] [Accepted: 10/30/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Ultrasound imaging has many clinical applications, but there is a lack of data about its use by infectiologists. The aim of this study was to describe ultrasound performed routinely by infectiologists and to assess the diagnostic performance of ultrasound with aspirate and fluid analysis in prosthetic joint infections. METHODS Retrospective study between 1st June 2019 and 1st June 2020 in an infectious and tropical diseases unit in a tertiary University Hospital. RESULTS One hundred and thirty-one ultrasounds were performed on 127 patients by the infectious diseases team. These included 64 musculoskeletal ultrasounds (31 in native joints and 33 in prosthetic joints including 15 knees, 13 hips and 5 spacers) and 33 led to a fluid aspirate. Fourteen lung ultrasounds were done, 11 confirmed pneumopathy and 7 resulted in pleural puncture. Twenty-three vascular ultrasounds were done, 17 to insert a catheter, and four to perform a blood test. Five ultrasounds explored adenopathy, of which one node tuberculosis and one Bartonella infection were diagnosed. In prosthetic joint infections, sensitivity and specificity of ultrasound with fluid aspirate and analysis were respectively 100% and 100% for the knee and 40% and 100% for the hip. CONCLUSION Ultrasound performed by infectiologists is useful and contributes to a faster diagnosis. Furthermore, the specificity of ultrasound with aspirate and fluid analysis is very high in prosthetic joint infection. Ultrasound training courses should be considered for infectiologists including residents.
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Affiliation(s)
- J Leitao
- Service de maladies infectieuses et tropicales, Centre de référence Infections ostéo-articulaires complexes, Hôpital Pellegrin, CHU de Bordeaux, 33000 Bordeaux, France.
| | - L Martin
- Service de maladies infectieuses et tropicales, Centre de référence Infections ostéo-articulaires complexes, Hôpital Pellegrin, CHU de Bordeaux, 33000 Bordeaux, France
| | - A Desclaux
- Service de maladies infectieuses et tropicales, Centre de référence Infections ostéo-articulaires complexes, Hôpital Pellegrin, CHU de Bordeaux, 33000 Bordeaux, France
| | - H Dutronc
- Service de maladies infectieuses et tropicales, Centre de référence Infections ostéo-articulaires complexes, Hôpital Pellegrin, CHU de Bordeaux, 33000 Bordeaux, France
| | - D Neau
- Service de maladies infectieuses et tropicales, Centre de référence Infections ostéo-articulaires complexes, Hôpital Pellegrin, CHU de Bordeaux, 33000 Bordeaux, France
| | - F-A Dauchy
- Service de maladies infectieuses et tropicales, Centre de référence Infections ostéo-articulaires complexes, Hôpital Pellegrin, CHU de Bordeaux, 33000 Bordeaux, France
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Martin PV, Chataigneau A, Arnaud FX, Rozwadowski F, Cournac JM, Martin AC. Transthoracic Doppler echocardiography during a military mission in a French role II in Mali: is it useful to learn this practice? Mil Med 2020; 185:e1562-e1568. [DOI: 10.1093/milmed/usaa126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Ultrasound is now recognized as a key tool in the practice of medicine in isolated situations. This study aims to evaluate the impact of transthoracic echocardiography (TTE) in a military mission when performed by a trained military practitioner (MP).
Materials and Methods
We conducted a 2-month retrospective observational study on the use of TTE in a French medical complex in Mali with a mission that included providing a medical aid to the population. All patients were included. Every ultrasound performed by the MP was listed, and the epidemiologic data, indication for the exam and results were collected for each TTE.
Results
A total of 349 patients were included, 16 were war-wounded patients and 333 came for a general medical consultation. In all, 153 ultrasounds were performed, including 48 TTEs. Sixteen TTEs were performed to evaluate injuries in war-wounded patients. During the 333 medical consultations, 32 TTEs were realized. The indications were dyspnoea (10), heart murmur (7), acute chest pain (5) and assessment of heart disease (10). TTE permitted a direct positive diagnosis for 18 patients: 7 with acute heart failure and 11 with morphologic problems. The normality of the exam was a supplementary argument to exclude a cardiac implication for eight patients.
Conclusions
TTE can provide important information with a direct impact on the management of patients. Faced with cardiac emergencies, an adapted training can be proposed for the MP. Thereby, the transfer of conventional cardiac views could facilitate the advice of a cardiologist.
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Affiliation(s)
- Paul-Vincent Martin
- Emergency department at the Percy Army training Hospital, 101 avenue Henri Barbusse, 92140 Clamart, France
| | - Anaïs Chataigneau
- Orthopedic and traumatology department at the Percy Army training Hospital, 101 avenue Henri Barbusse, 92140 Clamart, France
| | - François-Xavier Arnaud
- Radiology department at the Percy Army training Hospital, 101 avenue Henri Barbusse, 92140 Clamart, France
| | - Faye Rozwadowski
- FAAFP, Primary Care Physician for U.S. Military Veterans, Tallahassee, Florida, 3231, USA
| | - Jean-Marie Cournac
- Internal Medecine department at the Percy Army training Hospital, 101 avenue Henri Barbusse, 92140 Clamart, France
| | - Anne-Céline Martin
- Department of Cardiology, European Hospital Georges Pompidou, Paris, France
- Université de Paris, Innovative Therapy in Haemostasis, INSERM 1140, Paris, France
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Bobbia X, Claret PG, Perrin-Bayard R, de La Coussaye JE. Place de l’échographie clinique en médecine d’urgence. ANNALES FRANCAISES DE MEDECINE D URGENCE 2020. [DOI: 10.3166/afmu-2019-0150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
L’échographie clinique en médecine d’urgence (ECMU) devient une pratique intégrée à l’exercice de la spécialité. Quatre étapes semblent nécessaires au déploiement de cet outil : l’existence de preuves scientifiques sur sa pertinence clinique, l’implantation d’échographes dans les structures d’urgences (SU), la formation des médecins et l’objectivation d’un impact secondaire à son utilisation. Les preuves sur la pertinence diagnostique des techniques utilisées datent des années 1990 pour la majorité des applications utilisées aujourd’hui. La disponibilité d’un échographe adapté est également nécessaire. Si la majorité des SU disposent aujourd’hui d’un échographe, selon les recommandations françaises, toutes le devraient. Des échographes de mieux en mieux adaptés à la pratique de l’ECMU arrivent sur le marché. L’objectif doit être de permettre des examens rapides et fiables. Pour cela, une ergonomie épurée et l’implication de techniques d’intelligence artificielle semblent être l’avenir. Les médecins doivent également être formés. En France, l’utilisation de l’ECMU va se généraliser grâce à la formation de tous les nouveaux internes de médecine d’urgence. Cependant, beaucoup d’urgentistes exerçant actuellement doivent encore être formés. Pour répondre à cette demande, de nombreuses formations sont aujourd’hui accessibles. Enfin, peu de données sur l’impact clinique secondaire à l’utilisation de cet outil dans les SU sont disponibles. Après avoir défini l’ECMU, l’objectif de ce texte est d’expliquer la place de l’échographie clinique dans la spécialité de médecine d’urgence. Des perspectives d’évolution de l’ECMU sont également proposées.
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Houzé-Cerfon CH, Lauque D, Wiel E, Bounes V, Charpentier S. Conception d’un programme d’enseignement par simulation dans le DES de médecine d’urgence selon la méthode du modèle logique. ANNALES FRANCAISES DE MEDECINE D URGENCE 2019. [DOI: 10.3166/afmu-2019-0137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Dans le cadre de la création du diplôme d’études spécialisées de médecine d’urgence (DESMU), l’intégration d’un programme national de simulation est difficile à promouvoir face à la grande variabilité des ressources de chaque université. Nous proposons une méthodologie de conception et de mise en oeuvre d’un programme de formation par simulation (PFS) fondée sur les spécificités de chaque université et intégrant une démarche évaluative selon une approche par compétences. La méthode du modèle logique a été utilisée pour définir les objectifs en lien avec le contexte de formation, préciser les ressources disponibles puis décrire le processus de mise en oeuvre et d’évaluation d’un PFS intégré au DESMU de l’université de Toulouse. La méthode du modèle logique a permis la conception d’un PFS à partir de six étapes successives : 1) l’objectif qui tient compte du contexte ; 2) les ressources ; 3) les activités ; 4) les groupes visés par le programme ; 5) les produits issus des activités ; 6) les résultats à court, moyen et long termes. Il a permis d’intégrer la simulation dans le cursus de formation des DESMU selon une approche réaliste et adaptée aux ressources locales avec un processus d’évaluation cohérent (satisfaction, mobilisation des compétences en situation de soins et impact sur l’organisation des soins). Dans le cadre d’une approche par compétences dans le cursus des DESMU, le modèle logique a mené à la conception, à la mise en oeuvre et à l’évaluation d’un PFS cohérent avec comme défi de rester dynamique afin d’intégrer l’évolution des variables pendant la période du projet.
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Lesage B, Martinez M, Lefebvre T, Cavalli P, Cailasson L, Léger M, d’Arras A, Boyer A, Redjaline A, Viallon A. Pratique de l’échographie clinique au sein d’un réseau territorial d’urgence. ANNALES FRANCAISES DE MEDECINE D URGENCE 2019. [DOI: 10.3166/afmu-2018-0086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Objectif : L’échographie clinique en médecine d’urgence (ECMU) est un outil essentiel de notre pratique. L’objectif principal de notre étude était d’évaluer les caractéristiques des médecins pratiquant l’ECMU au sein de notre territoire. L’objectif secondaire était d’analyser les facteurs influençant une pratique régulière.
Matériel et méthodes : Étude descriptive multicentrique et déclarative, réalisée auprès de médecins urgentistes travaillant au sein d’un réseau territorial de médecine d’urgence à l’aide d’un questionnaire en ligne.
Résultats : Cent onze questionnaires sur 120 envoyés ont été renseignés (92 %). Onze services (92 %) étaient dotés en échographe dont neuf (82 %) en dotation propre. Soixantesix médecins (59 %) déclaraient pratiquer l’échographie régulièrement. La FAST (focused assessment with sonography for traumas) était la plus pratiquée (80 médecins, 72 %), suivie de l’exploration hémodynamique (50 médecins, 45 %) et pleurale (44 médecins, 40 %). Dans le groupe des médecins ne pratiquant pas l’ECMU, 17 médecins sur 22 (77 %) l’expliquaient par un manque de formation. Dans le même temps, l’intérêt porté à l’ECMU par les urgentistes était coté à 7 ± 2 sur une échelle de 0 à 9. Les facteurs associés à la fréquence de la pratique de l’ECMU étaient le sexe (p < 0,001), le type d’activité (p = 0,005), le type de formation à l’échographie (p < 0,001) et l’ancienneté d’équipement de son service en échographe (p < 0,001).
Conclusion : Cette enquête a montré que la pratique régulière était majoritaire avec un intérêt porté par les praticiens à l’ECMU élevé. Cependant, le frein principal à son développement était un niveau de formation jugé insuffisant par certains praticiens.
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